Would you ever consider yourself to be no more than a sum of your shortcomings?
Why should our clients be only their symptoms, their diagnosis, and conditions?
Why should they be resigned to just coping?
It is possible and realistic to be able to grow in spite of challenges and setbacks, to feel joy alongside the pain, heal while you build for the future, experience progress while learning to alleviate symptoms.
Psychotherapy can and should be centered on cultivating positive aspects of being in the world while exploring what may prevent clients from realizing their potential. Positive Psychotherapy (PPT) represents a reorientation of the therapeutic approach that balances out the traditional focus on weakness.
Positive Psychotherapy equips clients to use their inner resources to participate in the process of meeting life’s challenges through learning personally relevant and practical skills that magnify their strengths and empower them to look beyond deficits and diagnosis toward resilience, wellbeing, and growth.
This article contains:
- What is Positive Psychotherapy (Incl. Definitions)
- Benefits of Positive Psychotherapy – Beyond the Medical Model
- How Does Positive Psychotherapy Relate to Positive Psychology?
- Positive Effects
- Positive Psychology Interventions in Clinical Settings (+ List)
- Model of Positive Psychotherapy (Table with Brief Session Descriptions)
- Beyond Therapy
- Positive Psychotherapy Resources
- A Take-Home Message
What is Positive Psychotherapy (Incl. Definitions)
Positive Psychotherapy (PPT) represents a perspective on healing that does not settle for alleviating symptoms and developing coping mechanisms. It focuses first and foremost on wellbeing, on what is good in our clients by amplifying, assessing and appreciating their strengths, and all the while without minimizing their distress.
Positive Psychotherapy encourages clients to fully recognize what is already good in their lives and their nature. It also teaches them to employ what is best about them to buffer against the challenges that come with mental conditions (Rashid, & Seligman, 2018).
In addition to doing away viewing clients as broken, PPT brings a form of positive inception into the process of therapeutic interaction by injecting optimism at the outset, in hope to build a foundation for a supportive and co-creative relationship.
While setting goals and framework for the therapeutic relationship, it is imperative for the practitioner to hold themselves to a gold standard. One such standard for the practice of positive psychology could be conceptualized through the concept of Michelangelo phenomenon that posits that those closest to us can encourage the expression of our ideal selves through affirming our potential.
As the quality of the client-practitioner relationship has always been a strong predictor of therapeutic outcomes, it stands to reason that the relationship should be a goal in and of itself. Therapy, in particular, is often sought after as a solution by those who do not have such affirming relationships in their lives.
And let us not forget that truth must be experienced. Positive Psychology Interventions (PPIs) strive to allow clients to experience a sense of wellbeing during sessions and throughout the client practitioner engagement, while the attitude of nonattachment and realistic expectation are practiced and instilled.
Positive psychology practitioners see the client as their source of change and stress autonomy in all interventions. They often borrow from the field of coaching, which does not diagnose or prescribe, but instead allows clients to gleam and own solutions to their problems.
Positive psychology practitioners will often be found using metaphors as a way to reframe and bring creativity to problem-solving, as well as a tool for the cultivation of meaning. Even positive psychology assessments, when used to support therapy, are treated more as awareness tools than a means of diagnosis and understood as a frame of reference for reflection (Rashid, & Seligman, 2018).
Positive Psychotherapy builds on strengths and positive emotions and equips clients to find meaning in their lives in the effort to undo psychopathology and promote wellbeing. Many practitioners today argue that psychotherapy needs to go beyond negatives and extend into cultivating the best in our clients by focusing on the positives systematically (Rashid, & Seligman, 2018).
Benefits of Positive Psychotherapy – Beyond the Medical Model
Positive psychotherapy (PPT) can be defined either as a therapeutic approach based on the principles of positive psychology or as the clinical and therapeutic work within positive psychology.
Positive psychotherapy represents a strengths-based approach to ameliorating psychological distress. It rests on the assumption that this focus expands the scope and the outcomes of psychotherapy beyond the medical model. It has a significant potential of improving the effectiveness of psychotherapeutic process both for the patient and the practitioner.
A most important attribute of employing nurturing and restoring techniques in conjunction with therapy, is its positive effect on client-practitioner relationship (Rashid, & Seligman, 2018).
As the awareness of mental health concerns in the public arena grows, so do the expectations of treatment. Many clients want a full recovery that’s beyond simply eliminating their problems.
Positive psychotherapy scaffolds personal development through a focus on strengths and development of skills, aptitudes, and talents to enhance clients’ functioning. PPT moves clients toward overall wellbeing through the cultivation of hope, relationships, and meaning in their lives (Secker, Membrey, Grove, & Seebohm, 2002; Slade, 2010).
If on the average only 65% of clients in psychotherapy see any benefit from the treatment, can we break that barrier with the help of positive psychotherapy? According to Dr. Martin Seligman and Dr. Tayyab Rashid, the answer is a resounding yes.
Davidson and colleagues defined treatment that cultivates the positive elements of a person’s life such as assets, aspirations, hopes, and interests as “recovery-oriented care,” (Davidson, Shahar, Lawless, Sells, & Tondora, 2006). There is evidence that shows even serious conditions can benefit from a focus on strengths:
- psychosis (Schrank et al., 2016),
- suicidal ideation (Johnson et al., 2010), and
- borderline personality disorder (Uliaszek et al., 2016).
Similarly, Huta and Hawley (2008) showed that the presence of specific character strengths like hope, appreciation of beauty and excellence, and spirituality could make a significant contribution toward recovery from depression.
Other studies showed that cultivation of hope and optimism (Carver, Scheier, & Segerstrom, 2010) as well as gratitude (Flinchbaugh, Moore, Chang, & May 2012) could lead to lower levels of stress and depression.
PPT’s theoretical orientation, as promoted in practices, is equally beneficial to the wellbeing of its practitioners and has a potential of undoing the effects of compassion fatigue and burn out that manifest through emotional exhaustion, depersonalization, and a lack of personal accomplishment (Berzoff & Kita, 2010; Deighton, Gurris, & Traue, 2007; Hart, 2014).
Harrison and Westwood (2009), who embarked on exploring what sustains well-being in clinicians and what makes them exemplary, found that they all shared a positive orientation based on three core beliefs:
- the self as good enough where the clinician has confidence in his or her expertise;
- trust in the therapeutic change process; and
- a perspective on the world that sees it as a place of beauty and potential, despite the pain and suffering.
How Does Positive Psychotherapy Relate to Positive Psychology?
Martin Seligman, the father of modern positive psychology, has described some key connections between positive psychotherapy and positive psychology in interviews and instructional DVDs (Seligman & Wyatt, 2008).
He says that positive psychotherapy involves a person discovering insight and going beyond the pain and suffering of the process. Other therapy (especially when talking about incidents of childhood trauma) can be especially painful, and testifying can initially be as painful as “rip[ping] off nature’s scabs” (Seligman & Wyatt, 2008).
Acknowledging pain is still a part of the therapy—it is not necessary to deny the suffering a person might be experiencing. However, positive psychotherapy does involve more positive emotions, gratitude, and meaning – a much more positive focus.
Although forms of positive psychotherapy have developed since the 1970s, figures like Martin Seligman have been influential in the therapy’s development and testing. Here is an interview during which he introduces this field.
Seligman has published earlier work showing the effects of positive psychotherapy. By delivering individual and group therapy to students, Seligman and his colleagues showed significant, long-lasting decreases in depression (Seligman et al., 2006).
More recent reviews have combined the data from many smaller studies to conclude that positive psychotherapy can have significant positive effects, even though the impact of these benefits has been questioned (Bolier et al., 2013). As part of a broad range of positive psychological interventions, psychological and subjective well-being can be enhanced.
Other emerging studies have shown various positive effects, even on the body. In one study, researchers investigated cardiac vagal tone – a good measure of how strong a part of the nervous system is, and a potential measure of stress (Lü, Wang, & Liu, 2013).
The tone influences heart rate level at the end of breathing cycles, and is an excellent way to measure the body’s functional flexibility. Past studies have shown how cardiac vagal tone is related to a person’s positive affect, so Wei Lü and colleagues ran a positive psychotherapy intervention for participants with low positive affect.
Seventy participants from a Chinese college were scored as having either high or low trait positivity, and then half of the 34 that scored low attended group psychotherapy for 16 weeks. Physiological data were obtained with electrodes and software. Although the low-scoring group had lower tone levels, these levels improved significantly after psychotherapy.
Increasing positive affect and vagal tone can then have broader health effects for individuals and is even associated with a lower risk of illness in the longer term (e.g., Thayer & Lane, 2007).
Positive Psychology Interventions in Clinical Settings (+ List)
Positive psychotherapy interventions offer the potential for clients to develop the ability to function well in the face of psychological distress and use their strengths to cultivate resilience in the presence of symptoms. PPIs have been applied widely (e.g., Parks et al., 2012; Proyer et al., 2013; Quinlan et al., 2015; Winslow et al., 2016).
The specific practices included in the model of positive psychotherapy described here were empirically validated as positive psychology interventions. Either on their own or in sets of two or three practices, some by Martin Seligman and colleagues, others through either independent lines of research or through parallel ongoing theoretical and clinical attempts to foster well-being and positive attributes.
They include the following:
- Three good things, also known as Blessings Journal, (Seligman et al., 2005; Gander et al., 2013; Mitchell et al., 2009; Schueller & Parks, 2012),
- Using Signature Strengths in a New Way (Seligman et al., 2005; Schueller, & Parks, 2012; Duan et al., 2014; Vella-Brodrick, Park, & Peterson, 2009),
- Gratitude Visit (Seligman et al., 2005; Gander et al., 2013; Mitchell et al., 2009; Mongrain, Anselmo-Mathews, 2012),
- Gratitude (Emmons & McCullough, 2003),
- Forgiveness (Worthington & Drinkard, 2000),
- Savoring (Bryant, 1989),
- Strengths (Buckingham & Clifton, 2001; Saleebey, 1997),
- Psychological well-being (Ryff & Singer, 1996; Ryff, Singer, & Davidson, 2004), and
- Empathy (Long et al., 1999).
Positive Psychology Interventions have contributed to the development and refinement protocols in psychology-based clinical treatments such as positive psychotherapy (Rashid, & Howes, 2016), well-being therapy (Fava, 2016), and quality of life therapy (Frisch, 2016) and have been reinterpreted from the vantage point of positive psychology in traditional treatments such as acceptance commitment therapy, client-centered therapy, and schema therapy.
The table below lists 20 Positive Psychology Interventions applied in a variety of clinical and health care settings used with adult participants. Clinical issues being addressed and focused on through the use of these PPIs included depression, anxiety, eating disorders, suicidality, and conduct problems.
Descriptions of methods and sample populations were left out but can be found in the Positive Psychotherapy Workbook, a companion to the Positive Psychotherapy Clinical Manual, by Tayyab Rashid and Martin Seligman (2018). (See Resources, below)
|No.||Source||Clinical Focus||Relevant PPT Practice||Outcome|
|1.||Huffman et al., 2011||Cardiac Concerns||Gratitude
Best Possible Self
Three Acts of Kindness
|In a cohort of patients with acute cardiac illness, PPI intervention appeared feasible and accepted.|
|2.||Fung et al., 2011||Caregiving Stress||Character Strengths
Using Strengths to Resolve Problems
|Significantly lower parental stress was experienced by participants. Higher hope level after the four intervention sessions and at the booster session, and increased perception of social support when the group was ongoing but not after it ended.|
|3.||Cheavens et al., 2006||Depression||Character Strengths||Faster rate of symptom change compared to alternative approaches when participants were in a group that focused on strengths.|
|4.||Flückiger et al., 2008||Anxiety||Client’s sources, such as individual strengths, abilities, and readiness are incorporated in the treatment||Positive treatment outcomes were registered irrespective of prior distress, symptom, and duration of treatment reduction, and better therapists’ experience as a result of focusing on competencies.|
|5.||Ho, Yeung, & Kwok, 2014||Depression||Story of Happiness,
Noticing gratitude daily,
Identifying optimistic way of thinking,
|Reduction in depressive symptoms and increase in levels of life satisfaction, gratitude, and happiness.|
|6.||Andrewes, Walker, & O’Neill, 2014||Brain Injury||Three Good Things Signature Strengths||Increase in happiness and improved self-concept after 12 weeks.|
|7.||Huffman et al., 2014||Suicidality||Gratitude Visit
Best Possible Self
|PPIs proved feasible and acceptable and both gratitude and personal strengths showed effectiveness.|
|8.||Kerr, O’Donovan, & Pepping, 2015||Psychiatric concerns including depression, anxiety, substance abuse, and such||Gratitude and Kindness||Brief PPI can reliably cultivate the emotional experiences of gratitude but not kindness. Both the gratitude and kindness interventions built a sense of connectedness, enhanced satisfaction with daily life and optimism, and reduced anxiety compared to a placebo condition.|
|9.||Huffman et al., 2015||Type-2 Diabetes||Gratitude for Positive Events
Acts of kindness
|Patients with chronic illnesses (Type II diabetes) showed higher levels of positive affect, optimism, and well-being that resulted in improved health behavior adherence (and outcomes).|
|10.||Huynh et al., 2015||Conduct problems resulting in incarceration||Activities and assignments based on PERMA incorporated in Good Lives Model||Significant differences in pre-and post-intervention scores on measures of gratitude, hope, and life satisfaction.|
|11.||Ko & Hyun, 2015||Depression||Writing about Good Things,
Letter of Gratitude
|Group receiving PPIs reported significant decline in scores on measure of depression and significant increase in scores on measures of hope and self-esteem.|
|12.||Lambert D’raven, Moliver, & Thompson, 2015||Depression||Writing Gratitude Letters Engaging in good deeds||Results showed scores improved from baseline to six-month follow-up for health, vitality, mental health, and the effects of mental and physical health on daily activities.|
|13.||Retnowati et al., 2015||Depression following a natural disaster||Hope Intervention
Keeping the Motivation
|The intervention group at the posttreatment showed a significant decrease in depression.|
|14.||Chaves et al., 2017||Depression||Gratitude Savoring
|Clients in both groups showed significant pre-to-post intervention changes on all major outcomes but no significant differences were found between two treatments.|
|15.||Nikrahan et al., 2016||Coronary bypass||Gratitude & Forgiveness
Best Possible Selves Positive Interactions
|Significantly lower high sensitivity and cortisol awakening response were recorded at seven weeks when compared with control participants.|
|16.||Sanjuan et al., 2016||Cardiac Rehabilitation||Noticing Good Things
Best Possible Self
Acts of Kindness
|The well-being program in a rehabilitation group reported a significantly less negative affect than the rehabilitation group alone, after controlling for functional capacity.|
|17.||Wong et al., 2018||Psychiatric Distress||Gratitude Letters||The gratitude condition participants reported significantly better mental health than those in the expressive and control conditions.|
|18.||Harrison, Khairulla, & Kikoler, 2016||Eating Disorder||Cultivation of Positive Emotions Character Strengths||Meaningful improvement was reported by 75% of patients in subjective happiness and 87.5% in life satisfaction.|
|19.||Terrill et al., 2016||Rehabilitation following stroke||Expressing
|Participants reported being “very satisfied” with the intervention (M = 3.5 out of 4). Participants were couples where one partner was recovering from a stroke and where one or both partner(s) reported depressive symptoms.|
|20.||Muller et al., 2016||Chronic pain and a physical disability||Expressing Gratitude
Acts of kindness Forgiveness
Taking care of body
|Significant pre-to post-intervention improvements in pain intensity, pain control, pain catastrophizing, pain interference, life satisfaction, positive affect, and depression and were maintained at the 2.5-month follow-up.|
Model of Positive Psychotherapy (Table with Brief Session Descriptions)
The therapy model for the exercises included here are based on Dr. Tayyab Rashid’s model of positive psychotherapy, which he conceptualized together with Martin Seligman. The therapy model described below, employs techniques from three key areas of wellbeing (2008) and are an example of a model for a sequence of therapy sessions.
|Session I||Positive Inception||Exploration of strengths and positive attributes is accomplished by inviting the client to share a personal story that shows them at their best.|
|Session II||The Powers Within||Strength assessment is given, and the concept of engagement is explained.|
|Session III||Amplify Your Internal Assets||Development of practical intelligence is initiated through considering how client’s strengths can be translated into concrete purposeful actions that enhance commitment, engagement or problem solving|
|Session IV||Me, but Better||Visualize a better version of yourself.|
|Session V||Positive Reappraisal||Open and closed memories are reappraised through four different methods.|
|Session VI||Forgiveness is Devine||Forgiveness letter is assigned as homework to transform bitterness.|
|Session VII||Good Enough||Concepts of satisficing and maximizing are introduced, and an action plan to increase satisficing is devised.|
|Session VIII||Count Your Blessings||Enduring thankfulness is discussed, a gratitude exercise introduced, blessings journal is assigned.|
|Session IX||Instilling Hope and Optimism||One Door Closes, One Door Opens exercise is introduced and the client is encouraged to reflect on three doors that closed and what opportunities that offered.|
|Session X||Resilience||Post-traumatic growth is practiced.|
|Session XI||Taste for Life||Savoring exercise is assigned based on the client’s preference and strategies to safeguard against adaptations are discussed.|
|Session XII||People Matter||Positive relationships and spotting strengths in others is practiced.|
|Session XIII||Politics of Wellbeing||Positive communication is addressed through learning about active constructive responding and the client is encouraged to look for opportunities to practice.|
|Session XIV||Gift of Time||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.|
|Session XV||A Life Worth Living||The concept of full life is explained as integration of enjoyment, engagement, and meaning and ways of sustaining positive change in the future are devised.|
Detailed descriptions of many of the specific interventions as well as other tools addressing particular areas of wellbeing can be found in our positive psychology toolkit.
Decades of psychotherapy attest to the lack of a systematic approach to focus on the positives. Going to therapists to discuss one’s troubles and repair wounds rely on the largely untested belief that discussing difficulties is curative.
Positive Psychotherapy (PPT) offers an alternative approach to recovery that suggests that despite limitations caused by psychological distress, clients should be able to live a fulfilling and satisfying life.
It expends the concept of full recovery into using strengths as an active ingredient in treatment of psychological conditions, and further into developing new meaning and purpose in one’s life as one grows beyond the effects of mental illness (Crits-Christoph et al., 2008; Le Boutillier et al., 2011; Rapp & Goscha, 2006).
Although the positive psychotherapy model focuses predominantly on the wellbeing of the individual client while addressing psychological distress, there is no reason why some of the more fully functioning clients can’t go beyond learning the core concepts of positive psychotherapy.
Many clients can benefit from expanding into cultivating optimal performance, emotional intelligence, guided exploration, improvisations, and servant leadership.
They can pursue these goals in therapy sessions or as additional homework assignment or even through coaching modalities as a complement to therapy. For such clients, the practitioner may want to place even more focus on self-direction and client’s ownership of the progress.
Positive Psychotherapy Resources
- Positive Psychotherapy Clinician Manual by Tayyab Rashid and Martin Seligman (Amazon)
- Positive Psychotherapy Workbook by Tayyab Rashid and Martin Seligman (Amazon)
- 101 Healing Stories: Using Metaphors in Therapy by G. Burns (Amazon)
- Practical Wisdom by Barry Schwartz (Amazon)
- Existential Psychotherapy by Irvin Yalom (Amazon)
- Positive Psychology: Exploring the Best in People by Shane Lopez (Amazon)
- Writing to Heal: A Guided Journal for Recovering from Trauma and Emotional Upheaval by J. W. Pennebaker (Amazon)
- Savoring: A New Model of Positive Experience by F. B. Bryant & J. Veroff (Amazon)
Dr. Hugo Alberts and Seph Fontane Pennock discuss why it is so important to ‘meet clients where they are,’ how forcing progress or awareness onto your client can be counter-productive, and share personal experiences from their therapy sessions.
- The Science of Character: an eight-minute documentary presenting a compelling case for character strengths toward a fulfilling life.
- TED Talk: Joshua Prager: Wisdom from Great Writers on Every Year of Our Life.
- Cognitive restructuring in cognitive behavioral therapy, a video from the Beck Institute for Cognitive Therapy.
- Virtual Gratitude Visit: Dr. Daniel Tomasulo discusses how to conduct a virtual gratitude visit.
- Shelley Gable explains Active Constructive Response (ACR).
The Positive Psychology Toolkit© is the world’s largest science-based, online platform containing 270+ exercises, activities, interventions, questionnaires, and assessments.
A Take-Home Message
Despite psychological distress caused by their mental conditions, many clients today want to pursue more than just recovery.
Positive psychotherapy can teach our clients to go beyond learning coping strategies and teach them to build on their strengths, to reach their goals via a path of least resistance, and to create new habits for cultivating joy and vitality. It can bring back their childish curiosity, allow them to learn self-forgiveness, and help them re-discover how to be in love with life through savoring and gratitude.
Positive Psychotherapy promises to help our clients explore their values, their superpowers, help them paint a picture of an ideal self and a future worth living, and all while practicing resilience to setbacks in the here and now. Positive psychotherapy can allow our clients to re-define their lives for a better way of being in the world that feels more authentic, meaningful, and engaging.
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