Frankl explains that logotherapy is well-suited to treating “anticipatory anxiety,” in which a person’s fear of something makes that thing actually happen. For example, a man worried about performing well in bed is then unable to perform well in bed. Frankl also discusses “hyper-reflection,” in which the patient is so attentive to an issue that his attention affects his life. For example, a woman who had been sexually abused had trouble enjoying sex with her partner because she was so worried about the toll this abuse might take on her sex life, not because of the actual abuse itself. She was too focused on her anxiety, and thus could not focus on the sexual act itself.
Here, Frankl discusses the more clinical aspects of logotherapy. He describes problems that are more applicable to the average reader’s life than those Frankl himself experienced in the camps. His basic idea is that by fearing something and worrying about it so much, one actually brings about that which one fears. Even though Frankl doesn’t seem to consider sexuality very important except as an aspect of love, many of his examples of psychological concepts revolve around sex.
Logotherapy uses “paradoxical intention” to counteract these two tendencies. By instructing patients to bring about that which they fear or that which hyper-reflection prohibits, logotherapists can help them overcome their neuroses. For example, Frankl worked with a patient who was so afraid of sweating profusely that he sweated all the time. When the patient tried his hardest to sweat, however, he found that he could not sweat at all. By reversing a patient’s habits, paradoxical intention can help expose patients’ anxieties and hyper-attentions and give them control over their lives.
This section provides specific instructions for how logotherapists can help their patients. It also explains a method that readers of the book can try themselves. This method is very similar to what is known as “exposure treatment,” where one is exposed to the very thing one is afraid of. This method empowers patients and makes them feel as if they have control over their minds and destinies.
Frankl successfully treated many patients, including a bookkeeper afflicted with bad handwriting and a man with a horrible stutter, through paradoxical intention. Frankl says that this form of treatment is particularly helpful for those with obsessive-compulsive disorder. While paradoxical intention cannot fix everything, it is a useful therapeutic device in that it cuts through the cycle by which anxious behaviors are reinforced. The patient can only heal when he orients himself toward a unique goal and meaning.
The type of treatment described here is widely considered to be the most effective method for treating OCD, even today. Instead of fearing what they will do in the future, patients are taught to take control over their futures and possibilities. Once they find a will to meaning instead of being afraid of the future, they start to overcome their neuroses.