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LOGOTHERAPY AS A MODALITY FOR TREATING

VETERANS WITH PTSD AND/OR SUBSTANCE ABUSE

BILL MULLENER, MA, LPC, LCDC, NCC

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LEARNING OBJECTIVES 1. Become familiar with the tenets of Logotherapy,

to include origins, the three pillars, interventions, and methods and techniques.

2. Learn how Logotherapy can be incorporated into your own counseling technique for treating PTSD.

3. See how Logotherapy can be utilized with Veterans or anyone with substance abuse issues.

4. Share experiences utilizing existential analysis. “ I have used the techniques and interventions for

years, but I couldn’t speak the language”.

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Notable Quotes “..the most significant psychological movement of

our day.” Gordon Allport “..perhaps the most significant thinking since Freud

and Adler.” American Journal of Psychiatry “Logotherapy...remains a neglected but most worthy

legacy.” Liesl Kosma (Frankl’s niece) “Frankl is..the last of the great European

philosophers and psychiatrists of the Twentieth Century.” Dr. Robert C. Barnes

“As there is a Statue of Liberty on the East coast, there should be a Statue of Responsibility on the West coast” Dr. Viktor Frankl

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A FEW FACTS ABOUT DR. VIKTOR E.

FRANKL

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Dr. Viktor E. Frankl MD, PhD(1905-1997)

1. Founded the Third Viennese School of Psychotherapy, after Freud and Adler.

Founder of Logotherapy and Existential Analysis

Held 29 honorary doctorates and authored 32 books in 26 languages

“Man’s Search for Meaning”, (1946) is his most famous book; one of the ten most influential books in America today.

Spent 3 years in concentrations camps during WWII, including Auschwitz.

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Dr. Frankl (continued) Institutes of Logotherapy have been

established around the world. Logotherapy can be used in conjunction with

other forms of intervention, primarily CBT. “Logos” (Greek) refers to meaning; life

involves suffering, but out of that suffering comes meaning. Meaning can be described in terms of creative, experiential, and attitudinal virtues. Every human is body, mind, and spirit.

Self-transcendence is, according to Frankl, the authentic essence of existence.

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LOGOTHERAPY IN PRACTICE

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The three pillars of Logotherapy

1. The Meaning of Life (Life holds meaning in any situation,

even the most miserable). 2. Freedom of Will (Not freedom from conditions, but

freedom to face whatever conditions might confront you).

3. Will to Meaning (The primary motivator in life, as

opposed to pleasure (Freud) or power (Adler).

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Logotheraputic Interventions Avoiding hyper-reflection (open ended

questions) Distance from symptoms (freedom &

responsibility) Modification of attitudes Letting go of hyper-intentions (manifested in

addictions). Combating negative self image (identify

blockage) Orientation toward meaning (joint venture

between the therapist and the client)(Creative, Experiential, and Attitudinal).

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Logotheraputic Guideposts Self Discovery – The Ah-Hah! Moment Choices – “You may be trapped, but you

are not without choices.” Uniqueness – “When we become aware of

personal uniqueness, meaning emerges.” Responsibility – “Life will be meaningful if

you learn to take responsibility for your choices.”

Self-transcendence – the human capacity to reach beyond ourselves to other people.

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Logotheraputic Techniques Paradoxical Intention – self distancing

from symptoms with the use of humor (facing fear).

Dereflection – happiness is not the goal, distance ourselves from conditions and reach beyond.

Modification of Attitudes – there is meaning in every situation, regardless of conditions. “The defiant power of the human spirit”.

Humor, metaphors, and logoanchors

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WHAT ABOUT VETERANS FROM ANY

CONFLICT?

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The cold, hard truth Every 80 minutes, a veteran of OIF (Iraqi Freedom), or

OEF (Enduring Freedom), commits suicide. Many of these suicides are preventable if the veteran

can access help. The Veterans Administration and Active Duty Military

are overwhelmed in terms of mental health services. It falls on civilian counselors and therapists to pick up

the slack and provide services to our heroes. The number of Afghanistan and Iraq veterans seeking

care for PTSD was roughly 30% of the total number who sought health care from 2002 to 2012, according to a revised VA report. NextGov (12/26)      

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Some Good News! Effects of Cognitive Therapy on symptoms of

PTSD and depression – TCA Newsline Report chronicles the rising burden of military

mental health care – TCA Newsline DOD to break ground on Ft. Belvoir TBI, PTSD

center – Army Times Intrepid Fallen Heroes Fund to pledge $100

million for state–of-the-art treatment centers at nine military bases – AF Times

Center provides advice on post-deployment intimacy issues – American Forces press

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CASE STUDY OF JAMES

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Case Study James is a 33 year old, white, male, with a wife

and a five year old daughter. He spent nine years in the U.S Marine Corps, primarily in motor transport. While in Afghanistan, he suffered four TBI’s as a result of grenade and rocket concussions. Each time, he was treated and released to resume duty. Six months after his return symptoms began to appear (flashbacks, balance, migraines, social phobia, nightmares, lack of motivation, and anger issues). He was subsequently given a medical Honorable Discharge two years ago.

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Case Study (cont.) Clients wife contacted me for help, because James had

never been able to find a counselor that he could “relate to”. We established a good therapeutic relationship, because I “spoke his language”, and could provide interventions he had not experienced. The wife has joined us twice to work on relationship issues.

I sought to establish meaning in James’ life by using a combination of humor, story telling, and metaphors. I used paradoxical intention to overcome agoraphobia and anxiety. I used “will to meaning” to encourage him to become involved in his passion, working on old cars. I used concentration on a candle on the floor to encourage Socratic dialog about his experiences.

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Case Study (cont.) I used a metaphor of “just as you need rehab to

get better, don’t you think your old car needs rehab?” to encourage his mechanic hobby. I also encouraged him to take “baby steps”, but be sure to “complete the mission”. Repair with his wife was condensed as “others have gone through this and been successful”. I confronted him over his anger issues by saying, “quit treating your wife and daughter the way you treated your Marines!” I used the “magic question” as a means of getting him to project into the future and verbalizing his dreams.

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Case Study (outcomes to date) I see James on a bi-weekly basis, with his wife

attending every other session. Last session they could not recall an argument they had in the last two weeks. They are creating “alone time” and making love twice a week. James is still dealing with multiple physical issues, but I have seen remarkable progress in his outlook on life, motivation, willingness to consider alternative strategies, and his relationship with his wife and his daughter. We have walked through the grieving process around the loss of his military career. He has also recently become involved with Special Olympics as a coach and a referee.

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“DRINK HARD, FLY HARD, LEAVE A GOOD LOOKING

CORPSE”

“LOVER OF FAST AIRPLANES, BEAUTIFUL

WOMEN, AND FINE WHISKY, NOT NECESSASRILY IN THAT

ORDER”

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Logotherapy and Substance Abuse

Did you know? Afghanistan is the # 1 producer of poppies/opium in the world?

Alcohol is supposed to be forbidden in Muslim countries, but military members are resourceful.

Many of the Logotheraputic interventions are equally effective with substance abusers.

Be aware of the diagnosis called COPSD, or co-occurring psychiatric and substance disorders.

DO NOT be afraid to refer to specialists. We are not always free to choose life conditions,

but we are free to be responsible for our own actions.

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Military substance abuse There is a huge perceived stigma attached to

admitting you might have a drug/alcohol problem (denial of promotion or ultimately discharge).

USMC to begin twice yearly random testing for all Marines starting this year.

Military tends to “take care of their own”. Alcohol use DOD-wide is being de-emphasized;

no more “mandatory happy hour”. Substance abuse makes you a liability! Abusing your body is disrespecting God.

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AN OPPORTUNITY TO SHARE YOUR OWN EXPERIENCES WITH

EXISTENTIAL ANALYSIS

QUESTIONS?

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REFERENCES Marshall, M. and Marshall, E. (2012).

Logotherapy Revisited. Ottawa, Ontario, Canada Graber, Ann (2004) Viktor Frankl’s Logotherapy.

Wyndham Hall Press Frankl, Viktor E. (1959) Man’s Search for

Meaning. Beacon Press, Boston, MA Frankl, Viktor E. (1986) The Doctor and the

Soul. Vintage Books, New York. The Viktor Frankl Institute of Logotherapy. www.viktorfranklinstitute.org