Changing “What’s Wrong?” to “What’s Strong?” (Part 1 of 2)

Bridget Grenville-Cleave, MAPP graduate of the University of East London, is a UK-based positive psychology consultant, trainer and writer. She is author of Introducing Positive Psychology: A Practical Guide (2012), and The Happiness Equation with Dr Ilona Boniwell. She regularly facilitates school well-being programs and Positive Psychology Masterclasses for personal and professional development. Find her on LinkedIn, Facebook and Twitter @BridgetGC. Website. Full bio. Her articles are here.

Introductory classes in positive psychology often differentiate it from “psychology as usual” by arguing that the latter operates in the disease or deficit model whereas positive psychology operates in the health model. In other words, positive psychologists say that traditional psychology, especially clinical psychology, is concerned by and large with diagnosing mental disorders such as anxiety and depression, and is primarily focused on finding out what’s wrong with people in order to come up with a solution. Positive psychology, on the other hand, focuses on optimal functioning, in other words, what’s right with us, what enables us to live fulfilling, happy lives, bounce back from adversity and perform well whether at home, school or work.  Whether or not it’s that clear-cut, it’s helpful to explore what positive psychology can bring to the traditional psychology table.

It’s with this in mind that Tayyab Rashid of the University of Pennsylvania and Robert F. Ostermann of Farleigh Dickinson University put positive psychology, and in particular strengths-based approaches, into a clinical context, providing a compelling argument for clinicians to consider using strengths in their assessment of clients. In their paper, “Strength-based Assessment in Clinical Practice,” they outline:

• The benefits as well as shortcomings of the “deficit–oriented approach”
• A strength-oriented assessment and what it might look like, and finally
• 10 ways to incorporate strengths into clinical practice

Negatives are Fascinating, Persuasive, and Potent

First and foremost, the so-called “negativity bias” is compelling and adaptive. We humans wouldn’t have survived as a species if we hadn’t had the predisposition to focus on what could go wrong. Stone-age man wouldn’t have lived long if he hadn’t had the ability to weigh the risk of single-handedly wrestling a sabre-tooth tiger to the ground, and to settle for quietly catching limpets in rock-pools instead. But our fascination with the Dark Side is still very evident; 21st media is far more focused on the negatives – reading about death, destruction and failure still sells more copy than Happy Ever After stories.  As Roy Baumeister of Florida State University and colleagues pointed out so succinctly, bad is stronger than good.

With this in mind, clinicians and therapists as well as their clients have become used to an assessment process whereby setback, negative emotions, and failures are examined and discussed in detail for clues to the current state of mind and opportunities to “correct” them and move on. As Rashid and Ostermann point out, so entrenched are we in belief that symptoms are authentic, central ingredients to be assessed that ‘the diagnostic statistical manual (DSM-IV) labels affiliation, anticipation, altruism and humor as “defense mechanisms.”’  In other words, it is as if such positive behaviors as altruism are considered to be mere coping mechanisms which counteract underlying guilt rather than traits to be explored, understood, and encouraged in their own right.

The authors argue that the traditional deficit model of clinical assessment reinforces our existing negativity bias. They quote empirical research in which participants playing the role of the clinician were asked what information they would like to know about a client. When the client was initially presented in a negative light (e.g. just been released from a psychiatric facility) they asked for significantly more negative information (such as “is the client cruel?” rather than “is the client intelligent?”) than when the client was initially presented in a positive light (e.g.  just completed undergraduate studies).

They suggest that the deficit approach encourages clients to label themselves and reduces the holistic view of themselves, resulting in clients presenting themselves with a ready-made negative diagnosis for depression, anxiety, or whatever (often courtesy of symptom-searching on Google).

The deficit approach may also create a power differential in favor of the clinician – since the clinician is the one with the expertise to diagnose the problem and recommend treatment. This results in the client being more likely to passively comply with the clinician’s negative assumptions, and work towards managing or overcoming symptoms. It also means that if the client doesn’t actually share the clinician’s perspective of the issue, diagnosis and resolution, the client might be labeled by the clinician as resisting, or being in denial.

Thus Rashid and Ostermann make their case for a more balanced approach to clinical assessment which focuses as much on strength as it does on weakness.

What Is a Strength-Based Assessment?

SWOT Analysis

“Exploring what’s strong to supplement traditional digging for what’s wrong”

A strength-based assessment is not just about exploring the client’s strengths alongside their weaknesses.  However, it’s about creating an integrated understanding of the client so that “strengths can be marshalled to undo troubles.” One definition of a strength-based assessment is as follows:

“The measurement of those emotional and behavioral skills, competencies and characteristics that create a sense of personal accomplishment; contribute to satisfying relationships with family members, peers, and adults; enhance one’s ability to deal with adversity and stress; and promote one’s personal, social, and academic development”

Thus a strengths-based assessment focuses on identifying

• strengths and assets the person brings to the issue
• deficiencies and undermining personal characteristics
• resources and opportunities for facilitating positive human functioning, and
• deficits and destructive factors in the client’s environment contributing to the issue

I was struck by how much this approach resembles the corporate SWOT (Strengths/ Weaknesses/ Opportunities/ Threats) Analysis, taught in MBA and business studies, which pays equal attention to the upsides and downsides. In clinical assessment, to focus entirely on the traditional deficit model would be the equivalent of looking only at the right-hand side of the model, the client’s weaknesses and environmental threats. But Rashid and Ostermann’s suggestion is not that we abandon the deficit approach entirely but that we balance it out by exploring the client’s individual and personal strengths and the environmental opportunities too.

The Benefits of Strengths

To those clinicians who might think this is a light-hearted way to treat serious mental disorders, Rashid and Ostermann stress that the goal is not to create a Pollyannish caricature of the client to inflate egos or to mask negative events such as abuse neglect or suffering. But we know from various empirical studies that focusing on strengths brings a variety of benefits, both physical and psychological, such as:

• Encouraging insight and perspective
• Generating optimism
• Providing a sense of direction
• Developing confidence
• Generating energy
• Buffering against physical illness
• Building resilience

In tomorrow’s article, I will summarize the ten strategies Rashid and Ostermann suggest for incorporating strengths into clinical assessments.

 
References:

Baumeister, R.F., Bratslavsky, E., Finkenauer, C., & Vohs, K.D. (2001). Bad is stronger than good. Review of General Psychology, 5, 323–370.

Lopez, S.J. & Snyder, C.R. (Eds). (2006). Positive psychological assessment: a handbook of models and measures. Washington D.C.: American Psychological Association.

Ong, A.D. & Van Dulmen, M.H.M. (2007). Oxford handbook of methods in positive psychology. Oxford: Oxford University Press.

Rashid, T. & Ostermann, R.F. (2009). Strengths-based assessment in clinical practice. Journal of Clinical Psychology, 65(5), 488—498.

Images:

1. Bad and good courtesy of Doing
2. Chart courtesy of Bridget Grenville-Cleave
3. swot_img courtesy of jean-louis Zimmerman