Existential Therapy and Logotherapy

Existential Therapy 1. Victor Frankl, a psychiatrist and neurologist propounded Logotherapy. 2. Logos is the Greek word for soul and Logotherapy means treatment for the soul. 3. Frankl calls this process of finding meaning even in life-threatening circumstances as the process of meaning making. 4. The basis of meaning making is a person’s quest for finding the spiritual truth of one’s existence. 5. Just as there is an unconscious, which is the repository of instincts, there is a spiritual unconscious, which is the storehouse of love, aesthetic awareness, and values of life. 6. Neurotic anxieties arise when the problems of life are attached to the physical, psychological or spiritual aspects of one’s existence. 7. Frankl emphasised the role of spiritual anxieties in leading to meaninglessness and hence it may be called an existential anxiety, i.e. neurotic anxiety of spiritual origin. 8. The goal of logotherapy is to help the patients to find meaning and responsibility in their life irrespective of their life circumstances. The therapist emphasises the unique nature of the patient’s life and encourages them to find meaning in their life. 9. In Logotherapy, the therapist is open and shares her/his feelings, values and his/her own existence with the client. 10. The emphasis is on the here and now. Transference is actively discouraged. The therapist reminds the client about the immediacy of the present. The goal is to facilitate the client to find the meaning of her/his being. Cognitive Therapy Cognitive therapies locate the cause of psychological distress in irrational thoughts and beliefs. Rational Emotive therapy 1. Albert Ellis formulated the Rational Emotive Therapy (RET). The central thesis of this therapy is that irrational beliefs mediate between the antecedent events and their consequences. 2. The first step in RET is the antecedent belief-consequence (ABC) analysis. 3. Antecedent events, which caused the psychological distress, are noted. The client is also interviewed to find the irrational beliefs, which are distorting the present reality. 4. Irrational beliefs may not be supported by empirical evidence in the environment. These beliefs are characterised by thoughts with ‘musts’ and ‘shoulds’, i.e. things ‘must’ and ‘should’ be in a particular manner. Examples of irrational beliefs are, “One should be loved by everybody all the time”. 5. This distorted perception of the antecedent event due to the irrational belief leads to the consequence, i.e. negative emotions and behaviours. 6. Irrational beliefs are assessed through questionnaires and interviews. In the process of RET, the irrational beliefs are refuted by the therapist through a process of non-directive questioning. 7. The nature of questioning is gentle, without probing or being direct. The questions make the client think deeper into her/his assumptions about life and problems. 8. Gradually the client is able to change the irrational beliefs by making a change in her/his philosophy about life. 9. The rational belief system replaces the irrational belief system and there is a reduction in psychological distress. Aaron Beck’s cognitive theory 1. His theory of psychological distress characterised by anxiety or depression, states that childhood experiences provided by the family and society develop core schemas or systems, which include beliefs and action patterns in the individual. 2. Thus, a client, who was neglected by the parents as a child, develops the core schema of “I am not wanted”. During the course of life, a critical incident occurs in her/his life. S/he is publicly ridiculed by the teacher in school. 3. This critical incident triggers the core schema of “I am not wanted” leading to the development of negative automatic thoughts. 4. Negative thoughts are persistent irrational thoughts such as “nobody loves me”, “I am ugly”, “I am stupid”, “I will not succeed”, etc. Such negative automatic thoughts are characterised by cognitive distortions. 5. Cognitive distortions are ways of thinking which are general in nature but which distort the reality in a negative manner. These patterns of thought are called dysfunctional cognitive structures. 6. They lead to errors of cognition about social reality. Repeated occurrence of these thoughts leads to the development of feelings of anxiety and depression. 7. The therapist uses questioning, which is a gentle, nonthreatening disputation of the client’s beliefs and thoughts. Examples of such questions would be, “Why should everyone love you?”, “What does it mean to you to succeed?”, etc. The questions make the client think in a direction opposite to that of the negative automatic thoughts whereby s/he gains insight into the nature of her/his dysfunctional schemas, and is able to alter her/his cognitive structures. 8. The aim of the therapy is to achieve this cognitive restructuring which, in turn, reduces anxiety and depression. Similar to behaviour therapy, cognitive therapy focuses on solving a specific problem of the client. Unlike psychodynamic therapy, behaviour therapy is open, i.e. the therapist shares her/his method with the client. It is short, lasting between 10–20 sessions. Cognitive Behaviour Therapy 1. The most popular therapy presently is the Cognitive Behaviour Therapy (CBT). 2. Research into the outcome and effectiveness of psychotherapy has conclusively established CBT to be a short and efficacious treatment for a wide range of psychological disorders such as anxiety, depression, panic attacks, and borderline personality, etc. 3. CBT adopts a biopsychosocial approach to the delineation of psychopathology. It combines cognitive therapy with behavioural techniques. 4. The rationale is that the client’s distress has its origins in the biological, psychological, and social realms. 5. Hence, addressing the biological aspects through relaxation procedures, the psychological ones through behaviour therapy and cognitive therapy techniques and the social ones with environmental manipulations makes CBT a comprehensive technique which is easy to use, applicable to a variety of disorders, and has proven efficacy. Factors Contributing to Healing in Psychotherapy There are several factors which contribute to the healing process. Some of these factors are as follows : 1. A major factor in the healing is the techniques adopted by the therapist and the implementation of the same with the patient/client. If the behavioural system and the CBT school are adopted to heal an anxious client, the relaxation procedures and the cognitive restructuring largely contribute to the healing. 2. The therapeutic alliance, which is formed between the therapist and the patient/client, has healing properties, because of the regular availability of the therapist, and the warmth and empathy provided by the therapist. 3. At the outset of therapy while the patient/client is being interviewed in the initial sessions to understand the nature of the problem, s/he unburdens the emotional problems being faced. This process of emotional unburdening is known as catharsis, and it has healing properties. 4. There are several non-specific factors associated with psychotherapy. Some of these factors are attributed to the patient/client and some to the therapist. These factors are called non-specific because they occur across different systems of psychotherapy and across different clients/patients and different therapists. Non-specific factors attributable to the client/patient are motivation for change, expectation of improvement due to the treatment, etc. These are called patient variables.