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Home » All, Health, Home and Family, Positive Feelings

Putting the “Positive” Back into Psychotherapy

By on March 25, 2009 – 1:53 am  8 Comments

Laura L.C. Johnson, MA, MBA, LMFT, LPCC is a Cognitive Behavior Therapist and the founder and executive director of the Cognitive Behavior Therapy Center of Silicon Valley and Sacramento Valley. She integrates positive psychology with cognitive behavior therapy and schema therapy, which have been shown to be effective for a wide variety of problems in hundreds of studies. Her clients learn skills to build positive emotions, optimism, and resilience while decreasing unhelpful thinking, behaviors, and emotions. Full bio. Laura's articles are here.



Editor’s Note: This is Laura’s first article.  Welcome to PPND!

I look forward to the day when the word “positive” is no longer needed to describe psychology or psychotherapy because the association will automatically be there.  How is the field of psychotherapy integrating with the positive psychology movement to re-gain its original focus on helping people to achieve their potential? As a therapist, I am interested in helping my clients using the latest research.

Psychotherapy: The Once and Future Flourishing

Chaise PPT PPND happinessIn the last 60 years, psychotherapy has come to be associated with pathology and a “fixing” framework of healing the pain and trauma of the past while life coaching (when it has been linked to research) has been more closely linked with the positive psychology movement by focusing on personal growth and actionable outcomes for the future. I have heard people say therapy takes the client from –10 to 0 and coaching takes them to +10. As other PPND writers have noted, Seligman wrote that “before World War II, psychology had three distinct missions: curing mental illness, making the lives of all people more productive and fulfilling and nurturing high talent.” With the economic incentives made available for research on curing mental illness, the later two goals of helping people flourish fell away until the past decade, when Seligman launched the positive psychology movement at the 1998 American Psychological Association convention in San Francisco.

Client as the Agent of Change

Change PPT PPND happinessWhile research indicates that psychotherapy is effective and all modes of psychotherapy work equally well, Miller and his team at The Institute for the Study of Therapeutic Change indicate the evidence shows that client factors, or the resources and strengths the client already holds, account for 87% of change. Recalling the work of Carl Rogers focusing on people’s innate ability to know what is best for themselves (the “orgasmic valuing process”), authors Joseph and Linley write in their positive psychology and therapy handbook, “the positive psychology movement is supportive of those therapeutic approaches which serve to facilitate the client’s ability to hear their own inner voice.”

New Positive Therapy Approaches

A positive therapy movement has been emerging under different names including Positive Psychotherapy (Seligman, Rashid & Parks, 2006), Well-Being Therapy (Fava, 1999), Quality of Life Therapy (Frisch, 2006), and Hope Therapy (Cheavens, Feldman, Woodward & Snyder, 2006), to name just a few, as well as approaches integrating positive psychology with cognitive-behavioral therapy (Ingram & Snyder, 2006). While not directly based on positive psychology interventions, approaches like Solution-Focused Brief Therapy and Narrative Therapy also take a strength-based approach. With positive therapy approaches, therapists are helping both clinical populations with a diagnosable mental disorder as well as non-clinical populations not just to reduce discomfort, but also to significantly increase well-being, that is, to get from anywhere to +10.

Three Sets of Results

  1. Balance PPT PPND happinessPositive psychology interventions for depression. In the first large randomized control trial of positive psychology for people with clinical depression, researchers delivered positive psychology interventions over the Web to almost 600 people (Seligman, Steen, Park, & Peterson, 2005).
    • The study found that two exercises – using signature strengths in a new way and three good things – increased happiness and decreased depressive symptoms for six months while the gratitude visit caused large positive changes for one month compared to the placebo control exercise – writing about early memories – which had positive but transient effects.
    • In two face-to-face studies of group and individual positive psychotherapy (PPT), researchers tested PPT by using techniques to help depressed clients develop positive emotions, engagement and meaning (Seligman, Rashid, & Parks, 2006; pdf here).
  2. Group positive psychotherapy (Group PPT). Group PPT was delivered to 40 mildly to moderately depressed students and included six weekly exercises: using your strengths, three good things/blessings, obituary/biography, gratitude visit, active/constructive responding and savoring.
    • Group PPT clients experienced a Beck Depression Inventory score reduction of 0.96 points per week, which was significantly greater than that of control clients. In addition, substantial symptom relief lasted through one-year follow-up with the PPT participants scoring, on average, in the nondepressed range, whereas controls remained in the mild-to-moderate range.
  3. Individual positive psychotherapy (Individual PPT). Recently, 46 adults with major depression completed a 12-week course of individual PPT sessions. Sessions included psychoeducation, discussion, exercises and homework on such themes as positive resources, signature strengths, positive emotions, good vs. bad memories, forgiveness, gratitude, satisficing instead of maximizing, optimism and hope, love and attachment, family tree of strengths, savoring, gift of time, and, finally, integration of all the concepts with a focus on the full life.
    • Individual PPT had larger effect sizes of between 1.03 and 1.41, on four kinds of outcome measures including depressive symptoms, global improvement, happiness and well-being, and remission, compared to the other two treatments.

Positive Therapy and the Future

Future PPT PPND happinessWhile the research is preliminary and needs to be replicated, it is promising to see the progress in putting the “positive” back into psychotherapy, and in returning psychology to its roots as a science to understand and build the factors that allow individuals not just to heal from mental illness but to also flourish and live the full life. In future articles, I will review some of the newer positive therapy approaches and interventions mentioned above in more detail.

 


 

References:

Cheavens, J.S., Feldman, D.B., Woodward, J.T. & Snyder, C.R. (2006). Hope in cognitive psychotherapies: On working with client strengths. Journal of Cognitive Psychotherapy, 20, 135-145.

Fava, G. (1999). Well-being therapy: Conceptual and technical issues. Psychotherapy and Psychosomatics, 68, 171-179.

Frisch, M. B. (2006) Quality of Life Therapy: Applying a Life Satisfaction Approach to Positive Psychology and Cognitive Therapy. New Jersey: Wiley & Sons.

Ingram, R.E. & Snyder, C.R. (2006). Blending the good with the bad: Integrating positive psychology and cognitive therapy. Journal of Cognitive Psychotherapy, 20,117-122.

International Coach Federation – how Coaching and Therapy are different

Joseph, S. & Linley, A. (2005). Positive psychological approaches to therapy. Counseling and Psychotherapy Research, 5, 5-10.

Seligman, M.E.P., Rashid, T. & Parks, A.C. (2006). Positive psychotherapy. American Psychologist.

Seligman, M.E.P., Steen, T.A., Park, N. & Peterson, C. (2005). Positive psychology progress: empirical validation of interventions. American Psychologist, 60, 410-421.


Solution-Focused Brief Therapy

Talking Cure

Images:
Squint Chaise by boopalina + bebe™ | eco modern baby design™
Time for Change by David Reece
Balance by Pink Sherbet Photography
Its Future is in our Hands – Live Earth by aussiegall

8 Comments »

  • Senia Maymin says:

    Laura! Delighted to see an article on therapy and positive psychology. Look forward to hearing more.

    That’s why I love research so much. Interventions like your three examples can be shown and compared using the randomized control gold-standard. Love it. Thank you.

    Senia

  • Todd Kashdan says:

    Nice details. I thought you did a splendid job of conveying complex research in simple terms. A skill most people don’t possess.

    Quick thought. From my reading of the literature, there is only one client trait (not counting disorders) that consistently predicts tx outcomes. That is, the clients’ perception of the therapists’ efficacy. Speaks volumes about the importance of psychoeducation and clearly defining the parameters of what is going to be done and what the data say and don’t say (no false expectations). So I am a bit baffled by this single finding by the Institute of Change that 87% of the variance in tx change is due to client factors. Can you flesh this finding out?

    thanks,
    Todd

  • Kathryn Britton says:

    Todd,

    Interesting question. But isn’t a client’s perception largely a client factor? There are all sorts of prior perceptions and the interpretations that the client puts on them that shape what he or she will experience with the current therapist?

    Welcomd Laura! It’s so good to have new voices from different perspectives join in.

    Kathryn

  • LeanRainmakingMachine says:

    Laura:
    This is fascinating. Thanks for the info in such a clear style.
    Is there a way to compare these results with results from Cognitive Therapy and traditional therapeuticic interventions? In other words, what are the Beck results for other forms of intervention, and what measures of the tenacity of the results exists (if any)?

  • WJ says:

    Laura, Like Todd I’m a little baffled by this. The research I have seen suggests that its the perception of efficacy that matters.

  • Laura says:

    Hi Todd and WJ, From what I understand, the client factors includes the client’s perception of the therapist’s efficacy and how much the therapist’s orientation fits their own view of change. On the Institute for Therapeutic Change’s website, it says “the client view of the presenting complaint, potential solutions, and ideas about the change process form a theory of change that can be used as the basis for determining, which approach, by whom, would be the most effective for this person, with that specific problem, under this particular set of circumstances. This same research shows that the probability for success is greater when the treatment offered fits with or is complementary to the client’s theory.” This seems consistent with Kathryn’s comment.

  • Laura Johnson comment in response to Todd Kashdan (also blocked by the spam filter, which is why I’m posting it.)

    Thanks for your feedback, Todd.

    On the Institute’s research page, they state, “the client view of the presenting complaint, potential solutions, and ideas about the change process form a ‘theory of change’ that can be used as the basis for determining, which approach, by whom, would be the most effective for this person, with that specific problem, under this particular set of circumstances. This same research shows that the probability for success is greater when the treatment offered fits with or is complementary to the client’s theory.”

    It sounds like if the therapist’s approach is consistent with the client’s “theory of change” and expectations about therapy, then the the client will have a more positive view of the therapist’s efficacy, thereby leading to more positive treatment outcomes.

    I sent an e-mail to the Institute for the Study of Therapeutic Change to get more clarification on your question. I will post a reply when I hear.

    Laura

  • Another Laura Johnson comment – to LeanRainmakingMachine,

    LeanRainMakingMachine,

    The PPT study did compare PPT to TAU “treatment as usual” which was represented by an eclectic and integrative therapy. As described in my summary, PPT had superior outcomes compared to traditional therapy. I did not come across a direct comparison of PPT to cognitive therapy. In a future article, I will be writing about how positive psychology is being used to enhance cognitive behavioral therapy. Laura

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