DEPRESSION, EXISTENTIAL FAMILY

THERAPY, AND VIKTOR FRANKL’S

DIMENSIONAL ONTOLOGY
Jim Lantz

ABSTRACT: In existential family therapy, it is believed that Viktor

Frankl’s dimensional ontology is a useful way to understand the differ-
ent levels of depression that are important in both family assessment
and family treatment. This article reviews Frankl’s dimensional ontol-
ogy, its usefulness for existential family treatment, the “must,” “can,”
and “ought” levels of family depression, and presents clinical material
illustrating the described existential family treatment approach.
KEY WORDS: depression; existential family therapy; dimensional ontology; Viktor
Frankl; Existenzanalyse.

One of the most common problems presented to general medical

practitioners, psychiatrists, crisis intervention centers, hospital emer-
gency rooms, social service agencies, individual psychotherapists, and
marital and family therapists is depression (Lantz, 1978; Lantz &
Thorword, 1985; Maxman & Ward, 1995). Although depression is often
described as the kind of problem that responds most effectively to
medications and individual psychotherapy (Maxman & Ward, 1995),
family therapists have rather consistently pointed out that depression
cannot be wholistically understood or treated without an adequate
understanding of the family context of the symptoms of depression
(Andrews, 1974; Lantz, 1978; Lantz & Thorword, 1985). In this article
the author seeks to provide an existential family therapy understanding
of depression by outlining Viktor Frankl’s (1955, 1959, 1967, 1969,
1975, 1978, 1997) existential dimensional ontology from a family-cen-

Jim Lantz, PhD, is a Professor at The Ohio State University College of Social
Work, 1947 College Road, Columbus, OH 43210, and Director, The Midwest Existential
Psychotherapy Institute, Worthington, OH.
Contemporary Family Therapy 23(1), March 2001
 2001 Human Sciences Press, Inc. 19
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CONTEMPORARY FAMILY THERAPY

tered point of view. Case illustrations will be presented to show how

Frankl’s dimensional ontology can be used during existential family
therapy to more effectively structure the assessment and treatment of
depression within its family context. The author believes that the use
of Frankl’s dimensional ontology often results in a more effective, pre-
cise, and cost-effective treatment experience for couples and families
facing depression.

ABOUT DEPRESSION

Depression strikes between 15 and 25 percent of the general popu-

lation of the United States at least once during their lives (Maxman &
Ward, 1995). Symptoms of depression can be severe, leading to suicidal
attempts to “stop the pain,” or less severe yet still unpleasant and
disruptive to family life. The etiology of depression is mixed but is
generally understood to include biological, neurochemical, genetic, psy-
chosocial, family, developmental, ecological, and existential factors
(Maxman & Ward, 1995).
Depression is generally considered to be a treatable problem, and
most authorities (Frankl, 1955, 1967; Maxman & Ward, 1995) believe
that a flexible treatment approach using medications, environmental
modification, and psychotherapy will most frequently be effective. In
existential family therapy (Lantz, 1974, 1978, 1993, 2000), Viktor
Frankl’s dimensional ontology can be utilized as a wholistic framework
around which to organize a flexible yet systematic approach to the
family-centered treatment of depression.

FRANKL’S DIMENSIONAL ONTOLOGY

In Viktor Frankl’s (1969) “Existenzanalyse” approach to existential

family therapy, the “we are” of family existence includes three dimen-
sions and/or levels of understanding. For Frankl (1955, 1969) family
existence (“we are—we stand out”) includes what we “must” do, what
we “can” do, and what we “ought to” do. Using Frankl’s dimensional
ontology, it is possible to identify three dimensions of family depression:
the “must” dimension, the “can” dimension, and the “ought” dimension.
An outline of Frankl’s dimensional ontology for use during the existen-
tial family treatment of depression is presented in Figure 1.
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JIM LANTZ

FIGURE 1

Family Existence and Viktor Frankl’s Dimensional Ontology

THE “MUST” DIMENSION OF FAMILY DEPRESSION

In Frankl’s (1959, 1969) dimensional ontology, the “must” level of

family existence refers to those aspects of family life that cannot be
changed by will or choice. For example, all family members must die
if deprived of food, water, or shelter for an extended period of time.
There is no will or choice in such a situation. In Frankl’s (1955, 1969,
1978) dimensional ontology, it is understood that certain physical, ge-
netic, neurological, and/or biochemical “must” factors contribute to fam-
ily life, and that this “must” level of family existence is an extremely
significant factor in the development of many mental health problems,
such as depression, mania, and schizophrenia. In an existential family
therapy understanding of depression, it is accepted that chemical im-
balances within the central nervous system may contribute signifi-
cantly to the development of depression and that medical intervention
is usually necessary on the “must” level of treatment for depression
among family members (Frankl, 1955, 1959, 1969; Lantz, 1978, 1993,
2000; Lantz & Thorword, 1985). In existential family therapy, it is
believed that family members suffering from biologically based depres-
sion “must” continue suffering such depression until biochemical imbal-
ances resulting in such depression are treated through medical inter-
ventions such as the use of antidepressant medications (see Figure 1)
22

CONTEMPORARY FAMILY THERAPY

(Lantz, 1978, 1993, 2000). In existential family therapy, it is important

to help “must” dimension depressed family members (as well as other
family members) to realize that their “must” level symptoms of depres-
sion are not a result of their weakness or any lack of character or
will (Frankl, 1969; Lantz, 1978; Lantz & Thorword, 1985). For the
existential family therapist (Lantz, 2000), it is extremely important to
teach “must” level depression families to avoid anger toward the self
about those aspects of depression that family members cannot change
through will or choice.
During the past 20 years there has been an explosion in under-
standing of biochemical (“must” level) depression and in development
of medications to help family members cope with or overcome the biolog-
ical (“must”) component of depression (Frankl, 1997; Maxman & Ward,
1995). Such drugs fall into three general categories: the tricyclic drugs,
the MAO inhibitors, and a group of second-generation antidepressants
that include the newest drugs for the treatment of depression. All of
these drugs probably correct biochemical imbalances that result in
family member “must” dimension depression and in this way normalize
the depressed family member’s mood.
In existential family therapy, it is also understood that an impor-
tant element of “must” dimension depression treatment is to help all
family members learn more about the chemical aspects of depression,
the symptoms of depression and family coping mechanisms that can
help all family members resist, contain, and manage the impact of
depression upon family life (Lantz, 1978, 1993; Lantz & Thorword,
1985). In existential family therapy, it is believed that psychoeduca-
tional methods can provide considerable relief with families and couples
who are trying to deal with “must” level depression (Lantz, & Thorword,
1985). The following two case illustrations demonstrate existential fam-
ily therapy in a clinical situation where the primary element of depres-
sion was “must” level depression.

The James Family

Mr. and Mrs. James were referred to marital therapy by their

priest after Mrs. James had complained to her priest about sleepless-
ness, crying spells, and guilt about “not wanting sex with my husband.”
Although the couple was willing to follow their priest’s advice and
engage in marital therapy, both the couple and the existential family
therapist quickly realized that Mrs. James was suffering with “must”
level (biological) depression that required psychiatric intervention and
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JIM LANTZ

medications as the primary mode of intervention. Mrs. James was

referred to the author’s consulting psychiatrist who started her on
antidepressant medications and provided (initially) weekly supportive
and educational counseling sessions to help the couple understand and
cope with Mrs. James’ biologically based “must” depression. Mrs. James
responded well to medications, and within three months was free of
her depressed mood, crying spells, suicidal ideation, reduced level of
libidinal energy, general energy loss, and difficulty eating. Mr. and
Mrs. James also experienced a considerably improved marital relation-
ship with the decreased symptoms.
In this clinical illustration, Mrs. James responded well to medica-
tions designed to meet her treatment needs at the “must” level of
existence. Although significant marital treatment on the “can” and/or
“ought” levels of family existence was not needed, it is important to
remember that successful “must” level treatment of depression often
results in a couple’s or family’s realizing that additional treatment on
the “can” and/or “ought” levels of family existence is also necessary
(Frankl, 1955, 1969, 1997; Lantz, 1978; Lantz & Thorword, 1985).

The Jackson Family

The Jackson family requested family treatment services after their

son overdosed on street drugs. The son stated that he had tried to kill
himself “to end the pain.” The family was referred to treatment by the
physician at the emergency room where the son had been treated for
the overdose. At the time of the first family session, the son scored 87
(marked depression), the father scored 53 (minimal depression) and
the mother scored 51 (minimal depression) on the Zung (1964) Self-
Rating of Depression Scale.
It was difficult to determine any unusual or pathological family
interactional patterns in the Jackson family. The parents had an open
and nurturing relationship with each other and appeared to be support-
ive parents who were able to provide appropriate structure, guidance,
and warmth to their son. The parents reported that their son’s grandfa-
ther on the father’s side of the family had committed suicide and that
his uncle on the mother’s side of the family had suffered recurrent
major depressions for many years. In view of this history, the son’s
symptoms, and the apparently stable family atmosphere, the son was
referred to a psychiatrist for a medication evaluation at the end of the
fourth family treatment session. The son was placed on an antidepres-
sant medication by the psychiatrist. The family continued in family
treatment that focused on helping the parents to protect and support
the son until it could be determined whether medication was or was
not helping.
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CONTEMPORARY FAMILY THERAPY

The son responded very favorably to the medication and reported

being free of symptoms five weeks after he started on medication. At
this time the family was given a second Zung (1964) Self-Rating of
Depression Scale test. The son scored 52 (minimal depression), the
mother scored 38 (normal) and the father scored 46 (normal) on the
depression inventory. To be noted is that at the second test, there was
a decrease of 35 in adolescent depression and also a decrease of 20 in
parental depression.

For the Jackson family, parental depression scores decreased in

conjunction with a decrease in adolescent depression. A different pat-
tern was observed for the three families suffering “can” level depression
who are discussed in the next section of this article. In existential
family therapy, it is believed that adolescent depression in “can” level
depression families is reactive to and signals a major structural and
communication problem within such families. “Can” level depression
is often labeled as “reactive” or “exogenous” depression in the mental
health literature (Frankl, 1955, 1978; Lantz & Thorword, 1985). The
adolescent in the Jackson family was apparently suffering from a type
of depression that was not reactive or exogenous in nature. His form
of “must” level depression is generally labeled as a “major” or “endoge-
nous” depression. In the three families suffering exogenous or “can”
level depression whose stories follow, a decrease in adolescent depres-
sion was accompanied by an increase in parental depression. Such data
suggest that exogenous or “can” level adolescent depression may often
be reactive to a structural or communication problem within the total
family, whereas endogenous or “must” level adolescent depression may
often be a function of the adolescent’s biochemical tendency toward the
development of a major or biochemical form of depression. Lowered
levels of depression were maintained by all Jackson family members,
and termination of family therapy occurred after 17 family sessions.
The son is still being treated by the psychiatrist and is taking antide-
pressant medications.

THE “CAN” DIMENSION OF FAMILY DEPRESSION

In Frankl’s (1955, 1969) dimensional ontology, the “can” dimension

of existence refers to those patterns of family life that “can” be affected
through will, freedom, responsibility, and choice. The “can” dimension
of family depression includes symptoms of depression that are reactive
 25

JIM LANTZ

to learned patterns of family interaction that “can” be changed through

reflection, practice, and will. Knowledge about the “can” dimension of
family depression includes the contributions of existential, structural,
behavioral, narrative, transactional, solution-focused, and psychoana-
lytic family therapy and can help family therapists and their clients
understand how patterns of family living often result in depression.
Family psychotherapy approaches focusing upon helping the family
or couple to challenge and change dysfunctional problem-solving and
interpersonal patterns can often be extremely effective with a couple
or family suffering “can” dimension depression. The following clinical
material illustrates how existential family treatment may be useful to
a couple or family suffering this type of depression.

The Smith Family

The Smith family requested treatment after their 15-year-old son

told the school guidance counselor that he was having problems study-
ing due to concentration difficulties, sleep problems, and a loss of en-
ergy. The counselor referred the total family for treatment. At the first
session the son scored 73 (severe depression), the father scored 53
(minimal depression) and the mother scored 38 (normal) on the Zung
(1964) Self-Rating of Depression Scale. After a few exploratory family
sessions, the therapist concluded that the son’s depression seemed
reactive to a family transactional process in which the parents chan-
neled marital conflict through their relationship with the son. The son
felt “trapped” in the middle and ended up feeling “disloyal” to both
parents. Intervention was directed toward helping the son to “stay out
of the middle” and toward helping the parents to manifest their marital
problems to each other in a clear, direct, and congruent way. The son’s
depression quickly lifted, and during the sixth family session, the family
members were again given the depression rating scale.
On test number two, the father scored 67 (marked depression), the
mother scored 79 (severe depression) and the son scored 51 (minimal
depression). These test scores reflected a decrease of 22 in adolescent
depression and an increase of 55 in parental depression. At this point
the focus of treatment changed, and both the therapist and the parents
concentrated upon improving the parents’ marital relationship. Good
progress was made and termination occurred after 13 sessions. At
termination the father scored 49 (normal), the mother scored 42 (nor-
mal) and the son scored 48 (normal) on the Self-Rating of Depression
Scale. The Smith family’s scores on the depression scale documented
an increase in parental depression following a decrease in adolescent
depression during conjoint family therapy. This was followed by a de-
26

CONTEMPORARY FAMILY THERAPY

crease in parental depression after the parents worked through some

of their marital difficulties.

The Jones Family

The Jones family requested family treatment after their 17-year-

old daughter overdosed on her mother’s blood pressure medication. The
family was referred for treatment after the daughter was released from
a medical facility. At the initial treatment session, the daughter scored
73 (severe depression), the mother scored 53 (mild depression) and the
father scored 36 (normal) on the depression inventory.
In the Jones family the mother and father had a distant marital
relationship and the mother used the daughter as a nurturing object.
She was unable to obtain this nurturing from her husband. The daugh-
ter’s role of “mother’s emotional caretaker” inhibited the daughter’s
ability to spend time with peers and also blocked her natural develop-
mental push toward autonomy and independence. Intervention focused
upon freeing the daughter from her pathogenic role and helping the
parents begin to reestablish mutual nurturing within their marital
relationship.
At the eighth family session, the family members were given test
number two. At this time Tina (the daughter) was beginning to distance
herself from her dysfunctional family role. Tina scored 51 (mild depres-
sion), the mother scored 82 (severe depression) and the father scored
68 (marked depression) on the depression inventory scale. Test number
two revealed a decrease of 22 in adolescent depression and an increase
of 61 in parental depression.
The family remained in treatment for a total of 16 sessions, and
at the time of termination, the father scored 39 (normal), the daughter
scored 32 (normal) and the mother scored 47 (normal) on the depression
inventory. Again in the Jones family, a decrease in adolescent depres-
sion coincided with an increase in parental depression at the time of
test number two. And once again, at termination test number three
revealed decreased parental depression that coincided with an im-
proved marital relationship and stabilization of a lower level of adoles-
cent depression.

The Hubbard Family

The Hubbard family requested treatment after their daughter com-

plained of energy loss, crying spells, and a sleep disturbance. The family
initially contacted their family physician, who referred them for fam-
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JIM LANTZ

ily treatment. In the Hubbard family, the daughter also performed the
family system role of being “mother’s emotional helper” in reaction to
the distant relationship between the parents.
On test number one, the daughter scored 71 (extreme depression),
the mother scored 56 (mild depression) and the father scored 47
(normal). Test number two was given during family session twelve
after the daughter had begun to have some success moving away from
her pathogenic role. On test two, the daughter scored 34 (normal),
the mother scored 66 (moderate depression) and the father scored 83
(marked depression) on the depression inventory. There was a decrease
of 38 in adolescent depression and an increase of 46 in parental depres-
sion on test number two. Termination occurred after 22 sessions. On
test number three the father scored 43 (normal), the mother scored
48 (normal) and the daughter scored 38 (normal). Again, the Hubbard
family demonstrated an initial increase in parental depression follow-
ing a decrease in adolescent depression. The level of parental depres-
sion then decreased following an improvement in their marital relation-
ship.

In the three previous “can” depression families, an adolescent fam-

ily member developed severe depression reactive to problems in the
parental relationship. In all three families, there was decreased adoles-
cent depression and increased parental depression when the adolescent
was helped to “stay out” of the parents’ marital problems (Lantz, 1978,
1993, 2000) and the parents began to challenge and change their mari-
tal difficulties. The three previously described “can” level depression
families are typical examples of families that develop a symptomatic
adolescent reactive to structural, interactional and/or communication
problems.

THE “OUGHT” DIMENSION OF FAMILY DEPRESSION

In Frankl’s (1955, 1997) “ought” dimension of existence, there is

a focus upon what the couple or family “ought” to do or is “called” by
life to accomplish and/or achieve. On the “ought” level of existence, the
couple or family is understood to be a recipient of “meaning opportuni-
ties” presented to the family by life (Lantz, 1993, 2000). An “ought”
dimension understanding of depression includes the awareness that
depression is sometimes a direct result of a couple’s or family’s avoid-
ance or repression of the “call of life” (Frankl, 1955, 1997; Lantz, 1974,
1993, 2000). In such a situation, the couple or family develops an
28

CONTEMPORARY FAMILY THERAPY

existential-meaning vacuum that becomes filled with symptoms of de-

pression reactive to the family’s failure (i.e., bad faith) to respond to the
call of life and to the meaning potentials and opportunities presented by
life (Frankl, 1975, 1997; Lantz, 1974, 1993, 2000). In Frankl’s (1975,
1997) dimensional ontology, finding the “oughts” in a family’s life can
prevent the occurrence of some depression and can often help the couple
or family to overcome the symptoms of depression that grow and flour-
ish in an existential-meaning vacuum. This author believes that only
existential family therapy and its practitioners have shown an ade-
quate interest in helping depressed couples and/or families to notice
and respond to the meaning potentials and opportunities in life and
exploring how this approach can be helpful in the treatment of depres-
sion. This existential family therapy approach to the treatment of
“ought” dimension depression may be described as existential reflection
directed toward discovering Frankl’s “unconscious ought” (Lantz,
1993). The following clinical material is presented to illustrate “ought”
dimension family depression and its treatment.

Mr. and Mrs. Sampson

Mr. and Mrs. Sampson requested clinical services after the death
of their son from an AIDS-related illness. Mr. Sampson indicated that
he was having problems sleeping “because my conscience is bothering
me.” Mrs. Sampson stated she was worried about her husband. Mr.
Sampson explained, “I kicked my son out of the house three years ago
when he told me he was gay. Knowing my son was gay was a big shock.
I didn’t handle it well.” Mrs. Sampson reported that she, her husband,
and the son had eventually reconciled and that the son had lived at
home for “the last three months of his life.”
Mr. and Mrs. Sampson both said they felt proud they had “been
there” for their son when he was dying. The couple also reported that
they were “fools” to have “kicked him out of the house,” and that they
would always feel guilty about their “ignorance.” They stated they had
“lost a year and a half” with their son because of their “ignorance,” and
now that the son was dead they would “give anything to get that time
back.” Mr. Sampson reported that he could not sleep at night because
he kept thinking about his “mistake.”
In this situation the existential family therapist initially encour-
aged the couple to talk about their tragedy and their feelings about it.
The therapist was very careful not to give advice and simply listened
to the couple until they felt comfortable that the therapist had some
understanding of their feelings. It was only after the therapist was
assured that the couple had perceived him to be an empathic person
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JIM LANTZ

who had worked hard to understand them that the therapist was willing
to give the couple a suggestion.
When empathic trust had been developed, the therapist asked the
couple how they might feel about giving talks about “the mistake” to
other parents—those who had recently discovered their son or daughter
to be lesbian or gay. They initially felt uncomfortable with this idea,
but as time went on, decided it was a “really good idea.” The couple
felt this suggestion gave them a way to “help others” and “help turn a
mistake into something useful.” Mr. and Mrs. Sampson were linked
with a gay rights organization for volunteer work and were also pro-
vided with support and training in their public speaking activities. By
the time this article was written, they had shared their experience and
“mistake” in over 50 speeches. Also, Mr. Sampson no longer experiences
difficulty sleeping.

The Roberts Family

Mr. and Mrs. Roberts were referred for treatment by Mr. Roberts’
oncologist. Mr. Roberts had throat cancer and could no longer eat solid
foods. His feeding process was considerably less than dignified. Mr.
Roberts reported that he obsessed about solid food, and Mrs. Roberts
reported that “it gets to me that he cannot even enjoy his food.” For
over 40 years the members of the Roberts family had been sitting down
at the dinner table and “sharing bread.” The family had abandoned
this activity reactive to Mr. Roberts’ inability to eat solid food.
In this family the members had always used the family dinner as
a ritual to signify, share, and experience meaning. With the loss of this
ritual, the family experienced an emptiness in their daily life. They
experienced an existential vacuum. The existential family therapist’s
task with the Roberts family was complex. One part of the task was
to help the family create a new ritual that family members could use
to share and experience meaning. After the Roberts family replaced
the dinner ritual with poker parties and the game of “fish,” Mr. Roberts
reported that he no longer was “obsessing about solid foods.” Replacing
the lost ritual helped the family discover the family “ought” of celebrat-
ing the closeness and love that they had shared over the past 40 years
as Mr. Roberts approached his death.

The Jabco Family

Mr. Jabco was brought for admission to a psychiatric hospital by
his adult son and daughter. His presenting problem was labeled as a
“biological depression” by his psychiatrist and the hospital treatment
team. Mr. Jabco was 68 years old. The onset of his depression occurred
soon after he had lost his wife to her year-long fight with cancer.
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CONTEMPORARY FAMILY THERAPY

Mr. Jabco had retired one year prior to his wife’s death only to
discover that his first year of retirement would be spent helping his
wife deal with her deadly disease. Mr. Jabco had never suffered with
depression before, and there was no history of depression in his family
of origin. Both the son and daughter reported that they were “frantic”
because Mr. Jabco had said he was thinking about killing himself. The
son and daughter did not want to face the death of both parents. Both
the client and his children reported that Mr. Jabco had not been de-
pressed while his wife had been alive.
In spite of the fact that Mr. Jabco exhibited some of the classical
symptoms of a biological depression (energy loss, suicidal thinking,
crying spells, and sleep disturbance), he was not suffering from merely
biological (“must” level) depression. In this clinical situation, Mr. Jabco
was also suffering from an existential vacuum. Mr. Jabco and his chil-
dren had suffered a tragedy. When Mr. Jabco was provided an opportu-
nity to discuss, explore, and challenge the meaning vacuum he was
experiencing reactive to the family tragedy, Mr. Jabco was able to
overcome his depression. His children were also able to overcome their
feelings of anxiety.
Mr. Jabco and his adult children were seen together by a family
therapist in a conjoint family interview at the request of Mr. Jabco’s
psychiatrist. During the initial family interview, Mr. Jabco reported
that he and his wife had been looking forward to his retirement with
great expectations of having fun through both travel and cultural activi-
ties. Mr. Jabco reported that for him retirement was now “empty” and,
as far as he could see, so was the rest of his life. He indicated that he
wanted to die so that he could again see his wife “in heaven.” Mr. Jabco
believed in an afterlife and felt that life on earth could not be meaningful
without his wife. He was not aware of what life might be calling him
to do on the “ought” level of existence.
The family therapist asked Mr. Jabco exactly what he and his wife
had planned to do and see after his retirement. Mr. Jabco explained in
great detail the plans he and his wife had made and the cultural activities
they had hoped to experience. Mr. Jabco reported that his wife had always
wanted to visit her relatives in Italy. He sobbed as he explained how
unfair it was that his wife would not get to have this visit.
At this point, the family therapist asked Mr. Jabco, “Do you think
your wife will be disappointed in not getting to hear about your trip
to visit her relatives in Italy or your experience of the other activities
you and she had planned?” Mr. Jabco immediately stopped sobbing.
He remained silent for a few minutes and stared directly at the family
therapist. He then laughed and stated, “I always did want to be a
reporter.” He also told the family therapist, “That is the kind of question
that shocks you into seeing a good reason to keep on living.”
At the next family interview, Mr. Jabco reported that he had
 31

JIM LANTZ

stopped having crying “attacks,” that his food tasted better, that he
was sleeping well, and was getting his energy back. He added, “Killing
myself seems like a very bad idea now; I want to get out of this hospital
as soon as possible so I can get on with my retirement.”
Both adult children reported that they felt much better and be-
lieved that the family therapist had performed “magic.” The family
therapist thanked the son and daughter for the compliment, but said
there is no magic in helping an individual remember that their relation-
ship with someone they love can still be meaningful after death.
The existential questions used in this clinical illustration were
based upon the beliefs and values of the family. Mr. Jabco and his
children believed that Mr. Jabco would see his wife again after his
death. They also believed that action and behavior are only meaningful
if done in a transcendent way for the benefit of those one loves.
The “Existenzanalyse” question used by the family therapist
helped Mr. Jabco to see that he could go on living and enjoy his retire-
ment in a way that was giving to his wife and compatible with the
beliefs and values of the family. It allowed him and his children to see a
meaning potential in retirement that they had not been able to perceive
previously on a conscious level of awareness. Mr. Jabco is presently
enjoying his retirement, visiting his children on a frequent basis, and
has had no recurrences of depression.

CONCLUSIONS

In existential family therapy, it is believed that Viktor Frankl’s

dimensional ontology can be used as a framework to ensure that fami-
lies suffering depression will be treated in a wholistic manner. Within
this framework, family depression is understood to include three levels:
the “must” (biological), “can” (interactional), and “ought” (existential)
dimensions of family existence. Numerous case examples have been
presented to illustrate the treatment of family depression on all three
levels of existence.

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Frankl, V. (1969). The will to meaning. New York: New American Library.
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