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(p. 1) Introduction to This Workbook 

(p. 1) Introduction to This Workbook
Chapter:
(p. 1) Introduction to This Workbook
Author(s):

Tayyab Rashid

and Martin Seligman

DOI:
10.1093/med-psych/9780190920241.003.0001
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date: 20 January 2019

What Is Positive Psychotherapy?

Positive psychotherapy (PPT) is a therapeutic approach that attempts to counteract your symptoms with strengths, weaknesses with virtues, and deficits with skills, to help you understand complex situations and experiences in a balanced way.

The human brain pays more attention and responds more strongly to negatives than to positives. However, PPT helps by teaching us to build up our positives. To deal with the toughest challenges in life, we need our toughest internal resources, which in turn will build our resilience. Much like health is better than sickness, mastery is better than stress, cooperation is better than conflict, hope is better than despair, and strengths are better than weaknesses.

The positives in PPT are primarily based on Dr. Martin Seligman’s ideas of well-being. Dr. Seligman organized happiness and well-being into five scientifically measurable and teachable parts: (a) Positive emotion, (b) Engagement, (c) Relationships, (d) Meaning, and (e) Accomplishment, with the first letters of each part forming the mnemonic PERMA (Seligman, 2012). These elements are neither exhaustive nor exclusive, but it has been shown that fulfillment of these elements is associated with lower rates of distress and higher rates of life satisfaction.

PPT practices will help you assess your strengths from multiple perspectives, followed by a series of practices that will help you develop what we call “practical wisdom.” Examples include how to decide between taking a risky new initiative versus relying on the tried and tested; how to strike a balance between fairness and kindness; and how to show empathy to a friend but also be objective. The goal of practical wisdom is to help you better deal with challenging situations, that is, to choose the wise way when there are many options for how to deal with a challenge.

PPT teaches about strengths, but in context. In fact, under some circumstances, negatives such as sadness and anxiety may be more adaptive than positives, especially when survival is at stake. Similarly, anger—expressed as protest to work toward a greater good—is more adaptive than compliance. You and your clinician will work together to understand your pain and hurts, and you will also be looking to find meaning from this pain.

PPT can be divided into three phases:

  • Phase One focuses on helping you to come up with a balanced narrative by exploring your strengths from multiple perspectives. You will create meaningful goals using your signature strengths.

  • Phase Two focuses on building positive emotions and, with support, dealing with negative memories, negative experiences, and negative feelings. These negatives may be keeping you stuck and not allowing you to move forward.

  • Phase Three focuses on exploring your positive relationships and strengthening the processes that nurture these relationships. This final phase of PPT also allows you to explore the meaning and purpose of your life.

(p. 2) The Sessions and Practices

Table I.1 outlines the PPT sessions and main practices. Not everyone completes every practice, and your clinician may decide to work with you in a different session order.

Table I.1. Positive Psychotherapy: Session-by-Session Description

Session Number and Title

Content

Main Practices

Phase One

1: Positive Introduction and Gratitude Journal

Session One explains the clinical environment and clarifies both your and your clinician’s roles and responsibilities. This session also teaches you how to start the ongoing practice of cultivating gratitude through journaling positive experiences and appreciating the impact of gratitude on well-being.

Positive Introduction:

You will recall, reflect on, and write a one-page story (that called for the best in you) with a beginning, middle, and positive end.

Gratitude Journal:

You will start an ongoing journal to record three good things every night (big or small) and also write about what made these good things happen.

2: Character Strengths and Signature Strengths

This is the first of three sessions focusing on character strengths and signature strengths, which are positive traits that can be developed through practice and can contribute to personal growth and wellness.

Character Strengths:

You will compile your signature strengths profile by collecting information from multiple resources including self-report, an online measure, a family member, and a friend.

3: Practical Wisdom

This session presents the skills of practical wisdom. These skills teach you how to apply your signature strengths in a balanced way to solve problems.

Know How of Strengths:

You will learn how to apply practical wisdom strategies (seeking specificity, finding relevance, resolving conflict, reflection, and calibration) to resolve three specific scenarios.

4: A Better Version of Me

This session looks at articulating and implementing a written plan of positive, pragmatic, and persistent self-development.

A Better Version of Me:

You will create a self-development plan called A Better Version of Me that uses your strengths through specific, measurable, and achievable goals.

Phase Two

5: Open and Closed Memories

In this session, you will learn to recall, write about, and process your open (negative) and closed (positively resolved) memories. You will learn to develop skills for dealing with open memories.

Positive Appraisal:

After practicing relaxation, you will write about bitter memories and explore four ways to deal with them adaptively.

6: Forgiveness

This session teaches that forgiveness is a process for change, rather than an event. This session explains what forgiveness is and what it is not.

REACH:

You will learn about REACH—a process of forgiveness; and/or:

Forgiveness Letter:

You will write a letter of forgiveness, but you may not necessarily deliver it.

7: Maximizing versus Satisficing

This session presents the concepts of maximizing (aiming to make the best possible choice) and satisficing (making a “good enough” choice).

Toward Satisficing:

You will explore in which areas of life you maximize or satisfice. You will then draft a plan to increase satisficing.

8: Gratitude

This session expands the concept of gratitude by having you recall and write to someone who is alive now and who in the past did something positive but who you have never fully thanked.

Gratitude Letter:

You will reflect on and write a letter of gratitude to someone who helped you during a time of need and who you have not thanked properly.

Gratitude Visit:

You may invite the person to whom you wrote the Gratitude Letter, for a one-on-one meeting. Without explaining in advance, you read the letter in person.

Phase Three

9: Hope and Optimism

In this session, you will learn to see the best possible, realistic outcomes. You will see that challenges are temporary and learn how to develop a sense of hope.

One Door Closes, Another Door Opens:

You will reflect on and write about three doors that have closed in your life and three doors that have opened.

10: Posttraumatic Growth

This session invites you to explore deep feelings and thoughts about a traumatic experience that continues to bother you.

Expressive Writing:

You can complete an optional exercise of transporting troubling and traumatic experiences to a piece of paper, with the assurance that this writing is for your eyes only. The practice is done after you have developed healthy coping skills and are no longer overwhelmed by current stressors.

11: Slowness and Savoring

In this session, you will learn how to deliberately slow down and develop an awareness of how to savor. In so doing, you will learn to attend mindfully to positives.

Slow and Savor:

You will select one slowness technique and one savoring technique to try that fit your personality and life circumstances.

12: Positive Relationships

In this session, you will learn about the significance of recognizing the strengths of your loved ones.

Tree of Positive Relationships:

You will assess and plot your strengths on a large “tree,” drawn on paper. You will then discuss with your loved ones ways of enriching your relationships by celebrating one another’s strengths.

13: Positive Communication

In this session, you will learn about four styles of responding to good news and which of these predicts relationship satisfaction.

Active Constructive Responding:

You will practice responding to a positive event shared by your loved one in a lively and authentic way.

14: Altruism

In this session, you will learn how being altruistic helps both you and others.

Gift of Time:

You will plan to give the gift of time by doing something meaningful that also uses your signature strengths.

15: Meaning and Purpose

This session focuses on the search and pursuit of meaningful endeavors for the greater good.

Positive Legacy:

You will write about how you would like to be remembered, especially in terms of your positive footprints.

The Structure of the Sessions

There is a general pattern to how the sessions unfold, although your clinician has flexibility to structure the sessions to work best for you and your needs. Table I.2 provides an outline of a typical PPT session. (p. 3) (p. 4) (p. 5)

Table I.2. Positive Psychotherapy: Generic Session Structure

Core Concepts

Your clinician may begin sessions by describing evidence-based core concepts in easy-to-understand language. These concepts explain why each session is important.

Relaxation Practice

Each session begins with a relaxation practice; typically you will be guided through a three- to five-minute relaxation practice.

Gratitude Journal

Following the relaxation practice, your clinician will ask you to share a few positives events or experiences noted in your Gratitude Journal from the past week.

Review

You and your clinician will review the previous session’s core concept/s and practice. Your clinician will encourage you to share your experiences, reactions, and reflections regarding the concepts discussed and practiced during the previous session.

In-Session Practice

Each session has at least one in-session practice that continues between sessions with the hope that you will continue to practice at home.

Reflect and Discuss

These are questions to encourage you to reflect on and discuss the in-session practices.

Relaxation

We recommend that each session end with the same brief relaxation practice that started the session.

Is PPT Right for You?

If you have been experiencing problems, seeking psychotherapy is most likely to be beneficial for you. Since there are many varieties of psychotherapy, you may wonder if PPT is right for you. The following five questions and answers will help you make an informed and thoughtful decision.

  1. 1. Is PPT an evidence-based treatment? More than 10 randomized controlled studies, mostly conducted by clinical researchers not affiliated with the authors of this workbook, have demonstrated that PPT is effective when compared to no treatment, and comparably effective when compared to an active treatment such as cognitive behavior therapy (Rashid & Seligman, 2018).

  2. 2. Is PPT right for my psychological problems? PPT has been applied with a number of clinical conditions. PPT has also been shown to be effective with a range of psychological disorders, including depression (Csillik, Aguerre, & Bay, 2012), addiction (Akhtar & Boniwell, 2010), borderline personality disorder (Uliaszek, Rashid, Williams, & Gulamani, 2016), posttraumatic stress (Gilman, Schumm, & Chard, 2012), and psychosis (Meyer, Johnson, Parks, Iwanski, & Penn, 2012; Schrank et al., 2015).

  3. 3. Which mode is more effective—individual or group? Both can be helpful. It depends on your level of comfort regarding the issues you want to tackle in therapy. For example, individual therapy enables you to discuss highly personalized concerns within the confidential and safe confines of a one-on-one therapy setting. Group PPT will allow you to listen to the strengths-based narratives and stories of resilience that the other members of the group are likely to share, and this sharing will allow you to review and appraise your own concerns in perspective. In addition, this process of sharing can lead to an environment of trust that often creates therapeutic synergy that helps group members bond in support of one another’s well-being. You can also switch from individual to group and vice versa.

  4. 4. I have significant problems, and PPT seems like it is all about positives. Do I understand correctly? Because of its name, PPT may give this impression that is all about positives. Unlike its name, PPT fully attends to your distressing experiences without dismissing, ignoring, or, most importantly, minimizing them. However, PPT attempts to give equal weight to your strengths. For example, if you discuss a painful memory, the PPT trained clinician—using basic therapeutic skills such as warmth, genuineness, and positive regard—will attend to your feelings and thoughts. However, whenever appropriate, the clinician will also help you recall your joys and pleasant memories. You will be encouraged to think about moments of isolation as well as when you felt connected. Within the safe therapeutic environment, PPT will offer you space and time to express your resentments and also what you may appreciate. PPT will process the harsh criticism you may have encountered and will balance it with recalling instances when you were genuinely complemented.

  5. 5. Will I be expected to do homework? My schedule is so busy that I hardly have time to come in for therapy. I don’t think that I will have time to do any homework. PPT sessions generally do not include homework. There is a practice to be done within each session, followed by reflections and discussion. The aim is to prepare you to apply the skills learned in session in your everyday life. For example, the Gratitude Journal practice will ask you to notice and record (in a manner convenient to you) positive things that happen. Signature Strengths will help you to use your already intact and positive resources in a more focused manner. Active-Constructive Responding will teach you ways to respond to your loved one’s good news in a positive and constructive manner. In summary, you are (p. 6) not expected to start a new set of behaviors and habits. You will apply skills and perspective to behaviors already in place.

Starting the Journey

Seeking therapy is an act of courage. Sustaining it is act of persistence. Both courage and persistence need your motivation, willingness to change, and openness to try things differently. If your clinician presents specific rules pertaining to the clinical setting, please review them and discuss, should you have any concerns. This will help you to understand the structure and sequence of the treatment. Like all clients, you will not be starting therapy as blank slate. Rather, you are likely to bring “heavy baggage” (issues) with you. Like most clients, you may have previously tried to resolve these issues, in ways you thought might work—because when we are stressed, we try to alleviate it. Sometimes the ways we try work, and sometimes they don’t. If the latter is true for you, please do not feel inadequate! The fact that you are seeking treatment shows your adequacy in that you are willing to solve your problems. However, as you embark on this journey, keep the following tips in mind:

  1. 1. Expect some discomfort: Engaging in PPT, like any treatment, is not easy. Therapy is supposed to shake up your equilibrium, which can cause temporary disruptions. Therefore it is helpful from the start to expect some disruption. However, if you persist, you will most likely be able to find a balance that works for you and those around you. Please keep in close contact with your clinician about your progress throughout the PPT process.

  2. 2. Motivation: As you start this journey, please understand that treatment cannot be forced or coerced. If you are attending the treatment on your own volition, build on this initiative by seeing yourself as an agent of change in your life. From the start, try to connect the concepts and practices from your PPT sessions to your everyday life. For example, through the practice of the Gratitude Journal (which will be covered in your first PPT session), begin to look at positive events and experiences: If someone holds a door for you, smiles at you, or does a favor for you that you were not expecting, briefly pause and think about this. Such pause and reflection will gradually help you cement changes in your daily life—for the better.

  3. 3. PPT is not a panacea: PPT is not universally applicable, relevant, or appropriate for every clinical condition. If you have chronic, complex, and severe mental health concerns, it is important that you seek an appropriate level of care, including psychiatric, medical, and vocational. Developing a positive outlook, learning to more effectively use your character strengths, and developing a sense of purpose or meaning may not be sufficient or even relevant to all of your psychological problems. Setting realistic expectations from the start regarding the extent to which PPT can be helpful is an important consideration.

  4. 4. Progression is not linear: Changing behaviors, especially those developed and cemented over many years, takes time, and we highly recommend that you and your clinician periodically monitor your progress using a valid and reliable feedback system. Also, a number of external factors over which you may have little or no control—such as conditions at work; mental health issues of a loved one; or social, economic, or political challenges (e.g., economic depression, unexpected climate-related disasters, cyber-bullying, or terrorist attacks)—may adversely impact or derail your therapeutic progress. Please make sure that your clinician is aware of any such factors that may impact your progress. Such communication will help to develop a shared understanding and also help the clinician understand your circumstances. Furthermore, some PPT practices. Such (p. 7) as Positive Appraisal (which looks at open/negative memories) and Expressive Writing (which looks at posttraumatic growth), can potentially trigger unpleasant memories. Therefore, it is important to discuss your therapeutic progress with your clinician on a regular basis and make ant necessary changes.

  5. 5. PPT is not for everyone: Individuals with some acute psychological conditions such as severe and frequently experienced symptoms of panic disorder, those with an entrenched sense of perceiving themselves as a victim, or those who have experienced severe and prolong abuse may need another specific treatment protocol to first deal with the acute symptoms. After stabilizing, such clients can consider pursuing PPT.