Paradoxical Intention and Dereflection

Preview Chapter 12 . Paradoxical Intention and Dereflection This chapter presents two therapeutic techniques developed by Viktor Frankl to treat various neuroses: paradoxical intention and dereflection. The chapter illustrates these techniques in 14 different patient cases. Paradoxical intention can be understood in the light of the theory of “Reactive Neuroses” developed in chapter 5 . In cases of anxious neurotic fear and of obsessive-compulsive fear, something abnormal is feared rather than accepted. The patient seeks to flee from or fight against the symptom or compulsion, and this gives rise to anticipatory anxiety, which in turn increases the likelihood of the feared symptom or compulsive behavior. In the case of sexual neuroses, we are dealing with a forced desire (hyperintention) of something normal (potency or orgasm) which results in anticipatory anxiety of failure, which in turn increases the likelihood of failure. Logotherapy asks: What would happen if we prompted phobic patients to attempt to desire that which they fear? Or prompted obsessive-compulsive patients not to fight their compulsion, but to act on it? Or prompted the sexual neurotic to seek impotence or frigidity? In each instance such a “paradoxical intention” takes the wind out of the sails of anticipatory anxiety and effects “self-distancing.” The fact that there is often humor involved only aids in this self-distancing process. Dereflection can be understood in the following manner. Human beings are meant to know and love things beyond themselves. Neuroses often lead to a misuse of our faculties insofar as individuals suffering from anxiety, obsessive-compulsive, and sexual neuroses tend toward compulsive self-observation. For example, a person who suffers from neurotic insomnia may both fear sleeplessness and hyperintend sleep (a natural function)—in either case the individual is focused inward on the self, its fears, and symptoms. Thus, logotherapy posits that anticipatory anxiety and hyperintention can be diminished by directing attention outside of oneself (dereflecting). The patient is led to ignore fears, symptoms, and hyperintentions. This is best accomplished indirectly insofar as the patient discovers a concrete meaning or purpose. Here psychotherapy becomes logotherapy. The therapist may also use cognitive or pharmacological therapies to help restore the patient’s trust in natural processes (e.g., ability to sleep or attain an erection). Both of these techniques often work very quickly and without identifying the underlying initial causes of the neurotic behavior. While some patients experience complete and lasting success using these techniques, other patients (e.g., some patients with obsessive-compulsive disorders) may require continuous psychotherapeutic care and occasional inpatient treatments if only to provide a helpful change in environment. Even in such cases the techniques of paradoxical intention and dereflection may help patients to manage symptoms.