In a time of great national and global upheaval, increasing social problems, migration, climate crisis, globalization, and increasingly multicultural societies, our patients and their needs are unique, diverse, and changing. We need a new understanding of mental health to be able to adequately meet the demands of an ever-changing world. Treatment exclusively with psychotropic medications or years of psychoanalysis will not meet these needs.
Psychiatrists and psychotherapists feel (and actually have) a social responsibility, particularly in a multifaceted global society. Psychotherapeutic interventions may contribute to a more peaceful society1 by reducing individuals’ inner stress, solving (unconscious) conflicts, and conveying a humanistic worldview. As an integrative and transcultural method, positive psychotherapy has been applied for more than 45 years in more than 60 countries and is an active force within a “positive mental health movement.”2
The term “positive psychotherapy” describes 2 different approaches3: positive psychotherapy (1977) by Nossrat Peseschkian,4 which is a humanistic psychodynamic approach, and positive psychotherapy (2006) by Martin E.P. Seligman, Tayyab Rashid, and Acacia C. Parks,5 which is a more cognitive-behavioral therapy (CBT)–based approach. This article focuses on the first approach.
Why ‘positive’ psychotherapy?
The term “positive” implies that positive psychotherapy focuses on the patient’s possibilities and capacities. Symptoms and disorders are seen as capacities to react to a conflict. The Latin term “positum” or “positivus” is applied in its original meaning—the factual, the given, the actual. Factual and given are not only the disorder, the symptoms, and the problems but also the capacity to become healthy and/or cope with this situation. This positive meaning confronts the patient (and the therapist) with a lesser-known aspect of the illness, but one that is just as important for the understanding and clinical treatment of the affliction: its function, its meaning, and, consequently, its positive aspects.6
Positive psychotherapy is a humanistic psychodynamic psychotherapy approach developed by Nossrat Peseschkian (1933-2010).4,7 Positive psychotherapy has been developed since the 1970s in the clinical setting with neurotic and psychosomatic patients. It integrates approaches of the 4 main modalities of psychotherapy:
- a humanistic view of human beings
- a systemic approach toward culture, work, and environment
- a psychodynamic understanding of disorders
- a practical, goal-oriented approach with some cognitive-behavioral techniques.
The concept of balance
Based on a humanistic view of human beings and the resources every patient possesses, a key concept of positive psychotherapy is the importance of balance in one’s life. The balance model (Figure) is the core of positive psychotherapy and is applied in clinical and nonclinical settings. This model is based on the concept that there are 4 main areas of life in which a human being lives and functions. These areas influence one’s satisfaction in life, one’s feelings of self-worth, and the way one deals with conflicts and challenges. Although all 4 capacities are latent in every human being, depending on one`s education, environment, and zeitgeist, some will be more developed than others. Our life energies, activities, and reactions belong to these 4 areas of life:
- physical: eating, tenderness, sexuality, sleep, relaxation, sports, appearance, clothing
- achievement: work, job, career, money
- relationships: partner, family, friends, acquaintances and strangers, community life
- meaning and future: existential questions, spirituality, religious practices, future plans, fantasy.
A goal of treatment is to help the patient recognize their own resources and mobilize them with the goal of bringing them into a dynamic equilibrium. This goal places value on a balanced distribution of energy (25% to each area), not of time. According to positive psychotherapy, a person does not become ill because one sphere of life is overemphasized but because of the areas that have been neglected. In the case vignette described in the Box, the problem is not the patient’s work but that his physical health, family and friends, and existential questions are being neglected. That the therapist is not critical from the start of treatment is a constructive experience for the patient and is important and fruitful for building the relationship between the therapist and the patient. Instead of emphasizing the deficits or the disorders, the patient and his family hear that he has neglected other areas of life and not developed them yet.
Mr. M, a 52-year-old manager, is “sent” by his wife to see a psychotherapist. “My wife says I am married to my job, and I should spend more time with her and the children. I understand this, but I love my job. It is no stress for me, but a few minutes at home, and I feel totally stressed out,” he says. During the first interview, the therapist asks Mr. M to draw his energy distribution in the balance model (Figure), and it becomes clear he spends more than 80% of his time and energy on his job.
That is not such a surprise for him. But after some explanation, the therapist tells him that he should continue to do so and that it is an ability to be able to spend so much time every day for his job. Mr. M says, “You are the first person to tell me that it is good that I am working so much. I expected you, like all the others, to tell me I must reduce my working hours immediately, go on vacation, etc.”
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