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| Revised version of a lecture, given in Regensburg at the 3rd International Congress of Logotherapy (June 17, 1983) |
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| Logotherapy as Cognitive Therapy |
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| Michael Titze |
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Only a few decades ago, many academically founded psychotherapists patterned their theoretical paradigm on the model of classical physics because they considered «scientifically» relevant only those facts which had filtered through the mechanism of naturalistic cognition (cf. Mahoney 1977). However much they differed from one another in their specific «technology», they all wanted to be «natural scientists» the «classical» behaviorists as well as the «orthodox» psychoanalysts.
While the analysts built up their quixotic physics-based wind-mills in order to battle mechanistic, energetic, and thermodynamic fantasies, the behaviorists, following John B. Watson, thought they could reduce psychological problems to glandular secretions or muscle movements. Both the Freudians and the Watsonians agreed that cognitive phenomena could be dismissed as «ego-psychological» (Freud) or «mentalistic» (Watson) pseudo-problems.
But then a unique and radical change occurred in the theory of cognition which, as we now see, had revolutionary consequences. It was a radical turning away from the premises of an «old-fashioned scientific theory» (Sigmund Koch), which made a «cult out of facts» (Henri F. Ellenberger) and reduced the human dimension of body, psyche, and spirit to a physical level that could be manipulated. This rejection of logical positivism coincided with an orientation towards a cognitive model of phenomenology, radically changing the paradigm. Human subjectivity then became a genuine research subject for psychology. Attention was given to that area of human existence which in objectivistic «General Learning Theory» and its Stimulus-Response-Paradigm had at best the meaning of a «black box». At this point psychologists could deal in good conscience, without endangering their scientific reputation, with those phenomena which from the perspective of an «objective scientist» are non-observable and covert. Gradually, «true behaviorists» began to deal with something which they originally had denominated «mediational» processes but now called «cognitive.»
This «cognitive turn-about» of behavior therapy corresponds to a similar process within psychoanalysis which had shaken up its scientific-theoretical world view. It is true that here the change was much slower and less spectacular. It is my thesis, however, that without the turning of psychoanalysis toward cognitive phenomena (which psychoanalysts call «ego-psychology») neither the non-analytic cognitive theories would have arisen, nor would the «cognitive turn-about» in behavior therapy have been so extensive.
The Beginnings of Cognitive Therapy
In 1911 the first split occurred in psychoanalysis which at that time was hardly older than one decade. Alfred Adler, himself a pioneer psychoanalyst and prominent in the Psychoanalytical Society, had arguments against Freud’s biologism and physicalism, so that further collaboration seemed impossible. Adler then founded his own school of Individual Psychology. Up to now it has been generally less known what the real reason for the split was.
Freud all his life followed the naturalistic philosophers of the 19th century who, in turn, had followed the premises of positivism. His expressed goal had bean to establish the system of psychoanalysis merely as a first step toward a comprehensive neurophysiological system that would explain and treat neuroses (and therefore would be part of natural science). But Adler, who was much younger, had right from the start been more oriented towards the humanities than Freud. He was greatly influenced by Kantian idealism and European pragmatism. He was therefore inclined to systematically explore those «creations of the mind» which he called «opinions», «attitudes», «fictions», and «tendencies». For Freud this was incomprehensible and an expression of a superficial «ego psychology» (Ellenberger 1973).
Today, Adler is not necessarily considered the founder of cognitive therapy, but rather as one of its earliest precursors. Albert Ellis (1957, 1973) refers to him in this sense. Also Viktor E. Frankl who in the 20’s contributed significantly to the formation of Individual Psychology’s theories, recognizes Adler in this manner (Frankl, 1982).
After the first split in psychoanalysis others followed, although they were less spectacular. It is noteworthy that most of the «neo»-analysts who went their own ways, had undergone a change to paradigms which today are understood as cognitivistic: That changeover implied a turning away from naturalistic positivism and a an orientation towards the subjective realm of the mind, the area of cognitive phenomena (cf. Hoffman, 1979, p. 14).
Viktor Frankl's Contribution to the Establishment of Cognitive (Behavior) Therapy
In the preface of an important German-language work about cognitive therapy, Nicolas Hoffmann (1979, p. 5) points out that «cognitive therapy» represents one of «the newest and most promising developments in psychotherapy» (1979, p. 5). Hoffmann describes the contributions of Aaron Beck, Albert Ellis and Viktor Frankl as «pointing the way». I myself can only agree to this and will not discuss who of these authors played what part in the establishment of cognitive therapy (and even less who made the more significant contributions). I only wish to outline what modern cognitive theory owes Viktor Frankl specifically. Without any doubt, he is one of the pioneers. While Beck and Ellis developed their early contribution to cognitive therapies in the 50’s and 60’s, Frankl started to establish Logotherapy in the late 20’s, which makes Logotherapy one of the first cognitive therapies.
Some remarks about Logotherapy
At the beginning of his scientific career, Frankl faced the alternative of joining the school of Freud or that of Adler. Both were likely because the subsequent founder of the «Third Viennese school of Psychotherapy» was a contemporary and fellow Viennese of both these ounders of depth psychology. Frankl decided in the early 20’s against psychoanalysis because it seemed to him too mechanistic and too reductionistic. Frankl rejected the psychoanalytical concept that human beings were «nothing but» products of their drives and instincts. According to Frankl we do not experience «drives as such» but rather take a stand toward them, either giving in to them or overcoming them. Young Frankl also rejected psychoanalysis because «Freud was deeply rooted in the naturalism of his time that regarded humans as creatures of nature only, disregarding the dimension of spirit» (Frankl, 1971, p. 24). This anti-reductionistic and anti-mechanistic view still characterizes Logotherapy today, and is a position which is also accepted by cognitive therapy (cf. Titze, 1985).
Logotherapy considers reductionistic that view that regards human beings as «nothing buts», i.e. nothing but a «biochemical mechanism,» a «computer» or a «stimulus-response mechanism.» In this connection, Frankl invokes the simile of an x-ray specialist who looks at the screen and sees the person as «nothing but» a skeleton. What he sees is true, but he does not see the whole person. Freud, according to Frankl, had acted similarly.
Thus Frankl (1975) defines reductionism as a pseudo-scientific procedure by which specifically human phenomena are reduced to subhuman phenomena, or are being deduced from them. Hence, reductionism could be defined as a «subhumanism» in which the human mind is regarded as nothing but the highest form of the central nervous system’s activity (in the sense of Pavlovian theories.
Cognitive therapists, especially Mahoney (1979), have generally accused classical behavior therapists of reductionism. Consequently, Beck (1970) states that behavior therapists deal with disturbances of behavior that need to be eliminated within a theoretical framework which originates in learning theory, thereby making consequent use of classical and operant conditioning. Because these concepts were primarily developed in animal experiments, they need to concentrate on the observable behavior of the organism.
The Approach of Logotherapy
After having decided against psychoanalysis, for a time Frankl joined the Adlerians. But Individual Psychology also could not satisfy him in the long run. Without doubt, it did go beyond the biological reductionism of psychoanalysis insofar as it included the dimension of the psyche and truly psychological phenomena. But for Frankl it disregarded the dimension of «specifically human phenomena» – a dimension which Frankl called the «spirit», or the «noos». In Frankl's view, a truly effective psychotherapy has to consider exactly this dimension – never, however, in isolation because it is based upon the «lower» dimension of psychophysics, or at least is conditioned by it. Thus the spirit of a person, to manifest itself, needs a functioning organism (see Frankl, 1975, p. 154). Nevertheless, the spirit or – if one may call it that way – one’s cognitive capacity, can never be deduced from the conditioning dimensions of body and psyche.
Classic behavior therapy, just as orthodox psychoanalysis, was all too greatly influenced by the mechanistic ideas of the 19th century as Hoffmann (1979, p. 14) consequently points out. Following this ideology, behavior therapy ignored an important human dimension, beyond the somatic-psychological realm.
The Phenomenological Position of Logotherapy
Such radical rejection of naturalism and positivism necessarily enabled Logotherapy to move closer to Edmund Husserl’s phenomenology. Consequentially, Viktor Frankl describes Logotherapy as «implementing» phenomenology as a methodology for the enhancement of the human being’s unbiased self-understanding» (Kovacs, 1980, p. 34). In addition to this methodological foundation, Logotherapy utilzes essential topics of existential and value philosophies.
This solid philosophical anchor makes Logotherapy a therapeutic system whose representatives can find answers even to «ultimate questions.» This is not so unconditionally for of cognitive behavior therapy. Although this relatively young school has a sufficiently validated repertory of effective methods, beyond this «technology» a specific knowledge based on epistemology and a philosophy of values is still lacking. Mahoney (1977, p. 291) specifically points to this elementary problem.
The Subject Matter of a Phenomenological Psychology
The subject matter of Logotherapy is the emphasis on the unique experiences of the individual person. Thus Logotherapy uses an inventory of methods that is truly subjectivistic and includes such concepts as intuition, artistic skill, empathy, ideation, and others, none of which is objectifiable or in accord with the criteria of positivistic experimental psychology.
The objectivistic and positivistic psychologies which follow the premises of natural sciences naively assume a separation of consciousness and outer world, of ego and alter ego, of subjectivity and reality. Excluded is in this connection, however, the sphere of subjectivity – the spirit.
This reductionistic view has been rejected as untenable by phenomenology since Husserl. Phenomenology was able to prove that the so-called external world, the world of «natural things», does not exist per se. The «thing» we perceive and experience is our own construction, the «subjective correlate» of our consciousness of the «thing-in-itself» (Kant) which we perceive.
Cognitive psychology deals likewise with «ideas», «opinions», «cognitions», «attitudes», or «values. These entities are, however, no mere images of a hypothesized «reality», as having been suggested, for instance, by the British empiricists. The «thing-in-itself» is presented to the perceiving person only passively, so one can – as we have learned from Adler – only interpret, selectively process, and «shape» it (cf. William Stern). And this is where Logotherapy has its impact: it starts with the fact that it is the person who has experiences and transforms them to specific opinions. On this epistemological basis, the existential fact of human freedom of choice is postulated and is placed in opposition to the positivistic dogma of causality, of «pan-determinism» (Frankl). Hence, Logotherapy expressly states that human freedom is indeed not a freedom from the conditions set by life, be they biological, psychological, or sociological, but a freedom to something, namely the freedom to take a stand toward any circumstance or condition (Frankl 1975, p.3).
Convergences
Today cognitive therapy generally starts from phenomenological constructs like «ideas», «opinions», and «attitudes». Here a clear convergence with the view of Logotherapy is evident (cf. Mahoney, 1977, pp. 260 ff). According to Fischbein and Ajzen (1975, p. 6), attitudes are considered as «intervening variables» that guide behavior more or less permanently, as an «acquired predisposition to react in a consistently favorable or unfavorable manner». These authors also maintain that attitudes are based on existing opinions. Hoffmann (1979, p. 73) defines opinions as «subjective links between two different aspects of a person’s world; by assigning a certain attribute to something, we form opinions which, in turn, become the basis for attitudes.» An attitude therefore is our subjective evaluation of an object. The social-psychological theory of attribution has been formulated by Heider (1958), Jones and Davis (1965), and Kelley (1967, 1973). These findings are in line with the phenomenological theory of «typification» as proposed by Aron Gurwitsch (1967) and Alfred Schütz (1971). (For details see Titze 2012).
Logotherapy places prime importance upon human attitudes. This has significant effects on therapeutic practice. Logotherapy poses the fundamental question concerning» what attitudes the (healthy as well as ailing or suffering) human being forms toward what he/she is experiencing. And only the attitude taken will determine whether a so-called trauma [...] will result in a lasting scar, a lasting damage» (Frankl, 1971, p. 87). And further: «Insofar as logotherapy does not deal directly with symptoms but tries rather to bring about a change of personal attitudes toward the symptoms, it is a genuine personalistic psychotherapy» (Frankl, 1982 p. 80).
Intentionality and Meaning
The phenomenological postulate of an active attitude toward the world, as it manifests itself in the forming of opinions, rejects the traditional determinism of positivistic psychology. Phenomenology does not assume that the human being is passively affected by specific events in the environment or that one «reacts» solely to its stimuli. According to Husserl (1968, pp. 87 ff., p. 378), the act of cognition always includes an «aiming at the object of cognition». For this reason, this active selecting of a certain event in the world is being denoted «intentional» and the act itself «intentionality». In this sense every cognition is concerned with how an event is interpreted – and thus points beyond the subjective limits of the individual existence; it «transcends» them (as Frankl puts it) and this forms the connection between the living and the nonliving universe.
Frankl (1972, p. 416) states unswervingly that the human being is directed toward something or someone, toward an idea or a person: «Intentionality means being directed to what is called in phenomenology ‘intentional referents’ – a relation to its own objects. This is the most constitutive characteristic of any subject. But intentional referents, the respective meanings and values, also serve as motives and reasons. As soon as we disregard them, there is no longer any motivation for us, there are only conditioning processes» (Frankl, 1979, p. 59).
Because a person basically decides actively and responsibly which objects to intentionally turn to, solely that person can judge whether the specific direction thereby taken is meaningful or not. «Meaning», in this context, is something highly subjective, but also something «objective» insofar as it is inherent in the specific objects and situations existing «out there» in the world. For Logotherapy meaning is something that does not lie within us but presupposes a «reaching out beyond oneself»: this is what self-transcendence means.
Convergences
The concept of «intention» has become part of the terminology of cognitive therapy. Originally it was used by attribution theory (cf. Heider, 1958; Jones and Davis, 1965; Kelley, 1967, 1973). Fischbein and Ajzen (1975) have formulated a theory of intention, taking intention to mean the subjective probability with which a person assumes that he or she will behave in a certain way. Hoffmann (1979, p.75) defines intentions as aspects of attitudinal behavior, in the assumption that this aspect of intention is closely connected with cognitive and affective aspects.
Cognitive behavior therapy has found no solution for this specifically human problem. Mahoney (1974, 1977), who must be credited for his efforts to face questions of values and ethics, poses several fundamental questions: What does a therapist do when a client’s distress is exacerbated by a value premise which the therapist does not share? What are the professional and ethical obligations, for example, when a devoutly religious client is anxious and guilt-ridden due to belief-behavior discrepancies? (Mahoney, 1974, p. 283). It was Logotherapy that found satisfactory answers to all these questions.
Consequences for Practice
As Hoffmann (1979, pp. 14ff.) points out, Logotherapy is specifically indicated for sicknesses that have their roots in problems of the spirit, in a moral conflict or an existential crisis: «The therapy that Frankl considers useful here goes far beyond the basic concept of Freud’s psychoanalysis which considers repression the cause of the disturbance and transference as the fundamental therapeutic process. The logotherapeutic approach attempts a psychotherapy using the resources of the human spirit. It is specific therapy for noogenic neuroses but also provides a valuable unspecific therapy for somatogenic and psychogenic sicknesses, serving as a complement to other forms of therapy.»
Logotherapy aims at «education for responsibility», for helping the patient find meanings and values. It aims at filling the existential vacuum and preventing neuroses and other psychological illnesses from entering. Logotherapy offers a number of techniques, which, by influencing the cognitive area, also include emotions and behavior» (Hoffmann, 1979, pp. 14 ff).
This summary by a cognitive therapist may serve an introduction to a presentation of some of the most important logotherapeutic methods. An attempt is herewith made to show the relationship between these methods and the corresponding «technological principles» of cognitive therapy.
Modification of attitudes
While classical behavior therapy is undoubtedly oriented toward the symptoms, cognitive therapy is not concerned primarily with surface symptoms. It aims rather at correcting the cognitive conditions behind the symptoms, such as ideas, conceptions, convictions, attitudes, and opinions. Logotherapy is primarily concerned with bringing about a modification of attitudes (which can influence specific symptoms). In this sense, Logotherapy can be understood as a therapy of the causes.
Admittedly, the therapeutic intention to modify the clients’ convictions, beliefs, and opinions, poses a problem. How is the therapist to achieve this? Has he to confront the clients with the values and concepts which one holds because of philosophical, religious, or psychological ideology? There are today still some psychotherapies that take this approach, and therefore are more likely pedagogical systems. (From the logotherapeutic view, they try to indoctrinate the clients’ quest for meaning, rather helping them find it.) If a cognitive therapist does not wish to achieve a mere «brain washing», he/she has to use an approach that motivates clients:
1) to question their own convictions, beliefs and opinions;
2) to find a «rational» attitude toward what they are, what they do, and what direction they wish to go;
and 3) to create for themselves an ethical world view which can become the basis of a rational, that is relativizing conscience.
These are the fundamental considerations of all cognitive therapies, for which the rational-emotional therapy of Albert Ellis can be considered a pioneering effort. The following is a brief survey showing by what methods this problem of «modification of attitudes» has been solved along cognitive therapy lines.
The Socratic effect
The method is well-known by which Socrates succeeded didactically in helping his students gain knowledge through their own thinking. He refrained from the usual methods of instruction: Rather he questioned ideas of his students which he considered false, erroneous, or illogical. This process allows the students to re-evaluate for themselves (although induced by the teacher) their thinking and to arrive at new and genuine «rational» opinions.
Cognitive therapy, after much research, uses the «Socratic effect» (cf. McGuire 1960, Rosen & Wyer, 1972) which proves the effectivity of uncritically preconceived notions. Mahoney (1977, p. 233) summarized these findings: «When individuals are allowed to examine and evaluate the rationality and coherence of their own beliefs, resulting cognitive changes are often more dramatic and enduring than when a didactic strategy is applied [...] It may be more therapeutic to be ‘gently directive’ in self-discovery exercises than to beat a client over the head with the salience of his irrationality».
Frankl has applied the method of the «Socratic dialogue» for decades. He has found this method well suited to motivate people to find meaning for themselves. It would, however, be incorrect to consider this method as a mere «system». Socratic dialogues can never be planned as a standardized aid (which provides the student of psychotherapy with a systematized learning). The term connotes a specific therapeutic action which cannot be sufficiently understood through objective psychology. Rather, phenomenological structures are of central importance in this context. This, in turn, implies the therapist’s subjective ability that cannot be made to work for everyone: «Psychotherapy must always be more than mere technical skill: It is, fundamentally, an art. Considering the irrational factors which are part of the art of psychotherapy, it is not surprising to see how much psychotherapy depends on a momentary understanding of the concrete person and the concrete situation of the patient – how much it depends on improvisation. There is no plan that must be rigidly followed: Each case requires its own method, which must be improvised, discovered every time and in every case anew!» (Frankl, 1947, 1982, p. 170).
This demand requires a thorough adjustment in the thinking of traditional behaviorists who are accused (not entirely without justification) of being, «technocrats». Indeed, contemporary scientific literature widely discusses the factor of subjectivity when, for instance, Hoffmann (1979, p. 85) mentions such variables as «therapeutic experience» and «intuition», or when Mahoney (1977) states: «lt is interesting to note that our clinical paradigms portray the behavior therapist as an emotionless (albeit skilled) technician. Just as his communication skills (both verbal and non-verbal) have remained virtually unexamined due to their prohibition from the popular fare of «acceptable» research, so has his autonomic nervous system escaped our scrutiny. We often measure our client’s emotional responses during therapy, and assume that the therapist’s physiology has nothing important to offer. Might not «empathy» be partially reflected in the clinician’s autonomic responsiveness? [...] Therapy is not a consummatory response – there are two organisms in the chamber and we need to take a much closer look at both sides of their interaction» (Mahoney, 1974, p. 281).
Distancing
Logotherapy teaches that effective «change» is possible only when clients succeed in distancing themselves from the effects of those cognitive contents which need to be modified in psychotherapy. Seen in this light, the process of self-distancing is an essential precondition of any further therapy. Cognitive therapy clearly understands this necessity. Beck (1979a, p. 108) writes: «Even when patients have learned to identify their idiosyncratic ideas, they still may find it difficult to face them objectively. Thoughts often have the same characteristics as the perception of an external stimulus. ‘Distancing’ is the process to gain objectivity toward cognition. Because a neurotic patient tends to accept uncritically his idiosyncratic ideas, he has to be taught to distinguish between thoughts and external reality, between hypotheses and facts.»
I cannot help but consider this statement, although correct in principle, as too meager and too «dry» to be used effectively by the practicing therapist for the client’s benefit. Here cognitive therapy is certainly still in its beginning stage. If one considers, on the other hand, how many concrete possibilities are offered by Logotherapy to bring about self-distancing in the client, the entire therapeutic relevance becomes once more apparent.
In the technique of paradoxical intention, Logotherapy has chosen humor to bring about this self-distancing from the problems of neurosis. In fact, neurotics suffer from taking too seriously life in general and personal shortcomings in particular. So these persons tend to magnify or «catastrophize» (Beck) such problems. Logotherapy teaches patients to systematically lose their awe of everything they consider «horrible», «frightful», or «catastrophic». They are not talked out of it, on the contrary, they are prompted to wish upon themselves what they dread so much – to blush, to faint in public, to experience sexual failure, to become infected with germs, etc. Hence, they are encouraged to intentionally desire to have happen exactly what their common sense had always told them to avoid – thus bringing about an anticipatory anxiety that had set in motion a vicious cycle of fear and had caused them to seek therapeutic help. These patients are challenged to laugh in the face of their «terrible symptoms» and to prove empirically to themselves that such symptoms need not be taken seriously. Thus they gain a new, more assertive attitude towards the problems of life.
This logotherapeutic method of paradoxical intention requires continuous practice by the clients. Hence they are offered the technique of humorous formulations similar to Ellis’ «inner monologues» that are to serve as a method of systematic self-instruction. For instance, the compulsive-obsessive patient who fears infection through germs, is to tell himself again and again: «Today I have been infected by 10 billion germs, now I'll see if I can get up to 20 billion!» This technique leads to the gaining of distance and objectivity as demanded by Aaron Beck. By that, the symptom that tyrannizes the neurotic is «ironized» and «objectivized» (Frankl, 1947f; 1982, p. 138).
Among other therapeutic systems, such as communication therapy, cognitive behavior therapy is beginning to accept paradoxical intention, but only its technological aspect, rather than the far-reaching possibilities of the application of humor in psychotherapy.
It is not uncommon for clients to report that they are depressed «because» they are depressed, or anxious «because» they are anxious. The act of perceiving oneself as «not handling it» is often an exacerbating element in subjective distress. To be depressed or anxious implies personal inadequacy and the inability to cope. The «fear of fear» maxim may deserve more credence than has yet been acknowledged. It is interesting to speculate that Frankl's technique of «paradoxical intention» may have bearing on this same vicious cycle (cf. Mahoney, 1974, p.221).
Another specific method of distancing is the technique of dereflection which, according to Frankl, is particularly indicated in cases of sexual neuroses. Here the problem lies in the fact that patients pay too much attention to those somatic functions that cannot be controlled by will. They «hyperreflect», thereby focusing their attention onto their symptoms. Dereflection is a technique that leads them to ignore their symptoms, to bypass them, by turning their attention to something or someone that is more important and they consider being meaningful to them.
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