Positive CBT E-Book

Fredrike Bannink

• Herausgeber: Hogrefe Publishing
• Kategorie: Fachliteratur
• Sprache: Englisch
• Veröffentlichungsjahr: 2021

Seitenzahl: 289

Beschreibung

Positive CBT integrates positive psychology and solution-focused brief therapy within a cognitive-behavioral framework. It focuses on building what's right, not on reducing what is wrong. - Learn about the evidence-base for Positive CBT - Teach clients what works for them with the treatment protocols - Download client workbooksMore about the bookPositive CBT integrates positive psychology and solution-focused brief therapy within a cognitive-behavioral framework. It focuses not on reducing what is wrong, but on building what is right. This fourth wave of CBT, developed by Fredrike Bannink, is now being applied worldwide for various psychological disorders. After an introductory chapter exploring the three approaches incorporated in Positive CBT, the research into the individual treatment protocol for use with clients with depression by Nicole Geschwind and her colleagues at Maastricht University is presented. The two 8-session treatment protocols provide practitioners with a step-by-step guide on how to apply Positive CBT with individual clients and groups. This approach goes beyond simply symptom reduction and instead focuses on the client's desired future, on finding exceptions to problems and identifying competencies. Topics such as self-compassion, optimism, gratitude, and behavior maintenance are explored. In addition to the protocols, two workbooks for clients are available online for download by practitioners. The materials for this book can be downloaded from the Hogrefe website after registration

Leseprobe

Positive CBT

Individual and Group Treatment Protocols for Positive Cognitive Behavioral Therapy

Fredrike Bannink

Nicole Geschwind

Library of Congress of Congress Cataloging in Publicationinformation for the print version of this book is available via the Library of Congress Marc Database under the Library of Congress Control Number 2020952417

Library and Archives Canada Cataloguing in Publication

Title: Positive CBT : individual and group treatment protocols for positive cognitive behavioral therapy / Fredrike Bannink, Nicole Geschwind.

Names: Bannink, Fredrike, author. | Geschwind, Nicole, author.

Description: Includes bibliographical references.

Identifiers: Canadiana (print) 20210095202 | Canadiana (ebook) 20210095261 | ISBN 9780889375789

(softcover) | ISBN 9781616765781 (PDF) | ISBN 9781613345788 (EPUB)

Subjects: LCSH: Cognitive therapy. | LCSH: Positive psychology.

Classification: LCC RC489.C63 B36 2021 | DDC 616.89/1425—dc23

©2021byHogrefe Publishing

www.hogrefe.com

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|v|Preface

Life can only be understood backwards, but it must be lived forwards.

Søren Kierkegaard, Danish philosopher

Positive cognitive behavioral therapy (positive CBT) does not focus on what is wrong with our clients and how to repair that, but on what goes well in their lives and how to build on that. The focus is on the person, not the disease; the well-being of our clients takes center stage. And it does not only concern the well-being of our clients, but also our own well-being as cognitive behavioral therapists.

Positive CBT is not only an important different perspective for clients, but also for ourselves as therapists, as an antidote to burnout and negativity.

Prof. Filip Raes, Belgium

Source: Positieve cognitieve gedragstherapie © 2014 Fredrike Bannink

Practicing Positive CBT integrates the research and practice of positive psychology and solution-focused brief therapy within the cognitive behavioral therapeutic framework. Bannink’s book Practicing Positive CBT, which was published in 2012, describes her model of positive CBT and is the founding text in positive CBT. This form of CBT, also called fourth wave CBT, is now practiced worldwide, from Japan to Brazil and from Germany to Iran, and is being applied with various diagnoses. The book on this subject by Fredrike Bannink has so far been translated into Dutch, German, Japanese, Farsi, and Portuguese, and there is interest in more translations.

Fredrike Bannink captures the essential importance of building on positive feelings, motives, imagery, memories, and behaviors. The psychology of “cultivation,” so much a focus in Buddhist approaches to human suffering, is brought to life in new ways with extensive knowledge of the research literature. Full of fascinating insights and practical applications, this is a book to change what we focus on and how we do work in helping people change. A book to read many times.

Prof. Paul Gilbert, UK

Source: Practicing Positive CBT: From Reducing Distress to Building Success. © 2012 Fredrike Bannink

|vi|In recent years we have received many requests to provide a treatment protocol for positive CBT. Many colleagues have asked us to provide a “cookbook,” a manual, to enable them to apply positive CBT in their workplace. We are happy to be able to offer two protocols now: a protocol for individual positive CBT and a protocol for positive CBT in a group (see Chapter 3 and Chapter 4). The protocol for individual positive CBT in the treatment of major depressive disorders has been studied at Maastricht University, the Netherlands, by Nicole Geschwind and colleagues. Nicole actually obtained her PhD at Maastricht University, researching the value of positive emotion in the treatment of depression (Geschwind, 2011).

The individual positive CBT protocol in the treatment of major depressive disorders showed promising results in that study. Moreover, clients preferred positive CBT over traditional CBT, as is evident from the quotes we have included from the study throughout this book. We describe our quantitative and qualitative research in more detail in Chapter 2. Articles describing the complete study were published in Behavior Research and Therapy and in Psychotherapy (Geschwind et al., 2019, 2020).

Now I am really building the life that I want.

Client

You will find a detailed description of the protocol for positive CBT in a group in eight sessions in Chapter 4. Fredrike developed this protocol in collaboration with her colleague Fourough Jafari from the Azad University of Tehran.

In Chapter 5 we describe Carin’s case, in the hope of providing a concrete picture of what positive CBT can look like. Chapter 6 lists 12 frequently asked questions and our answers. We provide answers to questions such as, “What if my client cannot find a goal?” and “Isn’t positive CBT a bit problem-phobic?”

The two Appendices contain the client’s Workbooks: one for individual positive CBT and one for positive CBT in a group. As a purchaser of this book, you may use the Workbooks and exercises for your clinical work, as long as you give credit to the source.

We prefer to call the first and second wave in CBT “traditional” instead of “negative,” as some colleagues have suggested. It is also our preference to speak of “clients” instead of “patients,” because we believe this latter term tends to invite passivity.

To use the positive CBT protocols properly, please take note of the following:

It is recommended that you read the entire protocol before you start the sessions with your client or group. It would also be helpful to read the description of the exercise and the associated homework suggestions before each session, as well to take a look at the clients’ Workbook.

The two client’s Workbooks can be found in the Appendix 1 and Appendix 2. Therapists can download the Workbooks and their worksheets for use in the clinical work (please see the appendix on how to access these).

After having focused for almost twenty years on what is wrong with my clients, this approach feels like a breath of fresh air.

Cognitive Behavioral Therapist

We wish you lots of inspiration, and hope that positive CBT will contribute to the well-being of your clients and yourself. After all, life must be lived forwards.

Fredrike Bannink & Nicole Geschwind

Contents

Preface

Chapter 1 Positive Cognitive Behavioral Therapy

Introduction

Three Approaches Within Positive CBT

Comparing Traditional and Positive CBT

Comparing Traditional and Positive CBT Processes

Role of the Positive CBT Therapist

Chapter 2 Research Into Positive CBT for Depression

Introduction

Results of the Quantitative Study

Results of the Qualitative Study

Conclusions

Chapter 3 Individual Positive CBT Protocol

Introduction

Overview of the Individual Positive CBT Protocol

Overview of the Sessions

Session 1

Session 2

Session 3

Session 4

Session 5

Session 6

Session 7

Session 8

Chapter 4 Positive Cognitive Behavioral Therapy Protocol in a Group

Introduction

Positive CBT in a Group

Brief Overview of Positive CBT Protocol in a Group

Overview of the Sessions

Session 1

Session 2

Session 3

Session 4

Session 5

Session 6

Session 7

Session 8

Comparison With the Protocol for Individual Therapy

Chapter 5 Case Carin

Introduction

Carin

Chapter 6 Frequently Asked Questions

Introduction

Twelve Frequently Asked Questions and Our Answers

Epilogue

References

Appendix: Tools and Resources

Client’s Workbook for Positive Cognitive Behavioral Therapy With Individuals

Client’s Workbook for Positive CBT in a Group

Acknowledgments

About the Authors

Notes on Supplementary Materials

|1|Chapter 1Positive Cognitive Behavioral Therapy

The secret to change is to focus all of your energy,not on fighting the old, but on building the new.

Seneca, Roman philosopher

Introduction

Positive cognitive behavioral therapy (positive CBT) integrates the research and practice of the positive psychology movement and of solution-focused brief therapy (SFBT) within the cognitive behavioral therapeutic framework (Bannink, 2012). It is a competency-based approach that shifts the focus away from what is wrong with clients and what does not work, to what goes well and does work in their lives.

This competency-based approach – an approach that looks for existing competencies of clients – focuses on uncovering and expanding their skill repertoire. Competency implies that we have sufficient skills to adequately perform the tasks necessary in daily life. The principles of the competency-based approach are:

Connect with the strengths of your clients and activate those strengths in helping your clients to realize their goals.

Listen to your clients’ needs, wishes, limits, and norms, and take these seriously.

Focus on creating new opportunities.

Client:

Sometimes I feel a bit guilty. When I got up a few days ago and saw that the sun was shining I wanted to go out and have a coffee on a terrace. A little voice inside of me said I shouldn’t do that, because my sister just died. When a friend phoned me and I told her that I was sitting on a terrace, she said, “What? Am I calling the right number?”

|2|Three Approaches Within Positive CBT

In this section we briefly discuss the three approaches that come together in positive CBT: traditional CBT, positive psychology, and SFBT. We will provide a comparison of traditional and positive CBT and their processes, and discuss the different role of the positive CBT therapist in each approach. To mention just a few highlights: In positive CBT, goal formulation replaces problem exploration; a focus on competencies replaces a focus on deficits; self-monitoring is used with exceptions to the problem instead of the problem itself; the upward arrow technique is used instead of the downward arrow technique; and the focus is on behavior maintenance instead of on relapse prevention.

Cognitive Behavioral Therapy

The roots of CBT can be traced to the development of behavior therapy in the early 1920s, of cognitive therapy in the 1960s, and the subsequent merging of these two. Cognitive therapy assumes that maladaptive behavior and disturbed mood are the result of inappropriate or irrational thinking patterns, called automatic thoughts. Instead of reacting to the reality of a given situation, an individual reacts to their own distorted viewpoint of the situation. In therapy, clients are made aware of these distorted thinking patterns and change them (cognitive restructuring). Behavioral therapy, or behavioral modification, trains clients to replace undesirable behaviors with healthier behavioral patterns. CBT integrates the cognitive restructuring approach of cognitive therapy with the behavioral modification techniques of behavioral therapy. Many CBT programs have been tested for their effectiveness: The emphasis is on applying evidence-based treatments. This is the basis for CBT often being preferred over other psychotherapeutic methods.

Traditional CBT may be seen as a class of treatments which have the same features in common but also differ in important aspects. It is problem-focused and structured toward the client; it requires honesty and openness between the client and therapist, as the therapist offers strategies and asks the client to apply and evaluate them. Guided discovery or Socratic questioning is often used to help clients to gain insights.

Positive Psychology

Positive psychology was developed in the 1990s as a scientific movement that tries to understand positive human functioning – its cognitions, emotions, and behavior. It is the study of what makes life worth living and what makes people and societies thrive. The movement is focused on bringing out the best in oneself and others with the aim of functioning optimally. The focus is not only on reducing problems or complaints, but also on increasing strengths and well-being. This strengths-based approach – identifying and deploying your strengths – offers a good starting point for further conversations.

When looking at mental health, we find that health is not same as the absence of disease. Mental health concerns both the absence of pathology as well as the presence of well-being. Psychotherapy should therefore no longer be the place where only problems are |3|discussed and repaired, but also the place where strengths are discovered, positive emotions are reinforced, and hope, gratitude, and optimism are nourished (Bannink & Peeters, 2020).

Research shows that psychopathology and positive mental health are two different complementary indicators of mental health (Keyes, 2005). And although psychological problems are more often associated with poor positive mental health than with good, their relationship is limited. The degree of psychopathology does not say much about the degree of positive mental health, and vice versa. Someone with serious psychiatric disorders can still experience a high degree of well-being, and the other way around – absence of mental disorders does not guarantee a high degree of well-being.

Nowadays, positive psychology has a large body of completed research examining its constructs, including optimism, well-being, gratitude, resilience, flow, hope, courage, and positive emotion. The most common theory in the positive psychology field is the well-being theory of Martin Seligman (2011). Five pillars together ensure well-being: positive emotion, engagement, positive relationships, meaning, and accomplishment, which give the acronym PERMA. The five pillars in more detail are

Positive emotion: Focusing on positive emotions is more than just smiling; it is the ability to be optimistic and view the past, present, and future from a positive perspective. This positive view of life, where there is room for fun and enjoyment, can help us in relationships and work, and inspire us to be more creative and take more chances. It is about experiencing positive emotions: To what extent do we feel happy and content?

Engagement: Finding activities that take our full engagement helps us to learn, grow, and nurture personal happiness. This life of involvement refers to our commitment to do what we do: To what extent do we experience a sense of personal fulfillment?

Relationships: Having relationships and social connections is one of the most important aspects of life. We are social animals that thrive on connection, love, intimacy, and a strong emotional and physical interaction with other humans. Building positive relationships with our parents, siblings, peers, and friends is important for spreading love and joy. Having strong relationships gives us support in difficult times.

Meaning: Finding meaning and a reason we are on this earth is important to living a life of happiness and fulfillment. Rather than the pursuit of pleasure and material wealth, there is an actual purpose for our life. To understand the greater impact of our work and why we choose to pursue that work will help us enjoy our tasks more and become more satisfied and happier. Living a meaningful life is not only about us, but also about something larger than us – about altruism and caring for others: To what extent do we have the feeling of being part of, and contributing to, a greater whole?

Accomplishment: Having goals and ambition in life is important also. We should make realistic goals that can be met; just putting in the effort to achieve those goals can already give us a sense of satisfaction. When we finally achieve them, we will experience a sense of pride and fulfillment. Pursuing success, accomplishment, winning, achievement, and mastery for their own sake will help us thrive and flourish.

The higher you score on all five pillars – the higher the sum – the greater your well-being is (Bannink, 2017a). Well-being is important because it forms an important buffer against psychopathology. Recently there seems to be a growing consent to choose the letter V for Vitality as the sixth building block of well-being. Vitality is about taking good care of our |4|body and mind – for example, by exercising regularly, following a healthy diet, getting enough sleep, and applying mindfulness. Seligman, cofounder of the positive psychology movement, states

The message of the positive psychology movement is to remind our field that it has been deformed. Psychology is not just the study of disease, weakness, and damage; it is also the study of strength and virtue. Treatment is not just fixing what is wrong; it is also building what is right. (Seligman, 2005, p. 4)

Client:

At the request of my therapist I asked a few friends to write down my strenghts and virtues. Scary, but at the same time fun. They wrote that I was someone they can rely on, I tend to forget that sometimes. So I thought: if they think they can rely on me, then I may well see myself in the same way.

Tayyab Rashid (2009) mentions four implications that positive psychotherapy has:

Positive psychology interventions (PPIs) do not imply that other interventions are negative.

People quickly get used to new circumstances. To experience more well-being, people must regularly develop new activities that fit with their values, strengths, and interests.

It is intended that PPIs invite people to consider new activities and not prescribe them what to do. Attention must also be paid to individual and cultural differences with regard to happiness and well-being.

PPIs are not only intended for people with problems or disorders; positive psychology also relates to work, education, insight, love, growth, and play.

Client:

My psychologist said: “You can compare your body with a car. If you only look at defects and everything that is wrong or may go wrong, you no longer enjoy driving. And that is exactly what I want you to have: a nice ride. Therefore, I want us to discover how you can enjoy driving.

Solution-Focused Brief Therapy

In SFBT, building solutions is central, not solving or reducing problems. It consists of the pragmatic application of a number of principles and exercises, best described as finding the direct route to what works (De Shazer, 1985, 1991; Bannink, 2010, 2015b).

The two solution-focused simple assumptions are:

If something works (better), do more of it.

If something does not work, stop and do something else.

SFBT is a structured process, with ample acknowledgment for the suffering that the problems or complaints cause. However, problems need not to be analyzed. There is a useful interaction with the therapist in which clients find solutions and are invited to change. By focusing on what works in their lives, they gain more hope, have more creative ideas, feel more competent, and see more possibilities.

|5|SFBT helps clients to develop a vision of a better future and to take notice of – both by the client and the therapist – their strengths and resources. Clients may then apply those to make their vision a reality.

Solution-focused questions lie at the heart of SFBT: They invite clients to think differently, notice positive differences, and achieve desired changes. SFBT does not work on the basis of systematically investigated or general applications, as positive psychology does. It is all about finding what works for this client, at this moment, in this context. The techniques and specific solution-focused questions have been researched by Franklin et al. (2012).

The solution-focused approach is complementary to the medical model. The approach is about starting or expanding desired behavior. It is goal- and future-oriented, short and practical, and focuses on concrete results. It is light and positive in tone, and it saves energy at the end of the day. Some solution-focused assumptions include

You do not need to know the cause or perpetuating factors of a complaint or problem to resolve it.

A quick change or solution of the problem is possible.

Focus on solutions and possibilities instead of on pathology.

Invite clients to take action.

Look, together with the client, for small positive changes, and amplify those.

Client:

I wanted to resume my life after my wife’s death and meet new people. First I wanted to write a letter to apply to volunteer at the library, but it just didn’t happen. My GP asked me: “How are you going to write that letter? How will you start? Where will you be sitting?” I replied that I would be sitting at my table with my laptop. We discussed a few more details, and then my GP asked me: “When will you come and tell me that you succeeded?” “Next Friday,” I said. “I now work in the library for three mornings a week and enjoy it.”

In SFBT, the role of therapists is different from other forms of psychotherapy: They are no longer the only experts who make the diagnoses and give advice, but they consider their clients to be coexperts in the field of their own lives. Research shows that SFBT usually requires fewer sessions than problem-focused psychotherapy, and therefore SFBT is more cost-effective. Research also shows that the clients’ autonomy is well guaranteed, and there is less burnout among practitioners (Franklin et al., 2012; Medina & Beyebach, 2014). SFBT cofounder Insoo Kim Berg, a few months before she passed away, wrote in her Foreword for Fredrike Bannink’s Dutch book Oplossingsgerichte vragen. Handboek oplossingsgerichte gespreksvoering, 4th ed. (Bannink, 2019, first published in 2006), which was later published in English as 1001 Solution-Focused Questions. Handbook for Solution-Focused Interviewing:

Solution-focused interviewing is based on the respectful assumption that clients have the inner resources to construct highly individualized and uniquely effective solutions to their problems. (Bannink, 2010, p. xi)

Client:

If I had had a suicide pill, I am not sure I would not have taken it. I thought: “I’ll never be able to get out of this.” My therapist then asked me why I would not have taken that pill. And then I thought of all the things in my life that I find important, the lovely people that I know, my hobbies and vacations. And then the sun started to shine again.

|6|Client:

My therapist told me that you don’t always have to know the cause of a problem to be able to start working on improvement[s] by taking small steps. And that you can start searching for possibilities and the beginning of success, rather than dwell on the impossibilities. I then told her that I had recently started a mindfulness training [sic], hoping it will help me to become a bit more relaxed. She thought that was a good example of what works for me. And that I can start looking for more things that work or have worked for me. I then suggested continuing to work with the mindfulness trainer because I had already spoken with him. My therapist said she thought this was a very good idea.

Comparing Traditional and Positive CBT

As we wrote earlier, CBT can be seen as a class of treatments, with some similarities and some differences among them. The purpose of all forms of CBT is to help clients to make desired changes in their lives.

When we look at positive CBT, it differs from traditional CBT in two important aspects:

Traditional CBT has an explicit theory about the cause and/or perpetuating factors of problems. SFBT has no assumptions about how people end up in difficulties. Steve De Shazer, cofounder of SFBT, once summarized this rather bluntly: “Shit happens.” Positive CBT assumes that well-being can be increased by focusing on the positive things in life (see PERMA; Seligman, 2011).

Traditional CBT assumes that knowledge about the cause or perpetuating factors in problems is necessary to help clients get better. Positive CBT assumes that the (causes or perpetuating factors in) problems do not tell us how we as therapists can be useful for our clients.

We see positive CBT as fourth wave CBT. It is future-focused and offers hope for a better life. It is about designing an outcome that was not there before. Positive CBT is transdiagnostic – it can be applied to all mental disorders – and is also transcultural. Currently positive CBT is used worldwide, from Japan to Brazil and from Germany to Iran.

Fredrike Bannink described the learning theory implications and further theoretical points of view in her book Practicing Positive CBT (Bannink, 2012). She also described what already can be seen as more positive within traditional CBT. Third wave CBT can be thought of in terms of approaches such as competitive memory training (COMET), acceptance and commitment therapy (ACT; Hayes et al., 2003), and behavior activation (Ferster, 1973; Beck, 2011).

Client:

People should pay more attention to everything that goes well, and that is exactly what this therapy is about. I noticed that if I pick out the things that do go well, the things that do not go well naturally become less important.

|7|Client:

I now feel a much stronger woman. What I realize is that I am linked with this society and that I do matter. That is a big difference compared to the situation before this therapy. I have had psychotherapy for many years focusing on my traumas.

Client:

At first I thought: traditional psychotherapy will probably be more helpful. But in the end my thoughts about traditional CBT were: if I have more of these sessions, I’ll quit. With positive CBT I was reluctant at first, I thought that won’t work, but I have learned ten times more from it. You really start to look at yourself differently and apply things much better. It is a steeper path, but it is much better. For me, positive CBT was a turning point, because I really enjoyed going to the sessions and thought: this is gonna help me.

Comparing Traditional and Positive CBT Processes

The CBT process has three general phases: diagnosis, treatment, and closing phase. Then, in traditional CBT, we see the following more specific phases: problem exploration, choosing a problem to work on, self-monitoring of the problem, designing functional behavioral analyses, specifying a plan and objectives, applying modification procedures, and evaluation during the closing of the therapy.

The phases in traditional CBT versus positive CBT processes are shown in Figure 1 and highlighted in the following paragraphs. You may notice that positive CBT has one phase fewer than traditional CBT.

The first phase, introduction and building rapport is more or less the same in positive CBT as it is in traditional CBT. One difference is that from the start of the session, the focus in positive CBT is positive: What does the client do in daily life? What do they think they are doing well? What do they like about the things they are doing? Also, the therapist asks about any pretreatment change since the client first contacted the therapist. A significant number of clients will already be able to mention positive changes when they come for the first session (Weiner-Davis et al., 1987). To find out what these changes are, the therapist should, of course, ask that particular question.

The second phase in positive CBT concerns the goal formulation (instead of the problem exploration in traditional CBT): It is about designing an outcome that was not there before (using the synthesis paradigm, which is looking forward to what might be created, instead of the analysis paradigm, which is looking back at what already is). The therapist invites the client to provide a detailed description of their preferred future. In traditional CBT, attention to a plan and objectives is only given in the fifth phase, when the overall diagnostic phase has been finished. In traditional CBT, therapists usually pay no explicit attention to the collaborative relationship that the therapist has with the client. This concerns questions such as, “To what extent is the client motivated to change?” “Who will do what to achieve this change, and when?” Positive CBT is not about goals or objectives (plural); there is just one goal, this being the preferred future or outcome of the client (and of important others |8|in their life), with a focus on desired behavior, desired cognitions, and desired emotions. This goal is stated in positive, achievable, and concrete terms.

Figure 1 Comparing the traditional and positive CBT processes.

Objectives (plural) in traditional CBT are usually formulated in negative terms, such as “to worry less” or “to decrease depression.” This is also seen in book titles that are based on traditional CBT: How to overcome your fear, Help yourself get out of depression, and How to deal with trauma.

It may be useful for your clients to make the following comparison: “Before you go to the supermarket, do you sometimes make a shopping list?” If the client answers affirmatively, then ask, “Do you put things on that list that you do NOT want to buy? It would become a very long list, because in the supermarket you can actually buy around 5,000 things… Of course not! You’ll make a list of what you DO want to buy.”

|9|So, while traditional CBT focuses on goals or objectives (plural), in positive CBT, the question is always: “Suppose you have reached your goal, what will your new and better life look like?” For example, if one of the goals of the client is to become more assertive, the therapist might ask, “So suppose you become as assertive as you want to be, how will your life be different from what it is now? What will you think, feel, and do differently?” The therapist thus asks questions about all of the positive differences the client can come up with. Working on objectives (plural) has the risk that if an objective such as becoming more assertive is not achieved, the therapy may get stuck, and the client’s preferred future does not come closer, or it may even disappear from view. There are always more roads (goals or subgoals) to Rome (being the preferred future or outcome). As they say: All roads lead to Rome! If one road is not possible, then the client and therapist can look for another road. And just to be clear: It is the client who decides what the goal should look like, not the therapist.

Questions about goal formulation in positive CBT include, “What will be the best outcome for you from this therapy?” or “How will we know you no longer need to come here?” or, in the case of n mandated (involuntary) client, “When will the person or institute who referred you think you no longer need to come here?” Or you may ask, “What are your best hopes?” “And what difference will it make for you and/or for important others when everything you hope for has become a reality?” or “What will your new and better life look like?” Or you may ask, “When does this therapy or this session get an 8 (or a 9, or even a 10)?”

Client:

I don’t want to be on the edge every time and fear that my depression is coming back again. I want to take 10 steps in the right direction. I don’t want to think: I hope I don’t turn 40. I want to think that life is worth living and hope I can make it worthwhile. So, what are my best hopes? That I won’t be depressed 90% of the time in a year’s time, but only 50%. That it has become a habit to see the beautiful and good little things in life.

Sometimes people ask whether positive CBT might be a bit problem-phobic, but this is not the case. Clients get the opportunity to describe briefly what is going on in their lives (see also Chapter 6). The difference with traditional CBT is that the therapist does not ask questions about the details of the problem (and thus does not reinforce the client’s problem talk). However, the therapist does give acknowledgment to the difficult situations client find themselves in, asking, for example, “Am I correct in understanding that this must be a very tough situation for you?”

Positive CBT does not use the phase of problem exploration and problem selection, as is common in traditional CBT. It uses the method of stepped diagnosis (Bakker et al., 2010): In the first and second echelons of mental health, the treatment can start right away; but only if the necessary diagnostics are added.

Constructing a holistic therory about the causal relationships between problems, as is often done in traditional CBT, is not necessary in positive CBT. Searching for causes and/or perpetuating factors usually only leads to statements, most likely not to solutions. Also, searching for explanatory assumptions is seen as superfluous.

|10|Client:

And then my psychiatrist asked, “What do you want?” I was surprised: I was never asked this question in the many admissions I had. The question in itself is not difficult, but if no one ever askes you, you have to think about it for a while.