Psychotherapy with Dignity: Logotherapy in Action

Foreword for the Series Living Logotherapy

In our time, people usually have enough to live on. What they often lack, however, is something to live for. This is how Viktor E. Frankl, the Viennese psychiatrist and founder of logotherapy, summarised a problem that is just as relevant today as ever. Elisabeth Lukas, a clinical psychologist and psychotherapist, has an international reputation as Frankl's most important student. In her many books, she illustrates how logotherapy provides help in cases of mental illness, enriches the everyday life of healthy people and inspires us all to lead a meaningful, fulfilling life. Her books illustrate how humane, authentic and up-to-date a living logotherapy can be. The main objective of this new series is to make her books, which have enjoyed lasting success in the German-speaking world, more accessible to speakers of English.

Many people have worked hard to make it possible for the Elisabeth Lukas Archive to publish this new series. Particular thanks are due to our translator Dr. David Nolland, who has produced a fluid text that remains very close to the original. He has excellent knowledge in the field of logotherapy and supervises this series in all matters relating to the English-speaking market. Thanks are also due to Prof. Dr. Alexander Batthyány, who supported us from the beginning and will accompany this series as a guide. The formatting and layout is due to Bernhard Keller, and the beautiful presentation of the books is wholly attributable to his expertise.

The first book in this series is a collaborative project combining discussions of the theory of logotherapy by Lukas with numerous case studies by Schönfeld, and the second book is a textbook by Elisabeth Lukas on the fundamental concepts of logotherapy and their applications.

This third book is a further collaboration between Lukas and Schönfeld. It mainly consists of case studies supplemented with theoretical analyses of how these cases illustrate the practical application of logotherapy. The book includes a short introduction to logotherapy and ends with discussions of a number of topics from a logotherapeutic perspective.

We sincerely hope that this practical guide to the application of logotherapeutic methods will be helpful and illuminating for English speaking practitioners and other interested parties and will clearly illustrate the effectiveness and applicability of logotherapy.

Dr. Heidi Schönfeld

Director of the Elisabeth-Lukas-Archive

Translator's Note

Logotherapy presents a particular challenge for the translator. Viktor Frankl's own works are full of humour and metaphor, and his distinctive way of making his point often relies heavily on wordplay, poetic forms of expression and nuances of language that combine colloquial language with philosophically suggestive formulations distilled from a profound understanding of the history of European thought. He coined a number of original terms and concepts that play a key role in his work. Frankl was often dissatisfied with the published translations of many of these key terms, and his own translations, where available, provide valuable clues to his thinking.

Elisabeth Lukas has a distinctive written style that shares the aforementioned features of Frankl's writing. She has continued in Frankl's footsteps linguistically as much as she has intellectually and spiritually. Frankl never saw the logotherapy he had originated as something finished and set in stone, but as a system of thought that should continually be developed in response to the inexhaustible insights into human nature arising from his focus on meaning and the possibilities of the human spirit. In this book, Elisabeth Lukas and Heidi Schönfeld have produced a remarkable testimony to how therapeutically effective this system of thought is in practice.

Translations of Frankl’s works have, where possible, been taken from the standard editions of his works in English cited in the footnotes. Where this is not possible, I have cited the German editions, and the translations are my own.

I would also like to thank Heidi Schönfeld for her close collaboration in producing this translation. Without her help, an accurate and faithful English-language account of Frankl’s methods in action would have been impossible.

Dr. David Nolland

A Brief Introduction to Logotherapy

(Elisabeth Lukas interviewed by Bernd Ahrendt)

Bernd Ahrendt is a Professor of Business Administration, with a particular interest in human resources management, working at the FOM University in Hannover. In 2018, he travelled to Vienna to interview Elisabeth Lukas. Bernd Ahrendt has agreed for passages from his interview to be reprinted here to provide readers with an introduction to the basic concepts of logotherapy.

Ahrendt: Prof. Lukas, could you sum up the essence of logotherapy in a few words?

Lukas: Viktor Emil Frankl, born in 1905, began his research as a young doctor with two basic questions that interested him as a prospective psychiatrist. The first question was: What makes a human human? Is there anything that is unique to being human? The second was: What keeps humans psychically healthy, or enables them to get healthy again if they are ill? The second question was particularly innovative in Frankl's time, because all the psychiatric experts of that time considered only the causes of becoming ill, and not the basis for getting healthy again.

To answer his first question, Frankl began to investigate the human spirit, which, according to his definition, is the third dimension of being human. One should bear in mind that according to the philosophy current at that time, one only talked about the body (the first dimension) and the soul (the second dimension), and that in the developing field of psychology, the traditional concept of soul was simply translated as psyche. So all of our cognitions and emotions were subsumed under the heading of psyche. This left out everything that is specifically human, because thoughts and feelings also exist to a certain extent for animals. If one wants to pick out what is uniquely human, one must venture into the third dimension, in which Frankl located phenomena such as our (potential) freedom of will and responsibility, our ethical and artistic sensibilities, and our search for meaning and our yearning for an ultimate meaning (God?). These phenomena take us beyond the horizon of the animal world, and in a modern context also beyond the horizon of intelligent computers and robots.

To answer his second question Frankl discovered the immense significance of one's perspective on meaning for the stability of the human psyche (and body). It is precisely when life becomes difficult that it becomes decisively important whether one sees a meaning in continuing to live. But even in comfortable circumstances, life becomes less satisfying when it is empty of meaning. In the light of these two groundbreaking realisations, Frankl founded his meaningcentred psychotherapy, which he called logotherapy. It can be seen as a psychotherapy from the spiritual and towards the spiritual.

Ahrendt: What did Frankl find in the course of his research?

Lukas: In the 1930s, Frankl worked at the psychiatric hospital Am Steinhof in Vienna. There he had the opportunity to talk with hundreds of sick and severely depressive people. Amongst other things, he heard about the hardships of their childhoods, about their disappointments and psychic injuries. It was there that he had the idea to carry out a controlled experiment, in which he interviewed numerous healthy people (doctors, nurses, students) and found that these inconspicuous and psychically normal people, who were pursuing their professions and getting on with their daily lives without difficulty, had typically had just as many traumas, disappointments and injuries in their lives as his patients. As a result, Frankl abandoned Sigmund Freud's trauma theory. He recognised that there are certainly pathogenic, that is, illness-causing factors in life, but at the same time there are also protective factors. And that when enough protective factors are present, the illness-causing factors become less dangerous. This thesis is now undisputed. It has been known for a long time from general medicine that, for example, infections have an effect when a person's immune system is already weak, and cause little damage when the organism's resistance to illness is well-developed. In the psychic domain, a person's inner meaning fulfilment is one of the most powerful protective factors. Frankl deduced from this that any form of finding and fulfilling meaning contributes to psychic healing. It can be seen from his many well-documented case studies that this really works in practice.

I would like to add one more thing: recent resilience studies have confirmed Frankl's discoveries 100%. People who pick themselves up after a severe blow of fate has knocked them down, do so on the basis of affirming a particular meaning perspective. Instead of always looking back on what they have suffered, they live primarily in the present, which they shape as best they can according to a valueoriented vision of the future. In this way they rescue themselves from the unhealthy miasma of their trauma (much as Baron Münchhausen pulled himself out of a swamp by his own ponytail).

Ahrendt: But then why are so many people stuck in their negatively perceived past?

Lukas: There are many explanations for this. It is easier to complain about something than to make it better, it is easier to blame someone else than to do something on one's own initiative, and so on. The way of thinking of traditional psychoanalysis is also partly responsible for our unhelpful tendency to look backwards. It has propagated the idea of delving into the past. But I do not want to blame psychotherapy, because it is a very new discipline, only about 120 years old. Every evolutionary process proceeds by trial and error, and this has also been the case with psychotherapy. Therapeutic methods have been developed one after another, always needing to be corrected. Frankl himself was an important corrector. Meanwhile, the psychoanalytic illusion that a psychic illness will disappear when its causes are discovered has melted away. Strategies based on uncovering causes have not proved successful, quite apart from the part that they are usually associated with too much unprovable speculation.

Ahrendt: Does this also have to do with the fact that there is often more than one cause that leads or can lead to a psychic illness?

Lukas: The progress made in neurobiology and psychology since Freud's time has shown that the causes of illness are closely interrelated. Genetic research has revealed that many more psychic conditions than we thought can be traced back to genetic predispositions. One does not only inherit blonde hair or blue eyes from one's genes, one also inherits character dispositions such as a tendency to addiction, hysteria or depression. This does not mean that the corresponding illness will necessarily occur, only that one should be careful in certain situations. These endogenous dispositions interact with exogenous influences, and not just from parents and teachers. The media also has a powerful influence, and the effect of societal trends should not be underestimated.

But all this is still not the heart of the matter. For amongst all these diverse influences is the human capacity for self-determination, which shapes each person as an individual. Even children already have their own personalities and make their own individual choices. Although the spiritual dimension in little people is still partly dormant or not yet fully developed, it still permeates the psychophysical level and helps to determine what the little person becomes. Children are not determined by how they are brought up by their parents, and adults are not pure victims of their past circumstances.

Ahrendt: This would mean that all people have a significant influence on their own lives. Even as a child, but also as an adult.

Lukas: Yes. According to a famous analogy by Frankl, a person is like a builder. Genetic predispositions and the various influences from one's environment form the building material that each person has to work with. Unfortunately this building material is not fairly distributed. Some inhabitants of this world have excellent building material: loving parents, a healthy body, they live in a peaceful country. Others have inferior building materials available: an antisocial milieu, poverty or the ravages of war. This is when the third dimension comes into play: the builder uses this material in a unique way. And one finds that some builders who have been given the best marble blocks to work with (an outstanding musical talent or a superb role model for loving behaviour, for example) leave these blocks unworked and squander their time away. Other builders, who have been assigned only crumbly sandstone (for example a low birth weight or poor educational opportunities) use them to build a cosy cottage or a pretty chapel by the wayside. Frankl said, Man is the being who always decides. And what does he decide? What he will be in the next moment.

Ahrendt: You have told us about the concept of meaning, which plays a big role in Frankl's terminology. Could you explain this term in more detail?

Lukas: First, I would like to differentiate between the concept of meaning and the concept of values. Values are meaning universals. Meaning, on the other hand, is unique. This means that the meaning of the moment, as Frankl calls it, always exists with reference to a particular person in a particular set of circumstances. It is the optimal result (for all people involved) that this particular person can achieve in this particular situation. What one is called to, so to speak. To illustrate this with the two of us: for me the meaning of the moment is to answer your questions as well as I can. If I, for example, said, The weather is beautiful today, Professor, so I think it would be meaningful to take a walk, you would answer, No, Mrs Lukas, that would not be meaningful at this time. I have travelled all the way from Germany to interview you. You agreed to this. So what is meaningful is to sit here and continue to talk with me! What this example shows is that although a pleasant walk on a sunny day certainly has a value, this value is not what is important right now. It is not its turn to be actualised. Later this afternoon, after we have said goodbye, it may be very meaningful to go for a walk before bed instead of continuing to sit here.

Likewise, the meaning of the moment is different for each person. Later, when you leave me, something different will be waiting for you than for me. In other words, meaning is ever-present, and ever-different. As long as we are conscious, there exists some meaningful possibility for us, whatever our situation. People who have a well-developed system of values, who acknowledge many sources of value in their lives, naturally find it easier to discover the meaning of the moment than those for whom a single value is always in play. Nevertheless, they must take care to keep their other values waiting in their order of precedence and not be pressurised by them. And it is also important to remember that rest and leisure time also has a high value.

Ahrendt: What about the three categories of value that Frankl developed?

Lukas: Frankl spoke of three main avenues of meaning-discovery: creative values, experiential values and attitudinal values. Creative values and experiential values are shared by almost everyone. They build a bridge between a person and the world. Creativity allows one to bring something new into the world. For example, a woman knits a sweater. She gives it to the world and she is happy if it fits the recipient well. In contrast, experiential values have to do with receiving something good from the world – the world gives something to us. This presupposes that we are open to receive this gift and that we know how to appreciate its value. For example, walking outdoors is only a valuable experience for someone who is receptive to the beauty of nature. People who stomp around complaining and pay no attention to the surrounding flowers and fields destroy the experiential value for themselves.

Then we have the attitudinal values. For Frankl, these were the highest possible values that can be actualised by a person, because they are the hardest to actualise. They have nothing to do with joy (as creative or experiential values do) but with suffering, because they can be chosen in the case of misfortune, loss of hope, or when people come up against insurmountable obstacles. If action can still be taken in such cases to improve the unfortunate situation, of course this action (inspired by creative values) takes precedence, it has the higher priority. If, for example, someone has lost his or her job, it is certainly meaningful to look for a new one. If, however, nothing more can be done to eliminate the misfortune, if one is confronted with unalterable suffering, for example on the loss of a loved one, then the question is how one bears and endures this suffering. One can always adopt various attitudes. One can wildly shout out one's anger and non-acceptance of fate, one can sink into dull despair, but one can also win through to an heroic acceptance of fate and in this way adopt a valuable attitude (actualise an attitudinal value). This value is superior. For example, someone may think, I have received many good things in life. I enjoyed the company of the person I loved for many years, and I will be thankful for this, even if I am now alone. My love does not end with death, it remains alive in my heart… This is a wonderful attitude to adopt in the face of mourning and loss.

The significance of attitudinal values is particularly apparent in the following context. According to the laws of biology, frustration automatically produces aggression. At the psychophysicalanimalistic level, aggression is nothing more than a spurt of energy. If, for example, an animal is being hunted by another animal, this is a frustration in biological terminology, and the animal responds by becoming aggressive, that is, hormones are released which give it the energy to fight for survival or to flee. With humans, frustrations are usually psychic pressures that similarly give rise to aggression, but unlike animals, humans can choose what to do with the biological spurt of energy. Humans can also fight or flee, or even harm themselves (which animals do not do), or they can transform their energy into an admirable attitude – in cases where it would not be meaningful to fight or to flee.

Ahrendt: But one does feel this enormous anger in oneself.

Lukas: Yes, that is true. This is why many people are tempted to let their anger out somehow, to direct it against someone. They are like a tiger in the zoo that attacks its keeper because it has a toothache. The toothache is not the keeper's fault! In technical language we call this a displacement (of the aggression onto the wrong person). But a human is more than a tiger, which is why displacements like this are unethical in human society. If a man who is annoyed at his boss comes home in the evening, kicks the dog and shouts at his wife, in other words if he takes out his feelings on the innocent and the uninvolved, it doesn't help him that much. He just adds to the suffering in the world, and it does not solve his problem. It is much better either to address the conflict constructively with his boss (actualising creative values) for example by speaking out clearly, changing work priorities, etc. or – if there is no alternative – to adopt a positive attitude to the situation, for example by saying to himself that at least he has a job, that it is good that he can feed his family and he will learn how to handle the idiosyncrasies of his boss without losing his calm. This would be an admirable attitude for him to develop.

Ahrendt: You are asking a lot from people: on the one hand selfreflection, to allow one to recognise what is going on in the situation, and