#23 Logotherapy Techniques: Supplementary Techniques

Click here to download Logotherapy Techniques: Supplementary Techniques

Today's topic covers a number of supplementary techniques developed within the context of logotherapy.  The topics covered in this podcast, and their references, are listed below.

Writing Assignments:

King, L.A. (2001). The health benefits of writing about life goals,  Personality and Social Psychology Bulletin, 27, 798-807.

King, L.A. and Miner, K.N. (2000). Writing about the perceived benefits of traumatic events: Implications for physical health, Personality and Social Psychology Bulletin, 26, 220-230.

Values Clarification and Goal Setting:

Hutzell, Robert R. and Eggert, Mary D.  (1989, 1995, 2009).  A Workbook to Increase Your Meaningful and Purposeful Goals (2009 PDF Edition).  Online at:
http://www.viktorfrankl.org/source/hutzell_workbook_2009.pdf

Structured Experiences

Barnes, Robert C.  (1995, 2006).  Franklian Psychology and Attitudinal Change.  Edited by George E. Rice and developed by Paul Welter.  Abilene, Texas:  Viktor Frankl Institute of Logotherapy.

Existential Dream Analysis

Frankl, Viktor E.  (2000).  Man's Search for Ultimate Meaning.  New York:  Basic Books.

Logoanchor Technique

Graber, Ann V.  (2004).  Viktor Frankl's Logotherapy:  Method of Choice in Ecumenical Pastoral Psychology.  Lima, Ohio:  Wyndham Hall Press.

The Golden Imprint

Lukas, Elisabeth.  (2000).  Logotherapy Textbook:  Meaning-centered Psychotherapy consistent with the principles outlined by Viktor E. Frankl, MD.  Translated by Theodor Brugger.  Toronto:  Liberty Press.
http://www.liberty-press.com

And, as promised, my Mountain Range Experience sample:

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

#22 Interview with David A. Hallowell, M. A.

Click here to download Interview with David A. Hallowell, M. A.

LogoTalk.Net is pleased to be joined today by David A. Hallowell, M. A.  David is a U.S. Fulbright Fellow alumnus of the Viktor Frankl Institute Vienna and holds the master of arts degree in philosophy from Boston College.  He is an aspiring author who is fascinated with the notion of finding meaning and conversion in the face of hedonistic technocracies.

David authors a blog entitled the Existential Cosmopolite.  The blog is focused on the pursuit of authentic subjectivity for the aspiring Cosmopolite: Pondering philosophy of science & religion, post-pop psychology, existentialism, critical realism, and illumination in the spirit of Søren Kierkegaard, CS Lewis, Viktor Frankl, Bernard Lonergan, JRR Tolkien, St. Augustine, St. Bonaventure, and any other thought that shines a light.

David is also the creator and administrator of the Official Viktor Frankl Facebook page, with the permission of the Frankl family.

The references for David's papers and the links to them are:

Hallowell, David A.  (2010).  Personhood in an Anti-Reductionist's Universe: Frankl's Dimensional Ontology and Lonergan's Notion of the Thing  The International Forum for Logotherapy, 32, 89-100. 

Frankl, Viktor E.  (2008).  The Pluralism of the Sciences and the Unity of the Person.  Translated by David A. Hallowell.  Unpublished translation.

The original paper was published as:

Frankl, Viktor E.  (2005).  Der Pluralismus der Wissenschaften und die Einheit des Menschen.  In Der Mensch vor der Frage nach dem Sinn, Munchen:  Piper.

The book David mentioned is:

The Feeling of Meaninglessness: A Challenge to Psychotherapy and Philosophy
by Viktor E. Frankl.
Edited and with an Introduction by Alexander Batthyány.

Published 2010 by
Marquette University Press






Summary of links:

David's Paper on Personhood in an Anti-Reductionist's Universe

Translation of Frankl's paper on the Pluralism of the Sciences and the Unity of the Person

The Existential Cosmopolite

Official Viktor Frankl Facebook page

Viktor and  I - A Film by Alexander Vesely

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

#21 Logotherapy Technique: Dereflection

#21 Logotherapy Technique: Dereflection
Replaced by Lesson 4: The Primary Techniques of Logotherapy
11 September 2010

#20 Logotherapy Technique: Paradoxical Intention
Replaced by Lesson 4: The Primary Techniques of Logotherapy
14 August 2010

#19 Logotherapy Technique: Socratic Dialogue
Replaced by Lesson 4: The Primary Techniques of Logotherapy
15 July 2010

Dereflection is to divert attention away from one's symptoms.  Dereflection ignores the self and leads to self-transcendence through focusing attention on someone or something else.  Lukas defines it a "disregarding of something that can be disregarded, which would become worse through reflection, not better.  At the same time, it is more than a disregarding and quite more than a diversionary tactic."

Frankl himself recognized two techniques:  Dereflection, based on the human capacity for self-transcendence and Paradoxical Intention, based on the human capacity for self-distancing.  Lukas and others have added the third technique, taught by the Viktor Frankl Institute of Logotherapy as Socratic Dialogue and referred to by Lukas as Attitude Modification.  

Case studies are presented from Dr. Frankl, Dr. Lukas, and my own practice.

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

#20 Logotherapy Technique: Paradoxical Intention

#21 Logotherapy Technique: Dereflection
Replaced by Lesson 4: The Primary Techniques of Logotherapy
11 September 2010

#20 Logotherapy Technique: Paradoxical Intention
Replaced by Lesson 4: The Primary Techniques of Logotherapy
14 August 2010

#19 Logotherapy Technique: Socratic Dialogue
Replaced by Lesson 4: The Primary Techniques of Logotherapy
15 July 2010

Paradoxical intention is to wish for that which is most feared.  By pushing one's fear to exaggeration, usually in a humorous way, the wind is taken out of the sails of the fear.

Humor is one of those characteristics of the human spirit that, according to Frankl, can be used as a source of health.  Of course, when using humor, one must be careful to understand that the humor is directed toward the symptom, not toward the person.  That is, when using paradoxical intention, humor is used as a tool to defeat the symptom, not used to poke fun at a human being.

Paradoxical intention appears to be associated with para-sympathetic arousal, particularly learning to decrease sympathetic arousal through humor (as opposed to the more common approach of relaxation).  As such, it teaches the client that she is not a slave to her anxiety, that she can take a stand against it, and even reduce it.

Case studies are presented from Dr. Frankl, Dr. Lukas, and my own practice.

Update:  Since this podcast was recorded, Dagmar Devorah Sigrid Fabry has published a comprehensive review of outcome studies on paradoxical intention and concludes that "...Paradoxical  Intention has a sound evidence base."

Reference:  Fabry, D. D. S.  (2010).  Evidence base for paradoxical intention:  Reviewing clinical outcome studies.  The International Forum for Logotherapy, 33, 21-29.

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

#19 Logotherapy Technique: Socratic Dialogue

#21 Logotherapy Technique: Dereflection
Replaced by Lesson 4: The Primary Techniques of Logotherapy
11 September 2010

#20 Logotherapy Technique: Paradoxical Intention
Replaced by Lesson 4: The Primary Techniques of Logotherapy
14 August 2010

#19 Logotherapy Technique: Socratic Dialogue
Replaced by Lesson 4: The Primary Techniques of Logotherapy
15 July 2010

The Socratic Dialogue is a way of engaging the client in a discussion that allows the client to discover what he or she already knows on some level.  The Socratic Dialogue is a technique shared with other forms of psychotherapy, though in other therapies it often involves "trapping" the client in a logical snare, revealing to them the errors of their reasoning.  In Logotherapy, Socratic Dialogue is closer to the vision attributed to Socrates.  That involves "midwifing" or allowing the client to give birth to new ideas.  For this reason, the technique is often called Maieutic Dialogue in Logotherapy.  Maieutic is a term derived from the Greek that means to act as a midwife. 

One may surmise that the client has already formed these ideas, either preconsciously, unconsciously, or through the spiritual unconscious.  The therapist does not presume to know the right solution for the client, accepts this ignorance, and appeals to the wisdom of the client's spirit.  Frankl wrote: "It is not necessary, however, to enter into sophisticated debate with the patients.  Logos is deeper than logic." 

One way in which Socratic or Maieutic Dialogue is begun in Logotherapy is by asking what Dr. Elisabeth Lukas calls a two-legged question.  A two legged question has one leg in the client's presenting problem and the other leg in the client's area of freedom.  A famous example from Dr. Lukas is, "Why stand among the flowers and water the weeds?"  This same principle is illustrated in another famous quote by Dr. Jerry Long, a Franklian psychologist who was paralyzed from the neck down, when he said, "I broke my neck, it did not break me,"

Case studies are presented from Dr. Frankl, Dr. Lukas, and my own practice.

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

#18 Logotherapy and American Health Care Reform

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Click here to download Logotherapy and Evidence Based Practices

Click here to read the blog post Logotherapy and Evidence Based Practices

Click here to read a related blog post on American Health Care Reform

The Affordable Health Care Act of 2010 passed the United States Congress on March 21, 2010.  The act provides for full parity between mental health services and general medical services.  This means that the provisions of the new law directly impact your local psychotherapeutic practice.  Most provisions of the new law do not go into effect until January 1, 2014.

Background:  The new law is designed to reform two main problems with American healthcare:  The overuse of high cost interventions and the underuse of prevention strategies.  To that end, national health reform has four goals, or "pillars," of which the new law primarily addresses the first two.

Four Pillars of Healthcare Reform

1. Insurance Reform
2. Coverage Expansion
3. Delivery System Redesign
4. Payment Reform

Coverage Expansion and Insurance Reform

According to the National Mental Health Association, 83.1% of Americans currently have some type of insurance coverage.  After the provisions of the new law go into effect, this number will rise to 93%.  These numbers represent 30 million Americans.  Sixty-six percent of the increase will come through an expansion of Medicaid, while the remainder will come from insurance reform and the creation of state insurance exchanges.  Medicaid expansion will be accomplished by making the only requirement for coverage set at a household income of 133% of the federal poverty level.

Delivery System Redesign

Previous studies have shown that 29% of those receiving Medicaid had a mental health problem.  A new study, based on data gathered about medications prescribed and not based on providers seen, suggests that 49% of those receiving Medicaid have a mental health issue.  This means that those extra 20% are receiving psychiatric medications, but are not being seen by a psychiatric specialist.

The new law calls for a closer integration of mental health and general medical services.  It remains unclear what this new integration will look like.  It may mean local mental health centers entering into contractual relationships with existing medical practitioners, or it could mean local medical clinics hiring mental health staff and local mental health centers hiring general medical staff.

Such a redesigned community mental health center may come to be known as a "federally-qualified behavioral healthcare center."  This represents the greatest redesign of public mental health services since the passage of the Community Mental Health Act of 1963 that originally established community mental health centers.

Payment Reform

The fee-for-service model is moving toward extinction with the new law.  It is being replaced by a "case rate" model.  That is, a federally-qualified behavioral healthcare center would receive funds from a payor, say Medicaid, based on the number of Medicaid consumers seen.  Moreover, centers with better outcomes would be paid more than centers with worse outcomes, adjusted for number of patients.

For example:  Assume the ABC Center for Logotherapy has 200 Medicaid clients in 2014, and the XYZ Center for Logotherapy has 200 Medicaid clients in 2014.  If the clients of the ABC Center show more improvement than those of the XYZ Center, then the ABC Center would receive more Medicaid dollars than the XYZ Center, though serving the same number of clients.

Opinion:  Opportunities and Challenges for Logotherapy

With an additional 30 million people receiving health care coverage, and with conservative estimates that more than 10 million of them will required mental health treatment, a demand for therapists of all kinds will increase.  If we use Frankl's numbers that about 20% of clinical cases are noogenic in origin and suitable for logotherapy, then we have an increase of at least 2 million people likely to respond to logotherapy.  How many more logotherapists do we need to treat those 2 millon people?

A closer integration of mental health and general medical care will provide more settings in which logotherapists could be employed.  Frankl's concept of a Medical Ministry may become more fully realized, if logotherapists start positioning themselves for it now.

Evidence Based Practices and outcome data will tie into reimbursement.  Logotherapy simply must develop more hard data.   I encourage you to download and listen to the podcast on Logotherapy and Evidence Based Practices for more information in this area,

There are currently about 4 or 5 outcome measures on the market that are positioning themselves to take advantage of payment redesign.  Logotherapy, with its special emphasis on the therapeutic relationship, could and should get on the forefront of that developing research.

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