Session VIII – Count Your Blessings
Goal: The notion of counting one’s blessings and enduring thankfulness is discussed, gratitude exercise is introduced, and blessings journal is assigned.
Tool: Three Good Things and Gratitude Visit
Rationale: Extensive research shows that enduring thankfulness has many health benefits (Emmons, 2007). In one clinical study, the gratitude condition participants reported significantly better mental health than those in the expressive and control conditions.
This session introduces the client to the practice of gratitude by counting one’s blessings daily and planning a gratitude visit. Clients are also asked to keep a gratitude journal between sessions.
In-session Worksheets:
Three Good Things
Before going to bed, write about three good things that happened to you that day. Reflect on those good things by answering the following questions:
- Why did this good thing happen and what does it mean to you?
- What lessons have you learned from reflecting on this good thing?
- How did you or others contribute to this good thing happening?
Gratitude Visit
Gratitude is oriented toward others. Think of a person to whom you would like to express gratitude. Write a letter to them. Try to be specific in describing the way in which their actions have made an important difference in your life. When finished, arrange a visit with that person without explaining the purpose. Try to make it as casual as possible.
When you see them after you settle in, read your letter slowly, with expression and eye contact. And allow the other person to react unhurriedly. Reminisce about the times and specific events that made that person important to you.
Discussion questions:
- What feelings came up as you wrote your letter?
- What was the easiest part to write and what was the toughest part?
- Describe the other person’s reaction to your expression of gratitude?
- How were you affected by their reaction?
- How long did these feelings last after you presented your letter?
- How often did you recall the experience in the days following?
Homework: Blessings journal is assigned, and client is asked to write about three good things that happened that day before bedtime every night for a week in a way that was introduced during the session.
Suggest that clients socialize with more people who are grateful and observe if that improves their mood. People who are thankful have a language of future, abundance, gifts, and satisfaction.
You can also ask clients to find ways to express gratitude directly to another person. While doing so, ask them to avoid saying just thank you and express gratitude in concrete terms.
Clinician notes: Considerable effort and time to manage the logistics are required to write a letter and arrange a visit. Be sure to provide clients adequate time and support to complete this practice over the course of therapy. You can discuss the timeline, periodically remind them, and even encourage clients to read their Gratitude Letters so they can make changes and rehearse the experience of writing it and reading it out loud.
Be sure clients have the opportunity to share their experiences of the Gratitude Visit.
Session IX – Instilling Hope and Optimism
Goal: One Door Closes, One Door Opens exercise is introduced and the client is encouraged to reflect on three doors that closed and what opportunities for growth it offered.
Tools: One Door Closes, One Door Opens, and Learning Optimism prompts
Rationale: Essentially, hope is the perception that one can reach the desired goals (Snyder, 1994). Hopeful thinking comes down to cultivating the belief that one can find and use pathways to desired goals (Snyder, Rand, & Sigmond, 2002).
Optimism can be learned and can be cultivated by explaining setbacks in a way that steers clear of catastrophizing and helplessness. Optimistic people see bad events as temporary setbacks and explain good events in terms of permanent causes such as traits or abilities.
Optimists also tend to steer away from sweeping universal explanations for events in their lives and don’t allow helplessness to cut across other aspects of their lives (Seligman, 1991).
Painful experiences can be re-narrated as it is the client who gets to say what it all means. Like a writer, a sculptor or a painter the client can re-create his or her life story from a different perspective, allow it to take a different shape and incorporate light into the dark parts of their experience.
In-session Worksheets:
- One Door Closes, Another Door Opens
Think of times when you failed to get a job you wanted or when you were rejected by someone you loved. When one door closes, another one almost always opens. Reflect and write about three doors that closed and what opportunities for growth it offered. Use the following questions to help with your reflections:
- What was the impact of doors that closed?
- Did this impact bring something positive to you? What was it?
- What led to a door closing, and what or who helped you to open another door?
- How did you grow from doors that opened?
- If there is room for more growth, what might this growth look like?
Learning Optimism
Think of something that happened recently that negatively impacted your life. Explore your beliefs about the adversity to check for catastrophizing.
- What evidence do you have that your evaluation of the situation is correct?
- What were the contributing causes to the situation?
- What does this mean and what are the potential implications?
- How is the belief about the situation useful to you?
Discussion questions:
- When a door closes, how do you explain the causes of failure to yourself?
- Regarding your happiness and wellbeing, what were the negatives and positives of this adversity?
- Was the impact of this setback all-encompassing or long-lasting?
- Was it easy or hard for you to see if a door opened, even just a crack?
- What does the closed door represent for you now?
- How did the One Door Closes, Another Door Opens practice enhanced your flexibility and adaptability?
- Do you think that deliberate focus on the brighter side might encourage you to minimize or overlook tough realizations that you need to face?
- Would you still like the door that closed to be opened, or do you not care about it now?
Homework: As a weekly exercise explain and write down your broad outlook on life in one or two sentences and then monitor if daily stressors have an impact on your overall perspective. If so, brainstorm ways to help your perspective remain constant.
Alternatively, to practice hope, ask the client to reflect on one or two people who helped to open the doors or who held the opened doors for them to enter.
And to practice optimism, ask the client to help a friend with a problem by encouraging him or her to look for the positive aspects of the situation.
Clinician notes: The benefits of optimism are not unbounded, but they do free us to achieve the goals we set. Our sense of values or our judgment is not eroded by learning optimism, it is enhanced by it.
Suggest to your clients that if rumination keeps showing up, they consider positive distraction and volunteer the time they normally spend analyzing problems to endeavors that make an impact on the world. Not only will they distract themselves in a positive way but may also gain a much-needed perspective on their problems.
Session X – Resilience
Goal: Posttraumatic growth (PTG) is introduced and practiced through writing therapy.
Tool: Expressive Writing
Rationale: Many patients following trauma develop Posttraumatic Stress Disorder (PTSD), but many also experience Posttraumatic Growth (PTG). Without minimizing the pain and while respecting clients’ readiness, exploration of the possibility for growth from trauma can help them gain insight into the meaning of life and the importance of relationships.
Research shows that PTG can lead clients to:
- mitigate the feelings of loss or helplessness (Calhoun & Tedeschi, 2006)
- develop a renewed belief in their abilities to endure and prevail
- achieve improved relationships through discovering who they can really count on
- feel more comfortable with intimacy (Kinsella, Grace, Muldoon, & Fortune, 2015)
- have a greater sense of compassion for others who suffer
- develop greater appreciation for life (Jayawickreme & Blackie, 2014; Roepke, 2015)
- enhanced personal strength and spirituality (Fazio, Rashid, & Hayward, 2008)
Positive reinterpretation, problem-focused coping, and positive religious coping facilitate PTG. Although time itself doesn’t influence PTG as it remains stable over time, intervening events and processes do facilitate growth.
James Pennebaker’s strategy, known as the Writing Therapy, showed that writing about a traumatic or upsetting experience can improve people’s health and wellbeing (Pennebaker, & Evans, 2014).
While assuring complete confidentiality, clients are asked to write for 15 to 30 minutes for three to five consecutive days about one of their most distressing or traumatic life experiences in detail and to fully explore their personal reactions and deepest emotions.
In-session Worksheets:
Using a note pad or journal, please write a detailed account of a trauma you experienced. In your writing, try to let go and explore your deepest thoughts and feelings about the traumatic experience in your life. You can tie this experience to other parts of your life, or keep it focused on one specific area.
Continue to write for at least 15 to 20 minutes a day for four consecutive days. Make sure you keep your writings in a safe, secure place that only you have access to. You can write about the same experience on all four days or you can write about different experiences.
At the end of four days, after describing the experience, please write if the experience has helped you with the following:
- understand what the experience means to you.
- understand your ability to handle similar situations.
- understand your relationships in a different light.
Discussion questions:
- What was the most difficult part of writing?
- Do you agree that even though it may have been difficult, it was still worth writing?
Some reactions to the trauma, adversity, or losses can be so strong that we deliberately avoid associated feelings.
- Did the writing process help you see this avoidance if any?
- Did writing help you to visualize growth in terms of your perspective on life?
- Did you experience healing or growth, despite having the lingering pain of the trauma or loss?
Homework: Ask the client to continue writing for three more consecutive days for 15 to 30 minutes each time. Remind the client to make sure to keep their writings in a safe, secure place that only he or she has access to. They can write about the same experience on all four days or they can write about different experiences.
Clinician notes: To better understand the context in which clients are living, the practitioner should continue discussing therapeutic changes with clients without necessarily asking about growth. It also helps to accept the fact that it may be difficult to pinpoint the start and end that marks when growth from trauma occurs.
Focusing on themes of change may help identify when additional support is needed to amplify PTG while keeping in mind that some clients for reasons outside of their control will not continue to experience long-term growth.
Session XI – Taste for Life
Goal: Tendencies toward busy behavior are assessed and savoring exercise is assigned based on the client’s preference and strategies to safeguard against adaptations are discussed.
Tool: Busy Behavior Assessment and Savoring Techniques
Rationale: According to Carl Honoré (2004), we live in a multitasking era where we have become addicted to speed. Evidence shows that people who are cognitively busy are also more likely to act selfishly, use sexist language, and make erroneous judgment in social situations.
On the other hand, research also shows that when people are in a relaxed state, the brain slips into a deeper, richer, more nuanced mode of thought (Kahneman, 2011). Psychologists actually call this “Slow Thinking,” and one method for achieving this cognitive state it to practice what is known as savoring.
Fred Bryant, a pioneer in savoring, defines it as a mindful process of attending to and appreciating the positive experiences in one’s life (2003). Bryant describes four types of savoring: basking, thanksgiving, marveling, and luxuriating. Research shows that savoring fosters:
- positive emotions
- increases wellbeing
- deepens a connection to the meaningful people in our lives.
Savoring requires effort that involves deliberately working against the pressures to multitask. Learning to savor requires time and becomes more natural the more we practice it.
Kinds of Savoring Experiences:
- Basking is about taking great pleasure or satisfaction in one’s accomplishments, good fortune, and blessings
- Thanksgiving is about expressing gratitude and giving thanks
- Luxuriating is about taking great pleasure and showing no restraint in enjoying physical comforts and sensations
- Marveling is about becoming filled with wonder or astonishment: beauty often induces marveling and exercising virtue may also inspire it
- Mindfulness is a state of being aware, attentive, and observant of oneself, one’s surroundings and other people.
In-session Worksheets:
Reflect on whether or not you find yourself constantly busy and how this manifest in your daily life by answering the following questions:
- Do you multitask or find yourself constantly short on time?
- What are some of the signs of being busy and living life in the fast track: information overload, time crunch, overstimulation, underperforming, anxiety, and multitasking?
- Which ones of these do you experience?
- Reflect on what drives your busy behavior.
- Do you believe that these drivers are internal, external, or a combination of both?
Savoring Techniques
Practice the following strategies to increase savoring. All of the strategies to slow down mentioned here require active engagement. Select one or two of the following Savoring Techniques:
- Sharing With Others: Seek out others to share an experience. Tell them how much you value the moment (this is the single strongest predictor of pleasure.)
- Memory Building: Take mental photographs or even a physical souvenir of an event and reminisce about it later with others.
- Self-praise: Share your achievements with others and be proud. Do so in a way that is authentic and honest in celebrating your persistence in maintaining focus in achieving something meaningful to you.
- Sharpening Perceptions: Focus deliberately on certain elements and block out others. For example, most people spend far more time thinking about how they can correct something that has gone wrong than they do basking in what has gone right.
Brainstorm specific actions you will take to practice one or more of these techniques and think about who will support you or what can inhibit your progress.
Discussion questions: When, where, and how frequently can you use it to increase positive emotions in your daily life?
Homework: Pick a favorite or a different savoring technique and practice it between sessions. Reflect and write your personal list of actions which can sustain and enhance savoring.
Clinician notes: Savoring requires practice and some clients may struggle with savoring practices because they overthink the experience which tends to interfere with their ability to notice and attend to their senses.
The focus of the Savoring practices is positive but if the clients are feeling distressed, see if they are able to put aside their negative thoughts and feelings by using the diversion strategy from Session Five: Open and Closed Memories to optimally benefit from this exercise.
Clients should attend mindfully to all aspects of a savoring experience, including its cognitive, affective, and behavioral aspects. However, tuning in too much to feelings or thoughts may backfire and could interfere, eventually dampening the savoring experience so encourage the client to monitor their experiences for adaptation.
Session XII – People Matter
Goal: Seeing best in others and developing strategies for cultivation of positive relationships
Tool: Strength Spotting Exercise
Rationale: Recognizing the strengths of one’s loved ones has been proven to have significant positive benefits on relationships and wellbeing of those who practice it actively.
Understanding one another’s strengths foster a greater appreciation for each person’s intentions and actions and promote empathy. Ultimately, positive relationships buffer us against stress. The central positive psychotherapy (PPT) practice covered in this session is learning to see strengths in others and creating a Tree of Positive Relationships.
In-session Worksheets:
Answer the following questions about people you have close relationships with:
- Who in your immediate or extended relationships always appears to be the most hopeful and optimistic person?
- Who in your relationship circles has the most humorous and playful disposition?
- Who in your relations is the most creative person?
- Who is always cheerful, bubbly, and smiley?
- Who is the most curious person?
- Who always treats others fairly and squarely?
- Who is the most loving person in your family or friends?
- Who among your loved ones loves to create new things?
- Who is a good leader?
- Who in your relations is the most forgiving person?
- Who among your loved ones shows balanced self-regulation?
Discussion questions:
- What behaviors, actions, or habits does your partner exhibit to denote the strengths you identified?
- Do you share strengths with each other?
- Discuss any you share as well as ones you don’t.
- In what ways do your strengths complement each other?
- Did you also look at your partner’s and your bottom strengths?
- What can you learn from those?
Homework: If practical, ask your family and friends to take the VIA strengths survey. Create a Tree of Positive Relationships to help you and people you are close to gain greater insight into each other’s strengths.
Encourage clients to have uninterrupted, quality conversations with their loved ones at least once per week.
Clinician notes: To maintain progress, suggest that clients brainstorm a way to celebrate each other’s strengths. Suggest they focus on bonding activities that establish communication patterns, routines, and traditions both through daily, casual ways of enjoying each other’s company as well as more elaborate planned celebrations and vacations.
Session XIII – Politics of Wellbeing
Goal: Positive communication is addressed through learning about Active Constructive Responding and client is encouraged to look for opportunities to practice.
Tool: Active Constructive Responding (ACR)
Rationale: Shelly Gable and her colleagues found that sharing and responding positively to good events in our lives increases relationship satisfaction and strengthens our bonds (2004). When we capitalize on positive events in our lives by allowing others to partake in the good news not only do we amplify it, but also increase feelings of being valued and validated.
In-session Worksheets:
- Active Constructive Responding (ACR)
Read carefully the following descriptions of different styles of responding to good news. Check off which type of responses you identify with most of the time.
- Active Constructive
- When I share good news, my partner responds enthusiastically.
- Sometimes my partner is more excited about my wins than I am.
- My partner shows a genuine interest and asks a lot of questions when I talk about good events.
- Passive constructive
- My partner is happy for me but does not make a big deal out of my sharing positive news.
- When good things happen to me, my partner is silently supportive.
- Although my partner says little, I know she is happy for me.
- Active Destructive
- Often when I share good news, my partner finds a problem with it.
- My partner often sees a downside to the good events.
- My partner is often quick to point out the downside of good things.
- Passive Destructive
- I’m not sure my partner often cares much.
- I often feel my partner doesn’t pay attention to me.
- My partner often seems uninterested.
Now let us try ACR in session. We will take turns sharing good news and then allowing the other person to respond. Think of something positive and recent that happened to you and tell me about it.
Discussion questions:
- What can you learn about yourself from identifying your response style?
- Are there any barriers that hinder you in engaging in ACR? They can be subjective or objective such as your personality style, preferences, and family of origin, culture, beliefs, or interpersonal dynamics.
- Should you already engage in some sort of ACR, what can you do to take it to a higher level?
- If you find that ACR doesn’t come naturally to you, what small steps can you take to adopt some aspects of this practice that are consistent with your disposition?
- Identify individuals or situations that display all four responding styles.
- What effects do you notice of each style both on sharer and responder?
Homework: Ask the client to practice ACR beyond his intimate relationships and use it with family member and friends.
Clinician notes: If the client is proficient in ACR, consider expanding the practice of positive communication into positive affirmations where partners offer each other words and actions that confirm the partners’ beliefs about themselves and behave in ways that are congruent with their partner’s ideal self (Drigotas, 2002).
Ask the client to practice perceptual affirmations where partners’ general view of each other is aligned with their ideal self, where we perceive our partners as trying their best, where we are forgiving of shortcoming and sympathize with the pain of failure, and finally, where we shine the light on qualities.
Ask the client to also practice behavioral affirmations where partners elicit behaviors that are in congruence with the other person’s ideal selves as well as create opportunities for expression of those ideal selves while decreasing situations that can negate them and behaviors that conflict.
This paves the way toward movement in the direction of being the most valuable self through skill development and reflection on aspirations congruent with deeply help hopes and dreams.
Session XIV – Gift of Time
Goal: Therapeutic benefits of helping others are introduced and the client is encouraged to Give the Gift of Time in a way that employs their strengths.
Tool: Gift of Time
Rationale: Helping others and practicing altruistic behavior has been shown to significantly increase a sense of meaning and purpose in life. In addition to making a difference, we also benefit from shifting our focus away from ourselves and indulging in our own thoughts (Keltner, 2009).
Research shows that material gifts lose their charm and value over time, but positive experiences and interactions continue to pay dividends through increased confidence that you can, in fact, do good (Kasser & Kanner, 2004).
In-session Worksheets:
Think of ways in which you could give someone you care about a Gift of Time. Brainstorm ways of doing something that requires a fair amount of time and involves using your strengths. Using your strengths to deliver the gift will make the exercise more satisfying.
- If creativity is your strength, write an anniversary note or make a gift by hand.
- If kindness sets you apart, prepare a dinner or run errands for a sick friend.
- If your humor is your strength, find a way to cheer someone up.
Write about your experience, recalling the details of what was involved in planning and reflect on how it made you feel.
Discussion questions:
- What feeling came up as you were giving your gift?
- How did you feel after giving your gift?
- What was the reaction of the recipient of your gift?
- What were the positive or negative consequences resulting from giving your gift?
- Did you use one or more of your signature strengths? If so, which one?
- Have you undertaken such an activity in the past? What was it?
- Did you find that it was different this time around? If so, what differences did you notice?
- Have there been times in the past when you were asked to give the Gift of Time and you didn’t want to?
- Have you been a recipient of someone else’s Gift of Time? What was it?
- Are you willing to give the Gift of Time regularly for a particular cause? What cause might this be?
- Do you anticipate any adaptation, and do you think the Gift of Time might not provide as much satisfaction as it did the first time?
- If so, what steps can you take to address this?
Homework: To maintain progress, suggest that the client performs a few random acts of kindness or consider volunteering for a cause they care about in a way that would allow them to use their strengths.
Clinician Note: Exercise caution if the self-care of clients is already compromised and make sure that their altruistic endeavors don’t negatively impact their self-care needs. To help clients decide on the scale of their altruistic endeavors, explore carefully client’s level of distress and wellbeing as it may reveal their exposure to a potential vulnerability.
Session XV – A Life Worth Living
Goal: The concept of a full life is explained as an integration of enjoyment, engagement and meaning and ways of sustaining positive change in the future are devised.
Tools: From Your Past Toward Your Future and Positive Legacy
Rationale: Cultivation of meaning helps us articulate our life goals in a way that integrates our past, present, and future. It provides a sense of efficacy, helps create ways to justify our actions and connects us to other people through a shared sense of purpose.
Cultivating long term life-satisfaction is closely tied to meaningful pursuits and our lives provide opportunities for meaningful stretches if one is willing to look.
In this final session, we combine the positive introduction with a better version of the self, and the hope of leaving a positive legacy.
In-session Worksheets:
- From Your Past Toward Your Future
If available, please read your Positive Introduction from Session I. If not, simply recall your story of resilience from our first session. Answer the following questions:
- From the experience of resilience in your Positive Introduction story, what meaning do you derive today? ____
- Which character strengths are most prominent in your story now that you have explored them further? _____
- Do you still use these strengths in everyday life? If so, how? ______
- What does your story of resilience tell you about your life’s purpose? ____
- What creative or significant achievements would you like to pursue in the next 10 years? ____
- If you were to pick one, what makes it most important for you and why? ____
- In what way will this goal make a difference for others? ____
- What steps do you need to take over the next 10 years to accomplish it? Describe what you need to do year by year? ______
- Which of your signature strengths will you use in accomplishing this goal? ____
Positive Legacy
Envision your life as you would like it to be and how you would want to be remembered by others. What accomplishments and strengths would they mention? What would you like your legacy to be? Describe in concrete terms. _____
Now look back at what you wrote and ask yourself if you have a plan that is both realistic and within your ability to do so.
Discussion questions:
- What was like it to re-read your story of resilience again?
- Would you write it the same way today? If not, what would you change?
- How has your thinking about the purpose and meaning of life changed over the course of our sessions?
- What was the process like for you of reflecting on and then writing about your goals for the future?
- What will your life look like when you accomplish your goals?
- What might happen if you do not accomplish your goals?
- Think of ways you can use your signature strengths to do something that would enable you to leave a Positive Legacy.
- What specific actions would you take to accomplish your short and long-term goals? What is the timeline for completion of these actions?
Homework: Resolve to keep this in a safe place and read it again a year from now. At that point ask yourself if you made progress, if you need to revise your goals, or if new goals have emerged for you.
Clinician notes: Some client may struggle to find purpose and meaning in their life, especially if they are struggling with a significant loss, trauma or severe depression. Nevertheless, it is very important for the client to be asked about meaning. Irvin Yalom (2020), the author of Existential Psychotherapy states that every one of his clients expressed concerns about the lack of meaning in their lives.
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