Putting the “Positive” Back into Psychotherapy

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

In 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

While 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. Positive 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

While 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

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