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 disturb him, since pressure precipitates counterpressure. Again the symptom is reinforced! On the other hand, as soon as the patient stops fighting his obsessions and instead tries to ridicule them by dealing with them in an ironical way - by applying paradoxical intention - the vicious circle is cut, the symptom diminishes and finally atrophies. In the fortunate case where there is no existential vacuum which invites and elicits the symptom, the patient will not only succeed in ridiculing his neurotic fear but finally will succeed in completely ignoring it.

Taken from : MAN’S SEARCH FOR MEANING - VIKTOR E. FRANKL

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Paradoxical intention can also be applied in cases of sleep disturbance. The fear of sleeplessness12 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 hyperintention 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 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 therapy.”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 tobe, nevertheless, a permanent one.

Taken from : MAN’S SEARCH FOR MEANING - VIKTOR E. FRANKL

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However, this presentation should not leave the impression that paradoxical intention is effective only in monosymptomatic 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.”

Handicapped 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.

Taken from : MAN’S SEARCH FOR MEANING - VIKTOR E. FRANKL

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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 ahappy 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 Hospital. 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.

Taken from : MAN’S SEARCH FOR MEANING - VIKTOR E. FRANKL

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