Evolution of Psychotherapy: Resilience through Client Strengths

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.

Earlier this month, I attended the Evolution of Psychotherapy. Billed as the world’s largest psychotherapy conference, it is held every 4-5 years and attracts over 6,000 people.

I first attended the Evolution conference in 2005, when I was fairly fresh in the psychotherapy field. I recall sitting at a table for lunch with some other attendees commenting on how we all felt like we were at a rock concert, here to see and hear the “rock stars” of psychology. This time, I felt like a groupie following around my favorite psychologists as well as becoming acquainted with some new ones. I continue to be in awe when I see the world’s most eminent psychology thinkers in person, not just talking about what they do but also demonstrating their work live.

Some of the highlights of this year’s conference included:

• Martin Seligman’s discussion of plans to train the Army in emotional resiliency to prevent mental health problems
   
• Marsha Linehan’s live demonstration of dialectical behavior therapy (DBT) and her workshop on mindfulness skills
   
• Judith Beck’s workshop on the Beck Diet Solution, which applies CBT to healthy eating for life
   
• Robert Sapolsky’s presentation about how stress and depression impact
   
• Kay Redfield Jamison’s moving account of her struggle as a psychiatrist with bipolar disorder
   
• David Barlow’s presentation on a unifying treatment protocol for emotional disorders (currently there are over 400 theories of psychotherapy)
   
• Aaron Beck by live satellite to talk about the creation of cognitive therapy and its future

Resilience in Psychotherapy

For me, the big “evolution” at this year’s conference was Christine Padesky’s work, in conjunction with Kathleen Mooney, on how to build resilience in psychotherapy. I’ve written before about the need to put the “positive” back into psychotherapy. Padesky has embarked on a much-needed mission to teach therapists how to bring a positive psychology approach into the therapy room.

The name of her model is PMR (name trademarked), which stands for Personal Model of Resilience. This approach integrates knowledge from resilience research with traditional cognitive therapy and constructive therapy approaches. In Kuyken, Padesky and Dudley (2009), the authors write:

“When building resilience is an explicit therapy goal, client and therapist are more likely to make proactive plans to use identified strengths to foster future resilience and improve well-being – important goals to many clients.”

Padesky defines resilience as the dual roles of persistence and acceptance or how “people persist in the face of obstacles and, when necessary, accept circumstances that cannot be changed.” Padesky described Nancy Davis’ research on resilience, which includes six areas of competence:

1. Physical (good health, easy temperament)
2. Spiritual (faith that one’s life matters, seeing meaning in pain and suffering, sense of connection with humanity)
3. Moral (ability to contribute to others and engage in socially or economically useful tasks)
4. Emotional (emotional regulation, ability to delay gratification, self-esteem, creativity, sense of humor)
5. Social Relational (secure attachment, basic trust, social support)
6. Cognitive (high EQ, language/reading skills, capacity to plan, self-efficacy, self-understanding, adequate cognitive appraisal)

Resilience Requires Three Beliefs and Four Steps

Padesky said three fundamental beliefs by therapists are necessary to maintain a resilience focus in therapy:

1. Change is always possible.
    
2. Every person has strengths and skills to be discovered.
    
3. Each person has the capacity to self-right, to be knocked down and stand up again.

Padesky’s four steps to build resilience include:

1. Search – for strengths and skills in something the client really enjoys that is not linked to the problem area, for example, hobbies and interests, relationships, and everyday activities the client never misses. Then ask questions to identify the things the client does to persist and show that these behaviors occur in the presence of problems.
    
2. Construct – the PMR (Personal Model of Resilience). Use basic counseling skills to make summaries and validate the client. Elicit client stories, metaphors, icon and symbols to bridge the experiential and analytical minds.
    
3. Apply – the PMR to the problem. Help the client pick a problem and set a goal to be more resilient in the face of that problem. Identify strategies to use, behaviors to try, and identify feelings desired.
    
4. Practice – being resilient. Identify challenges and principles for persistence, construct behavioral experiments and debrief through the resilience lens with the client.

How Resilience Builds on Previous Techniques

Throughout the PMR process, cognitive-behavioral therapy skills are embedded in the discussion, such as a collaborative approach, Socratic dialogue, behavioral experiments, and case conceptualization. Padesky stressed that the therapist needs to express interest and curiosity in the client’s world as well as include positive non-verbal feedback, especially smiling.

In closing, Padesky said that having resilience as a goal can change the therapy focus from solving or eliminating the problem to being resilient in the face of a problem.

Editor’s Note:  If you are interested in resilience, you may be interested in the little book that PPND has just published with sixteen chapters on how to build resilience. Laura L.C. Johnson authored one of the sixteen chapters: Resilience: How to Navigate Life’s Curves.

References:

Presentations and handouts by speakers at the Evolution of Psychotherapy Conference

Kuyken, W., Padesky, C.A. & Dudley, R. (2009). Collaborative Case Conceptualization: Working Effectively with Clients in Cognitive-Behavioral Therapy. New York: Guilford.

Maymin, S. & Britton, K. (Eds.) (2009). Resilience: How to Navigate Life’s Curves. Positive Psychology News.

Images (Creative Commons):

Rock concert courtesy of marfis75
Water drop courtesy of Appy(26)
Yoga courtesy of Canon in 2D
Trust courtesy of notsogoodphotography
Smiley candy courtesy of Marcus Vegas