A Logotherapeutic Approach to Pastoral Counseling Education for Catholic Seminarians

Viktor Frankl, MD, PhD is one of the most widely known and highly respected professors of psychiatry and neurology of the twentieth century. In this article, we adapt and apply some of his profound insights for Catholic pastoral counseling education. Pastoral counseling is a very important aspect of the general pastoral formation of Catholic seminarians. The goal of any pastoral counseling course should be twofold. First, it should give seminarians a basic knowledge of mental illnesses to understand their parishioners better. Second, it should offer them concrete techniques to be used in the context of pastoral counseling. Seminary classes in pastoral psychology and counseling sometimes lack a consistent, coherent theoretical foundation, or may attempt to teach techniques inappropriate for use by future parish priests. This paper presents a logotherapeutic approach for the formation of seminarians in pastoral counseling. This approach is congruent with the pastoral sphere as the focus is on meaning and the life of the spirit.


Preface
The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity-even under the most difficult circumstances-to add a deeper meaning to his life. It may remain brave, dignified, and unselfish. Or in the bitter fight for self-preservation he may forget his human dignity and become no more than an animal. Here lies the chance for a man either to make use of or to forgo the opportunities of attaining the moral values that a difficult situation may afford him. And this decides whether he is worthy of his sufferings or not [1].

Background
At the beginning of the twentieth century, the predominant priestly formation model in the Catholic Church in the United States was essentially monastic, with relatively little in the way of distinctly pastoral formation. The formational emphasis was on rigorous spiritual and intellectual development, often over an intense, eight year period [2]. However, as early as the 1920s, American Protestants, despite a much briefer clergy formation program, had begun to consider ways to better equip future clergymen in pastoral care, including ministry for those dealing with psychological issues [3]. Richard Clark Cabot, MD, a noted Boston hematologist and social work pioneer, suggested in 1925 that every candidate for the ordained ministry should receive clinical training for pastoral work, analogous to the clinical training offered to medical students [4]. The merits of Dr. Cabot's proposal were soon realized.
The Reverend Anton Theophilus Boisen, a multidenominational clergyman and collaborator of Cabot, helped to form the Council for the Clinical Training of Theological Students in 1930. The goal of the Council was to expose Protestant seminarians for extended periods of time to those suffering from serious illnesses, primarily in psychiatric hospitals [5]. In 1937, the Reformed minister, the Reverend Norman Vincent Peale, DD, and psychiatrist, Smiley Blanton, MD, worked together to establish the American Foundation of Religion and Psychiatry, now known as the Blanton-Peale Institute and Counseling Center [6,7].
The Reverend Seward Hiltner, PhD, DD, a Presbyterian minister and a professor at the Princeton Theological Seminary, was another important figure in applying modern psychology to the work of the clergy. His 1949 book, Pastoral Counseling, was the first English language work with that title [8]. Hiltner maintained that "pastoral counseling is only a part of the larger ministry to persons in need of pastoral care." [9] He viewed pastoral counseling as a "functional specialty" in ordained ministry and posited that "the clergymen carrying out this ministry are still, in every fundamental respect, clergymen-representatives of their faith and their religious institutions." [10] The 1965 promulgation of Optatam Totius by Pope Saint Paul VI was a very significant event in the formation of Catholic priests. The Second Vatican Council's "Decree on Priestly Training" encouraged both the study of the sciences, including psychology, as well as the promotion of "strictly pastoral training." [11] Currently, Catholic seminaries, guided by the fifth edition of the Program of Priestly Formation (PPF), incorporate a substantial amount of dedicated formation in pastoral ministry [12]. In fact, both Catholic and Protestant seminaries often incorporate clinical pastoral education (CPE) in their formation programs. Additionally, seminaries usually have at least one course in pastoral psychology or counseling to introduce future clergy to the scientific study of the human mind and the pastoral application of the clinical principles of mental health.
In a 1966 article in the American Journal of Psychiatry, Bernard L. Pacella, MD, points out that "the techniques used by pastoral counselors bear a similarity to those used by the psychiatrist." However, Pacella wisely notes that "if the pastoral counselor undertakes an interpretive or analytic type of therapy, he steps out of his role as pastor." [13,14] Pacella continues, If the clergyman-counselor…steps into the role of a behavioral scientist, who must become involved in transference, counter-transference problems, must frequently avoid direct activity in solving current reality problems, must avoid value judgments for the most part, must be an interpreter of unconscious motivations, and must not give direct guidance in critical situations or even spiritual matters…he is no longer a pastor in the meaning which it has for the patient; if he attempts to exercise his role as a clergyman while simultaneously involving himself in interpreting the unconscious, we have quite an unusual situation [15]. Pacella makes a very important distinction. While priests have also been trained as analytic therapists, they are not functioning in a ministerial role while providing that kind of therapy. In this light, how might a Catholic seminarian be best formed in pastoral counseling?

Motivation
Catholic priests, no matter what their particular assignment at a given time, e.g., parish priest; prison, hospital, or military chaplain; retreat director; high school teacher; university professor; etc.; are frequently engaged in pastoral counseling. Therefore, Catholic seminaries have a compelling interest to form future priests very well in this specific area of ministry. However, it is imperative that the theoretical orientation of the psychological approach be consistent with Catholic theological anthropology.
Every school of psychotherapy rests on what is known as a "theory of personality." These theories orient their respective schools by providing a field of reference to explain and describe human experience. Some of the most common schools of psychotherapy are psychodynamic, behavioral, humanistic, existential, and systemic. While there are aspects of each school that are congruent with Catholic anthropology and other aspects that are not, some are more suitable than others.
The Bible, and specifically the New Testament, offers a distinctive, theological understanding of the human person. The Sacred Scriptures often speak of: 1. λόγος (logos)-word, reason, or meaning. 2. σῶµα (soma)-body: the whole organism; the continuity of experience through time. 3. καρδία (kardia)-heart: the seat of the intellect and affection. 4. σάρξ (sarx)-[physical] flesh. 5. νοῦς (nous)-mind, also reason or intellect. 6. ψυχή (psyche)-soul: often referring to purely natural life; root of the word "psychology". 7. πνεῦµα (pneuma)-spirit: the principle of which is the Holy Spirit, dwelling and operating in the person. Catholic theological anthropology is based on these Biblical concepts that describe the human person's different dimensions.
According to Catholic doctrine, the rational soul, directly created by God, is the substantial form of the human body [16]. The Council of Vienne taught this belief de fide in 1311 [17,18]. Furthermore, the Church teaches that every human person is made in the image and likeness of God (Genesis 1: 27). Catholics also believe that every human life is unique and special, precious in the sight of God. The Catechism of the Catholic Church states, God, infinitely perfect and blessed in himself, in a plan of sheer goodness freely created man to make him share in his own blessed life. For this reason, at every time and in every place, God draws close to man. He calls man to seek him, to know him, to love him with all his strength. He calls together all men, scattered and divided by sin, into the unity of his family, the Church. To accomplish this, when the fullness of time had come, God sent his Son as Redeemer and Savior. In his Son and through him, he invites men to become, in the Holy Spirit, his adopted children and thus heirs of his blessed life [19].
Congruent with Catholic thought, Viktor Frankl's anthropology acknowledges all three dimensions of the human person: somatic, psychic, and noetic. He uses the German term Geist, which is often translated in English as spirit from the Latin spiritus [pneuma in Greek] to refer to the specifically human dimension of the person. Elaborating his concept of man, Frankl writes, Three factors characterize human existence as such: man's spirituality, his freedom, his responsibility. The spirituality of man is no epiphenomenon. It cannot be derived from and causally explained by something not spiritual; it is irreducible and indeducible. Spiritual life may very well be conditioned by something, without therefore being caused by it. Normal somatic functions are conditional to the unfolding of spiritual life, but they do not cause or produce it [20]. Like Catholic anthropology, Frankl's logotherapeutic (literally: healing through meaning) approach is rooted in the fact that man must be viewed holistically: body, mind, and spirit [21,22]. Frankl's ten theses of the human person can easily be interpreted as very compatible with a Catholic perspective: 1. The person is an individual unity; a person cannot be divided. 2. The person is whole and cannot result from merger; the person cannot be completely fit into non-personal entities such as class or race; the person as such cannot be procreated, it is only the organism that is procreated. 3. The person is absolutely unique. 4. The person is spiritual; this is why the spiritual person is in opposition to the psychophysical organism. The psychophysical organism is a means to a purpose. 5. The person is existential and not material; the person always presently decides who the person may become in the next moment. 6. The person is "I-bound"; the person is not dictated by the psychophysical drives. 7. The person is integrative; the person is the founder of the unity and wholeness of the person (Theses 1 and 2); the unity and wholeness of the person is a uniquely personal act. 8. The person is dynamic; that is, the person is able to distance the self from, and to transcend, the psychophysical. 9. The human is not merely an animal because the human is able to self-distance; therefore, the animal cannot be taken as a correlate to the person. 10. The person is a metaphysical entity; the human being understands the self only from the transcendent; the transcendent makes itself known through conscience; the person cannot invent or design the self [23]. The value of a logotherapeutic approach for pastoral counseling is not only in the compatibility with Catholic anthropology but in the following two points: 1. The splendid simplicity of the paradigm; alternatively learning psychodynamic or psychoanalytic therapy requires an in-depth training, which cannot be done in a single course. 2. The paradigm is close to the pastoral sphere as the focus is on meaning and the life of the spirit. Frankl writes that "logotherapy is a psychotherapy of the spiritual." [24] Frankl himself admits that logotherapy was never meant to deal with severe psychosis. However, it has been used to help people with these conditions as well with some degree of success [25].

History and Fundamentals of the Third Viennese School of Psychotherapy
The logotherapeutic paradigm of Viktor Frankl, MD, PhD (1905-1997 indeed offers a promising psychotherapeutic orientation with many points of continuity with Catholic anthropology and moral theology. Born in Vienna, then the capital of the Austro-Hungarian Empire, Frankl was deeply interested in the fields of medicine, psychology, and philosophy from a very early age. He earned the MD degree from the University of Vienna and then pursued a residency in neurology and psychiatry. Following the Anschluss of Austria by Nazi Germany in 1938, Frankl could no longer work in private practice as a physician. He was however able to take a position as the chief of the Neurological Department of the Rothschild Hospital, a medical center for Jewish patients. During this time, he obstructed numerous Nazi attempted medical murders by making false diagnoses to prevent the euthanasia of mentally ill patients. Due to the overwhelming hopeless feeling of many Jewish people in Austria, Frankl dealt with about ten cases of attempted suicides daily at the Rothschild Hospital. Typical incidents involved overdosing on sleeping pills. Frankl developed a technique to administer stimulants intravenously, and when necessary, intracisternally, i.e., directly into the cerebrospinal fluid of the brain ventricles by suboccipital brain puncture.
Despite not being originally trained as a neurosurgeon, out of necessity, Frankl developed a technique to drill into the skull, administering medication directly in the side ventricle, while draining the fourth ventricle with a suboccipital puncture. In doing so, he saved many patients who would have otherwise succeeded in their attempted suicides [26].
In 1942, the Nazis arrested Frankl, his wife, his parents, and many other Austrian Jews and deported them to concentration camps. His wife and parents did not survive. Viktor [28]. Frankl was granted a professorship in neurology and psychiatry at the University of Vienna in 1955. Over the course of his lifetime, Professor Frankl authored thirty-nine books, now available in fifty languages [29].
One of Frankl's greatest honors was an invitation to a private audience with Pope Paul VI. He and his wife, Elly, a practicing Catholic, were deeply impressed by their encounter with now Saint Paul VI. Frankl told Pope Paul: "While others may look at what I may have accomplished, or rather, at which turned out well by good fortune, I realize at such moments how much more I should have done, but failed to do. In other words, how much do I owe to God's grace, granted to me for all these years beyond the time I was forced to walk through the gates of Auschwitz." [30] In his autobiography, Frankl recounts how the Holy Father Acknowledged the significance of logotherapy for the Catholic Church and for all humankind…[and at] the end of the audience…he suddenly began to speak in German once again, calling after us-to me, the Jewish neurologist form Vienna-in exactly these words: "Please pray for me!" [31] Well aware of the very significant contributions of Sigmund Freud, MD and Alfred Adler, MD, Frankl disagreed profoundly with their psychodynamic theoretical orientations and clinical approaches [32]. According to Freud, the drive for pleasure, particularly sexual pleasure, was the dominant force in the human psyche and the repression of this drive is a primary cause of neurosis (transference often offering a possible cure) [33]. This view is a tenet of the first Viennese school of psychotherapy-Freudian psychoanalysis [34,35]. Adler, initially a student and later colleague of Freud, eventually parted ways with his mentor. Friedrich Nietzsche's theory of the will to power (der Wille zur Macht) was very compelling to Adler. Adler would eventually posit that the drive for power, not pleasure, was the key to understanding the human person. This presupposition is a pillar of the second Viennese school of psychotherapy-Adlerian individual psychology [36].
By contrast, Frankl's hypothesis, confirmed by his experience in Nazi camps, is that the strongest force in man is the will to meaning [37]. Frankl explains that meaning is something that is discovered, rather than produced, and can be encountered through experiential, creative, or attitudinal values. Frankl [38]. Despite the fact that Frankl and the other prisoners were largely unable to realize the desire for pleasure or the desire for power during their confinement, the Nazis guards were unable deprive them of sources of meaning. Victims of Nazi camps were still able to discover meaning in a person to love, perhaps a spouse in another camp or who escaped capture (experiential), a cause to serve, such as a religious mission to fellow prisoners (creative), or a courageous stance toward unavoidable suffering from starvation, disease, and torture (attitudinal). Interestingly, Frankl observed that those prisoners who fell into despair from a lack of meaning in their lives would often, in a matter of days, develop a serious somatic illness, such as typhus. Frankl astutely observed that "the sudden loss of hope and courage can have a deadly effect." [39] As a professor of neurology and psychiatry, Frankl developed an exhaustive classification of mental disorders [40]. In this context, he introduced a new and very important classification: noogenic neuroses [41]. This type of neurosis is a mental illness caused by a spiritual or existential crisis, e.g., adjustment disorder with depressed mood in reaction to a divorce [42]. Frankl's framework accounts for emotionalpsychological manifestations and symptoms that are rooted in a problem of meaning, i.e., a spiritual-existential origin. This is precisely in the sphere of the Catholic priest when called upon to provide pastoral counseling. Other theorists dealing with psychological problems do not directly engage these causal factors of symptoms.
The three hallmark techniques employed in logotherapy: paradoxical intention, dereflection, and Socratic dialogue, are also consistent with scope and aims of pastoral counseling in a Catholic ministerial context. Paradoxical intention is a technique that takes advantage of one of the most human activities, humor. With this technique, Frankl intensified a patient's emotional state in order to help him understand the irrationality of an emotional reaction. Frankl developed this technique to treat phobic and obsessivecompulsive disorders. For example, it may happen that a man suffering from hyperhidrosis may develop hydrophobia. A neurotic fear of sweating in public provokes hydrophobia and the hydrophobia reinforces the hyperhidrosis. To break the neurotic cycle, Frankl encouraged the patient to "paradoxically" will to sweat more than he has ever sweat before, to show the world what a great sweater he is. In doing so, the patient began to laugh and the absurdity of the suggestion allowed him to gain distance and eventually freedom from the phobia [43].
Dereflection is a logotherapeutic technique utilized when a patient is overly self-absorbed with a goal. Frankl found that by redirecting the attention, or "dereflecting" the attention away from oneself, the patient could achieve inner peace and often succeed in accomplishing his goal. This technique is especially useful for patients suffering from hyper-reflection and compulsive self-observation. For example, a married man may become impotent as a result of hyper-intending the pleasure of his wife in the marital act; the more he thinks about his potency during the act, the less likely he may be able to achieve it. In these cases, Frankl would ask the patient to abstain from relations with his wife. After some days of obedience to the doctor, the man's natural desire for physical intimacy would lead him to return to attempting marital relations, but this time able to give himself in the act, free from hyper-reflection, and succeed in marital intercourse [44].
Finally, Socratic dialogue is a logotherapeutic technique in which Frankl used the patient's own words as a method of self-discovery. By listening intently to what patients said, Frankl could point out specific patterns of words, or "word solutions" to patients, and allow the patients see new meaning in them. This process often brings about a "modification of attitudes" and allow a patient to discover the answer to his problem. Frankl's use of Socratic dialogue often involved specific questions aimed at helping the patient to acknowledge the freedom to fulfill meaning in his life [45]. As James M. DuBois, PhD, DSc puts it, "A patient's voice of conscience (the power to discern one's unique meaning) is often heard in dialogues." [46] In recent review article on the clinical applications of logotherapy and Frankl's legacy, show how Frankl's thought has found wide application in many areas, not limited to patients in a neuropsychiatric hospital ward [47]. They write, We must not forget how logotherapy has been put at the disposal of the sufferer in its broadest sense. Especially in the context of care and care of the chronically ill (e.g., cancer, heart disease, degenerative diseases, etc.)…The rehumanization of the relationship of care, the search for a meaning to give to one's own experience of illness, the distance from the symptoms, the rediscovery of the deepest spiritual meanings, are topics that have made logotherapy one of the main instruments of support to the patient, above all to the gravely or chronically ill patient, to whom we cannot give answers exclusively of a somatic type [48]. (Author's translation from the Italian) Laracy and Kelly suggest how Frankl's writings may contribute toward a general renewal of patient care, forming future physicians to view patients in a more holistic way: body, mind, and spirit [49]. This perspective is consistent with the innovations in the theory and practice of medicine initiated by Andrew T. Still, MD, DO.
How can Frankl's insights be concretely communicated to future priests destined for pastoral counseling?

Outline of a Possible Logotherapeutic Course in Pastoral Counseling
The applicability of Frankl's insights in an explicitly Christian pastoral setting has been well established. Donald F. Tweedie, Jr., PhD, a professor of psychology at Fuller Theological Seminary, conducted one of the first studies. He is the author of Logotherapy and the Christian faith: An Evaluation of Frankl's Existential Approach to Psychotherapy [50]. The Reverend Robert C. Leslie, PhD, a Methodist pastor and professor of pastoral psychology and counseling at the Pacific School of Religion, Berkeley, attempted to explicate how Jesus characteristically worked with suffering people. He examined eleven well-known encounters between Jesus and various Gospel figures and analyzed Jesus' approach within the perspective of logotherapy [51]. More recently, Ann Graber, DMin, PhD has demonstrated the effectiveness and ecumenical suitability of logotherapy for those in pastoral ministry. She validated how existential analysis can be both scientifically sound and theologically grounded [52]. The author finds her approach particularly helpful. Marie S. Dezelic, PhD and Gabriel Ghanoum, PsyD have recently published a book that offers an eight-session protocol which allows clinicians and facilitators to follow a manualized format to assist in existential exploration and personal growth. They offer insights applicable across clinical therapeutic settings and spiritual centers [53]. A logotherapeutic course in pastoral counseling for Catholic seminarians should begin with the students reading Frankl's magnum opus, Man's Search for Meaning. The seminarians would be expected to write a 1,000 word "book review" to demonstrate their comprehension of the material. A sequence of fourteen lectures, two and a half to three hours long is proposed. The lectures on the neurobiological basis of mental illness and psychiatric medications obviously require highly specialized, scientific expertise. It is envisioned that a neuropsychologist, neuroscientist, or physician would teach the neurobiological lecture. A physician would certainly be asked to teach the lecture on psychiatric medications. psychologists, counseling psychologists, school psychologists, licensed clinical social workers, licensed professional counselors, licensed marriage and family therapists, and psychiatric nurse practitioners; Confidentiality (ecclesial and legal); The role of the experience of beauty in psychotherapy [54]; Awareness and merit of other paradigms of clinical praxis, e.g., CBT; Final Remarks. The student's grade would be based on their book report (20%), class attendance and participation (30%), and a final comprehensive oral examination (50%).
The following works by Frankl, all available in English, would be included in the course syllabus bibliography, and constitute the primary sources for the lectures.

Conclusion
The integration of modern psychological principles and methods with traditional ministerial training to equip future Catholic priests to better address psycho-spiritual issues of the people entrusted to their pastoral care must be a priority for seminaries. The principles and methods of Viktor Frankl-logotherapy-offer an attractive paradigm for training future priests in the important ministry of pastoral counseling. A logotherapeutic course, as outlined above, has the potential to give future priests both the theoretical and practical knowledge to better serve the people of God suffering in mind, body, or spirit. [2] The typical sequence after high school for Catholic seminary was four years of Neo-Scholastic Thomistic philosophy and classical languages (Latin, Greek, and Hebrew) followed by four years of systematic theology, moral theology, canon law, church history, spiritual theology, etc.
[3] Following a BA degree, typically in liberal arts, the Protestant mainline seminary experience was traditionally a three year course of theological study leading to a Bachelor of Divinity (BDiv). In the second half of the twentieth century, American Divinity schools would rename this graduate professional degree as the MDiv.
[4] Richard C. [33] Classical psychoanalytic treatment sessions typically occur 4-5 times a week and last about an hour. The analyst asks the patient to expresses his thoughts freely, i.e., the method of free association. The patient then shares whatever comes to mind, including fantasies and dreams. The analyst then has the challenging of inferring the unconscious conflicts causing the patient's neurosis and interpreting the transference (and countertransference, i.e., the analyst's feelings for the patient). Transference (Übertragung) is a phenomenon posited by Freud and characterized by an unconscious projection of the feelings, e.g., rage, attraction, dependence, etc., a patient has about someone, e.g., one's father, on to the psychotherapist. A primary goal of psychoanalytic therapy is to reveal the unconscious content of a patient's mind in an effort to alleviate "psychic tension." For more details, see Sigmund Freud, A General Introduction to Psychoanalysis (New York: Boni and Liveright, 1920).
[34] Sigmund Freud, The Ego and the Id, trans. Joan Riviere (London: Hogarth Press and the Institute of Psychoanalysis, 1927).
[35] It is interesting to note that starting about forty years ago, the popularity of Freud's psychoanalytic model among practicing psychiatrists greatly declined as more effective psychiatric drugs became available. "Reductionist biologism" became the dominant paradigm. Niall McLaren, MBBS writes, "There was a revolution in psychiatry as the psychoanalytic model passed quickly from the scene to be replaced by a rigid biological reductionism. In a few years, the Freudian theories, which had so dominated academic and private psychiatry for half a century or more, disappeared from curricula all over the country. The many institutes of psychoanalysis lost their students and their prestige. Equally quickly, psychoanalytically oriented psychiatry lost its funding as insurers and governments swung behind the confidently Joel Paris, MD contends that "(psycho) analysis has separated itself from psychiatry and psychology by teaching its method in stand-alone institutes. The field may only survive if it is prepared to dismantle its structure as a separate discipline and rejoin academia and clinical science. Whatever its limitations, psychoanalysis left an important legacy to psychiatry. It taught a generation of psychiatrists how to understand life histories and to listen attentively to what patients say. In an era dominated by neuroscience, diagnostic checklists, and psychopharmacology, we need to find a way to retain psychotherapy, whose basic concepts can be traced back to the work of Freud, as part of psychiatry." Joel Paris, "Is Psychoanalysis Still Relevant to Psychiatry?" Canadian Journal of Psychiatry 62, no. 5 (May 2017): 312.
[36] Alfred Adler, The Neurotic Constitution: Outlines of a Comparative Individualistic Psychology and Psychotherapy, trans. John Edward Lind and Bernard Glueck (New York: Moffat, Yard and Company, 1917).
[37] The "will to meaning" could be understood in diverse ways and there is some ambiguity in Frankl's use of the concept. A reception of the theory consistent with Catholic thought would surely reject certain philosophical interpretations. For example, Catholics cannot accept an interpretation that would carry David Hume's "fact-value distinction." Hume conjectures that man is unable to ground normative arguments in positive arguments-to derive ought from is. In addition, Catholics would fervently argue against Friedrich Nietzsche's proposal that moral values are completely arbitrary and the "willing" or "creating" them is the most important thing, i.e., the act of valuing is more important than the content of the values. Friedrich Nietzche, Thus Spoke Zarathustra, trans. Graham Parkes (Oxford, UK: Oxford University Press, 2009). The will to meaning can be understood as the human aspiration to discover God's blessings in one's life in the gifts and talents bestowed, the love offered by Him and fellow men and women, and the grace available to endure unavoidable suffering recalling the redemptive example of the Lord.