128 Man's Search for Meaning
Logotherapy in a Nutshell 129
Paradoxical intention is the empirical
validation and clinical application of
Allport's statement.
A few more case reports may serve to clarify
this method further. The following patient
was a bookkeeper who had been treated by
many doctors and in several clinics without
any therapeutic success. When he was
admitted to my hospital department, he was
in extreme despair, confessing that he was
close to suicide. For some years, he had
suffered from a writer's cramp which had
recently become so severe that he was in
danger of losing his job. Therefore, only
immediate short-term therapy could alleviate
the situation. In starting treatment, Dr. Eva
Kozdera recommended to the patient that he
do just the opposite of what he usually had
done; namely, instead of trying to write as
neatly and legibly as possible, to write with
the worst possible scrawl. He was advised to
say to himself, "Now I will show people what a
good scribbler I am!" And at the moment in
which he deliberately tried to scribble, he was
unable to do so. "I tried to scrawl but simply
could not do it," he said the next day. Within
forty-eight hours the patient was in this way
freed from his writer's cramp, and remained
free for the observation period after he had
been treated. He is a happy man again and
fully able to work.
A similar case, dealing, however, with
speaking rather than writing, was related to
me by a colleague in the Laryngological
Department of the Vienna Poliklinik Hos
pital. It was the most severe case of stuttering
he had come across in his many years of
practice. Never in his life, as far as the
stutterer could remember, had he been free
from his speech trouble, even for a moment,
except once. This happened when he was
twelve years old and had hooked a ride on a
streetcar. When caught by the conductor, he
thought that the only way to escape would be
to elicit his sympathy, and so he tried to
demonstrate that he was just a poor
stuttering boy. At that moment, when he tried
to stutter, he
was unable to do it. Without meaning to, he
had practiced paradoxical intention, though
not for therapeutic purposes.
However, this presentation should not
leave the impression that paradoxical
intention is effective only in mono-
symptomatic cases. By means of this
logotherapeutic technique, my staff at the
Vienna Poliklinik Hospital has succeeded in
bringing relief even in obsessive-compulsive
neuroses of a most severe degree and
duration. I refer, for instance, to a woman
sixty-five years of age who had suffered for
sixty years from a washing compulsion. Dr.
Eva
Kozdera started logotherapeutic
treatment by means of paradoxical
intention, and two months later the patient
was able to lead a normal life. Before
admission to the Neurological Department
of the Vienna Poliklinik Hospital, she had
confessed, "Life was hell for me." Handi
capped by her compulsion and
bacteriophobic obsession, she finally
remained in bed all day unable to do any
housework. It would not be accurate to say that
she is now completely free of symptoms, for an
obsession may come to her mind. However,
she is able to "joke about it," as she says; in
short, to apply paradoxical intention.
Paradoxical intention can also be applied
in cases of sleep disturbance. The fear of
sleeplessness
12
results in a hyper-intention to
fall asleep, which, in turn, incapacitates the
patient to do so. To overcome this particular
fear, I usually advise the patient not to try
to sleep but rather to try to do just the
opposite, that is, to stay awake as long as
possible. In other words, the hyper-intention
to fall asleep, arising from the anticipatory
anxiety of not being able to do so, must be
replaced by the paradoxical intention not to
fall asleep, which soon will be followed by
sleep.
Paradoxical intention is no panacea. Yet it
lends itself as
12 The fear of sleeplessness is, in the majority of cases,
due to the patient's ignorance of the fact that the organism
provides itself by itself with the minimum amount of sleep
really needed.
130 Man's Search for Meaning
Logotherapy in a Nutshell 131
a useful tool in treating obsessive-compulsive
and phobic conditions, especially in cases
with underlying anticipatory anxiety.
Moreover, it is a short-term therapeutic
device. However, one should not conclude
that such a short-term therapy necessarily
results in only temporary therapeutic effects.
One of "the more common illusions of
Freudian orthodoxy," to quote the late
Emil A. Gutheil, "is that the durability of
results corresponds to the length of ther
apy."
13
In my files there is, for instance, the
case report of a patient to whom paradoxical
intention was administered more than
twenty years ago; the therapeutic effect
proved to be, nevertheless, a permanent one.
One of the most remarkable facts is that
paradoxical intention is effective regardless
of the etiological basis of the case concerned.
This confirms a statement once made by
Edith Weisskopf-Joelson: "Although
traditional psychotherapy has insisted that
therapeutic practices have to be based on
findings on etiology, it is possible that
certain factors might cause neuroses during
early childhood and that entirely different
factors might relieve neuroses during
adulthood."
14
As for the actual causation of neuroses,
apart from constitutional elements, whether
somatic or psychic in nature, such feedback
mechanisms as anticipatory anxiety seem to
be a major pathogenic factor. A given
symptom is responded to by a phobia, the
phobia triggers the symptom, and the
symptom, in turn, reinforces the phobia. A
similar chain of events, however, can be
observed in obsessive-compulsive cases in
which the patient fights the ideas which
haunt him.
15
Thereby, however, he increases
their power to dis-
20American Journal of Psychotherapy, 10 (1956), p.
134.
21"Some Comments on a Viennese School of
Psychiatry," The Jour
nal of Abnormal and Social Psychology, 51 (1955),
pp. 701-3.
22This is often motivated by the patient's fear that
his obsessions
indicate an imminent or even actual psychosis;
the patient is not aware
of the empirical fact that an obsessive-compulsive
neurosis is immuniz-
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