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Logotherapy: A Humanistic Group Therapy for Depression in Male Adults with Lower
Socioeconomic Status
Jeffrey W Gross, SAC-IT
The Wisconsin School of Professional Psychology
Course #783: Group Psychotherapy and Practicum
Dr. Samantha Washington
November 30, 2023
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Abstract
Logotherapy is an existential therapy created by Viktor Frankl that focuses on meaning as the
source of treatment. This paper will identify and examine the existential need for meaning in life,
providing the neural correlates of meaning and why this treatment works metaphysically,
biologically, and practically. The proposed logotherapy group will use the Purpose-in-Life (PiL)
test and the Beck Depression Index (BDI) for measures during the group to obtain the efficacy of
the group. The group adaptations include motivations, specific psychoeducation, and life skills
for the demographic of adult males in a lower socioeconomic status.
Keywords: existential, Logotherapy, meaning, depression, socioeconomic status
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Logotherapy: A Humanistic Group Therapy for Depression in Male Adults with Lower
Socioeconomic Status
Logotherapy is a meaning-oriented therapy developed by Auschwitz Survivor Dr. Viktor
Frankl (1955), initially prepared for an individualistic modality of treatment. But, for the
purposes of this group, it will be the foundation for group work. While the definition of the
construct of meaning is essential, what is more critical for Frankl is where meaning is to be
found. Frankl highlights three potential sources for finding meaning but more or less posits them
as "can" be found here—the search for meaning providing importance to meaning itself.
Merriam-Webster defines "meaning" as an implication of a hidden or special
significance (Merriam-Webster, 2023). Meaning as a construct derived from Logotherapy can be
operationally described best as a pathway to ameliorate pain and suffering by providing an
intrinsic light or a means to transcend suffering, which has been shown in Logotherapy to reduce
symptoms of depression (Robatmili et al., 2014). Yalom (2001) posits that a human life without
existential meaning can be very unsatisfactory, leading to a precondition of major depression.
The Western world identifies with the " happiness " construct and uses popular self-care
methods rather than delving into what self-care means. The real problem with "happiness" is
that it is not easily sustained during complex and challenging epochs of life. Identifying
meaning through difficult times can provide a basis for investment into the future. In the
Biblical corpus, we see text (Scripture) that describes why we might travel through difficult
times. "Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and
the God of all comfort, who comforts us in all our troubles so that we can comfort those in any
trouble with the comfort we receive from God (2 Cor 1:3-4, NIV). Here, we see that suffering is
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provided with a "future," meaning that the suffering we travel through will be used to comfort
others.
Group Logotherapy is uniquely positioned to provide a unique and novel template of care
for those suffering from depression. With a group modality, the group can set a precedence for
accepting and normalizing human problems. According to Uemura (2018), we can discover
meaning simply by being together, and through meaningful relationships, we can extrapolate coexisting values, enhancing the concept of meaning.
Etiology of Depression
Since the dawn of recorded time, humans have described a type of pain that strongly
impacts everyday well-being. According to Tossani (2013), mental pain is no less real than
physical pain, yet it gets less attention, and the major problem is in its conceptualization and
operational definition. The outcomes of mental pain can range from mild frustration to suicide
ideation, including suicide itself. The assessment of mental pain and descriptors are much more
convoluted to explain, and measures of pain rely heavily on language model self-assessments
and projective tests in the clinical setting.
According to APA (2023), depression is defined as extreme sadness or despair that lasts
longer than "days." The information described within the portal is vague and represents more
breadth than specificity. To be clinical depression, it has to interfere with daily life and fit
"typical" symptoms or descriptors, which may make it challenging to apply cross-culturally. The
concept of meaning, however, allows each participant to utilize their own meaning to transcend
their suffering, reducing mental or physical pain.
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Rationale for Logotherapy with Clients Suffering from Depression
In describing the concept of mental pain and anguish brought on by depression, an
antidote is sought, and the antidote needs to be something that transcends anguish, something
more metaphysical. The American Psychological Association (APA) defines hope as the
expectation that one will have positive experiences or that a potentially threatening or harmful
situation will not materialize or will ultimately result in a favorable situation (APA, 2023).
In the research published by Richter (1957), a relationship of hope is derived through an
arguably unethical experiment that used rats to understand survival instincts surrounding own
free will and minuet comfort. What they found was that rats will give up (and die) when placed
into a pool (a glass) of water in about 5-10 minutes, and then with a second group, the
experimenters will grab them up before death, holding them for a minimal amount of time, then
placing them back in the water, finding them able to swim for upwards of 81 hours.
Neural Correlates Used in Meaning
Viktor Frankl suggests that having meaning in life is being aware of the overriding goals
of one's life. That meaning adds purpose to everyday living and is our primary motivational
force in humans (Frankl, 1972), confronting both Freud's and Jung's primary motivations in life.
One could posit that Jung has a similar understanding but in a more abstract, metaphysical way
(Jung, 1983).
The meta-construct of meaning can be derived from a syncretization of the Jungian
archetypes and the functions of the unconscious and the neurological findings (Jung, 1960; Jung,
1923; Jung, 2012). The Orienting Response (OR) neuro-geographically found by Sokolov could
be described as “meaningful engagement” with "what" you are doing, “is” the
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psychophysiological marker, that you are acting in a way that takes all the stacked
representations into account simultaneously (Peterson, 1999).
The response to novelty has its indicators within what Sokolov tested in
hyperpolarization, stabilization, and depolarization (Sokolov, 1975). The response is central
nervous system behavior (CNS), which changes how we view the world and provides motivation
to move forward (Sokolov, 1975; Bradley, 2009). This means that if a meaningful and novel
stimulus can be introduced, behavior changes and mood can be altered positively, providing hope
for the future. The brain connects stimuli to novelty through a “remembering” of the past. The
neural correlates used to remember the past are used to "create" the future, or potential futures,
allowing us to see possible future events (Schacter et al., 2007). We can think of this as if the
brain is creating multiple avatars of our future selves, then interpreting or burning away
potentials that are conceptualized as wrong or not fitting to its conceptual schema, which may be
self-defeating unless other tools can be used to perpetuate growth.
With the help of Gray (2003), we can say that what people are trying to do by considering
all things simultaneously is that we are trying to find out where we are, say in a room, but that
may only be a single construction of perception based on one complexes (to use Jungian
thought). However, the schema is not as simple as one "thinks"; it is more like a nesting doll, a
subset of many subsets that interact with other lenses of interpretation. From this, we can use the
term microcosm to illuminate the display, meaning that how we orient is a sub-tapestry to how
humans derive meaning. We cannot derive where we are in the room from perception; instead,
how we orient ourselves is based on engagement.
Integrating the habituating system of the OR would activate a fundamental motivational
system that has evolved to support survival and evolution (Bradley, 2009). The activation of this
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system would provide a perceptual framework to re-interpret the world. The OR is our internal
investigation system that detects anomalies in patterns and refocuses according to the habituation
of novelty (Peterson, 1999). The focus or Frankl's basic assumption of "the meaning of life"
considers two points, ultimate meaning and situational meaning, and these meanings may
suggest potential or discovery of potential, which in some could be an orienting response, in and
of itself.
Cultural and Demographic Considerations
Regarding multicultural and demographic considerations, the modality of Logotherapy is
positively inclusive. Through various cultures and demographic considerations of age and sex,
meaning is internal and fluid in some respects, and Logotherapy is Humanistic at its core.
Humanism provides for the precondition of individual thoughts and belief structures, such that
any individual's hierarchy is respected and otherwise broadened, the internalizing structures that
govern meaning a preferential to the individual's background and identity.
The ground rules must be established to govern respect for everyone's cultural and
demographic identities. These therapeutic factors are noted in Yalom's 11 essential principles,
which are bridged between all principles and required for the group to effectively set a
precondition for change (Yalom & Leszcz,1970/2020; Strobbe, 2020).
Long-term Efficacy
The long-term efficacy of the proposed group for adult males with depression hinges on
the ability to produce and instill long-lasting change through the axioms of meaning within their
lives. To validate the long-term impacts and future group offerings, this group facilitator will
assess the efficacy through pre- and post-self-report measures to elucidate findings relative to the
effects on individuals' well-being from the constructs listed in this paper.
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Methodological Details
The proposed group intervention will consist of weekly 90-minute sessions spanning over
eight weeks. These sessions will incorporate the core principles of Logotherapy, tailored
explicitly to male adults with depression. Integrated Socratic and gestalt techniques will be
integrated at the facilitator's discretion depending on participants' understanding of the core
curriculum outlined in the designed Logotherapeutic sessions. The intervention will remain
structured yet flexible, discerning operational linguistics amongst the broadly determined yet
culturally sensitive integrated persons. No specific race or culture is identified for unity and
higher functioning goals. These higher-functioning goals are born from uniting individuals with
different perspectives to share a common existential goal.
The integration or the potential use of Gestalt Principles will be used at the facilitator's
discretion to raise awareness and provide a holistic understanding of the concepts. Aspects like
awareness and holism will provide the precondition of truth and strengthen operation pictures or
schemas required for Logotherapeutic interventions (Austin & Austin, 2022).
Participants
The intervention is designed for male adults aged 25-55 diagnosed with moderate to
severe depression who are also in a lower socioeconomic status group. The geographic location
will define the socioeconomic group criteria and identify a population percentage to run the
group effectively and ethically.
According to the identified themes from Niemeyer and Knaevelsrud (2022), Levi et al.
(2018) Heidenreich et al. (2021), The implementation of a Logotherapeutic group for individuals
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with lower socioeconomic status (SES) is strongly justified by the existing disparities in therapy
access and effectiveness for this demographic, as evidenced by research showing that lower SES
individuals face significant barriers to receiving therapy and exhibit different outcomes in
treatment compared to higher SES groups. Logotherapy's focus on existential themes, such as
meaning-making and confronting life's inherent challenges, is particularly pertinent for lower
SES individuals who often grapple with existential crises and cognitive and emotional
impairments related to poverty. Additionally, the comprehensive approach of Logotherapy,
which addresses not just symptoms but the broader existential and psychological needs, aligns
with the complex needs of lower SES individuals, making it an apt therapeutic choice for
facilitating meaningful psychological support and growth.
The inclusion will include a clinical diagnosis of depression, as defined by the DSM 5 TR (APA,2022). Exclusion criteria will consist of severe psychiatric diagnoses that would require
a different therapeutic approach than the designed Logotherapy group, for example, severe
bipolar disorder or schizophrenia. Substance abuse disorder would also hinder the effectiveness
of the designed curricula.
The ideal group size is between 8 and 10; this would allow for meaningful interaction and
group cohesion, identified in Yalom's therapeutic factors (Yalom & Leszcz, 1970/2020). This
group's aim for diversity will include differing socioeconomic status, ethnic backgrounds, and
life experiences to enrich group discussion and perspectives.
Rationale for Measurement Tools for Outcomes
While the research surrounding existential measures is limited, strong empirically
oriented self-report measures have been created and validated to discern the tested constructs.
One measure that was researched provided a multidimensional level of analysis, including
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subjective characteristics of suffering, personal responses to suffering, and meaning to suffering.
While this measure did show efficacy to validity constructs being tested, it was rather
cumbersome and did not fit the group's needs.
According to Schulenberg et al. (2010), the short form of the Purpose in Life Test is a
meaningful measure supported by factor analysis to provide reliable scores based on the
correlationally significant measures used to determine meaning in life. The test assessed
perceived meaning and life purpose, providing a relationally constructed verifier to Logotherapy
and Group Logotherapy. The Meaning in Life Questionnaire and the Noetic Goals Test were
also tested for construct validity.
The other test being incorporated into this group to assess the efficacy of the treatment of
depression is the Beck Depression Inventory (BDI). The validity and reliability of this measure
have been verified in multiple journals and remain one of the gold standards in research for
symptoms of depression (Richter et al., 1998). During the group, both of these measures, the PiL
and the BDI, will be used before treatment, in the middle, and post-treatment. Then, a thirty-day
treatment survey will be added to check how well the treatment modality affected symptoms and
self-reported purpose in life.
Implementation of Logotherapy Group Intervention
The implementation of themes to group sessions underlines and superfluous the idea of
meaning being brought forth or becoming, using the build-up of meaning as orienting
habituation. The idea of themes is paralleled in Somov's use of Logotherapy for treating
substance abuse (Somov, 2007). The sessions will last 90 minutes and travel through 10 themes
in eight weeks. The sessions will build from Frankl's axioms of meaning and the three pathways
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to meaning: creative values, experimental values, and attitudinal values (Frankl, 1955).
Adaptations will include diverse videos and exercises to inspire representation and story.
Sessions Outline
Appendix 1
Logotherapy Group Therapy.docx
Theme 1: Meaning of Meaninglessness
Theme 2: Meaning of Adversity: What is the Meaning of Pain and Suffering?
Theme 3: Meaning of Self: Who/What am I?
Theme 4: Meaning of Presence
Theme 5: Meaning of Death: Where am I Going?
Theme 6: Meaning of Freedom: Am I Free?
Theme 7: Meaning of Love
Theme 8: Meaning of Work or Responsibility
Theme 9: Meaning of Depression
Theme 10: Meaning of Dualities
Logotherapy offers a platform for transcending suffering via meaningful engagement
within the self and interpersonally with the group. Today's society has a higher orientation
towards individual consciousness, neglecting deeper aspects of meaning (Fabry, 1988). The
orientation toward a meaningful goal or new and improved avatar of the self-will could provide a
significant stimulus capable of triggering an orienting reflex (Bradley, 2009; Moscovitch et al.,
2023; Hobson & McCarley, 1977).
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Potential Benefits and Challenges
Logotherapy provides a platform that can be beneficial and transcend suffering while
being sustained. Still, in today's society, there can be a stronger orientation to the individual's
consciousness rather than something deeper (Fabry, 1988). This critique can be just that: a deep
sense of meaning can be derived from one's ability to strategically think through what meaning is
and where "awe" comes from. While the world is developing into a more self-centered framing,
a new orientation can be created, and some might posit that a new orientation is something novel,
inhibiting higher synchronicity towards a meaningful stimulus. A significant stimulus has the
potential to reign in an orienting reflex that also requires novelty (W.E., 1968; Bradley, 2009).
For instance, an atheist "could" activate an orienting reflex without the confines of a deity
or transcendent being. As some psychoanalysts might put it, a future avatar of the self could be
created, an ideal self-actualized self (Yaremko et al., 1972). This barrier and opportunity to not
be localized to a type of believer only provides context around the construct of what is deemed
meaningful or otherwise. Frankl deliberately separates religion and spirituality from meaning,
suggesting that priorities are the phenomenon, providing a pathway for the atheist, but still
emphasizing that spirituality and religion help people to find meaning (Baumel & Constantino,
2020; Okan & Eksi, 2017).
According to Tarkkala and Snell (2022), the science and science policy in this timelimited window could be beneficial to activating urgency in an ever-so-changing environment.
In this technology or technique, metaphors are used, and the closing window effect creates or
inspires innovation and competitiveness, which talks of values or spirituality can elucidate. This
opportunity window can provide a meaningful infusion of responsibility and direction.
CBT intervention and the integration of logotherapy technologies
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Research has been done within various modalities looking at the efficacy of incorporating
Logotherapy as an enhancer to Cognitive Behavior Therapy (CBT) models. Later in his life,
Viktor Frankl noted that the open Logotherapy system could be combined with other
psychotherapeutic orientations, providing higher attachment learning (Frankl, 2004).
According to Ameli and Dattilio (2013), the existential component of Logotherapy is
highly complementary to the techniques used in the cognitive behavioral therapy treatment
model. One approach highlighted in this research was incorporating the exposure procedure,
which motivated the clients to face their fears and anxieties. The second technique that was
helpful was facilitating perceptual shifts and actions by eliminating excuses rooted in prior
schemas.
Feedback Mechanisms
A feedback mechanism the facilitator may employ could be using the Socratic dialog
(S.D)., a method found to be effective in CBT that explores the complexities hidden in particular
thoughts and behavior (Mohammed, 2022; Kazantzis & Hofman, 2018). Encouraging group
cohesion can set the preconditions needed for multiple viewpoints to be thought over and
discussed, inciting opportunities for new input and ways of looking at the world, which inspires
hope (Copic,2011; Scoli,2020).
Ethical Considerations
For this group, ethical considerations like informed consent and confidentiality should be
at the forefront, as informed consent would travel through the risks and benefits of the treatment
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modality itself and provide an understanding of what Logotherapy is and the potential constraints
if confidentiality is not a primary focus of the group due to its delicate meaning orientation.
Conclusion
Given the increasing unique mental health needs of 2023 and the current zeitgeist, the
proposed Logotherapy group intervention could be a timely and relevant addition to mental
health services for this demographic. Further data will be required from the groups to ascertain
the locational features regarding the culture and efficacy of the proposed therapy type. Different
self-report measures could be defined as a form of contemplation for the individual and allow the
group facilitator to understand the needs or functions of future groups. This could mean adding
the measure around a construct of hope, a guiding force identified in the transcendence of pain
both existentially and from a neurological perspective (Vedrana et al., 2011; Berkman, 2018;
Gottschalk et al., 1993). A psychoeducation portion of the therapy could be beneficial to afford
clients' buy-in to the treatment modality. Moreover, higher-yielding cultural considerations
should be employed in the axiomatic presuppositions of Logotherapy and its formatting.
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