LOGOTHERAPY FOR CLINICAL PRACTICE

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LOGOTHERAPYFORCLINICALPRACTICESTEFANE.SCHULENBERGUniversityofMississippi,OxfordROBERTR.HUTZELLKnoxville,IowaCARRIENASSIFFortHaysStateUniversityJULIUSM.ROGINADioceseofNevadaLogotherapyisbasedonthemeaning-focusedexistentialphilosophyofViktorE.Frankl(1905–1997).Numerousmen-talhealthprofessionalshavebeenin-spiredbyhismostpopularbook,Man’sSearchforMeaning;however,manyareunfamiliarwiththedepthofFrankl’swork.Thepurposeofthisarti-cleistodiscussthetenetsoflogoth-erapy,includingfundamentalconcepts,applicabilityandtechniques,rolesofthetherapist,andassessmenttoolsandnewresearchfindings.Logotherapycanreadilybeintegratedwithtechniquesthatmentalhealthprofessionalsfre-quentlyuse,andthusithasmuchtooffermentalhealthprofessionalsre-gardlessoftheirtheoreticalorientation.Keywords:meaning,purposeinlife,logotherapy,ViktorFrankl,positivepsychologyLogotherapyisbasedontheexistentialcon-ceptsofViennesepsychiatristandphilosopherViktorE.Frankl(1905–1997).Franklchosethetermlogotherapy—basedontheGreekword“logos”as“meaning”—becausehisperspectiveemphasizestheuniquecapacityofhumanbeingstoperceivemeaning.ManyhavebeeninspiredbyFrankl’smostpopularbook,Man’sSearchforMeaning(Frankl,2006;originallypublishedinEnglishin1959asFromDeath-CamptoExis-tentialism),writtenovera9-dayperiodshortlyafterhisconcentrationcampliberationduringWorldWarII(Hutzell,2006;Klingberg,2001).Thebookcontainsanarrativeofconcentrationcampexperiencesandoutlinessomeofthebasicelementsoflogotherapy.Asenseofpersonallife-meaningiscriticaltologotherapy,andMan’sSearchforMeaningisaprimeexampleofhowpeoplemayreducedespairinseverecircum-stancesbyincorporatingpersonalmeaningthroughattitudes,experiences,andbehaviors.Man’sSearchforMeaningwaswrittenin1945,yetitwasstillratedasoneofthetop10bookstomakeadifferenceinthelivesofAmericanreadersasrecentlyasthe1990s(LibraryofCongress,1991).RussNewman,AmericanPsychologicalAs-sociationExecutiveDirectorforPractice,notedittobeofparticularrelevancetopsychologistsaftertheterroristattacksofSeptember11,2001(Newman,2002).ThenewestU.S.editionofthebook(2006)indicatesthattherearemorethan12millioncopiesinprint.Despiteitscontinuedrelevance,manymen-talhealthprofessionalsarenotfamiliarwiththedepthofFrankl’swork.Frankliscreditedwithwritingover30books.ManywerepublishedoriginallyinGerman,buttherehavebeentranslationsintoatleast32lan-guages.Hepublishedover700articles.Anabbre-viatedversionofFrankl’svitawaspublishedbyJ.I.Levinsonin2001(Levinson,2001).Formorein-formationaboutFrankl’slifeandhowitinfluencedtheformulationoflogotherapy,suchashisyouthinVienna,correspondencewithFreudandAdler,ex-periencesinconcentrationcampsduringWorldWarII,andhispersonalandprofessionaldevelop-mentthereafter,theinterestedreaderisreferredtoFrankl(1997b),Gould(1993),andKlingberg(2001).Thepurposeofthecurrentarticleistopresentvariousaspectsoflogotherapy,includingmajortenets,applicabilityandjudicioususeoftheStefanE.Schulenberg,DepartmentofPsychology,Univer-sityofMississippi;RobertR.Hutzell,Knoxville,IA;CarrieNassif,FortHaysStateUniversity;JuliusM.Rogina,DioceseofNevada.CorrespondenceregardingthisarticleshouldbeaddressedtoStefanE.Schulenberg,PhD,DepartmentofPsychology,Uni-versityofMississipi,Oxford,MS38677.E-mail:sschulen@olemiss.eduPsychotherapyTheory,Research,Practice,TrainingCopyright2008bytheAmericanPsychologicalAssociation2008,Vol.45,No.4,447–4630033-3204/08/$12.00DOI:10.1037/a0014331447 approach,therapiststrategies,assessment-relatedis-sues,andnewresearchsupportandremainingneeds.Ourintentistoprovideanin-depth,yetconcise,orientationtologotherapycompiledfromoftendifficult-to-findpublications(e.g.,out-of-printsources),incorporatingrecentlytranslatedtextsandcurrentandforthcomingempiricalfindings.Thisarticlerepresentsanupdateastologotherapy’scur-rentstatusintheUnitedStates,withemphasisonlogotherapy’sutilityandaccessibilitytoabroadaudience.MeaningandWell-BeingAmajorreasonthatlogotherapyhassomethingtooffermentalhealthprofessionalsacrossvarioustheoreticalorientationshastodowiththeinfluenceofthemeaningconstructonhumanhealthandbe-havior.Thereisagrowingbasisfortherelationshipbetweenasenseofmeaningandpsychologicalandphysicalwell-being(Melton&Schulenberg,2008;Reker,1994;Ryff,2000;Ryff&Singer,1998a,1998b;Savolaine&Granello,2002;Spiegel&Fawzy,2002;Zika&Chamberlain,1992).Forex-ample,meaningmaycontributetoanarrayofareasrelatedtowellness,includingawarenessofsocialsupport,senseofidentityandvalues,health-promotingbehaviors(motivationtofollowthrough),andstressinoculation(Ryff&Singer,1998b;Savolaine&Granello,2002).Moreover,inarecentreviewoftheliterature,MeltonandSchu-lenberg(2008)notedthatmeaningisassociatedwitharangeofoutcomes,suchasstablemoodandlesspsychologicaldistress,moreproactiveandso-ciablebehavior,andfavorableattitudestowardlifeandtheself.Meaninghasclearsignificancetothehumancondition.Theconceptsemphasizedinlogotherapyareofinteresttomentalhealthprofes-sionalsstrivingtofindwaystohelptheirclientshelpthemselvesandarecompatiblewithavarietyofexistingtheoreticalorientationsandthecontem-porarypositivepsychologymovement.RelationshiptoOtherTherapiesandPositivePsychologySeveralsourcesindicatethatspirituality(inthegeneralsenseofmeaning,values,andpurpose,asisemphasizedinlogotherapy)isbecomingincreas-inglyrelevantinmodernpsychotherapyandmedi-cine(seeDuBois,2007,Mahoney,2000,andSavolaine&Granello,2002),andthereisincreas-ingevidencethatspiritualityisassociatedwithpos-itivehealthoutcomes(Seeman,Dubin,&Seeman,2003).Thefieldofpsychologyhasshownincreasedinterestoflatenotonlyinspiritualitybutalsoinresilienceandpositivementalhealth(e.g.,Emmons&McCullough,2004;Keyes&Haidt,2003;Lopez&Snyder,2003;Snyder&Lopez,2002).Logoth-erapyhaslongemphasizedtheimportanceofmean-ing,faith,hope,humor,andmanyotheradaptiveconstructsthathavebecomeapartofpositivepsy-chology;thusthereisincreasingsupportfortheutilityoflogotherapyconceptstoresearchersandclinicians.Franklandotherlogotherapistshavedonemuchclinicalworkintheseareas,andthisexistingworkcanreadilybeincorporatedintopositivepsychology,aswellasother,specificparadigms.Logotherapyisoftenregardedasahumanistic–existentialschoolofthought,butithasmuchincommonwithotherparadigms.Indeed,McMul-lin(2000)notedthat“logotherapyisoneoftheprecursorstocognitivetherapy”(p.31),andindescribinginnovativetechniquesusedincogni-tiverestructuringtherapy(specificallyperceptualshifting),heoutlinedmanytechniquesthatareconsistentwiththosepracticedbylogotherapists.ParticularlyrelevantexamplesofperceptualshiftingdescribedbyMcMullinincludebridgingtechniques,withthe“HierarchyofValuesBridges”exercisebeingaprimeillustrationofhowclients’personallymeaningfulvalueshier-archymaybeusedtoshiftfromold,maladaptivebeliefsintonew,moreadaptivebeliefs.1Simi-larly,thecreative,active,andstrengths-focusedaspectsoflogotherapyhaveparallelswithcon-structivetherapies,suchassolution-focusedornarrative-focusedtherapies(Combs&Freedman,1994;Furman&Ahola,1994),intheencourage-mentofamorepositiveoutlookinrelationtolifecircumstances.Franklsawlogotherapy,withitsemphasisonthemeaning-dimensionofhumanbeings(oftentermedthespiritualdimensioninthebroadsenseoftheword)asanadditiontoothertherapies(Frankl,1985,1986,1988,2006),withthegoalofenhancingtechniquesasopposedtoreplacingthem.Simplyput,logotherapyisintendedtobecollaborative(Fabry,1981;Kovacs,1999),andithasbeenexploredinrelationtoanumberof1Logotherapytechniquesaredescribedinasubsequentsectionofthisarticle.Foradditionalinformationregardingperceptualshiftingandrelevantexamples,thereaderisre-ferredtoMcMullin(2000).Schulenberg,Hutzell,Nassif,andRogina448 specificformsoftherapyovertheyears,withrationalemotivebehaviortherapy(Hutchinson&Chapman,2005)andacceptanceandcommit-menttherapy(Sharp,Schulenberg,Wilson,&Murrell,2004;Sharp,Wilson,&Schulenberg,2004)beingrecentexamples.Traininginlogoth-erapymaybenefitcliniciansfromavarietyofperspectives,givenitscongruencewithmanydif-ferentmethods.FundamentalTenetsThefundamentaltenetsoflogotherapyhavebeendocumentedbyFranklinanumberofEnglish-languagetexts.AvailablebooksincludethemostrecenteditionofMan’sSearchforMeaning(Frankl,2006)andtherecenttranslationofOntheTheoryandTherapyofMentalDisor-ders:AnIntroductiontoLogotherapyandExis-tentialAnalysis(Frankl,2004).AdditionalEnglish-languagetextsincludeTheDoctorandtheSoul:FromPsychotherapytoLogotherapy(Frankl,1986),TheWilltoMeaning:Founda-tionsandApplicationsofLogotherapy(Frankl,1988),TheUnheardCryforMeaning(Frankl,1985),andMan’sSearchforUltimateMeaning(Frankl,1997a).Describedintheaforementionedtexts,oneconstructcentraltologotherapyisreferredtoasthetri-dimensionalontology—theconceptualiza-tionofhumanbeingsalongthreeoverlappingdimensions:physical,psychological,andspiri-tual(i.e.,noological,meaningoriented).Itiscommonlyunderstoodthathumanbeingsoftenrespondwithconditionedorautomaticreactions(suchasself-statements,behaviors,andemo-tions)inthefirsttwodimensionsandthatotheranimalsalsofunctioninthefirsttwodimensions.Thethirddimensionisemphasizedinlogoth-erapyasdistinguishinghumanbeingsfromotheranimals.However,humanbeingsdonothavetofunctioninthethirddimension(i.e.,canbehaveinconditionedandautomaticways).Functioninginthethirddimensionoftendemandsapercep-tualshiftawayfromthetypicalconditionedad-herencetopeergroupexpectanciesormassad-vertising,forinstance.Inadditiontothetri-dimensionalontology,logotherapy’sbasictenetsassertthat(a)humanlifehasmeaning,(b)humanbeingslongtoex-periencetheirownsenseofpersonallifemean-ing,and(c)humanbeingshavethepotentialtoexperiencelifemeaningunderallcircumstances.Franklheldthepositionthatopportunitiestorespond—inaction,experience,orattitude—existthroughoutanindividual’slife,andwhenthechosenresponseisconsistentwiththeindi-vidual’spersonalvalueshierarchy,theindividualexperiencesthelonged-forsenseoflifemeaning.Franklheldthateachindividual’spersonallifemeaningincorporatesreachingouttoanoverallordertotheuniverse,tootherhumanbeings,andtootheranimals.Responsesinconsistentwithone’spersonallifemeaningdostillhaveobjec-tiveimpact;however,theydonotprovidetheindividualasenseoflifemeaning.Oftentimes,individualsareobjectivelysuccessfulaccordingtowhatothers(e.g.,peergroups,marketingcom-panies,andculturalideals)mightfindimportant,buttheylackasenseoflifemeaning,leavingafeelingofemptinesslabeledexistentialvacuum.ApplicabilitytoMentalHealthProblemsInpractice,logotherapyhasapplicationateachofthedimensionsofthehumanbeing(thetri-dimensionalontology).Physiologically,logoth-erapyisrecognizedforitsefficacyinthereduc-tionofdespairinunavoidablesuffering.Psychologically,Frankldevelopedusefultech-niques,notablyparadoxicalintentionanddere-flection,especiallyforproblemsoriginatinginanticipatoryanxiety.Fromthespiritualsphere,manypeopleexperiencemeaninglessnessatsomepointthatischaracterizedbyexistentialvacuum(Frankl,2006;Hutzell,1990;Sahakian&Sahakian,1972).Assuch,individualsmayfeelboredorapathetic,asiftheyare“justgoingthroughthemotions”oftheirlives(Frankl,2006;Hutzell,1990).Itisthisfeelingofemptinessthatcanmotivatepeopletorespondtotheircircum-stances,anditistheirawarenessoftheirpersonallifemeaningthatcanguidetheminanobjectivedirectionthattheyexperienceasfullorsatisfy-ing.However,leftunchecked,thefeelingofemp-tinessmayleadtodisturbancesfromalackofactualizationofpersonallifemeaningorfromconflictsofpersonallymeaningfulvalues(Frankl,2006;Hutzell,1990;Sahakian&Sahakian,1972).Whentheexistentialvacuumleadstodistur-bances,themostcommonproblemsthatarepre-dictedtofilltheexistentialvacuumareviolationsofsocialnorms,distresssymptoms,andphysiological/psychologicaladdictions.FrankllabeledthesethemassneurotictriadandspokeLogotherapyforClinicalPractice449 ofthemasaggression,depression,andaddiction(Frankl,2006;Hutzell,1990).Althougheachoftheseproblemscanoriginatealsofromthephys-iologicalandpsychologicaldimensions,whenthesymptomsoriginatefromasenseofmeaningless-ness,theycanthenbetreatedwiththerapyde-signedtoworkparticularlywithdiscoveringpersonallifemeaning.Theideathatmeaningless-nessisassociatedwithalcohol(andotherdruguse)iswellsupportedintheliterature(Marsh,Smith,Piek,&Saunders,2003).TheparallelsbetweenlogotherapyandthespiritualelementsofAlcoholicsAnonymoushavebeendiscussed(Holmes,1991;Koster,1991),andlogotherapyhasbeenappliedinthetreatmentofalcoholprob-lems(Crumbaugh,1980,1981;Crumbaugh,Wood,&Wood,1980;Henrion,2002;Hutzell,1984).Inadditiontodrugandalcoholproblems,logo-therapyhasbeenusefulwithdepression,anxiety,andpsychoses,aswellasdespairassociatedwithincurableillnesses(seeFabry,1994;Frankl,2004;Lukas,2000;Lukas&Hirsch,2002).Logotherapyhasapplicabilityinagrowingnum-berofareas,suchasrehabilitation(Ososkie&Holzbauer,2004;Starck,1982,2003),mentalretardation/developmentaldisabilitieswork(Hingsburger,1989,1990;Schulenberg,2003a,2003c),pastoralpsychology(Graber,2003;Leslie,1965;Welter,1987),aging(Kimble,2000),familytherapyandrelationshipcounseling(Crumbaugh&Henrion,2004;Lantz,1993;Winters,2002),anddailylife/work-relatedissues(Crumbaugh,1973;Pattakos,2004).RecentWorldCongressesonLogotherapyhaveincludedcolloquiumsonincorporatinglogotherapyintothetreatmentofspecificdiag-nosesoftheDiagnosticandStatisticalManualofMentalDisorders(4thed.,textrev.;DSM–IV–TR;AmericanPsychiatricAssociation,2000).TheseprotocolsaresubsequentlypublishedinTheInternationalForumforLogotherapy.Exam-plesofrecentpapershaveincludedapplicationswithmooddisorders(Henrion,2004;Ungar,2002),anxietydisorders(Rogina,2002),andper-sonalitydisorders(Rodrigues,2004;Rogina,2004;Rogina&Quilitch,2006).JudiciousUseoftheApproachWhenapplicationsofaparticulartheoryortechniquearediscussed,thequestionofwhenthetheoryortechniqueiscontraindicatedoftenarises.Inotherwords,aretheresituationsinwhichlogotherapyshouldnotbeused?Thereislittleinthelogotherapyliteratureonthissubjectbecauselogotherapistsdonottendtothinkintheseterms.Logotherapistsconsiderthateachhumanbeinghasinternalresources,orstrengths,thatmaybeappliedinanygivensituation.Logo-therapistsworkwithclientsonhelpingthemtoidentifyandaccesstheseinternalresources.However,therearesituationsthatarisethatsig-nificantlyinhibittheabilityofclientstoidentifyandaccesstheirinternalresources.Forexample,whilethepotentialutilityoflogotherapywithpsychoseswasnotedpreviously,inextremecasesinwhichindividualsareexperiencingseverepsy-choticstatesandrealitytestingispoorbecauseofactivehallucinations,delusionalsystems,orboth,symptomsmustbemanagedviaothermethods(e.g.,medication)priortoapplicationoflogoth-erapeuticprinciples.However,eveninsuchcases,logotherapymaybeusefulwithfriendsandfamilywhoarestrugglingintermsofhowtheycanassisttheirlovedone.Moreover,intheaboveinstance,oncesymptomsarebroughtundercon-trolviaothertreatment,logotherapyisapplicablewithregardtohelpingclientsunderstandandaccepttheirdiagnoses,workwithmentalhealthprofessionals,andadheretotheirtreatmentpro-gramsinspiteofthefactthatthelogotherapyisnotexpectedto“cure”thepsychosis.Thus,ratherthanthinkingintermsofcontraindications,logo-therapiststypicallythinkintermsofjudicioususeoftheapproach,workingincollaborationwithotherstrategiesasnecessary,tomaximizethechancesofapositivetreatmentoutcomeontheonehandand,ontheotherhand,tominimizethedespairthatcanbeassociatedwithsituationsinwhichapositiveoutcome(cure)isnotpossible.LogotherapeuticStrategiesTherolesofthetherapist.Therolesofthetherapistinlogotherapyincluderegardingclientsasfellowhumanbeings,emphasizingtheiruniqueness,teachingthattheyhavesomefree-domtorespondtotheirsituationsorproblems,anddemonstratingtoclientsvarioustechniquesandhowtheymaybeappliedtotheirsituationsorproblems.Whenclientsassertthattheyhavenofreedomtorespond,thetherapisthelpsthemtosearchfortheirremainingfreedom,plusencour-agesthemtotakeresponsibilitytorespondtothatfreedomthroughbehaviors,experiences,oratti-Schulenberg,Hutzell,Nassif,andRogina450 tudechangesinwaysthattheyfindmeaningfulandadaptive.Inregardingclientsasequalhumanbeings,therapistssetahighstandardbyincludingnotonlytheirclients’physiologicalandpsychologi-caldimensionsbutalsotheirspiritualdimen-sions,inwhichresponsibility,morality,andper-sonallifemeaningarepossible.ModernizingaquoteoftheGermanpoetGoethe,Frankl(1967)said,“Ifwetakemanasheis,wemakehimworse;ifwetakehimasheoughttobe,wehelphimbecomeit”(p.12;seealsoFabry,1981).Thelogotherapist,JosephFabry,paraphraseditthisway:“Aslongaswetreathumanbeingsasani-malsthatcanbetrained,andmachinesthatcanbemanipulated,wemakethemintoanimalsandmachines.Ifwemakethemawareofthere-sourcesoftheirhumanspiritwehelpthemliftthemselvesintotheirtruehumanness”(Fabry,1981,p.11).Inotherwords,logotherapistsaffordclientsthedignityofexpectingthemtobecapa-bleashumanbeingsinspiteofthelimitationsoftheircurrentsituationorproblem.Inlogotherapy,theclientisactiveandpartic-ipatory,retainingresponsibilitytoaltermaladap-tivepatternsandtoactualizepersonallifemean-ings(Lukas,1979/1995).Thetherapistassiststheclientinfacilitatingthisprocess.Theclientisencouragedtorecognizethefreedomheorshehasandtoimplementthatfreedominordertotaketheenergyawayfromtheproblemorsymp-tomand,instead,tomoveinalessproblematic,andmorepersonallymeaningful,direction.Thetherapeuticrelationshipisoneofequalityandofferingopportunitiestoclientsratherthanoneofsuperiorityand“fixing”clients.Assuch,thether-apisthelpsclientstoclarifyandworktowardactions,experiences,andattitudesinwhichcli-entsexperiencepersonallifemeaning.Thether-apistinsiststhatchoicesarealwaysavailable,eveniftheyarelimitedtochoicesamongatti-tudes(Lukas,1979/1995).Phasesoflogotherapy.Whenlogotherapyisconducted,oftentimesaseriesoffourphases,orsteps,arefollowed(seeFabry,1994,andLukas,1979/1995).Thefirststepinvolvesdifferentiationofclientsfromtheirsymptoms.Clientsaremorethanclustersofsymptoms,andinlogotherapyitisimperativethattheynotoveridentifywithagivendiagnosis.Theyremainhumanbeingswiththeabilitytoovercomeobstaclesandexperiencepersonallifemeaning.Thesecondstepinvolvesattitudemodificationaboutthesymptoms.Atti-tudesareshiftedawayfromoverfocusonthesymptomsandshiftedtowardawarenessofre-mainingoptionsthatareinkeepingwithwhattheindividualperceivesashisorherpersonallifemeaning,inspiteofthesymptoms.Attitudesarenotforceduponclients(unlessinseverecasessuchassuicide);rather,intheprocessofworkingwithclients,alogotherapistfacilitatesthedevel-opmentofadaptiveattitudesthatarederivedfromeachclient’sperceivedpersonallifemean-ing(orpersonallymeaningfulvalueshierarchy).Whatchoicesareavailableinresponsetoapar-ticularsituationorproblem?Whatdirectionsaremostmeaningfultoaclient?Thethirdstepin-volvessymptomreduction,whichoftenoccursautomaticallyfollowingsuccessfulcompletionofmodificationofattitudes.Atothertimes,specifictechniquesforsymptomreductionareincorpo-rated(e.g.,copingskills,self-efficacytech-niques).Oncesymptomseparationhasbeenachieved,andmoreadaptiveattitudeshavebeendiscovered,clientssensethatoptionsareavail-able,andsymptomsbecomemoremanageable.Thefinalstepinvolvesmaintenanceofmentalhealththroughfutureorientationandfacilitationofcontinuedawarenessofpersonallifemeaningandtheresultantpurposeorgoalsinlife.Well-knowntherapeutictechniques.Logoth-erapyhasyieldedseveralspecific,well-knowntherapeutictechniques.Theyfocusonheighten-ingpeoples’awarenessoftheirpersonallifemeaning(i.e.,theirpersonallymeaningfulvalueshierarchy),facilitatinggoaldevelopment,livingresponsibly,andmakingadaptivechoicesconsis-tentwithpersonallifemeaning(Hutzell,1990).Attitudemodification,particularlyfacilitatedthroughSocraticdialogue(Fabry,1994;Gutt-mann,1996;Hutzell,1990;Lukas,1979/1995;Lukas&Hirsch,2002),isthemostoftenusedlogotherapytechnique.Socraticdialogueisatechniquewherebyatherapistasksquestionsofclientstofacilitateinternalexplorationtodis-coverpersonallifemeanings,toexplorehowthesemaybeactualized,andtofosterrecognitionthatchoicestowardtheseendsarealwaysavail-able.Inthecaseofworkingwithaclientwhofeelsfacedwithaninsurmountableproblemforwhichthereisnosolution,alogotherapistmayaskaboutresponsestosimilarproblemsinthepast,seekingcluesfromtheclientastoperson-allymeaningfulattitudemodificationsthatmayhavebeenusedsuccessfullytoreducethedespairoftheunchangeableproblem.Fortheclient,suchLogotherapyforClinicalPractice451 discussionpromptstherediscoveryofaperson-allymeaningfulhierarchyofvalues,thoughtpro-cesses,andmotivationsthatmaybebroughttobearonthecurrentsituation.Inadditiontoatti-tudemodification,well-knownlogotherapeutictechniquesthathavebeendevelopedincludepar-adoxicalintention,dereflection,andlogoanalysis.Paradoxicalintentionisatechniquethatbe-haviortherapistshaveempiricallyvalidated,thatFrankldevelopedindependentlyinthe1920s(Ascher,1989;Fabry,1982;Frankl,1975;Lukas,1986),andthatwasfirstpublishedin1939(Frankl,1939,1975,1978/1979).Ithasbeenuse-fulincasesinvolvingrecursiveanxiety,suchasagoraphobiaandpublicspeakinganxiety(Ascher&Schotte,1999;Schotte,Ascher,&Cools,1989;seealsoSchulenberg,2003a).Componentsofclassicalparadoxicalintention,whencon-ductedbylogotherapists,havebeendescribed(Fabry,1982;Frankl,1975,1985;Hutzell,1990;Lukas,1982,1986;Yoder,1994)andinclude(a)anonmanipulativetherapist–clientpartnership,(b)rulingoutofbiologicaletiology,(c)educatingclientsaboutparadoxicalintentionwithregardtowhatitisandhowitworks,(d)tailoringthetechniquetotheindividual’spresentingcom-plaints,(e)participatinginthefearstate,while(f)simultaneouslyincorporatinghumortocounter-actanxiety.(Inlogotherapy,thespiritualdimension—inthiscasethroughtheuseofhumor—isutilizedtofacilitateself-distancingtoallowattitudechangeandthenbehaviorchange.)Dereflection(Frankl,1975,1985,1988,2004;Hutzell,1990;Lukas,1986,2000),asreportedbyFrankl,appearedinthe1940s(inGerman),withthefirstEnglish-languageappearancein1952(Frankl,1952,1975).Itisknownthat,insomecases,peoplefocusonthepossibilityofaprob-lemorasymptomwithsuchintensitythattheycreateanticipatoryanxietythatactuallymakestheproblemorsymptomworse(Frankl,2006;Hutzell,1990;Sahakian&Sahakian,1972).Thepointofdereflectionistoreorientaclient’sat-tentionawayfromthepreoccupyingproblemorsymptomandrefocustheattentioninsteadontorelated,highlymotivatingareasofpersonallifemeaning(Frankl,2006;Hutzell,1990).There-sultingeffectistypicallyareductionofthean-ticipatoryanxietyassociatedwiththesymptomorprobleminquestionandthusareductioninthesymptomorproblemitself(Frankl,2006;Hut-zell,1990;Sahakian&Sahakian,1972).Dere-flectionisoftenatechniqueofchoicewhenworkingwithsexualdysfunction(reorientingthefocusofanindividualtowardthepleasureofone’spartnerinsteadofone’sownphysiologicalsuccess),andithasbeenarguedthattheinfluen-tialworkofW.H.MastersandV.E.JohnsoninrelationtosexualproblemsvalidatesFrankl’sapproachinthisarea(Frankl,1952,1975;Saha-kian&Sahakian,1972).Useofdereflectionhasgrownovertheyearssuchthatitisusedtohelpclientsrespondtoavarietyofmentalhealthdif-ficultieswhentoomuchfocusisplacedonsymp-tomstothedetrimentofclientstrengths.Anotherlogotherapeutictechnique,logoanaly-sis(developedbyCrumbaugh,1973),isappliedtopersonsexperiencingalackofsenseofper-sonallifemeaning(initiallyexperiencedasbore-domorapathybutwiththepotentialtoevolveintoviolationsofsocialnorms,distresssymp-toms,andphysiologicalandpsychologicaladdic-tions).Logoanalysisoffersasystematicprocessofmentalandwrittenexercisestohelpindividu-alssetalifedirectionandsubsequentachievablegoalsbasedontheirpersonallifemeaning.Theprocesslendsitselfwelltoself-help(Crumbaugh,1973;Hutzell&Eggert,1989;Hutzell&Jerkins,1995)andsmall-groupformats(Hutzell,1983,2002)andhasyieldedavarietyoftherapeuticexercises.Forexample,theMeaninginLifeEvaluationscale(MILE;Crumbaugh&Hen-rion,2004;Henrion,2001)wasdesignedtoheightenanindividual’ssenseofpersonallifemeaningthroughawarenessoftheirhierarchyofpersonallymeaningfulvalues,bypromptingindividualstoselectfromamong20differentvaluesviaapaired-comparisonsapproach.Ex-amplesofvaluesincorporatedintheMILEincludefriendship,acceptance,health,andsoforth.Ofthe20differentvalues,the5highestrankedbythepaired-comparisonsprocessarethenemphasizedtofostermeaningfulgoalset-ting.TheMILEfacilitatesactivethinkingandprioritizingofvalues,aswellasrecognitionastowhetherenergyisbeingfocusedonthepur-suitsthataremostmeaningfulinrelationtotheparticipant’svalueshierarchy.Lesser-knownlogotherapytechniques.Manyotherapplicationsandtechniquesoflogotherapyhavebeendevelopedthatarenotaswidelyknownasthosedescribedabove.ThesetechniquesincludetheMountainRangeExercise(Ernzen,1990;Schu-lenberg,2003c,2004b),theMoviesExercise(Schu-lenberg,2003b;Welter,1995),theFamilyShoeboxGame(Lantz,1993),useofstoriesandmetaphorsSchulenberg,Hutzell,Nassif,andRogina452 (Moore,1998;Schulenberg,2003b;Welter,1995),andavarietyofadditional,assortedexercisesde-signedtoclarifyvaluesandenhancemeaning.TheinitialideafortheMountainRangeExer-cisewasnotedbyFrankl(seeTheDoctorandtheSoul,Frankl,1986),anddevelopedasanactivitybyErnzen(1990).Amountainrangeisdrawn,andthepersoncompletingtheexerciseplacespeopleofimportancetohimorher(suchasfriendsorfamilymembers,authors,musicians,andthelike)onthevariouspeaks.Participantsareaskedwhattheyshareincommonwiththeindividualsontheirpeaks,aswellaswhosemountainstheywouldliketobeapartof.Theactivityassistsindividualsinidentifyingposi-tivesintheirlives,aswellasinvaluesclarifica-tion.Theactivityisusefulineitherindividualorgrouptherapeuticsettingsandhasbeenusedwithavarietyofpopulationsandtreatmentcontexts,suchaspeoplewithalcohol-relatedproblems,psychiatricinpatients,andmeaningfullivinggroups(Ernzen,1990).Ithasalsobeenusedwithadolescentmalesexoffenderswithmentalretar-dation(ordevelopmentaldisabilities)andsexualbehaviorproblemsasameansofbuildingrapportanddiscussingimportanttreatmentissues,suchasvaluesandsexualoffensehistories(Schulen-berg,2003c,2004b).VariationsonthetraditionalMountainRangeExercisehavealsobeenpro-posed.Pattakos(2004)suggestedadaptingtheMountainRangeExercisetotheworkenviron-menttoclarifyvaluesandfindmeaninginem-ploymentviathosepeoplewhohaveinfluencedaparticularindividual’sprofessionaldevelopment.TherearetwocomponentstotheMoviesEx-ercise(Schulenberg,2003b;Welter,1995),bothofwhichfocusonfacilitatingawarenessofper-sonallifemeaning.Thefirstcomponentpromptsanindividualtodevelopamovieofhisorherlife,focusingonthepastuptothepresenttime.Thesecondcomponentisamoviefromthepresentintothefuture.Thesecreativeactivitiesaffordopportunitiestodevelopvariousmovieaspects.(Whowillbeinthem?Whatactororactorswillplaytheleadroles?Whatarethemovies’titles?Whatkindofbudgetswillbeavailable?Whatwillthemoviesbeabout,andwhatgenrewilltypifyeachfilm?)Thesevariousaspectsaredis-cussedintermsoftheparticipant’spersonallymeaningfulvalueshierarchy,identityformation,interpersonalrelationships,andkeyexperiencesinordertohelpclarifytheparticipant’ssenseofpersonallifemeaning.IntheFamilyShoeboxGame(Lantz,1993),thetherapistpresentsafamilywithashoebox,tape,scissors,andmagazines;thetaskistoad-heremagazinepicturestotheshoeboxtorepre-sentfamilyvaluesandmeanings.Theoutsideoftheboxisusedforvaluesandmeaningsthatarepresentedtopeopleoutsideoftheimmediatefamily,whiletheinsideoftheboxisusedforvaluesandmeaningsofparticularimportancetothemembersoftheimmediatefamily.Lantz(1993)arguedthatsuchtaskshelpfamiliesintwoprimaryways:first,itgivesfamilymembersacleartaskthatrequirescommunicationaboutval-uesandmeaningsthatareimportanttothefamilyexperience,andsecond,itprovidesthefamilytherapistwithameansofobservingfamilyinter-actionpatternsthatmayhelporhinderafamily’ssearchformeaninganddirection.AnunderlyingpremiseofLantz’s(1993)applicationsoflogo-therapytofamilytherapyisthatincreasedknowl-edgeoffamilyvaluesandmeaningcanservetostimulatehealthyfamilyinteractionpatterns,whichcan,incyclicalfashion,furtherguidefam-ilymemberstowardanincreasedsenseofvaluesandmeaninganddirectionforthefamilyasawhole.Logotherapistsoftenusestoriesandmetaphorsasonemeansoffacilitatingattitudinalchange(Moore,1998;Schulenberg,2003b;Welter,1995).Frankl’sownlifeexperiencesinthecon-centrationcampsandhisattitudinalstanceto-wardadversity(Frankl,2006;Klingberg,2001)serveasoneremarkableexample.However,thelogotherapeuticliteratureisrepletewithstoriesandmetaphorsthatfunctionasillustrationsforhowonemayadaptivelydealwithadversity.Someofthesestoriesarereal-lifeexamplesoftheexperiencesoflogotherapists.Forinstance,inacaseofirreversiblephysicalloss,aswasre-countedbyLong(1995),Klingberg(2001),andLevinson(2002),awell-knownlogotherapist,JerryLong,wasateenagedbaseballplayerwhosepitchinghadtheattentionoftheprofessionalleagues.Thenhebrokehisneckandbecamephysicallydependentonothersforhismostbasicactivitiesofdailyliving.Whileherecognizedthathispotentialforanathleticcareerhadvan-ished,healsocametorealizethatmuchfreedomremainedinotherareasinwhichhecouldactu-alizepersonallifemeaning.Hetookresponsibil-ityforimplementingthatfreedom:graduatedfromhighschool,wentontocollege,andeven-tuallyearnedhisdoctorateinclinicalpsychologyLogotherapyforClinicalPractice453 andbecameapracticinglogotherapist.Hewasabletoleadafulfillinglifeinspiteofquadriple-gia.Heoftensummedupsuccinctlyhisinspiringcredoforlife:“Ibrokemyneck;itdidn’tbreakme.”Hetookresponsibilitytodowhathecould,withinthefreedomthathehad,toestablishandmaintainanattitudetopursueapersonallifemeaning,inspiteofhisphysicalcondition.Cli-entslearnfromsuchstoriesthatregardlessofone’scircumstances,aproactiveattitudinalstancetowardadversitymaybechosen.Anumberofadditionalexercisestoincreaseawarenessofpersonallifemeaningandtomoti-vatepeopletowardtheactualizationoftheirpo-tentialshavebeendescribedbyFabry(1988),Mendez(2004),Pattakos(2004),andCrumbaughandHenrion(2004).OneexamplecontainedinFabry’stextistheValueAuction,inwhichindi-vidualsareinvitedtoconsidervariousvaluesthatareauctionedoffandhowmuchtheywishto“bid”onthemfromtheirlimitedpoolof“funds.”AnotherexampleistheSelf-AppraisalExercise,inwhichpeopleareencouragedtoparticipateinansweringquestionssuchasthoserelatingtodescriptionsofthemselves,whomtheyandotherswishthemselvestobe,andtheirviewsastotheirpotentials.Suchexercisespromptreflectionontheconsistenciesbetweentheindividual’sinter-nalandexternalbehaviorsandtheirsenseofpersonallifemeaning.Mendez(2004)addition-allyoutlinedanumberoflesswell-knowntech-niquesappliedbylogotherapists(e.g.,Logo-drama,LifeReviewandLifePreview,GuidedDiscoveryofMeaningPotentials,theLogoan-chor,andAppealingTechniques).Finally,Pat-takos’(2004)exercisesaregearedtowardper-sonallifemeaningintheworkplace,whileCrumbaughandHenrion’s(2004)activitiesre-latetoenhancingpersonallifemeaninginin-terpersonalrelationships.PsychometricAssessmentoftheMeaningConstructAvarietyoflogotherapytoolshavebeenintro-ducedovertheyearstoquantifyandstudythemeaningconstruct.ThebestknownofthesearethePurposeinLifetest,theLifePurposeQuestion-naire,andtheSeekingofNoeticGoalstest.Thereisampleevidencefortheinternalconsistencyoftheglobalscoresgeneratedbythesemeasures,withcoefficientalphasoftenreportedinthe.80s,andinsomeinstancesexceeding.90(Melton&Schu-lenberg,2008).ThePurposeinLife(PIL)testistheearliestandmostwidelystudiedofthewell-knownlogo-therapypsychometricinstruments(Crumbaugh&Maholick,1964,1969)andistheprimarylogo-therapymeasureofthedegreetowhichanindi-vidualexperiencesasenseofpersonallifemean-ing.ThePILhasbeenpsychometricallyreviewedinanumberofsources(e.g.,Crumbaugh&Hen-rion,1988;Hutzell,1987a,1988;Melton&Schulenberg,2008;Reker,2000;Schulenberg,2004a).Withregardtovalidity,thePIL,asisexpected,correlatespositivelywithconstructssuchashappiness,emotionalstability,andextro-version,andnegativelywithconstructssuchasboredomproneness,anxiety,anddepression(Hutzell,1988,1989;Melton&Schulenberg,2007,2008;Robak&Griffin,2000;Schulenberg,2004a).Suchcorrelationsareconsistentwithlogotherapyconceptualizationsandresearchstudiesthatdemonstratetherelationshipbetweenmeaningandwell-being(Melton&Schulenberg,2008;Schulenberg,2004a).TheLifePurposeQuestionnaire(LPQ;Hablas&Hutzell,1982;Hutzell,1989)isanothermea-sureofthedegreetowhichanindividualexpe-riencesasenseofpersonallifemeaning,butitwasdesignedforusewithspecializedpopula-tions,suchasgeriatricneuropsychiatricinpa-tients,forwhomthePILprovesimpractical(Hablas&Hutzell,1982),andtheLPQissome-timesthemeasureofchoiceoverthePILbecauseitusesasimpledichotomous-choiceformat,incontrasttothePIL’smorecomplexLikert-typeresponseformat(Hablas&Hutzell,1982;Hut-zell,1989).TheLPQisthesecondmostfre-quentlystudiedofthelogotherapymeasures.Va-liditysupportisevidentviamoderate-to-highcorrelationswiththePILandscoresthatdemon-stratestatisticallysignificantimprovementinpro-gramsthatincorporatedalifepurposecomponent(Burnette,Swan,Robinson,Lester,&Little,2003;Kish&Moody,1989;Melton&Schulen-berg,2008;Schulenberg,2004a).TheSeekingofNoeticGoals(SONG)test(Crumbaugh,1977a,1977b)wasdevelopedtoassessmotivationtofindmeaning.Thereismuchlessempiricaldataavailableinthepublishedliteratureonitspsychometricproperties(Hutzell,1987b;Schulenberg,2004a).Schulenberg,Hutzell,Nassif,andRogina454