#13 Logotherapy and Evidence Based Practices

Today's topic is the thorny question of Logotherapy and Evidence Based Practices. When I started to practice, any professional therapist was expected to keep up to date with the latest scientific findings in the field. Of course, therapists ethically remain responsible for the techniques they use in their practices.

However, during the 1990’s, we saw the development of managed care. Third party payors became assertive in stating what forms of therapy they would and would not pay for. In the last decade, this has developed into the concept of evidence based practices, or EBPs. The idea is that a payor source, an insurance company, for example, will not pay for a form of therapy unless there is scientific evidence that it works. Different payors maintain their own lists of EBPs and the lists are not the same.

The US Federal government list is the National Registry of Evidence Based Programs and Practices maintained by the Substance Abuse and Mental Health Services Administration of the US Dept. of Health and Human Services. The list is at:

http://www.nrepp.samhsa.gov/

Another list is maintained by the Society of Clinical Psychology, which is Division 12 of the American Psychological Association. Their website is at:

http://www.PsychologicalTreatments.org

Logotherapy has yet to appear as an evidence based treatment in any of the lists, despite the fact that research is continually ongoing in logotherapy and among logotherapists. A list of scientific journals on logotherapy is maintained by the Scientific Society for Logotherapy and Existential Analysis at the Viktor Frankl Institute Vienna at:

http://www.viktorfrankl.org/e/periodicals.html

On the other side of the debate, another body of research stresses the therapeutic factors related to outcome. Consistent findings over many years demonstrate that differences among the various therapy models do not translate into differences in therapy outcomes. In fact, the preponderance of the evidence suggests that no meaningful differences exist among the various schools and forms of therapy.

Division 29, the Division of Psychotherapy, of the American Psychological Association has an interesting article presently posted on its website at:

http://www.divisionofpsychotherapy.org/wampold-2006/

The importance of the therapeutic relationship can be illustrated by this clinical example cited by Viktor Frankl at the First World Congress of Logotherapy:

"An American girl, a student of music, came to see me in Vienna for analysis. Since she spoke a terrible slang of which I could not understand a word, I tried to turn her over to an American physician in order to have him find out for me what had motivated her to seek my advice. She did not consult him, however, and when we happened to meet each other on the street, she explained: "See, Doctor, as soon as I had spoken to you of my problem, I felt such a relief that I didn't need help any longer." So I do not know even now for what reason she had come to me. This was an extreme example when human encounter, without any technique, was therapeutic."

In 1992, M.J. Lambert found 4 factors were responsible for psychotherapy outcome.

1. Extratherapeutic factors account for 40% of the positive change. These are factors not directly related to therapy at all. They include the strengths and resources of the client as well as random, chance happenings.

2. The therapeutic relationship accounts for 30% of the positive change. This refers to the quality of the relationship between the therapist and the client. Therapist factors include qualities such as empathy, respect and genuineness. Client factors include readiness for change, goals for therapy and the client's view of the quality of the relationship (not the therapist's view).

3. Specific therapeutic techniques account for 15% of the positive change.

4. Some combination of hope and the placebo effect account for the remaining 15% of change.

So what are we to make of this for logotherapy? Recently, I have started to speculate that the effectiveness we see with logotherapy is not because of the effect logotherapy has on the client, but on the effect logotherapy has on the therapist. Simply put, I believe that studying logotherapy makes us better therapists!

Bibliography

Lambert, M. J. (1992). Implications of outcome research for psychotherapy integration. In J. C. Norcross and M. R. Goldfriend (Eds.), Handbook of psychotherapy integration. New York: Basic

Wampold, B. E. (2006). Three ways to improve our effectiveness. In News you can use. Washington: APA Division 29. Online: http://www.divisionofpsychotherapy.org/wampold-2006/

See also:

Miller, S. D., Duncan, B. L., & Hubble, M. A. (1997). Escape from babel: Toward a unifying language for psychotherapy practice. New York: W. W. Norton & Company.

Norcross, J. C. (Ed.). (2002). Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. New York: Oxford University Press.

Wampold, B. E. (2001). The great psychotherapy debate: Model, methods, and findings. Mahway, NJ: Lawrence Erlbaum Associates.

Click here to download Logotherapy and Evidence Based Practices

Thank you for listening. Please email any questions or comments to logotalk@pld.com and may you have a meaningful day.

Episode 12: 1985 Interview with Dr. Viktor E. Frankl

Happy Hanukkah, Merry Christmas, and Welcome to Episode 12 of LogoTalk.Net. It is hard to believe that the world's first and only podcast on Viktor Frankl and logotherapy is now one year old. We now have over 4 hours of podcast material. Each podcast is downloaded an average of 68 times.

As we look forward to 2010, we have some improvements planned:

Presently, Logotalk is uploaded as an .mp3, or an audio only podcast. Beginning in January, Logotalk will become an "enhanced" podcast, or .mp4, allowing pictures, graphs, text, or links to be embedded into the audio soundtrack.

If you currently enjoy the podcast on an audio only .mp3 player, you will notice no change and will continue to receive LogoTalk.Net as you always have. If you listen on a computer, or on a video capable .mp3 player, then the enhanced content will be automatically available.

All the Links from Episode 12:

Because of the enhanced content capability, the LogoTalk.Net podcast will also be available on YouTube at:

YouTube.com/user/logotalk

This will not change current Logotalk delivery. Current users will continue to receive LogoTalk through the iTunes music store, news readers, email subscriptions, and direct downloads from this blog.

You can follow us on Twitter at:

twitter.com/logotalk

from which you will receive "tweets" when new podcasts are available.

Finally, a compilation of all the 2009 LogoTalk.Net podcasts will soon be available for purchase for your archive or library at:

cafepress.com/logotalk

Finally, the 1985 interview with Dr. Viktor E. Frankl on South African television has been found here:







Click here to download Episode 12: 1985 Interview with Dr. Viktor E. Frankl

Thank you for listening. Please email any questions or comments to logotalk@pld.com and may you have a meaningful day.

Episode 11: Logotherapy Potpourri

In this edition of LogoTalk.Net, we answer a question from a listener concerning the relationship between the will to meaning and drives and conditioning. As part of this discussion, we talk about the defiant power of the human spirit and the ability of the human spirit to take a stand against drives, conditioning, or elements of the mass neurotic triad which includes addiction, aggression and depression.

In further discussing the relationship between logotherapy and other therapies, I provide this interview from 2007, at a time when I was only beginning to read Frankl:



Then, we take a Franklian Psychology look at a scene from the SciFi Channel's re-imagined Battlestar Galactica. In only one scene, we see an existential crisis, a debate between a closed vs. open psychological system, a statement of creative, experiential and attitudinal values, the solving of an existential crisis through the defiant power of the human spirit, and an expression of self-transcendence. Not back for 10 minutes of television!


Click here to download Episode 11: Logotherapy Potpourri.

Thank you for listening. Please email any questions or comments to logotalk@pld.com and may you have a meaningful day.

Episode 10: Domestic Violence and Franklian Psychology

October is Domestic Violence Awareness Month. Some current publications from the American Psychological Association are linked here:

The Mind of the Batterer.pdf

Partner Violence: What you can do

Statistics:

A United States Department of Justice study found that 22% of women and 7% of men had been physically abused by an intimate partner at some point in their lives. The study also found that 1.3% of the women and 0.9% of the men had been abused within the past 30 days. Of those abused, 39% of the women and 23% of the men were injured.

Effects on the victim:

Physical abuse is often accompanied by humiliation, manipulation, and economic control. The effects on the victim include fear, the belief that escape is impossible, post-traumatic stress symptoms and sometimes substance abuse.

The risk of death or serious injury increases once the decision to leave is made.

Key Issues for Franklian Psychology

1) Sophisticated victims of domestic violence may have read Frankl or been drawn to his works in response to their trauma. It is important to know that Frankl taught that meaning in suffering is found only if the suffering is unavoidable. Frankl repeatedly taught that If the suffering can be avoided, it should be avoided.

2) Some victims may believe that they remain in the relationship for the value of love. Frankl taught that the deepest love is an awareness of the potentials of the spirit of the other. In this, the loved one cannot be replaced. If the significant other in your life wishes to control you rather than to see your true abilities and talents made real, then that is not love.

3) Frankl wrote a great deal about value judgments. Value judgments can become easily confused during and after trauma. It is true that great figures of history have sacrificed themselves for loving or meaningful causes. None of those figures, however, sacrificed themselves to another person for the purpose of satisfying the other person's violent temper.

How to respond if someone tells you of domestic violence:

DON'T minimize the abuse
DON'T blame the victim
DON'T shift the focus (to alcohol or some other problem)

DO be empathetic
DO tell the victim it is not her fault
DO offer to get her help (if you can)

Important Phone Numbers:

As always, if you are in danger in the United States, dial 9-1-1

National Domestic Violence Hotline:
1-800-799-SAFE (1-800-799-7233)


Click here to download Episode 10: Domestic Violence and Franklian Psychology.

Thank you for listening. Please email any questions or comments to logotalk@pld.com and may you have a meaningful day.

Episode 9: Conscience and the Spiritual Unconscious

Of Interest to Logotherapists:

Radio National's podcast All in Mind has a fascinating portrayal of 1900 Vienna available here:

http://www.abc.net.au/rn/allinthemind/stories/2009/2631888.htm

and here:

http://blogs.abc.net.au/allinthemind/

Definition of Terms:

Self: The core of our being, distinctly human, of an existential quality, associated with consciousness and responsibility. Cannot be reduced solely to the ego.

Conscience: Arises from the spiritual unconscious, of a transcendent quality, involves dialog with a transpersonal agent that we may or may not call God. Cannot be reduced solely to the superego.

Spiritual Unconscious: The unconscious aspect of the core of our being, the source of conscience, love, humor, artistic expression.


Unique Quality of Phenomena Arising from the Spiritual Unconscious:

Conscience: Acts as a compass, pointing us toward the one unique meaning that a concrete situation calls for.

Love: Allows us to see, or know, the potentials that are unique to the beloved, and to call forth the actualization of those potentials.

Artistic Conscience: Allows for the unique expression of meanings.

Click here to download Episode 9: Conscience and the Spiritual Unconscious.

Thank you for listening. Please email any questions or comments to logotalk@pld.com and may you have a meaningful day.

Episode 8: Toward a Meaning-Centered Cognitive Therapy

Today I would like to share with you an essay that I completed last month. It is an attempt to rehumanize Rational Emotive Behavior Therapy by using Franklian concepts.

"An ancient parable attributed to Aesop tells of a wager between the sun and the wind to determine which was stronger. A hapless passerby was to be the object of the dispute: whichever of them could make him remove his cloak was to be the winner. The wind began and blew harder and harder. Though flapping in the breeze, the cloak was not blown away as the traveler clutched it ever more tightly around himself. At last, the wind gave up. Then the sun came out and brightly warmed the traveler who immediately removed his cloak. This story demonstrates the relationship between cognitive psychotherapy, such as formulated by Albert Ellis, and the meaning-centered therapy of Viktor Frankl. Frankl considered most psychotherapy to be dehumanizing; the client was at the mercy of drives, conditioning, or biology. Frankl’s therapy was an attempt to rehumanize psychotherapy. I propose that cognitive therapy may be rehumanized by explaining Frankl’s meaning-centered therapy (Logotherapy) in the language of Ellis’ Rational Emotive Behavioral Therapy (REBT)."

Click here to download the full essay in PDF format.

Click here to download Episode 8: Toward a Meaning Centered Cognitive Therapy.

Thank you for listening. Please email any questions or comments to the address to the left and may you have a meaningful day.