Psychotherapy Notes, 2-7-23 Exam Tuesday, 50 MC On Thursday, some course content will be covered. Also guest lecturer on Thursday, which will not be tested on Friday review session – attend that if that will be helpful – just there to answer questions – so look at learning guides and ask for clarifying questions! – recording of the review session will be on Panopto until the exam Positive Psychology Pt. 2 PERMA model – doing all the pillars of this, which all work together, PERMA can be pursued simultaneously and inter…-ly The Full Life – thriving, flourishing – living a life worth living – goal of PPT Engagement and meaning are the most correlated with life satisfaction – I cant ignore other factors, but I’m heading there 1st Cannot chase positive emotions only. Engagement and meaning often involve some sort of challenge, sensory pleasures we will habituate to and get bored of Positive emotions are not everything. We’re looking for (recognizing negative emotions are part of being a human) … Role of positive emotions: positive emotions can act as a buffer to negative emotions. Looking to build this full life. PPT – how do they develop thriving? (write 3 things that went well today before going to sleep every night) Write vision for positive future, write their own model obituary. Not really after contentment Meaning in life is everyone’s birthright, and it’s teachable. The single best thing a person with depression can do is to go out and help someone else. Seligman using the PERMA model over and over again, bringing us back to empirical research – we need to measure it before we can do anything about it This is not about hedonic pleasures – this is about real meaning and engagement in one’s life. Gratitude journaling, writing down what we’re thankful for Positive emotions helping to buffer out the negative Make a conscious choice to recall the positive What would your grandchildren think of you? Helpful technique We sometimes talk about ourselves in ways we would never talk about others. Therapeutic relationship: P&T alliance (Psychoanalysis uses this, Mesmer taught us this) Therapeutic relationship a non-specific factor The environment T is trying to create. We’re looking for a warm, inviting, authentic T. We’re looking for collaborative and egalitarian therapy. Much more collaborative and egalitarian 2 people trying to figure out how to live a full life. A collaboration and a conversation Strength-based approach instead of deficit-based We have an absence or overuse of different strengths T looks for strengths in P, the solution is in helping people balance those strengths – what strengths do they have that we can build/hone to be used in the right amount? Therapist tries to understand P’s values, goals, resources around them, interpersonal relationships, daily life - look for strengths in situations to help reach goals and build/hone strengths. Assess Strengths - Signature Strengths: go-to strengths, use most often: Tonic strengths – use in all situations. Phasic strengths – use in specific situations. Sometimes you should tone down a tonic strength. Sometimes a phasic strength is not being used when it should be. Using a survey Values in action survey, 240Q questionnaire (available at UPenn website) Goal – find concrete actions someone can take to help balance their strengths. Cultivating strengths Gratitude: write things P is thankful/grateful for – focus on the positive, (really improves your life if you do it for a week), from this we can begin to learn other skills (like engagement) Engagement – be aware of emotions as they happen. Engaging with what we are grateful for, we can become more satisfied with our lives. These skills are like a muscle, the more you practice the easier they are to use and the more available they are People become more engaged in the moment. People who use gratitude journaling often go through day more engaged with positive. Reflection, savoring: slow down, create meaning around what we are savoring. Savor these positive things can have additional benefit Manage negative emotions. Being in a forest “lose sight of the forest for the trees” “lose sight of big forest when you just see the tree before you” Can we pull back and see more trees out there? Positive buffering, get mental space to see the whole landscape. Make sure that people can manage negative emotions, feel and express them healthily, get some space from them and see the bigger picture and have some buffers. Video: - Therapist targeting engagement and concept of flow (so absorbed with the thing that you’re doing that you lose track of time) Try to find how patient can find flow. Try not to be overbooked so that you can get engaged with your day. It’s hard to be engaged when you’re late for something. Encouraging, congratulating P Open warmth, casual Egalitarian, collaborative relationship Really reflective of what she is saying – good to help show empathy. Reflections are very valuable. T explaining why T asks P to do things Not overloading her with technical terminology - - This is great that you have identified painting has worked for you in the past, and also planting the seed that if this idea doesn’t work as good as we think it will, we can explore other things Being open that one strategy doesn’t necessarily work for everyone Try to make boring tasks enjoyable. Want people to leave PPT with enough knowledge that P can pivot to find different ways of finding flow when one doesn’t work out - - Multitasking vs. “utilizing flow in boring activities” Can you get lost in something you otherwise wouldn’t have gotten lost in – a totality of a flow experience- using sensory things to help you out – folding laundry and listening to music – develop flow being engrossed in a piece of music while you are rhythmically folding clothes – not really multitasking – it’s a slippery slope (fantastic question) T is not there to mansplain – a very egalitarian and collaborative relationship – let’s stick with what we’ve got and how we can look to the future Tangible things to go out and practice. T Really conscious and validating of P’s busyness Not really interested in the past That great you’ve done it before, but let’s focus on what we should do next week. (Zale comes from a motivational background) Changing your behavior is a really hard thing to do T is an active listener, engaged in what she is saying More methods of Psychotherapy for Positive Psychotherapy Therapists aren’t memorizing a script, there is give and take, a specific set of info to convey and also hw for the patient - 14 Session Model Sessions 1-3: orientation to PPT; client writes “positive introduction” of self; assess signature strengths; develop action plan to incorporate strengths Important, want people to understand why they should do what we suggest, therapist with a magnifying glass is looking for signature strengths, looking for strength imbalances, looking for strengths because that’s where we believe change is going to lie; engagement and savoring – tell P to sit down with pen and paper and write it down – we also want people to think of themselves in a strength-based approach, which is against the grain of our culture; “tell me the positive things that bring you in”; develop an action plan to help them incorporate their strengths – everyone’s action plan is different, and their plan might change. Every patient does something… Sessions 4-6: reappraisal of bitter memories; forgiveness; gratitude letter help people look at negative memories in a different perspective, often through writing. Holding onto and replaying negative memories is a choice (choose to savor the positive or the negative). Think about how they feel they should send forgiveness (sometimes letters sent, sometimes not sent). Gratitude letters – sent or not – help flip that script from negatives we carry with us to how we can make a positive choice to look at things differently. Session 7: feedback/check-in T comes in with no agenda – just open the floor to what works well and what does not, what should we change or shift bout the activities we’ve done before. An entire session to see how folks are doing at that halfway point. Sessions 8-9: cultivate positive emotions and growth from trauma help people grow, see this in meaning-making – how we can make meaning. Sessions 10-11: communication skills and strengths of others develop assertiveness and communication skills. Helping people see strengths in others as well. Try to see the strengths. Session 12: savoring every time we ask someone to do a written exercise, ex. gratitude exercise, we’re asking to savor. Session 13: altruism; helping others build meaning, accomplishment, engagement, & facilitate engagement in relationships. Session 14: integrate treatment gains – the full life in termination, bring all the things together to seeing how P has developed over the course of the treatment. Efficacy vs. effectiveness often these manualized treatments are being adapted – evidencebased practice – often deviates from manual – some T can repeat sessions but others cannot, some insurance authorizations don’t even go to 14 sessions Mechanisms, evidence, and cultural considerations We think PPT works b/c: - - Broaden and build resources for coping (look to how we can build full life around those things) – see this benefit and reduce mortality from cardiac… - building and experiencing positive moments to buffer against the negative – PERMA model can help us cope. Reprise negative memories – choose the positive instead of the negative “reeducation of attention” – teaching our attentional system to focus on the positive PPT came out of an Evidence Base Focused on measuring and testing things. Randomized control trials for decreasing depression, raising well being Helping young people develop social skills and well being Work coming out of cardiovascular disease. We can do this in groups. R, relationships is part of PERMA. RCTs support effectiveness for: Reduced depression Increased well-being Adolescent substance use; behavioral challenges; social skills; well-being Cardiovascular disease Group PPT provides more opportunities to reinforce treatment gains. Group can help P’s stay on task. We need to be careful to think about culture, how does this culture define happiness, what does a full life mean in this culture, what constitutes engagement or accomplishment – what is the environment you are using strengths in your culture (different for different cultures) How does this function in cultural context, base it off the patient? Think deep about questions for the guest lecturer on the Master of Social Work so you can make the lecturer meaningful for you Savoring video will be viewed on Thursday.
