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Therapy That Keeps On the Sunny Side of Life: Rising Number of Therapists Focus on the Positive

Publication Date: 2006-09-26

from Wall Street Journal, Sept. 26, 2006

A small but increasing number of therapists are employing an emerging discipline known as "positive psychology." The treatment focuses primarily on the affirmative aspects of a patient's life with the goal of helping them feel more optimistic and fulfilled. What if we had a department in government that trained teachers to accentuate the positive?

When Margaret Smith felt worried or sad, she did what many people do. She took antidepressants or talked to a therapist about issues that were bothering her: her divorce, her shyness, how her mother was depressed when she was growing up.

But neither the drugs nor the sessions made her feel much better. So when Ms. Smith started feeling anxious after moving to Boston last year, she decided to try a different type of therapy. Once a week for a year, she met with a psychologist to talk about the good things in her life, including her appreciation for Gustav Klimt's art and her gratitude for her father, who worked for decades at a grinding job to support his family.

"I thought it would be better to focus on my strengths, instead of the same old stuff of how I was inadequate or my family was inadequate," says Ms. Smith, a 45-year-old homemaker who now lives in Los Angeles. She says she sometimes still feels anxious, but the therapy sessions focusing on the positive helped her control her emotions, and she has fewer bad moods. "If you focus on what makes you feel good or things you're good at, it's logical you would feel better," she says.

For decades, many therapists have treated mental disorders such as depression with medication and talk therapies that often concentrate on family relationships and how they affect current problems. But some psychology experts worried that this approach addressed only half of the equation -- focusing on negative feelings, while ignoring the positives that help people feel happy. Now a small but increasing number of therapists are employing an emerging discipline known as "positive psychology." The treatment focuses primarily on the affirmative aspects of a patient's life with the goal of helping them feel more optimistic and fulfilled.

The new techniques often involve assessing a patient's strengths, such as creativity or humor, and implementing them in everyday life. The result can be small actions like taking a class or larger decisions like changing jobs. The positive approach is being used with everyone from depressed patients and anorexics to disaster victims and veterans returning from war with post-traumatic stress disorder. Increasingly, people who have no mental illness or disorder -- who function well but simply want to function better -- are giving the upbeat method a try.

Critics contend that positive therapy simply repackages ideas that have been around for a long time in other forms, such as the humanistic-psychology movement of the 1960s and '70s, or even Buddhism. And they bristle that the very label "positive therapy" implies that other types of therapies are negative.

"It's great if you can increase people's positive emotions, but this doesn't get rid of their negative ones," says Julie Norem, professor of psychology at Wellesley College in Wellesley, Mass. "The important thing is that people learn to manage them."

Proponents of the new techniques -- typically licensed psychologists, who must have a Ph.D. to practice -- say they are careful to deal with any negative feelings a client brings up. And some integrate positive techniques with other forms of therapy or a referral for medication, especially with clients diagnosed with a mental disorder such as depression.

The technique isn't for everyone, positive psychologists say. Patients with severe mental illness such as bipolar disorder or schizophrenia will need help working through their problems before they can learn to be positive. For patients who do seek positive therapy and have a diagnosed disorder, sessions are typically covered by insurance as treatment by a psychologist.

Growing Academic Field

The field of positive psychology was created in 1998 when Martin Seligman, a psychology professor at the University of Pennsylvania, became president of the American Psychological Association. During his year in office he made it his goal to persuade others in his profession to focus more on the traits and conditions that help people feel happy. He has founded the Positive Psychology Center at the University of Pennsylvania and organized conferences in the nascent field. Today, the field is being broadly studied, and about 200 positive psychology classes have popped up at universities. At Harvard, "Positive Psychology" was the most popular elective class last spring, with more than 800 undergraduates enrolled.

As positive psychology has taken off as an academic discipline, psychologists have developed therapeutic techniques to put the ideas into clinical practice. Currently there is no requirement for specialized training in this area of psychology. But positive psychologists have created assessment tests to determine strengths and positive traits, such as optimism, as well as exercises to increase these traits, such as making lists of good things that have happened. (Many can be found on two Web sites: www.authentichappiness.org1 and www.reflectivehappiness.com2.)

There are several new textbooks that aim to train therapists in positive techniques. Last year the University of Pennsylvania created a master's program in applied positive psychology, and received 100 applications for 35 slots. And Mclean Hospital in Belmont, Mass., a Harvard affiliate that specializes in psychiatry, is in the process of creating the Coaching Psychology Institute: Positive Psychology in Action, to train therapists and other health-care providers.

Noting the Positive

"The main thing is to teach people to put more positive experiences in their day, to appreciate and notice these experiences," says Carol Kauffman, a positive therapist and assistant clinical professor at Harvard Medical School. Dr. Kauffman says one of the many places she uses positive therapy is her group for women with eating disorders. After patients identify themselves and their disorder, Dr. Kauffman goes around the circle again and has them name something positive about their lives. "Now the bulimic says she is a senior at Radcliffe and won a prize and really loves beauty," says Dr. Kauffman. It makes them feel "empowered."

Tayyab Rashid, a psychologist in Toronto, has developed a 12- to 14-session therapy program that begins by assessing the person's strengths and symptoms. Then each week he discusses a specific issue with the client, such as the power of gratitude: He may have them write a thankful letter to someone in their lives, which he says helps build relationships in a positive way. In another assignment, the "family strength tree," the client asks each family member to take a questionnaire about his or her strengths and holds a family conference to discuss them.

Positive therapy "is not about candy and chocolates and vacations," says Dr. Rashid, who has a practice in Toronto. "It's about working on your strengths, and there are no short cuts."

Heidi Hall, an editor at the Tampa Tribune, turned to a positive psychologist to learn to be a better manager at work and to be happier. She says he assigned her several exercises. In one, she wrote a letter expressing forgiveness to someone who had wronged her. She chose her landlord, who had charged her $500 for damage she says wasn't her fault. "I had a lot of anger and sense of injustice," says Ms. Hall, 36 years old. The letter helped her realize "you are only hurting yourself."

Psychologists in the field believe positive therapy has far-ranging uses, including helping people who may not need treatment in a traditional sense. For people who don't have a diagnosis of a mental disorder, the sessions are often considered "coaching" and likely wouldn't be covered by insurance. The cost varies, but may generally run $100 to $250 per session.

Each week business executive Robin Cole meets with a positive coach -- psychologist Paul Lloyd. Mr. Cole says he met Dr. Lloyd through business connections and became intrigued with the idea that positive-therapy techniques could improve his leadership at work. Dr. Lloyd coaches him on such topics as how to frame bad events in a positive context. Mr. Cole, 61, who is the president of Rite Group, an office-technology company in Cape Girardeau, Mo., also performs certain exercises at home. In one recent assignment, he identified an experience he savors -- his Saturday morning ritual of making coffee and biscuits -- and wrote a short essay about it.

Impact on the Job

Mr. Cole says he also anonymously surveys his employees each quarter about their contentment at work, to identify business issues to work on with his coach. He says the techniques he has learned have "contributed to a stronger outlook in the way I conduct myself personally and in the way I now lead my business."

The American Red Cross is utilizing some positive-psychology techniques. The agency recently revised the manual it hands out to psychologists and other mental-health experts who volunteer to work with victims of a disaster, encouraging them to help people focus on how they survived, as opposed to just going over the trauma that occurred. "You are reinforcing the coping skills rather than the horror of the experience," says Susan Allstetter Neufeldt, a retired psychologist from Santa Barbara, who volunteered with the Red Cross in Dallas and New Orleans after Hurricane Katrina. "I would tell people that if they could get three laughs a day they were helping themselves."

Write to Elizabeth Bernstein at elizabeth.bernstein@wsj.com3

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