The method of paradoxical intention underlies one of the most effective techniques for combating neuroses. American psychiatrist Viktor Frankl became interested in this phenomenon in the middle of the 20th century, resulting in a fairly simple and effective technique. Its essence is to change your attitude towards fear to a positive one, to expect something terrible with a smile. Unclear? Let's look at an example.

Natalia is afraid to use the elevator. As soon as the elevator doors close, she feels bad - her heart begins to beat strongly and frequently, sweat appears on her forehead, it becomes difficult to breathe and she feels dizzy. She has claustrophobia - one of the most common types of fear neurosis.

What do Natalia's loved ones say?

“Don’t be afraid, they still travel. And I drive, nothing bad happened to me. Give me your hand. Everything will be fine, I’m with you.”

What does a psychotherapist say when using the method of paradoxical intention?

"You are scared? Show me HOW afraid you are. You say your hands are starting to shake? Show me this please. Yes, yes, show me how much your hands shake.”

Do you see the difference in approaches? When others say “don’t be afraid,” when a person says this to himself, fear intensifies. The psychotherapist does the opposite. He asks to be afraid and even seems to be a little ironic. After the consultation, Natalya, before entering the elevator, will think something like this: “Now I’m going to faint, I’m going to start trembling!” Incredibly, such escalation of the situation works the other way around, and fear decreases! Of course, the example is very simplified, but the essence of the technique can be understood.

When is the method of paradoxical intention used?

Psychotherapists use the technique of paradoxical intention, mainly for phobic neuroses and obsessive-compulsive neuroses. What is it?

Phobic neuroses

This is an irrational, panicky fear (phobia). Phobias come in a variety of varieties; they can be roughly divided into:

• phobias of space (closed spaces, large areas, heights);
• social phobia (fear of crowds, public speaking, teachers, fear of wetting ourselves, blushing, trembling, etc.);
• medical phobias (fear of illness, injections, visiting doctors, blood, germs, stroke or heart attack);
• zoophobia and insectophobia (fear of animals and insects);
• transport phobias (flying on airplanes, traveling in a car, etc.);
• sexual phobias (fear of the naked body, intimacy, loss of erection, infection with sexually transmitted diseases, pathological fear of becoming pregnant).

Obsessive-compulsive disorder (obsessive-compulsive disorder)

This includes various intrusive thoughts or ideas. They can constantly or occasionally appear in a person’s head and provoke certain actions associated with these thoughts. It looks something like this:

Obsessive thoughts, just like phobias, can affect absolutely any area of ​​life. One person worries whether he turned off the gas and water when leaving the house, another experiences an obsessive desire to commit an antisocial act - and so on. The causes of such disorders are varied: attitudes from childhood, certain conditions (for example, pregnancy), various situations.

In the sexual sphere, obsessive thoughts are often associated with imperfection own body, the size of the genital organs, etc. Paradoxical intention is effective in many such cases. Of course, this method is rarely used on its own; more often it is combined with other types of psychotherapy.

Is everything as simple as it seems?

The technique of paradoxical intention seems so simple that almost everyone will ask: “Why do we need a psychotherapist at all? I can do that myself!”

Well, maybe it is. After all, neurosis, like any disease, can be mild, medium degree or heavy. With mild neurosis, you can actually try to cope with the problem yourself. For example, if your palms sweat before shaking hands, try to give yourself the attitude beforehand: “I’m about to start sweating!”

However, neuroses of moderate and severe degree “cling” to a lot of related problems. Let's give an example.

Victoria works for a large company and is about to go on a business trip to Japan. The problem is that she has aerophobia, she is afraid of flying on airplanes. It is logical that on the eve of the flight:

• She is haunted by obsessive thoughts: “What if the plane falls and crashes?”
• These thoughts cause blood pressure to rise, dizziness, and heart rate to increase.
• Victoria is looking for a way out, how to avoid flying: “Or maybe get sick?”

All these elements require separate study. Only a psychotherapist can often unravel the whole tangle of side fears and obsessive thoughts. And sometimes neurosis is a consequence of mental illness, and in this case a different strategy is needed.

Psychotherapists at Best Clinic practice treatment of neuroses using the method of paradoxical intention and other effective methods. These are people you can trust with any fears and be sure that no one will ever know about them. With the doctors of Best Clinic you will feel comfortable and cozy, because they will find an approach to any patient. Take a course of psychotherapy and stop worrying!

Trying to suppress unwanted symptoms and avoid situations in which they appear only makes the person’s situation worse. The method of paradoxical intention was formulated by V. Frankl in 1939 and explained further, now possessing sufficient fame.

People with phobias or deep-rooted fears anticipate unwanted symptoms that appear when they find themselves in unfavorable situations that they know. When the expected thing happens, fears and expectations of a repetition of the symptom are even more intensified. All this provokes flight from objects and situations of fear. Agoraphobes try not to leave the house for fear of fainting. Those suffering from excessive sweating or tremors in the hands during public speaking try to avoid public speaking, etc.

Also, under the yoke of obsessive ideas, there is an attempt to suppress and counteract unwanted symptoms, but this only increases the initial tension. The circle closes.

The essence of the method of paradoxical intention is an attempt to consciously and with a bit of humor perform an undesirable action and strengthen an undesirable symptom that manifests itself uncontrollably in situations of anxiety. It is also required not to avoid circumstances, objects, etc. that provoke fear.

Instead of avoiding objects/places or situations in which you experience anxiety and its undesirable consequences, encounter them intentionally and try to consciously force yourself to react in the way you expect in advance in case of a “bad situation”. Are you afraid of fainting on the street? Try to do this consciously. One patient only once said to herself in a similar situation the phrase “Now I will show everyone on the street how I can faint from fear,” in order to calmly reach her destination, and not run home in a panic. Are you afraid that when speaking in public or during meetings, your hands will shake, your legs will shake, or perhaps your sweating will increase? Repeat unwanted manifestations consciously, when meeting people, try to sweat three times more, try to make your legs shake like they have never walked. Do you suddenly panic and scream when you see a spider? Try consciously screaming twice as loud.

Do you suffer from insomnia and every time before going to bed you anticipate that you won’t be able to fall asleep? Try not to try to fall asleep, but, on the contrary, try to stay awake as long as possible. In other words, the intense desire to fall asleep, generated by the fear of not falling asleep, must be replaced by a paradoxical intention - the desire to not fall asleep, which should soon be followed by sleep.

An example from Frankl’s book “Suffering from the Meaninglessness of Life”:

“Muhammad Sadiq, whom I have already quoted, describes the case of an eighty-five-year-old patient who was addicted to sleeping pills, was admitted to the hospital and was admitted to his treatment. He writes: “At ten o’clock in the evening the patient left her room and asked to be given sleeping pills. I told her that, unfortunately, we had no sleeping pills left, and the nurse forgot to order a new batch. “And how do you think I can sleep now?” she said indignantly. “Today we’ll have to do without sleeping pills,” I said. Two hours later she left her room again and declared: “I can’t sleep.” Then I gave her this advice: “What if you go back to bed and try to overcome the dream!” She said: “I thought I was the only crazy one here, but now I see you are too.” “Sometimes it’s funny to feel like you’re crazy,” I said. “You understand me, right?” She asked: “Are you serious?” “What exactly?” I asked. “Did you seriously say that I need to overcome sleep?” she asked. “Of course, seriously,” I replied. - Yes, try it! At the same time, let's see if you can stay awake all night. Fine?". She agreed and left. When the nurse brought breakfast to the room in the morning, she found the patient sleeping."

Viktor Frankl insists that the resulting vicious circle is broken not by a neurotic focus on one’s own personality (self-pity, contempt, etc.), but by personal involvement in meaningful activity, which becomes the key to returning to a “working” state.

PARADOXICAL INTENTION: LOGOTHERAPY TECHNIQUE

Since the psychotherapeutic process is a chain of improvisations, the question often arises - how possible is it to teach and learn psychotherapy? In addition, it must be borne in mind that the infinite variety of patients excludes the possibility of extrapolation. Thus, the psychotherapist is always faced with a seemingly insurmountable double task: to take into account the uniqueness of each individual and to take into account the uniqueness life situation, in which everyone has to struggle. Nevertheless, it is individualization and improvisation that needs to be taught and trained.

The choice of the appropriate treatment method applicable in each case depends not only on the individuality of the patient, but also on the individuality of the therapist. The complexity of the problem lies in the fact that the last two factors are unknown, at least initially. To illustrate, I often tell my students that choosing a therapeutic modality to apply in a particular situation can be compared to solving the following algebraic equation: (= x + y, where ( is the therapeutic modality, x represents the personality of the patient, and y represents the personality of the treating physician .

This equation sheds light on the fact that the decisive factor in psychotherapy is not so much the method as the relationship between the patient and his doctor, or, in modern parlance, the “meeting” between the therapist and his patient. This relationship between two individuals is the most important aspect of the psychotherapeutic process, more important than any method or technique. However, we must not neglect technique, because in treatment the therapist needs to maintain a certain degree of detachment from the patient. Indeed, the treatment process requires a certain disregard for the human factor.

The therapeutic relationship develops in a field of tension between the pole of human intimacy, on the one hand, and the pole of scientific detachment, on the other. Therefore, the therapist should be careful not to become too involved in one or the other through his own fault. This means that the therapist should not be guided only by pure sympathy and his desire to help the patient, but should not suppress his human interest in another person, using only one bare technique in relation to him. The therapist must beware of understanding his role as purely technical, as the role of a medicin technicien. This is tantamount to assimilating the patient (in the words of the famous French materialist La Mettrie) I "homme machine.

The question whether logotherapy includes therapeutic technique in the strict sense of the word has already been asked. Although this question is often accompanied by some degree of doubt, logotherapy uses a special psychotherapeutic procedure. This method was first published by the author in 1946 in The Doctor and the Soul, and in more detail in 1956.

To better understand what happens when using this technique, we will take as a starting point the fear of anticipation - a phenomenon known to every experienced psychiatrist. Doctors know that such fear leads to exactly what the patient fears. For example, an erythrophobic individual who is afraid of blushing actually blushes at the very moment when he enters a room and appears in front of a group of people.

In histories of this disease, fear of some pathological phenomenon is very often encountered, and this fear, ironically, accelerates the onset of this phenomenon. This occurs as a result of increased self-control. For example, the history of patients suffering from insomnia often includes reports that when they go to bed, they begin to think intensely about their insomnia, which prevents them from falling asleep. As a result, this very attention disrupts the normal process of falling asleep.

We see that excessive attention turns out to be a significant pathogenic factor influencing the etiology of neuroses; in addition, in many neurotic patients, excessive intention can play a similar role. According to logotherapy, the cause of many sexual neuroses is a forced intention to achieve the goal of sexual intercourse - in a man this is expressed in the desire to demonstrate his sexual potency, and in a woman in the desire to show her ability to experience orgasm. The author discusses this topic in detail in his works, noting that the patient, as a rule, strives to achieve pleasure as such (we can say that he is guided by the “pleasure principle” literally). However, pleasure refers to states that cannot be reached directly - they can only be achieved “along the way” or as a side experience. Therefore, the more someone strives for pleasure, the less he achieves it. We can trace an interesting parallel: the fear of expectation, which causes exactly what the patient fears, as well as excessive intention, which encourages him to act straightforwardly, do not allow a person to achieve what he strives for. It is on this dual fact that logotherapy bases the technique known as paradoxical intention. For example, a patient suffering from a phobia and fearing that something will happen to him is encouraged by the logotherapist to wish, even for a second, that what he is so afraid of will happen.

The following clinical report illustrates what I want to say.

A young doctor came to our clinic about severe hydrophobia. He suffered from disorders for a long time nervous system. One day he met his boss on the street and, extending his hand in greeting, discovered that he was sweating more than usual. Another time, finding himself in a similar situation, he already expected that he would sweat again, and this fear of anticipation accelerated the excessive sweating. A vicious circle arose: hyperhidrosis caused hydrophobia, and hydrophobia, in turn, caused hyperhidrosis. We advised this patient, in an anticipatory anxiety situation, to try to deliberately demonstrate to people he met how much he could sweat. A week later he returned to tell how, during each meeting with those who caused him to fear anticipation, he said to himself: “I just sweated out a liter of water, and now at least ten liters will pour out of me.” ! What was the result of this paradoxical decision? He suffered from this phobia for four years, and was able to get rid of it in one session - thanks to this method!

The attentive reader will notice that this method treatment consists not only of changing the patient's view of his phobia and replacing the usual "avoidance" reaction with intentional efforts, but also of using, as far as possible, a sense of humor. It helps the patient change his attitude towards the symptom, gives him the opportunity to distance himself from it, to separate himself from the neurosis. This method is based on the fact that, according to logotherapeutic teaching, the pathogenesis of phobias and obsessional neurosis intensifies when the patient tries to avoid it or fight it. A person suffering from a phobia usually tries to avoid situations in which a state of fear arises, while someone who has obsessional neurosis tries to suppress thoughts that frighten him and thus overcome them. As a result, in both cases there is an increase in symptoms. On the contrary, if you lead the patient to the point that he stops avoiding the manifestation of symptoms, does not try to overcome them, and even tries to intensify them, then the symptoms disappear and no longer haunt him.

In practice, this method requires the use of those unique possibilities of self-distance that a sense of humor has. To Heidegger’s assertion that “the ability to recognize the frailty of being (Sorge) is an essential feature inherent in human existence, and to Binswanger’s “love affair” (liebendes Miteinandersein) as the main human property, I dare add that humor also deserves to be mentioned among the main human abilities. Animals cannot laugh.

In fact, when using paradoxical intention, the goal is to help the patient separate himself from the neurosis by laughing at it. Gordon Allport, in his book The Individual and His Religion, states something similar: “The neurotic who learns to laugh at himself is on the road to self-control, perhaps to recovery.” Paradoxical intention is a clinical application of Allport's statement.

A few more cases will help reveal this method more clearly.

One day I received a letter from a young student who had once attended my clinical lectures on logotherapy. She reminded me of how I had demonstrated the method of paradoxical intention, and continued: “I tried to apply your method to myself. I, too, constantly suffered from the fear that during dissection classes at the Anatomical Institute, when the anatomy teacher entered the room, I would begin to tremble. Soon this fear actually began to cause tremors. But, remembering what you told us at the lecture about how to act in such a situation, as soon as the teacher entered the room where the autopsies were carried out, I said to myself: “Oh, here comes the teacher! Now I’ll show him what a good shake is, I’ll show him how to shake!” But when I deliberately tried to pretend to tremble, I couldn’t do it!”

Unconsciously and unintentionally, the paradoxical intention is used everywhere. One of my American students, while answering an exam question on this topic, told the following incident from his life: “My stomach began to growl in the presence of other people. The more I tried not to do this, the louder he purred. Soon it began to seem to me that this would continue for the rest of my life. I accepted it and started laughing about it with others. It soon passed."

I once encountered the most severe case of stuttering in my practice: this was a man who stuttered all his life with the exception of one episode. This happened when he was twelve years old, during a ride as a “hare” on transport. He was caught by the conductor, and in order to avoid trouble, he decided to arouse the conductor's pity by posing as a "poor, stuttering boy." But when he tried to stutter, he found that he couldn't do it! Without knowing it, he used the method of paradoxical intention, although not for therapeutic purposes.

Another case of the use of the paradoxical intention method related to stuttering was told to me by the head of the department of psychiatry at the university in Mainz, West Germany. When he was in school, his class put on a play. One of characters was supposed to stutter, and the role was given to a student who actually stuttered. However, he was forced to refuse this role, because it soon became clear that he could not stutter at all while standing on stage. The role was given to another boy.

Another case was that of one of my assistants, Dr. Kurt Kocourek, a woman named Mary V. for eleven years who tried in various ways to get rid of what was causing her suffering, but her condition only worsened. She had attacks of palpitations, accompanied by severe anxiety and fears, which were associated with the expectation of sudden fainting. After the first attack, she began to fear that it would happen again, and, of course, it did. The patient said that whenever she began to feel this fear, it was immediately followed by an attack of palpitations.

However, her main fear was that she could faint right on the street. Dr. Kocourek advised her to say to herself at such moments: “My heart is beating faster! I’m going to faint right here on the sidewalk!” She was also advised to deliberately visit those places that she had previously avoided, considering them unacceptable and even dangerous for herself. Two weeks later, the patient reported: “I feel very well and do not feel any palpitations. The fear has completely disappeared." A few weeks into her recovery, she reported: “The palpitations sometimes happen, but as soon as I tell myself, ‘my heart should beat faster,’ the heartbeat becomes normal.”

The method of paradoxical intention can be used therapeutically in cases that arise against the background of a somatic illness.

The patient suffered a coronary infarction. Its consequence was the development of anxiety as a mental reaction to a somatic illness, but soon this anxiety became so acute that it turned into the patient’s main problem. He began to withdraw from his professional and social contacts; eventually he could no longer leave the hospital, where he stayed for six months, since the cardiologist there was always nearby. Finally he was transferred to our hospital and Dr. Gerda Baker began speech therapy. Here is an excerpt from the patient's taped commentary:

“I felt very anxious, and the pain in the heart area began to bother me again. I asked the nurse to call the doctor. The doctor came in for a minute and said that I needed to try to get my heart beating faster and try to increase the pain and fear until it came back. I did as she said, and when she returned about a quarter of an hour later, I admitted to her that my attempts were unsuccessful - I could neither increase the pain nor cause palpitations, but both disappeared!.. Encouraged by this turn of events events, I left the hospital for an hour or so and went for a walk through the streets, but for more than six months I had not even tried to do this. Entering the store, I felt a slight heartbeat, but on the doctor’s recommendation I immediately began to tell myself: “Try to feel even more anxious!” And again it didn’t work out for me! I returned to the clinic happy that I was able to walk around on my own, it was my achievement.” When he came to us six months later, he reported that there were no complaints and that during this time he had resumed his professional activities.

Let us now consider the following case.

Mrs. N. was admitted to hospital after fourteen years of suffering. She had a compulsive counting problem, as well as a compulsive urge to constantly check that her dressing table drawers were in order and securely locked. She constantly checked the contents of the drawers, sharply closing them with her fingers and then trying to turn the key in the lock several times. Eventually the habit became so obsessive that her fingers were often bruised and her keys and drawer locks were broken.

During appointment with doctor Eva Niebauer demonstrated to a patient how to use the method of paradoxical intention. She was shown how to carelessly throw things into the table and closet, how to make a big mess. She had to tell herself, “These drawers need to be as messy as possible!” The result was that within two days of visiting the doctor, her obsessive billing disappeared, and after four days, she no longer felt the need to double-check her table. She even began to forget to close it - and this had not happened to her for several decades! Sixteen days after hospitalization, she was completely free of her complaints, free of all symptoms, was proud of her achievements, and could perform daily calculations without obsessive repetition. She admitted that the obsessions returned to her from time to time, but she managed to ignore them or express them, “turning them into a joke.” Thus, she overcame her obsessive thoughts, not through a frantic struggle that only intensified them, but through the use of paradoxical intention.

A remarkable fact that occurred in this case is that after clarification of the symptoms, the patient spontaneously, during a conversation with the psychotherapist, recalled several important events. She remembered that when she was five years old, her brother broke her favorite doll. After that, she started locking her toys in the dressing table. When she was sixteen, she caught her sister trying on her best weekend dresses without asking. From then on, I always carefully locked up my clothes. Thus, even if we accept that her intrusive thoughts are rooted in these traumatic experiences, changing the patient's attitude toward her symptoms was nonetheless therapeutically effective.

The very manifestation of such mental traumas to consciousness cannot be a treatment, since, as a method, it does not include an effective procedure. This is reminiscent of the statement made by Edith Weiskopf-Joelson in her article “Some Thoughts on the Vienna School of Psychiatry”: “Although traditional psychotherapy insists that therapeutic practice should be based on discoveries of etiology, it is possible that certain factors can cause neuroses in early childhood, and, perhaps, completely different factors can relieve neuroses in adulthood.” It’s just that mental trauma is the content of corresponding obsessive thoughts and phobias. Even psychoanalysts are increasingly inclined to admit that mental trauma in itself is not the direct cause of neuroses. I would dare to say that mental traumas are not really the cause of neuroses, but in some cases it is the neuroses that cause the traumas to appear again and again. The therapy we use must be independent of etiological assumptions regarding any specific neurotic symptoms. Thus, Weiskopf-Joelson's thoughts are quite appropriate. It is interesting that in any case, more or less “free associations”, allowing one to remember mental traumas that influenced the formation of certain habits and symptoms, can occur even after successful treatment.

Thus, the method of paradoxical intention works even in those cases in which neither the somatic cause (the patient with a coronary infarction) nor the putative mental cause (the case of Mrs. N.) was touched upon by the therapist. Paradoxical intention is essentially not a specific method, since it is effective regardless of the underlying etiology. This therapy is palliative rather than causal. But this does not mean that it is symptomatic; however, for a logotherapist using the method of paradoxical intention, what matters is not the symptom as such, but the patient’s position in relation to his neurosis and its symptomatic manifestations. It is a change in this position that leads to the desired improvements.

This nonspecificity makes it possible to understand why, in severe cases, the method of paradoxical intention is sometimes effective. I want to emphasize the word “sometimes” because the reader should not get the impression that beneficial results are always achieved and that the method of paradoxical intention is a universal panacea. On the other hand, I feel obligated to provide accurate data on how applicable and effective it is. Here I would like to report that the percentage of recovered patients, or those who, as a result of improvements, no longer needed the help of a psychotherapist, is slightly higher (75.7%) than that given in the literature.

The method of paradoxical intention is also applicable in cases more complex than monosymptomatic neurosis. Next we will show that even cases of severe characteristic obsessional neurosis can be successfully cured by the method of paradoxical intention.

The patient, a sixty-five-year-old woman, had suffered from compulsive washing for sixty years, which had reached such an extent that she was admitted to our clinic for evaluation before a possible lobotomy (which I considered the only possible procedure that would bring relief in severe cases). She started showing symptoms when she was four years old. Even then they told her that she shouldn’t, for example, lick her hands. Later she became afraid of contracting skin diseases from other people. She never touched the door handle. Her husband was forced to adhere to a very complex preventative ritual. For a long time the patient was unable to do any housework and eventually began to stay in bed all day. Nevertheless, she insisted that the clothes be brushed for hours, three hundred times or more. She admitted that “life was hell for me.”

Hoping to avoid surgery, my assistant, Dr. Eva Niebauer, tried the logotherapy method of paradoxical intention. As a result, nine days after the first session, the patient began helping in the ward: darning stockings for her neighbors, washing instrument tables, dirty syringes, and in the end, even taking out buckets of bloody and foul-smelling bandages! Thirteen days after the session, she went to her home for a few hours and, returning to the hospital, proudly reported that she did not wash her hands before eating a bun. After two months, she was able to lead a normal life.

It would be an exaggeration to say that she was completely free of symptoms, because the obsessions returned from time to time. However, she was able to cope with them without fighting (fighting only strengthens them), but by forming an ironic attitude towards them in short, using the method of paradoxical intention. She learned to make fun of her obsessions. This patient continues to show up in the outpatient clinic because she still requires supportive speech therapy. She feels well, and the lobotomy, which previously seemed inevitable, is no longer necessary.

The author draws attention to the fact that it is no coincidence that he describes cases in which patients were helped rather by his employees than by himself. This proves that this method works not only for its creator (although, as I already noted, the personal factor cannot be ignored).

The reader undoubtedly noticed that in all the above cases, paradoxical intention was used as short-term therapy, especially in cases of phobias, which are based on the mechanism of fear of expectation. Here is a typical case of such short-term therapy, which was successful, despite the fact that obsessive thoughts bothered the patient for a long time. Here is a transcript of a message from the patient, Mrs. Rosa L.:

“One day I forgot to close the door, and when I returned home, it was open. This scared me very much. After that, whenever I left the house, I could not shake the feeling that the door was again left unlocked. I had to go back and check. This went on for twenty years. I was forced to obey my obsession, although I knew that this thought was absurd, because every time I returned home, the door was locked. Life has become unbearable. However, after my meeting with Dr. Becker, things took a different turn. When I had the urge to check if it was closed Entrance door, I said to myself: “So what if the door is open?” Let them steal everything in the apartment!” At that moment, I was able to ignore the urge and calmly go my way.”

Three months later we invited her to let us know how she was doing. She said: “I feel great; There was no trace left of obsessive thoughts. I can't imagine how I lived with all these thoughts in recent years. For twenty long years they tormented me, but now they are gone and I am happy.”

There is a misconception in psychotherapeutic circles that short-term Therapy inevitably produces only short-term results. Here is an excerpt from another entry that can refute this misconception: “Every day from morning to evening, the thought that I could break a store window did not leave me for a minute. Dr. Frankl suggested that I do this by walking straight up to a display window with the intention of breaking it. When I did this, the fear disappeared completely - I was sure that it would not return. Now it all seems like a dream to me; old fears and impulses disappeared completely.”

The most interesting thing is that this story was recorded twenty years after treatment!

In connection with short-term therapy, I will quote what Gahel said: ("Among the most common fallacies of Freudian orthodoxy are the following: the duration of therapy is synonymous with its depth; the depth of therapy depends on the frequency of sessions; the results of therapy are proportional to the duration and depth of treatment; the durability of results corresponds to the duration of therapy." In this regard, it can be noted that the paradoxical intention is not as superficial as it may seem. When it is used, something undoubtedly happens at a deep level. The phobic syndrome arises in the subconscious, like this, a paradoxical intention. also affects the subconscious. Humorous formulations are necessary for. effective treatment, are based on the restoration of basic trust in Being (Urvertrauen zum Daseiri). What happens in the treatment process is not just a change in behavior patterns, but rather an existential reorientation (existentielle Umstelluflg).

In this respect, paradoxical intention is a real logotherapeutic procedure in the true sense of the word. Argentine logotherapist Georges Marcelo David notes that its use is based on what in logotherapy is called psychonoetic antagonism (or the specific ability of a person to withdraw not only from the world, but also from himself). Paradoxical intention mobilizes this human ability to achieve the therapeutic goal of victory over neurosis.

Of course, individual differences between patients must be taken into account. This method cannot be applied in all cases, and the therapist must know the limits of its applicability to certain patients in certain situations. It would certainly be desirable to define criteria for establishing the limits to which the patient is capable of mobilizing his own psychonoetic antagonism. In any case, such tests have not yet been invented. The author claims that every person has this ability, since it is an essential part of human existence.

With paradoxical intention, a person enters the poetic dimension as a specifying and constitutive dimension of human existence. This dimension, from the point of view of logotherapeutic teaching, is the spiritual sphere of human life and includes not only rational or intellectual processes. As Gahel said in his latest

work “Problems in the treatment of obsessional neurosis”: “It is necessary to introduce new therapeutic agents... Appeal to reason, useless in other cases, is promising in cases of obsessional neuroses, in which rationalization and intellectualization play such a role big role» .

This, in turn, leads to another question, namely, whether the method of paradoxical intention belongs to the motivating methods, such as, for example, those spoken of by Paul Dubois. Since those who practice the method of paradoxical intention are not at all convinced that the patient is simply suppressing his fears by means of a rational belief in their groundlessness, but rather adhere to the idea that he is overcoming his fears by intensifying them, - The method of paradoxical intention is directly opposite to the methods of motivation. Polak drew our attention to the significant difference between paradoxical intention and suggestive techniques.

The paradoxical intention method, as mentioned above, can also be used in cases of sleep disorders. The fear of insomnia intensifies the sleep disorder, because the fear of waiting closes the vicious circle, making it self-perpetuating. The harder the patient tries to fall asleep, the less able he is to do so. Once the famous French psychiatrist Dubois compared a dream to a dove that sat down next to a person and sits until no one pays attention to it; if a person tries to grab it, it quickly flies away. But how can one avoid the fear of expectation, which is the pathological basis for increased intention? To take the wind out of the sails of this specific fear of anticipation and since the body provides itself with the necessary amount of sleep automatically, we recommend that the patient not try to fall asleep by resorting to any effort. Our recommendations are based on the fact that the body, in protecting itself, is able to do the opposite - remain awake for as long as possible. In other words, the intense attempts to fall asleep, arising under the influence of the fear of anticipation of lack of sleep, must be replaced by the paradoxical intention not to sleep at all! (After this, sleep usually comes very quickly.)

In recent years, the number of reports on the use of the method of paradoxical intention has increased in the literature. Authors from different countries, along with the staff of the Department of Neurology of the Vienna Polyclinic, publish the results of the clinical application of this technique. In addition to David (Buenos Aires), we can mention Prof. Kretschmer (Tübingen Psychiatric University-Clinic), Langen, Volard, Prill (Würzburg Gynecological University-Clinic) and Raeder (Hamburg). Prof. Bazzi (University of Rome) even developed special indicators that give the psychiatrist the opportunity to distinguish between those cases in which it is necessary to use the method of paradoxical intention, and cases in which it is more appropriate to use the Schultz method of autogenic training. At the International Congress of Psychotherapy, held in Barcelona in 1958, Ledermann (London) stated: “The results [of logotherapy] are undeniable. I have found this method useful in cases of obsessive-compulsive disorder." Frick (Bolzano, Italy) made an even more important statement when he argued that there are severe cases of compulsive neuroses for which the “only therapeutic method” is the logotherapeutic procedure. He cited several cases in which electroshock treatment had failed, while logotherapy served as the only and “final argument.” Statements by Prof. Lores Ibor (University of Madrid) are of a similar nature.

Among my collaborators, besides Kokourek and Niebauer, who published work on paradoxical intention, was a psychoanalyst whose training and orientation were purely Freudian. Over the course of a year, he treated almost all cases of sexual dysfunction in the outpatient ward of our hospital and, in cases where short-term therapy was indicated, he used exclusively logotherapeutic methods. His experience was summarized in a joint report given at the German Congress on Sexology.

I have already noted that the fear of expectation is accompanied by obsessive self-control, and that in the etiology of neurosis, along with an excess of intention, one can also detect an excess of attention. This is especially true for insomnia, in which an increased desire to fall asleep is accompanied by increased attention to whether it is possible to do so or not. This attention also prevents the onset of sleep.

In relation to this phenomenon, logotherapy uses a method called “dereflection”. Just as paradoxical intention is used to counteract anxious anticipation, so with the help of dereflection one can counteract the patient’s tendency to obsessive self-control. In other words, in such cases, it is not enough to make what worries you funny with the help of paradoxical intention and its humorous formulations; you still need to learn to ignore, to some extent, the anxiety itself. Be that as it may, such ignoring, or dereflection, can be achieved to the extent that the patient’s consciousness can be directed to something positive. Dereflection contains both negative and positive sides. The patient must be distracted from the fear of waiting and his attention must be switched to something else. Allport confirms: “As soon as we begin to concentrate our efforts not on internal conflict, but on some external goals, life as a whole becomes healthier, even if the neurosis does not completely disappear.” Such goals can be found using a specific analytical procedure that we call Existenzanalyse. In this way the patient can find a concrete meaning for his existence.

In conclusion, I want to consider cases where the application of paradoxical intention is shown in terms of four characteristic patterns of response to neurotic problems.

1. Erroneous passivity. Refers to a behavioral pattern that can be observed in cases of fear neurosis or phobia. This is avoidance of those situations in which the patient, due to fear of expectation, anticipates a repetition, a return of his fears. In this case, we are dealing with “flight from fear” - most often the fear of fainting on the street or the fear of having a heart attack.

2. Erroneous activity. A behavioral model that is primarily a characteristic of obsessive-compulsive neurosis. The individual does not try to avoid conflict situations, he fights obsessions and neurosis, thus strengthening them. One aspect of "faulty activity" is expressed in a struggle that is motivated by two basic fears: a) that the obsessions indicate an impending or already occurring psychotic state and b) that the obsessions will one day drive him to murder or suicide. Another aspect of "faulty activity" can be observed in sexual neuroses, namely, in the struggle for something rather than against something, in efforts aimed at achieving orgasm and potency. The basis of this struggle is usually the following motivation: the patient feels that his partner demands full sexual intercourse from him, the situation demands it, he himself demands it, and finally, the “planning” of this event demands it. As a result of this “pursuit of happiness,” the individual suffering from sexual neurosis fails, just as happens in the case of compulsive neurosis, when the person’s reactions do not correspond to the situation - effort causes countereffort.

In contrast to these negative, neurotic, “wrong” models of behavior, there are two positive models that normalize the patient’s life.

3. Correct passivity. This is the case when the patient, using a paradoxical intention, tries to laugh at his symptoms instead of avoiding them (phobia) or fighting them (compulsion).

4. Correct activity. Through dereflection, the patient is able to ignore his neurosis, focusing his attention on something extraneous. He directs his attention to a life full of potential meanings and values ​​that are directly related to his personal abilities.

But, in addition to this personal aspect, there is also a social factor. More and more we meet individuals who suffer from what logotherapy calls an “existential vacuum.” Such patients complain that they feel the complete meaninglessness of their lives. They feel an inner emptiness in which neurotic symptoms thrive. Thus, filling this vacuum can help the patient overcome his neurosis, reveal to him the full range of his specific and personal semantic and value possibilities, or, in other words, bring him before the “logos” of his being.

50. Logotherapy c. Frankl. Methods of Socratic dialogue, logotherapeutic theory of neuroses, techniques of paradoxical intention.

The founder of logotherapy (from the Greek “logos” - word and therapeia - care, care, treatment) is V. Frankl. IN In this direction, the meaning of human existence is considered and the search for this meaning is carried out; a person’s desire to find and realize the meaning of life is an innate motivational tendency inherent in all people, and the main driver of behavior and personal development. Frankl considered the “striving for meaning” to be the opposite of the “striving for pleasure”: “What a person requires is not a state of balance, peace, but a struggle for some goal worthy of him.” However, the human desire to realize the meaning of life can be frustrated, and this existential frustration can lead to neurosis.

V. Frankl considers man a creator who spends his whole life creating his own spirituality. He divides human actions into three types: 1. Contributing to the creation of a spiritual personality. 2. Destroying spirituality. 3. Indifferent to spirituality. A person is responsible for his actions. Avoiding responsibility is also an act for which a person pays. A person is always free to choose his actions, to make decisions, but only if he chooses a creative action is the meaning of life realized. Creative actions are aimed at searching for the values ​​of creativity, experience and relationship. For each person, these values ​​are unique, specific and inimitable, so a person, in search of the meaning of life, seeks and finds his own area in which he realizes himself and builds his personality. If a person experiences a loss of meaning in life, V. Frankl recommends understanding and feeling the uniqueness and originality of one’s own personality. Having acquired self-worth, the value of the people around him and the world in which he lives, a person gains confidence in himself, his usefulness, his necessity, i.e. the meaning of existence. A person's life cannot lose meaning under any circumstances - the meaning of life can always be found. V. Frankl’s approach to personality is based on three main concepts: “free will”, “will to meaning” and “meaning of life”. According to V. Frankl, the question of the meaning of life is natural for a modern normal person. And it is precisely the fact that a person does not strive to achieve it, does not see the paths leading to this, that is the main cause of psychological difficulties and negative experiences such as a feeling of meaninglessness, worthlessness of life. The main obstacle turns out to be centralization a person on himself, the inability to go beyond himself, to another person or to meaning. Meaning, according to V. Frankl, exists objectively in every moment of life, including the most tragic. A psychologist cannot give a person this meaning; everyone has their own. But a psychologist can help the client realize it. As a rule, loss of meaning in life occurs during strong psychotraumatic events: the death of loved ones, participation in hostilities, etc.

Consequently, the task of logotherapy is to help a person find the meaning of life. The unique meaning of life can be found by a person in one of three areas: creativity; emotional experiences; conscious acceptance of those circumstances that a person is not able to change. Central to V. Frankl’s concept is the problem of responsibility. Man is free to choose meaning, but having found it, he is responsible for realizing his unique meaning. Freedom prevails over necessity. V. Frankl refers to going beyond one’s limits with the concept of self-transcendence and considers self-actualization to be only one of the moments of self-transcendence. Frankl describes the mechanism of formation of a pathological reaction as follows:

fear: a person develops fear of some phenomenon (heart attack, heart attack, cancer, etc.), an expectation reaction - fear that this phenomenon or condition will occur. Individual symptoms of the expected state may appear, which increases fear, and the circle of tension closes: fear of waiting for an event becomes stronger than the fears directly related to the event. A person begins to respond to his own fear by escaping reality (from life). In this situation, Frankl suggests using self-detachment. The ability for self-detachment is most clearly manifested in humor. Humor allows you to distance yourself and thereby gain control over yourself and the situation. Fear is a biological reaction that allows you to avoid situations that seem dangerous. If a person himself actively looks for these situations, then he will learn to act “past” fear, and fear will gradually disappear, as if “atrophying from idleness.” From here follow the main principles of logotherapy: 1. A person cannot live normally if his life becomes meaningless , he loses peace until he regains the purpose and meaning of his life. 2. The meaning of life cannot be given to a person from the outside, suggested or imposed. He must find it entirely on his own.

Technicians

1.Dereflection method means removing excessive self-control, thinking about one’s own difficulties - what is commonly called self-examination. 2 . Method of paradoxical intention (intention) suggests that the psychologist inspires the client to do exactly what he is trying to avoid. At the same time, various manifestations of humor are actively used. Used in corrective work with fears. For example, if a person experiences a fear of closed spaces, he is asked to force himself to be in such a room. And as a result of being suspicious, as a rule, fear disappears, and a person gains self-confidence and ceases to be afraid of what he previously avoided. 3. Personal understanding of life. The technique is to tell and show a person who has lost the meaning of life that another person needs him, that life without him loses its meaning for this person. For a mother who has lost an adult child, raising her grandchildren may become the meaning of life. A woman who lost a child as a result of cancer establishes a charity foundation and finds the meaning of life in helping other mothers who find themselves in a similar situation. Thus, a person acquires the meaning of his life through the realization that he is needed and useful to other people close to him. This is one of the ways to transform a life devoid of meaning into a meaningful one, realizing one’s uniqueness, irreplaceability, at least for at least one more person. A person can find the meaning of his life in creativity, in doing good for others, in searching for truth, in communicating with another person. The most important thing is that he can receive satisfaction from all these matters and activities. According to Frankl, the problem is not what situation a person finds himself in, but how he feels about his situation. 4. “Socratic dialogue.” The purpose of this technique is to involve the client in cooperation and expand the sphere of his consciousness. “Socratic dialogue” is a kind of intellectual duel between a psychologist And by the client, during which they adjust inconsistent, contradictory And unsubstantiated client judgments. The psychologist gradually, step by step, leads the client to the planned conclusion. This process is based on logical argumentation, which forms the core of the technique. During the conversation, the psychologist formulates questions in such a way that the client gives the maximum number of positive answers. In this way, the client is led to make a judgment that was not previously accepted, was poorly understood or unknown.