The term reparation was used by Melanie Klein (1921) (an Austrian-British author and psychoanalyst) to indicate a psychological process of making mental repairs to a damaged internal world. In object relations theory, it represents a key part of the movement from the paranoid-schizoid position to the depressive position — the pain of the latter helping to fuel the urge to reparation.
Melanie Klein
Melanie Klein considered the ability to recognise our destructive impulses towards those we love and to make reparation for the damage we have caused them, to be an essential part of mental health. A key condition for that to take place is the recognition of one’s separateness from one’s parents, which makes possible the reparative attempt to restore their inner representations, however damaged they may be felt to be.
Acceptance of reality, inner and outer, forms a major part of the process and involves both abandoning fantasies of omnipotence and accepting the independent existence of one’s objects of attachment.
Where the damage done to the internal world is felt by a patient to be extreme, however, the task of reparation may seem too great, which is one of the obstacles facing the analytic attempt at cure.
Manic Reparation
Kleinian thought distinguishes between true reparation and manic reparation, the latter being driven by guilt rather than overcoming it. Manic reparation denies the pain and concern of feeling guilty by using magical methods of repair which maintain omnipotent control of the object in question, and refuse to allow it its separate existence. Thus manic reparation has to be endlessly repeated, since success would free the object from the manic person’s (contemptuous) power.
Donald Winnicott made his own distinctive contribution to the role of reparation in the “personalising” of the individual, the move from the ruthless use of the external object to a sense of concern. Winnicott focused on the way at a certain stage of development a feeling of guilt or concern begins to appear after the wholehearted instinctual experience of a feed. But once the reparative gesture—a smile, a gift—has been successfully acknowledged by the mother, Winnicott writes: “The breast (body, mother) is now mended and the day’s work is done. Tomorrow’s instincts can be awaited with limited fear”. The child’s contribution is a way of accepting the debt owed to the mother, for their survival and their participation in the work of reparation. If, on the other hand, the reparative gesture is not accepted, the infant is left with a feeling of depression or meaninglessness.
A similar dynamic may later appear between patient and analyst, with the making of progress being offered as a means of reparation.
Art
Kleinians considered that artistic creation was driven by the phantasy of repairing the loved object (mother).
Marion Milner in the Independent tradition also saw art as a way of both symbolizing and enacting inner reparation; but was criticised by Kleinians for giving too large a role to the omnipotent feelings of the artist in reparation.
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Donald Woods Winnicott (07 April 1896 to 25 January 1971) was an English paediatrician and psychoanalyst who was especially influential in the field of object relations theory and developmental psychology. He was a leading member of the British Independent Group of the British Psychoanalytical Society, President of the British Psychoanalytical Society twice (1956–1959 and 1965–1968), and a close associate of Marion Milner.
Winnicott is best known for his ideas on the true self and false self, the “good enough” parent, and borrowed from his second wife, Clare Winnicott, arguably his chief professional collaborator, the notion of the transitional object. He wrote several books, including Playing and Reality, and over 200 papers.
Early Life and Education
Winnicott was born on 07 April 1896 in Plymouth, Devon, to Sir John Frederick Winnicott and Elizabeth Martha, daughter of chemist and druggist William Woods, of Plymouth. Sir John Winnicott was a partner in the family firm, in business as hardware merchants and manufacturers, and was knighted in 1924 having served twice as mayor of Plymouth; he was also a magistrate and alderman. The Winnicott family were staunch, civic-minded Methodists.
The family was prosperous and ostensibly happy, but behind the veneer, Winnicott saw himself as oppressed by his mother, who tended toward depression, as well as by his two sisters and his nanny. He would eventually speak of ‘his own early childhood experience of trying to make “my living” by keeping his mother alive’. His father’s influence was that of an enterprising freethinker who encouraged his son’s creativity. Winnicott described himself as a disturbed adolescent, reacting against his own self-restraining “goodness” acquired from trying to assuage the dark moods of his mother. These seeds of self-awareness became the basis of his interest in working with troubled young people.
He first thought of studying medicine while at The Leys School, a boarding school in Cambridge, after fracturing his clavicle and recording in his diary that he wished he could treat himself. He began pre-clinical studies in biology, physiology and anatomy at Jesus College, Cambridge, in 1914 but, with the onset of World War I, his studies were interrupted when he was made a medical trainee at the temporary hospital in Cambridge. In 1917, he joined the Royal Navy as a medical officer on the destroyer HMS Lucifer.
Having graduated from Cambridge with a third-class degree, he began studies in clinical medicine at St Bartholomew’s Hospital Medical College in London. During this time, he learned from his mentor the art of listening carefully when taking medical histories from patients, a skill that he would later identify as foundational to his practice as a psychoanalyst.
Career
Winnicott completed his medical studies in 1920, and in 1923, the same year as his marriage to the artist Alice Buxton Winnicott (born Taylor). She was a potter and they married on 7 July 1923 in St Mary’s Church, Frensham. Alice had “severe psychological difficulties” and Winnicott arranged for her, and his own therapy, to address the difficulties this condition created. He obtained a post as physician at the Paddington Green Children’s Hospital in London, where he was to work as a paediatrician and child psychoanalyst for 40 years. In 1923 he began a ten-year psychoanalysis with James Strachey, and in 1927 he began training as an analytic candidate. Strachey discussed Winnicott’s case with his wife Alix Strachey, apparently reporting that Winnicott’s sex life was affected by his anxieties. Winnicott’s second analysis, beginning in 1936, was with Joan Riviere.
Winnicott rose to prominence as a psychoanalyst just as the followers of Anna Freud were in conflict with those of Melanie Klein for the right to be called Sigmund Freud’s “true intellectual heirs”. Out of the Controversial discussions during World War II, a compromise was reached with three more-or-less amicable groups within the psychoanalytic movement: the “Freudians”, the “Kleinians”, and the “Middle Group” of the British Psychoanalytical Society (the latter being called the “Independent Group”), to which Winnicott belonged, along with Ronald Fairbairn, Michael Balint, Masud Khan, John Bowlby, Marion Milner, and Margaret Little.
During the Second World War, Winnicott served as consultant paediatrician to the children’s evacuation programme. During the war, he met and worked with Clare Britton, a psychiatric social worker who became his colleague in treating children displaced from their homes by wartime evacuation. Winnicott was lecturing after the war and Janet Quigley and Isa Benzie of the BBC asked him to give over sixty talks on the radio between 1943 and 1966. His first series of talks in 1943 was titled “Happy Children.” As a result of the success of these talks, Quigley offered him total control over the content of his talks but this soon became more consultative as Quigley advised him on the correct pitch.[13]
After the war, he also saw patients in his private practice. Among contemporaries influenced by Winnicott was R.D. Laing, who wrote to Winnicott in 1958 acknowledging his help.
Winnicott divorced his first wife in 1949 and married Clare Britton (1906–1984) in 1951. A keen observer of children as a social worker and a psychoanalyst in her own right, she had an important influence on the development of his theories and likely acted as midwife to his prolific publications after they met.
Except for one book published in 1931 (Clinical Notes on Disorders of Childhood), all of Winnicott’s books were published after 1944, including The Ordinary Devoted Mother and Her Baby (1949), The Child and the Family (1957), Playing and Reality (1971), and Holding and Interpretation: Fragment of an Analysis (1986).
Winnicott died on 25 January 1971, following the last of a series of heart attacks and was cremated in London. Clare Winnicott oversaw the posthumous publication of several of his works.
Concept of Holding
Winnicott’s paediatric work with children and their mothers led to the development of his influential concept concerning the “holding environment”. Winnicott claimed that “the foundations of health are laid down by the ordinary mother in her ordinary loving care of her own baby”, central to which was the mother’s attentive holding of her child.
Winnicott considered that the “mother’s technique of holding, of bathing, of feeding, everything she did for the baby, added up to the child’s first idea of the mother”, as well as fostering the ability to experience the body as the place wherein one securely lives. Extrapolating the concept of holding from mother to family and the outside world, Winnicott saw as key to healthy development “the continuation of reliable holding in terms of the ever-widening circle of family and school and social life”.
Winnicott was influential in viewing the work of the psychotherapist as offering a substitute holding environment based on the mother/infant bond. Winnicott wrote: “A correct and well-timed interpretation in an analytic treatment gives a sense of being held physically that is more real…than if a real holding or nursing had taken place. Understanding goes deeper”.
His theoretical writings emphasised empathy, imagination, and, in the words of philosopher Martha Nussbaum, who has been a proponent of his work, “the highly particular transactions that constitute love between two imperfect people.”
Anti-Social Tendency
Connected to the concept of holding is what Winnicott called the anti-social tendency, something which he argued “may be found in a normal individual, or in one that is neurotic or psychotic”. The delinquent child, Winnicott thought, was looking for a sense of secure holding lacking in their family of origin from society at large. He considered antisocial behaviour as a cry for help, fuelled by a sense of loss of integrity, when the familial holding environment was inadequate or ruptured.
Play and the Sense of Being Real
One of the elements that Winnicott considered could be lost in childhood was what he called the sense of being – for him, a primary element, of which a sense of doing is only a derivative. The capacity for being – the ability to feel genuinely alive inside, which Winnicott saw as essential to the maintenance of a true self – was fostered in his view by the practice of childhood play.
In contrast to the emphasis in orthodox psychoanalysis upon generating insight into unconscious processes, Winnicott considered that playing was the key to emotional and psychological well-being. It is likely that he first came upon this notion from his collaboration in wartime with the psychiatric social worker, Clare Britton, (later a psychoanalyst and his second wife) who in 1945 published an article on the importance of play for children. By “playing”, he meant not only the ways that children of all ages play, but also the way adults “play” through making art, or engaging in sports, hobbies, humour, meaningful conversation, et cetera. At any age, he saw play as crucial to the development of authentic selfhood, because when people play they feel real, spontaneous and alive, and keenly interested in what they’re doing. He thought that insight in psychoanalysis was helpful when it came to the patient as a playful experience of creative, genuine discovery; dangerous when patients were pressured to comply with their analyst’s authoritative interpretations, thus potentially merely reinforcing a patient’s false self. Winnicott believed that it was only in playing that people are entirely their true selves, so it followed that for psychoanalysis to be effective, it needed to serve as a mode of playing.
Two of the techniques whereby Winnicott used play in his work with children were the squiggle game and the spatula game. The first involved Winnicott drawing a shape for the child to play with and extend (or vice versa) – a practice extended by his followers into that of using partial interpretations as a ‘squiggle’ for a patient to make use of.
The second, more famous instance involved Winnicott placing a spatula (tongue depressor) within the child’s reach for him to play with. Winnicott considered that “if he is just an ordinary baby he will notice the attractive object…and he will reach for it….[then] in the course of a little while he will discover what he wants to do with it”. From the child’s initial hesitation in making use of the spatula, Winnicott derived his idea of the necessary ‘period of hesitation’ in childhood (or analysis), which makes possible a true connection to the toy, interpretation or object presented for transference.
Many of Winnicott’s writings show his efforts to understand what helps people to be able to play, and on the other hand what blocks some people from playing. Babies can be playful when they’re cared for by people who respond to them warmly and playfully, like a mother who smiles and says, “Peek-a-boo!” when she sees her baby playfully peeking out from behind his hands. If the mother never responded playfully, sooner or later the baby would stop trying to elicit play from her. Indeed, Winnicott came to consider that “Playing takes place in the potential space between the baby and the mother-figure….[T]he initiation of playing is associated with the life experience of the baby who has come to trust the mother figure”. “Potential space” was Winnicott’s term for a sense of an inviting and safe interpersonal field in which one can be spontaneously playful while at the same time connected to others (again a concept that has been extrapolated to the practice of analysis).
Playing can also be seen in the use of a transitional object, Winnicott’s term for an object, such as a teddy bear, that has a quality for a small child of being both real and made-up at the same time. Winnicott pointed out that no one demands that a toddler explain whether his Binky is a “real bear” or a creation of the child’s own imagination, and went on to argue that it’s very important that the child is allowed to experience the Binky as being in an undefined, “transitional” status between the child’s imagination and the real world outside the child. For Winnicott, one of the most important and precarious stages of development was in the first three years of life, when an infant grows into a child with an increasingly separate sense of self in relation to a larger world of other people. In health, the child learns to bring his or her spontaneous, real self into play with others; in a false self disorder, the child has found it unsafe or impossible to do so, and instead feels compelled to hide the true self from other people, and pretend to be whatever they want instead. Playing with a transitional object can be an important early bridge between self and other, which helps a child develop the capacity to be genuine in relationships, and creative.
Playing for Winnicott ultimately extended all the way up from earliest childhood experience to what he called “the abstractions of politics and economics and philosophy and culture…this ‘third area’, that of cultural experience which is a derivative of play”.
True self and False Self
Winnicott wrote that “a word like self…knows more than we do.”. He meant that, while philosophical and psychoanalytic ideas about the self could be very complex and arcane, with a great deal of specialised jargon, there was a pragmatic usefulness to the ordinary word “self” with its range of traditional meanings. For example, where other psychoanalysts used the Freudian terminology of ego and id to describe different functions of a person’s psychology, Winnicott at times used “self” to refer to both. For Winnicott, the self is a very important part of mental and emotional well-being which plays a vital role in creativity. He thought that people were born without a clearly developed self and had to “search” for an authentic sense of self as they grew. “For Winnicott, the sense of feeling real, feeling in touch with others and with one’s own body and its processes was essential for living a life.”
True Self
“Only the true self can be creative and only the true self can feel real.” For Winnicott, the True Self is a sense of being alive and real in one’s mind and body, having feelings that are spontaneous and unforced. This experience of aliveness is what allows people to be genuinely close to others, and to be creative.
Winnicott thought that the “True Self” begins to develop in infancy, in the relationship between the baby and its primary caregiver (Winnicott typically refers to this person as “the mother”). One of the ways the mother helps the baby develop an authentic self is by responding in a welcoming and reassuring way to the baby’s spontaneous feelings, expressions, and initiatives. In this way the baby develops a confidence that nothing bad happens when she expresses what she feels, so her feelings don’t seem dangerous or problematic to her, and she doesn’t have to put undue attention into controlling or avoiding them. She also gains a sense that she is real, that she exists and her feelings and actions have meaning.
Winnicott thought that one of the developmental hurdles for an infant to get past is the risk of being traumatised by having to be too aware too soon of how small and helpless she really is. A baby who is too aware of real-world dangers will be too anxious to learn optimally. A good-enough parent is well enough attuned and responsive to protect the baby with an illusion of omnipotence, or being all-powerful. For example, a well-cared-for baby usually doesn’t feel hungry for very long before being fed. Winnicott thought the parents’ quick response of feeding the baby gives the baby a sense that whenever she’s hungry, food appears as if by magic, as if the baby herself makes food appear just by being hungry. To feel this powerful, Winnicott thought, allowed a baby to feel confident, calm and curious, and able to learn without having to invest a lot of energy into defences.
False Self
In Winnicott’s writing, the “False Self” is a defence, a kind of mask of behaviour that complies with others’ expectations. Winnicott thought that in health, a False Self was what allowed one to present a “polite and mannered attitude” in public.
But he saw more serious emotional problems in patients who seemed unable to feel spontaneous, alive or real to themselves anywhere, in any part of their lives, yet managed to put on a successful “show of being real”. Such patients suffered inwardly from a sense of being empty, dead or “phoney”.
Winnicott thought that this more extreme kind of False Self began to develop in infancy, as a defence against an environment that felt unsafe or overwhelming because of a lack of reasonably attuned caregiving. He thought that parents did not need to be perfectly attuned, but just “ordinarily devoted” or “good enough” to protect the baby from often experiencing overwhelming extremes of discomfort and distress, emotional or physical. But babies who lack this kind of external protection, Winnicott thought, had to do their best with their own crude defences.
One of the main defences Winnicott thought a baby could resort to was what he called “compliance”, or behaviour motivated by a desire to please others rather than spontaneously express one’s own feelings and ideas. For example, if a baby’s caregiver was severely depressed, the baby would anxiously sense a lack of responsiveness, would not be able to enjoy an illusion of omnipotence, and might instead focus his energies and attentions on finding ways to get a positive response from the distracted and unhappy caregiver by being a “good baby”. The “False Self” is a defence of constantly seeking to anticipate others’ demands and complying with them, as a way of protecting the “True Self” from a world that is felt to be unsafe.
Winnicott thought that the “False Self” developed through a process of introjection (a concept developed early on by Freud) or internalising one’s experience of others. Instead of basing his personality on his own unforced feelings, thoughts, and initiatives, the person with a “False Self” disorder would essentially be imitating and internalising other people’s behaviour – a mode in which he could outwardly come to seem “just like” his mother, father, brother, nurse, or whoever had dominated his world, but inwardly he would feel bored, empty, dead, or “phoney”. Winnicott saw this as an unconscious process: not only others but also the person himself would mistake his False Self for his real personality. But even with the appearance of success, and of social gains, he would feel unreal and lack the sense of really being alive or happy.
The division of the True and False self roughly develops from Freud’s (1923) notion of the Superego which compels the Ego to modify and inhibit libidinal Id impulses, possibly leading to excessive repression but certainly altering the way the environment is perceived and responded to. However it is not a close equation as the Id, Ego and Superego are complex and dynamic inter-related systems that do not fit well into such a dichotomy. The theory more closely resembles Carl Rogers’ simplified notions of the Real and Ideal self. According to Winnicott, in every person the extent of division between True and False Self can be placed on a continuum between the healthy and the pathological. The True Self, which in health gives the person a sense of being alive, real, and creative, will always be in part or in whole hidden; the False Self is a compliant adaptation to the environment, but in health it does not dominate the person’s internal life or block him from feeling spontaneous feelings, even if he chooses not to express them. The healthy False Self feels that it is still being true to the True Self. It can be compliant to expectations but without feeling that it has betrayed its “True Self”.
Winnicott on Carl Jung
Winnicott’s assessment of the other great pioneer of psychoanalysis, Carl Jung, appeared when he published an extensive review of Jung’s partially autobiographical work, Memories, Dreams, Reflections. In it Winnicott focuses on the first three chapters of the work that:
every psychoanalyst must read’ and in particular the first chapter, ‘First Years’. (Winnicott).
He discusses Jung’s evident early experiences of psychotic illness from around the age of four, from within his own theoretical framework. He goes on to comment on the relationship between Freud and Jung. He also discusses the Jungian ‘unconscious’ and Jung’s concept of the ‘self’.
Criticism and Influence
Winnicott’s theoretical elusiveness has been linked to his efforts to modify Kleinian views. Yet whereas from a Kleinian standpoint, his repudiation of the concepts of envy and the death drive were a resistant retreat from the harsh realities she had found in infant life, he has also been accused of being too close to Klein, of sharing in her regressive shift of focus away from the Oedipus complex to the pre-oedipal.
The psychoanalyst, Jan Abram, a former director of the Squiggle Foundation, intended to promote Winnicott’s work, who therefore may be said to be partisan, has proposed a coherent interpretation for the omission of Winnicott’s theories from many mainstream psychoanalytic trainings. His view of the environment and use of accessible everyday language, addressing the parent community, as opposed to just the Kleinian psychoanalytic community, may account in part for the distancing and making him somewhat “niche”.
Winnicott has also been accused of identifying himself in his theoretical stance with an idealised mother, in the tradition of mother (Madonna) and child. Related is his downplaying of the importance of the erotic in his work, as well as the Wordsworthian Romanticism of his cult of childhood play (exaggerated still further in some of his followers).
His theories of the true/false self may have been over-influenced by his own childhood experience of caring for a depressed mother, which resulted in the development of a prematurely mature self which he was only subsequently able to undo.
Nevertheless, Winnicott remains one of the few twentieth-century analysts who, in stature, breadth, minuteness of observations, and theoretical fertility can legitimately be compared to Sigmund Freud.
He has been a major influence for the American psychoanalyst Thomas Ogden, and the Italian psychoanalysts Giuseppe Civitarese and Antonino Ferro, all of which have cited Winnicott’s interest in play as being central to their work. He has also strongly influenced the work of Adam Phillips.
Along with Jacques Derrida, Winnicott is a fundamental resource for philosopher Bernard Stiegler’s What Makes Life Worth Living: On Pharmacology (2010).
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Donald Wallace MacKinnon (09 January 1903 to 20 January 1987) was an American psychologist and professor at the University of California, Berkeley. He was known for researching the psychology of creativity.
Career
After receiving his Ph.D. from Harvard University in 1933, he became a professor at Bryn Mawr College, where he remained until 1947. From 1944 to 1946, he went on leave from Bryn Mawr College to direct the United States Office of Strategic Services’s Station S during World War II. He joined the faculty of the University of California, Berkeley in 1947, and became the founding director of the Institute of Personality Assessment and Research there in 1949. He remained the institute’s director until 1970, and used the skills he had learned during World War II at the institute. He was the president of the Division of Personality and Social Psychology from 1951 to 1952, and of the Western Psychological Association from 1963 to 1964. He retired from Berkeley in 1970. In 1973, he began a one-year stint as a visiting fellow at the Centre for Creative Leadership and an adjunct professor of psychology at the University of North Carolina, Chapel Hill.
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David Graham Cooper (1931 in Cape Town, South Africa – 29 July 1986 in Paris, France) was a South African-born psychiatrist and theorist who was prominent in the anti-psychiatry movement.
Cooper graduated from the University of Cape Town in 1955. R.D. Laing claimed that Cooper underwent Soviet training to prepare him as an Anti Apartheid communist revolutionary, but after completing his course he never returned to South Africa out of fear that B.O.S.S. would eliminate him. He moved to London, where he worked at several hospitals. From 1961 to 1965 he ran an experimental unit for young people with schizophrenia called Villa 21, which he saw as a revolutionary ‘anti-hospital’ and a prototype for the later Kingsley Hall Community. In 1965, he was involved with Laing and others in establishing the Philadelphia Association. An “existential Marxist” he left the Philadelphia Association in the 1970s in a disagreement over its lack of political orientation. Cooper coined the term “anti-psychiatry” in 1967, and wrote the book Psychiatry and Anti-psychiatry in 1971.
Leading Concepts
Cooper believed that madness and psychosis are the manifestation of a disparity between one’s own ‘true’ identity and our social identity (the identity others give us and we internalise). Cooper’s ultimate solution was through revolution. To this end, Cooper travelled to Argentina as he felt the country was rife with revolutionary potential. He later returned to England before moving to France where he spent the last years of his life.
Cooper coined the term anti-psychiatry (see below) to describe opposition and opposing methods to the orthodox psychiatry of the time, although the term could easily describe the anti-psychiatrists’ view of orthodox psychiatry, i.e., anti-psychic healing.
He coordinated the Congress on the Dialectics of Liberation, held in London at The Roundhouse in Chalk Farm from 15 July to 30 July 1967. Participants included R. D. Laing, Paul Goodman, Allen Ginsberg, Herbert Marcuse and the Black Panthers’ Stokely Carmichael. Jean-Paul Sartre was scheduled to appear but cancelled at the last moment. The term “anti-psychiatry” was first used by David Cooper in 1967.
He was a founding member of the Philadelphia Association, London.
Family and The Death of the Family
Cooper describes how ‘during the end of the writing of this book against the family, I went through a profound spiritual and bodily crisis….The people who sat with me and tended to me with immense kindliness and concern during the worst of this crisis were my brother Peter and sister-in-law Carol…a true family’.
He had earlier described the need to break free from ‘one’s whole family past…in a way that is more personally effective than a simple aggressive rupture or crude acts of geographical separation’; as well as the kind of false autonomy which occurs when ‘people are still very much in the net of the internal family (and often the external family too) and compulsively search for rather less restricting replica family systems’.
The book may thus be seen as a self-reflexive attempt ‘to illustrate the power of the internal family, the family that one can separate from over thousands of miles and yet still remain in its clutches and be strangled by those clutches’.
The Language of Madness
In 1967, ‘David Cooper provided an introduction to Foucault’s Madness and Civilization which began “Madness has in our age become some sort of lost truth”‘ – a statement not atypical of ‘a time which posterity now readily regards as half-crazed’. Continuing the same line of thought, by the end of the following decade, ‘he elevated madness to the status of a liberatory force’ in his last publication. Here are a few typical utterances from The Language of Madness (Cooper 1980): “Madness is permanent revolution in the life of a person…a deconstitution of oneself with the implicit promise of return to a more fully realized world”‘.
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Military psychiatry covers special aspects of psychiatry and mental disorders within the military context. The aim of military psychiatry is to keep as many serving personnel as possible fit for duty and to treat those disabled by psychiatric conditions. Military psychiatry encompasses counselling individuals and families on a variety of life issues, often from the standpoint of life strategy counselling, as well as counselling for mental health issues, substance abuse prevention and substance abuse treatment; and where called for, medical treatment for biologically based mental illness, among other elements.
A military psychiatrist is a psychiatrist—whether uniformed officer or civilian consultant—specialising in the treatment of military personnel and military family members suffering from mental disorders that occur within the statistical norm for any population, as well as those disorders consequent to warfare and also stresses associated with military life.
By Country
Norway
From the 1960s Arne Sund, the chief psychiatrist of the Norwegian Armed Forces medical service, “established Norwegian military psychiatry as leading within NATO” and became the “founder of the research field of disaster psychiatry,” that evolved from military psychiatry.
United States
Active Duty Members
TRICARE is a health programme offered to uniformed service members, national guard or reserve members, survivors, former spouses, Medal of Honour recipients, and their families through the United States Department of Defence Military Health System. Upon enrolment, active duty members and their families gain access to emergency and non-emergency mental health care. In the case of a mental health emergency, members are advised to go to the nearest hospital emergency department. There is no requirement for prior authorization. Admissions must be reported to your regional contractor within 24 hours or the next business day. For non-emergency situations, active duty members must receive a referral and prior authorisation for all mental health care.
Veterans
The United States Department of Veteran Affairs offers mental health care to veterans through enrolment in VA health care. Benefits include emergency and non-emergency care. Emergency mental health care is available 24 hours a day, 7 days a week, through VA medical centres and the Veterans Crisis Line. Non-emergency mental health care services provided include inpatient and outpatient care, rehabilitation treatment and residential (live-in) programmes, and supported work settings. Conditions treated by the VA:
Posttraumatic stress disorder (PTSD)
Depression
Suicide prevention
Issues related to military sexual trauma (MST)
Substance use problems
Bipolar disease
Schizophrenia
Anxiety-related conditions
Epidemiology
Psychiatric disorders have been related to the greatest number of casualties and discharges in several wars. Such conditions typically have somatic manifestations. On-site, emergency psychiatric treatment reduces the prevalence of psychiatric morbidity within the military context.
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Narcissistic leadership is a leadership style in which the leader is only interested in themself. Their priority is themselves – at the expense of their people/group members. This leader exhibits the characteristics of a narcissist: arrogance, dominance and hostility. It is a sufficiently common leadership style that it has acquired its own name. Narcissism is most often described as unhealthy and destructive. It has been described as “driven by unyielding arrogance, self-absorption, and a personal egotistic need for power and admiration”.
Narcissism and Groups
A study published in the journal Personality and Social Psychology Bulletin suggests that when a group is without a leader, a narcissist is likely to take charge. Researchers have found that people who score high in narcissism tend to take control of leaderless groups. Sigmund Freud considered:
“the narcissistic type… especially suited to act as a support for others, to take on the role of leaders and to… impress others as being ‘personalities’.”,
one reason may be that:
“another person’s narcissism has a great attraction for those who have renounced part of their own… as if we envied them for maintaining a blissful state of mind—an unassailable libidinal position which we ourselves have since abandoned.”
According to the book Narcissism: Behind the Mask, there are four basic types of leader with narcissists most commonly in type 3 although they may be in type 1:
Authoritarian with task oriented decision making
Democratic with task oriented decision making
Authoritarian with emotional decision making
Democratic with emotional decision making
Michael Maccoby stated that “psychoanalysts don’t usually get close enough to [narcissistic leaders], especially in the workplace, to write about them.”
Corporate Narcissism
According to Alan Downs, corporate narcissism occurs when a narcissist becomes the chief executive officer (CEO) or other leadership roles within the senior management team and gathers an adequate mix of co-dependents around him (or her) to support the narcissistic behaviour. Narcissists profess company loyalty but are only really committed to their own agendas, thus organizational decisions are founded on the narcissist’s own interests rather than the interests of the organization as a whole, the various stakeholders, or the society in which the organization operates. As a result, “a certain kind of charismatic leader can run a financially successful company on thoroughly unhealthy principles for a time.
Neville Symington has suggested that “one of the ways of differentiating a good-enough organisation from one that is pathological is through its ability to exclude narcissistic characters from key posts.”
Impact of Healthy v. Destructive Narcissistic Managers
Lubit compared healthily narcissistic managers versus destructively narcissistic managers for their long-term impact on organisations.
Characteristic
Healthy Narcissism
Destructive Narcissism
Self-Confidence
High outward self-confidence in line with reality.
Grandiose.
Desire for Power, Wealth and Admiration
May enjoy power.
Pursues power at all costs, lacks normal inhibitions in its pursuits.
Relationships
Real concern for others and their ideas; does not exploit or devalue others.
Concerns limited to expressing socially appropriate response when convenient; devalues and exploits others without remorse.
Ability to Follow a Consistent Path
Has values; follows through on plans
Lack values; easily bored; often changes course.
Foundation
Healthy childhood with support for self-esteem and appropriate limits on behaviour toward others.
Traumatic childhood undercutting true sense of self-esteem and/or learning that they do not need to be considerate of others.
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Positive psychotherapy (PPT after Peseschkian, since 1977) is a psychotherapeutic method developed by psychiatrist and psychotherapist Nossrat Peseschkian and co-workers in Germany beginning in 1968. This humanistic psychodynamic psychotherapy is based on a positive conception of human nature. PPT is an integrative method which includes humanistic, systemic, psychodynamic and CBT-elements. Today there are centres and trainings in some twenty countries worldwide. It should not be confused with positive psychology.
Description
Positive Psychotherapy (PPT) is a therapeutic approach developed by Nossrat Peseschkian during the 1970s and 1980s. Initially known as “differentiational analysis,” it was later renamed as Positive Psychotherapy when Peseschkian published his work in 1977, which was subsequently translated into English in 1987. The term “positive” or “positivus” (from Latin) in PPT refers to the actual, real, and concrete aspects of human experiences.
The primary objective of positive psychotherapy and its practitioners is to assist patients and clients in recognising and cultivating their abilities, strengths, resources, and potentials. This approach combines elements from various modalities of psychotherapy, including a:
Humanistic perspective on human nature and therapeutic alliance;
Psychodynamic understanding of mental and psychosomatic disorders;
Systemic approach that considers family, culture, work, and environment, as well as a practical, self-help; and
Goal-oriented five-step therapy process that integrates techniques from different therapeutic methods.
PPT is characterised by its conflict-centred and resource-oriented approach, which draws influence from transcultural observations across more than twenty diverse cultures. Positioned between manualised cognitive behavioural therapy and process-oriented analytical psychotherapy, PPT employs a semi-structured approach to diagnostics, treatment, post-therapeutic self-help, and training.
About the Founder
Professor Doctor Nossrat Peseschkian, the founder of positive psychotherapy, was a German psychiatrist, neurologist, psychotherapist, and specialist in psychosomatic medicine, originally from Iran. During the late 1960s and early 1970s, he drew inspiration from various sources, individuals, and developments:
The prevailing spirit of that era, which gave rise to humanistic psychology and its subsequent advancements.
Personal interactions with notable and influential psychotherapists and psychiatrists like Viktor Frankl, Jacob L. Moreno, Heinrich Meng, among others.
The humanistic and integrative principles and values of the Baháʼí Faith.
The pursuit of an integrative approach, particularly due to the negative experiences of conflicts between psychoanalysts and behaviour therapists in Germany during that time.
Extensive transcultural observations in more than twenty cultures, driven by a quest for a culturally sensitive methodology.
Nossrat Peseschkian is tied to the development of the approach, as his life history and personality heavily influenced its creation. Peseschkian has been described by his biographer as a “wanderer between two worlds”, and his biography is subtitled “The East and the West”.
According to Peseschkian, the development of positive psychotherapy was motivated by his experience as an Iranian living in Europe since 1954, which made him acutely aware of the differences in behaviour, customs, and attitudes between cultures. This awareness began in childhood when he observed how religious customs varied among his Moslem, Christian, and Jewish classmates and teachers as a Bahá’í. His experiences led him to reflect on the relationships between different religions and people, and to gain an understanding of attitudes as coming from worldviews and family concepts. During his medical specialization, Peseschkian witnessed confrontations between different psychiatric, neurological, and psychotherapeutic positions, which taught him the importance of discarding prejudices. These experiences helped him feel comfortable in the West, where concepts like the equality of men and women have always been a given for him.
Positive psychotherapy can be traced back to the foundations of humanistic psychology and psychotherapy, which were established by pioneers like Kurt Goldstein, Abraham Maslow, and Carl Rogers. During his training, Nossrat Peseschkian was profoundly influenced by personal encounters with renowned psychotherapists such as Heinrich Meng, Viktor Frankl, and Jacob Levi Moreno, leaving a lasting impact on him. However, Peseschkian also witnessed the conflicts between various schools and approaches within the German psychotherapy community, where psychoanalysts and behaviour therapists refused to collaborate even for a simple lunch. Moreover, the strong influence of psychoanalysis and its subsequent developments, including Neo-Freudian, psychosomatic, and focus-oriented approaches like Balint, also shaped Peseschkian’s perspective. In response to these divisions, he aspired to construct a metatheory that could bridge the gaps between these different methods. Simultaneously, certain principles of the Bahá’í Faith deeply fascinated and inspired Nossrat Peseschkian throughout his life. These principles encompassed the harmony between science and religion, the Bahá’í concept of the human being as a “mine rich in gems of inestimable value,” and the vision of a global society embracing cultural diversity. These principles played a significant role in shaping his work and philosophical outlook.
The advancement of positive psychotherapy can be attributed to several factors that have contributed to its development over time. These factors include insights gained from ongoing medical education, experiences acquired through working with patients in psychotherapeutic and psychosomatic practices, interactions with individuals from diverse cultures, religions, and value systems, as well as the diverse and varied nature of psychotherapy methods. These cumulative experiences culminated in the creation of “Differentiational Analysis” in 1969, which subsequently underwent refinement and emerged as positive psychotherapy in 1977. The titles of early books authored by Peseschkian, such as Psychotherapy of Everyday Life (1974) and “In Search of Meaning” (1983), reflect the influence of psychoanalysis and existential schools of psychotherapy on the development of positive psychotherapy. Additionally, the title Positive Family Therapy (1980) underscores its parallel growth with systemic family therapy during the 1970s. In total, Peseschkian authored 29 books and numerous articles on this approach, contributing to its extensive literature and dissemination.
Brief History
1970-1980s
The 1970s marked an important period in the development and acceptance of positive psychotherapy as we know it today. It served as a turning point when PPT gained wider recognition within the field of psychotherapy. During this time, the foundational principles of PPT began to take shape and were implemented in the treatment of numerous patients and their families. These principles were also subjected to testing and were presented at international lectures, both within and outside of Germany. In this significant era, four out of the five fundamental books of PPT were published. These books include Psychotherapy of Everyday Life (originally published as Schatten auf der Sonnenuhr in 1974), Positive Psychotherapy (originally published in German in 1977), Oriental Stories in Positive Psychotherapy (originally published in German in 1979), and Positive Family Therapy (originally published in German in 1980). Moreover, the 1970s witnessed the establishment of the first postgraduate trainings in PPT, with the creation of a training organization in 1974, which later became the forerunner of the Wiesbaden Academy for Psychotherapy (WIAP). The Medical Chamber of Hesse recognised this training organisation in 1979 for psychotherapy residency training. Additionally, the German Association for Positive Psychotherapy was founded in 1977, becoming the world’s first national association of positive psychotherapy.
Throughout the 1980s, PPT experienced ongoing development, leading to the release of additional books, such as In Search of Meaning (originally published in German in 1983 and later translated into English in 1985). Collaborative efforts with young colleagues further contributed to the systematisation of the PPT method. A significant milestone during this time was the completion of Hamid Peseschkian’s dissertation in 1988, which marked the first dissertation focused exclusively on PPT. Within this dissertation, an important advancement was made in the structuring of the first interview in PPT. A questionnaire specifically designed for this initial interview was introduced and subsequently subjected to a psychodynamic study. In 1988, this questionnaire for the first interview, along with the WIPPF (questionnaire in PPT), was published with minor modifications. This precursor to the later semi-structured psychodynamic first interview was one of the early examples within the field of psychodynamic psychotherapy.
In the 1980s, Peseschkian travelled extensively to deliver PPT seminars in developing countries in Asia and Latin America. Important PPT works were translated into English during this time. Peseschkian also conducted seminars in management training and coaching, generating interest in applying PPT in these fields.
1990–2010
During this period, Peseschkian published his final fundamental work, Psychosomatics and Positive Psychotherapy in 1991 (German version) and later translated into English in 2013. This book introduced a structured and psychodynamic approach to treating various psychological and physical disorders.
The political changes in Central and Eastern Europe during the 1990s greatly accelerated the international expansion of PPT, which had already begun in the 1980s. PPT encountered significant interest in these cultures, which held a unique psychological position between Eastern and Western cultures. Eastern European colleagues, known for their organised working methods and thirst for knowledge, played a crucial role in systematising PPT seminars outside of Germany. By 1990, over 30 centres were established worldwide, starting with the first one in Kazan, Russia. The first national associations for positive psychotherapy were formed in Bulgaria (1993), Romania (2004), and Russia. PPT’s internationalisation continued with the legal registration of the International Centre for Positive Psychotherapy in 1996 as a NGO in Germany, which later evolved into the World Association for Positive and Transcultural Psychotherapy (WAPP). These developments coincided with the creation of the European Association of Psychotherapy (EAP) in Vienna in 1990, which set professional and legal standards for psychotherapy. Representatives of positive psychotherapy have been actively involved in the EAP since its inception.
In German-speaking countries, a debate on the effectiveness of various psychotherapy methods was sparked by Klaus Grawe’s publication in 1994 and the ensuing discussion surrounding psychotherapy laws. In response, Peseschkian and his colleagues conducted an extensive Effectiveness Study of Positive Psychotherapy, which received the Richard Merten Prize in 1997. This study provided empirical evidence of the practical effectiveness of PPT and aligned with the growing emphasis on evidence-based practices in psychotherapy.
In 1999, an international training curriculum for advanced studies in PPT was published, drawing from experiences across different countries. The year 2000 marked the inaugural of annual International Training for Trainers in positive psychotherapy. The expansion of PPT was formalised within Germany, with the Wiesbaden Academy for Psychotherapy (WIAP) receiving governmental recognition for postgraduate residency education pf psychologists in psychodynamic psychotherapy, and pedagogues and social workers in child and adolescent psychotherapy. The German law for psychotherapists of 1998, spurred further developments in the curriculum and systematisation of both basic and advanced PPT training, extending its influence beyond Germany. Over the years, basic level seminars held in Eastern Europe led to the emergence of new concepts. PPT transcended its original medical context and found application in various domains, including school and university education, management training, and coaching. The first world congress of PPT was organised in 1997 in St. Petersburg, Russia, and since then every 3–4 years. In 2005, the first graduate program offering a master’s degree in PPT was completed at UTEPSA University in Santa Cruz, Bolivia. The Prof.-Peseschkian Foundation, also known as the International Academy of Positive and Transcultural Psychotherapy (IAPP), was established in 2005 by Manije and Nossrat Peseschkian. It facilitates international initiatives and oversees the management of the International Archives of Positive Psychotherapy.
Since 2010
With the passing of Nossrat Peseschkian as the founder of PPT in 2010, the PPT community entered a new phase.
The World Association for Positive and Transcultural Psychotherapy (WAPP) is the global umbrella organisation for positive psychotherapy. Established in 1996 as the International Centre for Positive Psychotherapy, WAPP comprises individual members, national associations, training institutes, centres, and representative offices at national and regional levels. Its primary objective is to provide support to its members and individuals interested in studying, practicing, and promoting Positive Psychotherapy. WAPP is registered as a non-profit organization in Wiesbaden, Germany and in 2023 boasts over 2,200 individual members across 50 countries.
Positive psychotherapy is an officially recognised modality by the European Association for Psychotherapy (EAP). The European Federation of Centres for Positive Psychotherapy (EFCPP) is an organization that operates across Europe, serving as a European Wide Organisation (EWO), European Wide Accrediting Organisation (EWAO), and a European Accredited Psychotherapy Training Institute (EAPTI) through the IAPP-Academy, affiliated with EAP. Aspiring psychotherapists can obtain the European Certificate of Psychotherapy (ECP) in Positive Psychotherapy by undergoing training with EFCPP.
Positive psychotherapy is a registered trademark in the United States of America (the registration No. 6,082,225). In 2016, positive psychotherapy was officially registered in both the European Union and Switzerland.
As of 2023, national associations for PPT have been established in Bulgaria, Georgia, Germany, Romania, Kosovo, Ukraine, and Ethiopia. Furthermore, PPT is actively promoted through local or regional training centres in Armenia, Austria, Belarus, Bulgaria, China, Cyprus, Georgia, Germany, Kosovo, Latvia, North Macedonia, Poland, Romania, Russia, Turkey, Ukraine, and the United Kingdom. Seminars and lectures on PPT have reached more than 80 countries worldwide. Notably, PPT is now included in the curricula for psychology and psychotherapy programmes at universities in Bulgaria, Russia, Ukraine, and Turkey.
Theory
Main characteristics
The foundations of PPT are rooted in scientific theories that can also be found in other therapies. However, Peseschkian’s method combines elements of psychodynamic and humanistic psychotherapy theories and practices to create a transcultural psychotherapy approach. PPT also implements an integrative approach that considers the individual needs of the client, salutogenetic principles, family therapy, and self-help tools.
Main characteristics of the PPT method:
Integrative psychotherapy method
Humanistic psychodynamic method
Cohesive, integrated therapeutic system
Conflict-centred short-term method
Cultural-sensitive method
Use of stories, anecdotes, and wisdoms
Innovative interventions and techniques
Application in psychotherapy, other medical disciplines, counselling, education, prevention, management, and trainings.
Main Principles
The three main principles or pillars of Positive Psychotherapy are:
The Principle of Hope
The Principle of Balance
The Principle of Consultation
The Principle of Hope
This suggests that therapists aim to help patients comprehend and perceive the meaning and purpose behind their disorder or conflict. Consequently, the disorder is reframed in a “positive” manner, leading to positive interpretations. Here are a few examples:
Sleep disturbance is viewed as the ability to remain alert and manage with limited sleep.
Depression is seen as the capacity to deeply experience and express emotions in response to conflicts.
Schizophrenia is considered as the ability to exist simultaneously in two worlds or a vivid fantasy realm.
By adopting this optimistic perspective, a shift in viewpoint becomes possible not only for the patient but also for their surroundings. Thus, illnesses serve a symbolic function that both the therapist and patient need to acknowledge. The patient learns that the symptoms and complaints of the illness act as signals to restore balance to the four dimensions of their life.
The Principle of Balance
This acknowledges that despite social and cultural variations, all individuals tend to rely on common coping mechanisms when dealing with their problems. Nossrat Peseschkian, in conjunction with the Balance Model of Positive Psychotherapy, has developed a dynamic and contemporary approach to conflict resolution across different cultures. This model highlights four fundamental aspects of life:
Body/Health – psychosomatic concerns.
Achievement/Work – factors contributing to stress.
Contact/Relationships – potential triggers for depression.
Future/Fantasy/Meaning of Life – fears and phobias.
While these four domains are inherent in all humans, Western societies tend to prioritize the areas of physical well-being and professional success, whereas the Eastern hemisphere places greater emphasis on interpersonal connections, imagination, and future aspirations (a transcultural aspect of Positive Psychotherapy). Insufficient contact and lack of imagination are known to contribute to various psychosomatic illnesses.
Each individual develops their own coping preferences when confronted with conflicts. However, when one particular mode of conflict resolution dominates, other modes may be overshadowed. The contents of conflicts, such as punctuality, orderliness, politeness, trust, time, and patience, are categorised as primary and secondary capacities, built upon the foundational capacities of love and knowledge. This can be seen as a content-based differentiation of Freud’s classical model of the id, ego, and superego.
The Principle of Consultation
This introduces the concept of the five stages of therapy and self-help, which are closely intertwined in Positive Psychotherapy. In these stages, both the patient and their family are collectively informed about the illness and the individualised solution for it. The five stages are as follows:
Observation and Distancing: This stage involves perceiving and expressing desires and problems while maintaining a certain level of emotional detachment.
Taking Inventory: Cognitive capacities come into play as the patient reflects on significant life events that have occurred within the past 5 to 10 years.
Situational Encouragement: Self-help and activating internal resources become the focus at this stage. The patient is encouraged to draw upon past successes in resolving conflicts.
Verbalization: The communicative capacities of the patient are emphasized, enabling them to articulate and express outstanding conflicts and problems related to the four dimensions of life.
Expansion of Goals: This stage aims to foster a forward-looking orientation in life once the problems are resolved. The patient is prompted with questions like, “What would you like to do when all problems have been solved? What are your goals for the next five years?”
These five stages encompass a comprehensive approach to therapy and self-help, providing a framework for addressing the various aspects of an individual’s well-being and promoting their personal growth and future aspirations.
Positive Psychotherapy as a Metatheory
Peseschkian’s initial goal was twofold: firstly, to create a method that patients could easily understand and utilise, and secondly, to offer positive psychotherapy as a mediator between different psychotherapy schools. In his book Positive Psychotherapy (published in 1977 in German and 1987 in English), he devoted an entire chapter to this challenge, entitled “Positive Psychotherapy and Other Psychotherapies” (p.365–400). Peseschkian regarded this chapter as the most challenging and labour-intensive one in the book. He emphasized that positive psychotherapy should not be perceived as just another method within the field of psychotherapy. Instead, it provides a comprehensive framework that enables the selection of appropriate methodological approaches for specific cases and facilitates the alternation between these methods. In essence, positive psychotherapy represents a metatheory of psychotherapy. It views psychotherapy not merely as a fixed method to address specific symptom profiles, but also as a response to the broader societal, transcultural, and social contexts in which it operates.
Also Peseschkian insisted that positive psychotherapy should not be seen as a closed and exclusive system; instead, it assigns significance to different psychotherapeutic methods. It embraces various approaches such as psychoanalytic, psychodynamic, behaviour therapy, group therapy, hypnotherapy, medication-based treatment, and physical therapy. Positive psychotherapy can be considered an integrative method that incorporates multiple dimensions of therapy.
It took almost two decades before Klaus Grawe and his colleagues in Switzerland published a meta-analysis on the effectiveness of various psychotherapy approaches and proposed a general method that transcended traditional schools of psychotherapy. In the United States, Jerome Frank published a scheme for integrated psychotherapy, but this plan was also met with controversy and was not accepted. The movements for eclectic and integrative psychotherapy, which have found increasing acceptance since that time, have nonetheless skirted the core goal of theoretical integration and largely settled for the peripheral function of employing techniques from various schools. Today, there is a growing consensus that factors such as the therapeutic alliance, empathy, expectations, cultural adaptation, and the therapist’s personality are more important than specific methods and techniques.
Positive Approach
Positive psychotherapy emphasizes the mobilization of existing capacities and potential for self-help instead of primarily focusing on eliminating existing disturbances. The therapy begins with the possibilities for development and capacities of the individuals involved(Peseschkian N., p.1–7), following the approach of Maslow who coined the term “positive psychology” to highlight the importance of focusing on positive qualities in people. Symptoms and disorders are viewed as reactions to conflicts, and the therapy is called “positive” because it recognises the wholeness of the individuals involved, including both the pathogenesis of illness and the salutogenesis of joys, capacities, resources, potentials, and possibilities. (Jork K, Peseschkian N., p.13).
The term positive in positive psychotherapy is based on the “positive sciences” concept (based on Max Weber, 1988), which means a judgment-free description of the observed phenomenon. Nossrat Peseschkian uses the term positum in a broader sense, meaning that which is available, given, or actual. This positive aspect of the illness is just as important for the understanding and clinical treatment of the affliction as the negative aspect. The therapy aims to mobilise existing capacities and potential for self-help and focuses on the possibilities for development and capacities of the individuals involved, rather than just treating them as a “bag of symptoms.” Peseschkian believes that symptoms and disorders are reactions to conflicts, and the therapy is called “positive” because it proceeds from the concept of the wholeness of the persons involved as a given.
The concept of positive psychotherapy is based on a humanistic view of human nature, which emphasizes the inherent goodness and potential of individuals. According to PPT, people have two basic capacities: to love and to know, and through education and personal development, they can further develop these capacities and their unique personalities. Therapy, in this context, is seen as a tool for promoting further growth and education for the patient and their family.
In positive psychotherapy, disorders are reframed in a positive light. Depression, for instance, is viewed as “the capacity to react to conflicts with deep emotionality”; fear of loneliness is seen as “the desire to be with other people”; alcoholism is reinterpreted as “the capacity to supply oneself with warmth (and love) that is not received from others”; psychosis is considered as “the capacity to live in two worlds at the same time”; and cardiac disorders are seen as “the capacity to hold something very close to one’s heart”.
The positive process involved in PPT results in a shift in perspective for all parties involved, including the patient, their family, and the therapist/physician. Instead of focusing solely on the symptom, attention is directed towards the underlying conflict. Furthermore, this approach allows for the identification of the “real patient”, who is often not the one seeking treatment, but rather a member of their social environment. By interpreting illnesses in a positive light, patients are encouraged to understand the potential function and psychodynamic significance of their illness for themselves and those around them, and to recognise their abilities rather than just their pathologies.
Basic and Actual Capacities
Conflicts in everyday life as well as inner conflicts, which can lead to psychological disturbances and illness, often are connected to actual value judgments. Behind them stand concepts for instance of love or justice or of values such as orderliness, trust or patience, characteristics which in positive psychotherapy are called actual capacities. Ways of behaving, values, virtues and conflictual ideas are connected to specific contents of actual capacities which are present in all cultures. Each person reacts in his own way to a concept which he has learned and developed during the course of his or her life, one which is impressed upon him or her by individual experience, and which has become an inherited model through culture and education. Punctuality or trust, for example, will be treated differently by two different people in comparable situations. Conflicts leading to distress and even physical reactions often result from divergent concepts regarding the active actual capacities, in the example punctuality or trust. The different valuations of concepts result from differing cultural and family concepts. The importance of punctuality or trust in comparison to contact, achievement or justice are seen as different from one individual to another. This can lead to conflicts but also to exchange, learning and broadening of a person’s concepts. In 1977, Nossrat Peseschkian introduced the term “actual capacities”.
According to Peseschkian every person possesses two basic capacities: The capacity to love, expressed in the primary capacities as emotional needs, and the capacity to know, developed with the secondary actual capacities, the social norms. The capacity to love finds its expression in the primary actual capacities such as patience, time, and trust. The capacity to know finds its expression in the secondary actual capacities such as punctuality, cleanliness, and orderliness: “We structure our experiences with the help of the capacity to know… It contains the capacity to learn (to collect experiences) and to teach (to give experiences to others).”
Primary Capacities (Capacities to Love)
Secondary Capacities (Capacities to Know)
Love/Acceptance
Punctuality
Modelling
Cleanliness
Patience
Orderliness
Time
Obedience/Discipline
Contact
Politeness/Appropriateness
Sexuality/Tenderness
Openness/Honesty
Trust
Fidelity
Confidence
Justice
Hope
Diligence/Achievement
Belief
Thrift
Doubt
Dependability
Certainty
Exactness
Unity
Conscientiousness
Emotional needs and the capacity for relationships (achieved through modelling)
Social norms and formation of relationships (achieved through education)
Peseschkian developed the “Differentiational Analytical Theory” (p.25) as a complement to the psychoanalysis of that time, which was concerned primarily with the psychosexual phases of development (for example, oral, anal and oedipal), development of autonomy and conflicts between the id and the super-ego. The Differentiation Analysis asks which specific content arises in earlier stages: The parents’ patience, the development of trust, the experience of love in unconditional acceptance is a developmental psychological prerequisite for successful development in the oral phase. These capacities, known as “primary”, are imprinted on the child by the direct behaviour of the parents and through their modelling. Primary capacities such as having patience (with oneself or others), having trust (in oneself, in others, or in fate), having and giving time, are basic necessities for the development of the newborn child. The child needs warmth, time, patience and empathetic, unconditional acceptance in order to develop her/his own age-appropriate inner balance.
The primary actual capacities of the relationship with the first reference person makes it possible to relate to oneself, to be at peace with oneself, to perceive oneself, to develop a consciousness of oneself and the world and finally to deal appropriately with inner and outer conflicts. The primary capacity of “patience” is prerequisite for appropriate impulse control, the capacity “trust” is required for inner support, warmth and a feeling of safety. How important is the unconscious, loving acceptance received from one’s mother, the grandmother who always has time and patience, or the internal figure of the father whom the child could trust so completely as to allow herself to fall into his arms or to trust with him something that she did not yet really trust by herself!
The secondary actual capacities such as punctuality, politeness, openness, justice or fidelity often play a role as social norms in resolving conflicts and misunderstandings. Similarly, “orderliness” is one of the most frequent contents of conflicts between parents and children in occidental cultures, also between the couples themselves. “Justice”, a secondary capacity, and the experience of injustice must be faced and balanced again and again, loving acceptance, taking time to understand and being patient. “Obedience” as an expression of discipline is for historic reasons not much prized in democratic Germany, but despite this, it is generally accepted as a fact of life and seen as constructive in the schools and the inherent freedom to make decisions is set aside by the necessity to obey the rules. This, however, is one of the most frequent conflict factors in education. In psychotherapy, conflicts of the superego stand out in situations marked by religion as triggers for guilt conflicts.
It is noteworthy from a transcultural perspective that in Oriental cultures, primary capacities such as love, trust and contact are more highly valued, while secondary capacities such as orderliness, punctuality and cleanliness are more sharply pronounced in Western cultures. The emphasis is determined even in early childhood, for example, when the baby’s feeding times are set down and clear rules as to the exact time for the main meal are laid down, as well as other such rules. These differences often lead to misunderstandings, but also to conflicts and judgments.
Positive psychotherapy analyses the specific content of the conflicts as triggers for the emotions and focuses in counselling or therapy on the inner and outer conflicts or values and the capacities which are the contents of these conflicts. The emotions which lead to suffering, or the physical symptoms can then be understood as values functioning in a conflict of opposite concepts. In this connection the conflict-centred process focuses less on the triggers than on identifying and then working through the conflict which caused them.
Transcultural Approach
The integration of a transcultural perspective into psychotherapy was not only a primary focus of Nossrat Peseschkian from the outset, but also held a sociopolitical significance for him. Nossrat Peseschkian emphasizes the importance of a transcultural approach in positive psychotherapy, as it is a recurring theme throughout the method. This perspective offers valuable insights for understanding individual conflicts and holds significant social implications. Issues such as immigration, development aid, interactions with individuals from different cultures, transcultural marriages, addressing prejudices, alternative models from diverse cultural backgrounds, and political challenges arising from transcultural situations can all be addressed using this approach.
The inclusion of cultural factors and the recognition of the unique nature of each treatment has expanded the applicability of PPT and made it an effective method for use in multicultural societies. PPT has been taught and practiced by psychotherapists in over 70 countries, and it can be considered a transcultural approach to psychotherapy. Therefore, the principles of PPT form the foundation for defining and constructing the field of transcultural psychotherapy, which is essential for psychotherapy education, continuing education, and the recognition and adoption of new psychotherapy disciplines.
The meaning of “transcultural” in PPT can be understood in two ways:
Firstly, it refers to the recognition of the unique characteristics of patients who come from different cultural backgrounds, which is also known as intercultural or migrant psychotherapy.
Secondly, it involves considering cultural factors in every therapeutic relationship to broaden the therapist’s repertoire and promote a sociopolitical awareness.
PPT is a culture-sensitive method (concept of “unity in diversity”) that can be adapted to various cultures and life situations and should not be viewed as a form of Western “psychological colonization”. Nossrat Peseschkian highlights the significance of the social aspect in positive psychotherapy, suggesting that it can be applied broadly to various social relationships, such as those between groups, peoples, nations, and cultural groups. By doing so, a comprehensive social theory may be established, focusing on interaction challenges, human abilities, and economic circumstances.
Transcultural psychotherapy is not just a comparison between different cultures but a comprehensive concept that focuses on the cultural dimensions of human behaviour. It seeks to understand how people are different and what they have in common. PPT uses examples from other cultures to help patients broaden their own repertoire of behaviour and relativise their own perspective. Tools such as stories, tales, social norms, and the Balance Model are used to promote a transcultural perspective. In 1979, Nossrat Peseschkian used the term “transcultural psychotherapy” and dedicated a chapter to it in his book The Merchant and the Parrot: Oriental Stories in Positive Psychotherapy. He believed that the solution of transcultural problems will be one of the major tasks of the future due to the increasing importance of transcultural difficulties in private life, work, and politics. The principle of transcultural problems becomes the principle of relationships between people and of dealing with inner conflicts, ultimately becoming the object of psychotherapy.
First Interview in Positive Psychotherapy
Peseschkian developed a semi-structured first interview, which is one of the few in the field of psychodynamic psychotherapy. Hamid Peseschkian’s dissertation, presented in 1988, was the first doctoral dissertation dealing with PPT. The first interview in PPT was first structured in this dissertation, a questionnaire for this first interview was presented and a psychodynamic study of it was undertaken. This precursor to the later semi-structured psychodynamic first interview was a significant contribution to psychodynamic psychotherapy and was published in 1988 along with the WIPPF questionnaire on PPT.
The first interview in psychotherapy is a crucial component that can be compared to a medical examination and history-taking in somatic medicine. It serves several purposes, including diagnosis, therapy planning, prognosis, and hypothesis generation. In PPT, the first interview involves a diagnostic approach similar to that of a medical history, but also considers relationship factors and the therapeutic alliance. It acknowledges the impact of expectations, including the hope for effective therapy (Snyder, p.193–212, Frank). Due to its semi-structured nature and adaptable concepts, it can be applied in various contexts such as individual therapy, couples therapy, family therapy, counselling, and coaching, and is suitable for diverse cultural settings.
The first interview in PPT is a semi-structured interview that includes both mandatory and optional questions. Depending on the answers given to the mandatory questions, the therapist may or may not ask the optional questions. The questions can be open-ended or closed, and are designed to gather information for diagnostic, therapeutic, prognostic, and hypothesis-formulating purposes (p.31). The interview can be used during the initial meeting or early sessions as part of the preliminary phase of therapy, and can also be used for orientation purposes in the first session, with the therapist going into greater depth on particular areas during subsequent sessions. The first interview is applicable to a wide range of settings, including therapy with individuals, children, youth, couples, and families, as well as counselling and coaching, and can be adapted to different cultures.
Balance Model
The Balance model is widely recognised and can be applied in various fields, including therapy, self-help, and family therapy. It is comparable to Freud’s concept of libido, Adler’s life goals, and Jung’s four functions of perception, ratio, sensitivity, and intuition. The Balance Model offers a structural representation of the personality and enables the identification of areas in which an individual may be lacking. By addressing these areas, a new balance can be achieved, leading to a synthesis within the therapy.
Balance Model in positive psychotherapy developed by Nossrat Peseschkian.
The Balance Model is based on the concept that there are essentially four areas of life in which a human being lives and functions, and that significantly impact an individual’s overall satisfaction, self-worth, and ability to cope with challenges. These areas serve as key indicators of an individual’s personality in the present moment and encompass the biological-physical, rational-intellectual, socio-emotional, and imaginative, value-oriented aspects of daily life. While all individuals possess the potential for each of these areas, some may be more prominent or neglected based on variations in education and environment. Life energies, activities, and reactions are influenced by and connected to these four areas:
Physical activities and perceptions, such as eating, drinking, tenderness, sexuality, sleep, relaxation, sports, appearance, and clothing;
Professional achievement and capabilities, such as a trade, household duties, gardening, basic and advanced education, and money management;
Relationships and contact styles with partners, family, friends, acquaintances and strangers; social engagements and activities;
Future plans, religious/spiritual practices, purpose/meaning, meditation, reflection, death, beliefs, ideas and development of vision or imagination-fantasy.
The aim of the Balance Model is to restore equilibrium among the four areas of life. In psychotherapeutic treatment, the objective is to assist the patient in identifying their own resources and utilising them to achieve a dynamic balance. Specifically, this entails prioritizing a balanced allocation of energy, with each area receiving dynamically an equal proportion (25%) rather than an equal amount of time. Prolonged one-sidedness can lead to conflicts and illnesses, among other negative outcomes.
Model Dimensions
Assessing the impact of early childhood experiences on a patient is a crucial and difficult task in psychodynamic psychotherapy. In PPT, the Model Dimensions concept, also known as “examples”, “role models”, or “forms of love”, is used as a tool to describe the pattern of family concepts that shape an individual’s experience and development. Early upbringing and environment influence the unique development and expression of the basic capacities for love and knowledge, as described by Nossrat Peseschkian. The Balance Model illustrates the means of the capacity to know, while the four model dimensions illustrates the means of the capacity to love.
The four model dimensions of positive psychotherapy.
The use of the four model dimensions in PPT extends the analytic self and object theories of Kohut and Kernberg by introducing not only the “I” dimension, but also the “You,” “We,” and “Primary We” dimensions. The “You” dimension represents the relationship of the patient’s parents or primary care takers amongst each other, while the “We” dimension includes the parents’/primary care takers experiences with others. The “Primary We” dimension, which is unique to PPT, describes the relationships between the patient’s primary care takers such as parents and grandparents and their life philosophy or religious beliefs. By incorporating these four subject relations, PPT expands on the self-object theories and establishes itself as a distinctive approach that could potentially influence the future of psychodynamic therapies.
Dimension “I” is the model dimension that focuses on an individual’s relationship with themselves and their life-long struggles, such as self-esteem, self-confidence, self-image, and basic trust versus basic distrust. These issues are largely influenced by the individual’s childhood experiences and their relationship with their parents and siblings. During childhood, individuals learn to form a relationship with themselves based on how their wants and needs are fulfilled.
Dimension “You” refers to an individual’s relationship with others, specifically with their romantic partner. The primary model for this relationship is the example set by the individual’s parents, particularly in their own relationship with each other. The behaviour and interactions between parents serve as a model for the possible ways of behaving in a partnership, influencing how the individual forms their own relationship with their romantic partner.
Dimension “We” concerns an individual’s relationship to their social surroundings and is largely influenced by their parents’ relationship with their own social environment. Through socialisation, attitudes towards social behaviour and achievement norms are transferred from parents to their children. These attitudes and expectations are related to social ties beyond the immediate family, such as relationships with relatives, colleagues, social reference groups, interest groups, compatriots, and humanity as a whole. The ways in which parents interact with and navigate these social relationships shape their children’s understanding and approach to social behaviour.
Dimension “Origin/Primal-We” refers to an individual’s relationship with their origin or primal community, which is largely influenced by their parents’ attitude towards meaning, purpose, spirituality/religion, and worldview. This dimension is not solely based on formal membership in a religious community but is fundamental to the question of meaning that arises later in life. Even if an individual rejects religion, their relationship with their origin or primal community remains important as the basis for other systems of orientation that are expected to provide meaning and purpose.
Conflict Model
Peseschkian’s psychodynamic Conflict model (refer to Figure) highlights the differentiation of content, which is the focal point of contention, and its internal evaluation. The model distinguishes between the actual conflict that arises in a burdensome situation, the pre-existing basic conflict, and the unconscious inner conflict that causes physical and/or mental symptoms. The term “conflict” (from the Latin confligere, meaning to clash or fight) refers to the apparent incompatibility of inner and outer values and concepts or an internal ambivalence. Emotions, affective states, and physical reactions can be understood as signal indicators of an inner conflict of values and the distribution of actual capacities. Therefore, in PPT, the question is asked about the content: what causes or triggers this emotion?
The concept of the three main conflicts in PPT.
Peseschkian’s concept of “microtrauma” refers to the accumulation of small, repetitive psychic injuries that cause microstress or “trivia, or trifles” (p.80), and can trigger inner conflicts. These microtrauma are different from major life events or macrotrauma. They are considered to be conflict content and are related to the actual capacities that individuals possess, which enable them to form relationships but can also become a source of conflict. In an actual conflict, when coping mechanisms are overburdened, an old unconscious basic conflict may arise, pitting primary emotional needs such as trust, hope, or tenderness against secondary capacities or social norms such as orderliness, punctuality, justice, or openness. When the previous compromise that worked to resolve the basic conflict is no longer effective, an inner conflict arises, leading to symptoms that are seen as attempts at a solution. These conflict reactions can be represented using the Balance Model, even though they cannot bring about a resolution, they still have an impact.
When certain abilities, morals, ideas, or principles are consistently used without adaptation to the current circumstances, it can lead to disorders. If family concepts or compromises made in the past continue to be repeated, an unconscious inner conflict can arise, which can cause psychological, psychosomatic, or physical disturbances. These symptoms serve as a way for the patient to express something unconsciously and have a specific significance for everyone. The goal of PPT is to strengthen neglected areas and underdeveloped capacities within the therapeutic relationship and daily life, allowing patients to effectively resolve conflicts and achieve inner and outer balance.
Narrative Approach using Stories and Wisdom
A special technique used in PPT is the therapeutic use of tales, stories, and proverbs, which was first introduced by Nossrat Peseschkian in his work Oriental Stories as Tools in Psychotherapy – The Merchant and the Parrot in 1979. While hypnotherapy (Milton Erickson) had used this approach, it was not common in psychodynamic therapy until Peseschkian’s work. Unlike Carl Gustav Jung, who focused on fairy tales, the Peseschkian method employs a wider range of narrative therapy and association tools. “Using stories and parables from the Orient and other cultures, an effort is made to recognize and further a person’s potential for self-help. With reference to the symbolic meaning of proverbs and old words of wisdom drawn from many cultures, the person to whom they are told is led in psychotherapy to a more positive view of himself” (p.92).
The intended therapeutic effect of surprise that results from the use of Eastern stories, which may initially seem unfamiliar in European culture, has been proven effective not only in other cultures (p.24–34). Stories serve multiple functions in therapy, including creating norms for self-comparison and questioning established norms to view them as relative. In the first stage of therapy, these stories can lead to a change in perspective, which is then used in subsequent stages. Such narratives can also facilitate the release of emotions and thoughts, often playing a critical role in therapy. Storytelling in therapy serves as a mirror that allows readers or listeners to identify with the characters and their experiences, reflecting on their own needs and situations. By presenting solutions, stories can act as models that patients can compare with their own approach, leading to broader interpretations and the potential for change. Additionally, storytelling is particularly effective in helping patients who are resistant to change and who cling to old and outdated ideas.
Five-Step Concepts
The five-step concepts used in individual and family therapy, similar to the five fingers of each hand, closely resemble the natural process observed in group psychotherapy described by Raymond Battegay, psychodrama described by Moreno, and further education of people as described by Alfred Adler. What sets Peseschkian’s approach apart is the systematic application of this process model to psychotherapy. The five-step procedure serves as a roadmap for both the therapist and the client to find the most effective means of self-help. Research in therapy has shown that the better we handle challenging therapy situations and reflect on the therapeutic relationship, the more successful the outcome of therapy is likely to be.
The three stages of interaction in therapy (attachment, differentiation, detachment) involve a 5-stage process of communication, which is utilised both within individual sessions and throughout the course of therapy.
The first step is acceptance, observation, and distancing, which involves a shift in perspective.
The second step involves taking inventory, differentiating the contents and background of the conflict and the patient’s strengths.
The third step is situational encouragement, where self-help and resources are developed.
The fourth step involves working through the conflict through verbalization.
The fifth and final step, called broadening of the goals, involves reflecting on, summarising, and testing new concepts, strategies, and perspectives with a future-oriented focus.
This structured communication approach is unique to the Peseschkian method and contributes to successful therapy outcomes. This therapeutic process is focused on the future and change, and it involves using concepts from the past that are effective for the present. Additionally, concepts from other psychotherapy disciplines are used when appropriate (integrative aspect). The patient and their surroundings actively participate in understanding the illness process (self-help).
The 5 stages in PPT serve as a structure for communication within a therapy session or throughout the entire therapeutic process, which would otherwise lack direction. Through the use of appropriate understanding, leading questions, stories, association triggers, and revisiting previous themes, the therapist facilitates the patient’s storytelling and reflection. The process gives both the therapist and the patient a starting point and a sense of security, preparing the patient to work through conflicts and engage in self-help, especially after the therapy has ended.
Application
Fields of Application of PPT
The method of positive psychotherapy, which was originally developed for psychotherapy, has expanded beyond its traditional application and has been applied in various fields such as counselling, pedagogy, and social work. In Germany, PPT has been used in counselling since 1992, while in Bulgaria, it has been used in pedagogy since the same year. In China, it has been used to train social workers about mental health disorders, coping with families, and preventing burnout since 2014. PPT has also been used as a basis for specialized training programs in children and youth therapy in Bulgaria since 2006, and later in Ukraine and Russia. Professionals from various countries such as Germany, Bulgaria, Cyprus, Turkey, Kosovo, China, Bolivia, and Ukraine have specialised in PPT-based positive family therapy and counselling. As a result, PPT has become a means of sharing psychotherapeutic competences and experiences across different professional and cultural fields.
Originally designed as a fundamental positive psychosomatic treatment for mental health, psychosomatic medicine, prevention, and psychotherapy, Positive Psychotherapy has been utilised by numerous medical doctors in Germany. The approach has been implemented in a number of hospitals, as well as in the Wiesbaden Academy of Psychotherapy’s state-approved training programme for psychodynamic therapy in Germany.
Outside of Psychotherapy
Positive psychotherapy has found application in a wide range of settings, including education and schools, the psychology of religion, trainings for teachers, time management, various counselling contexts, management training, seminars for partnership or marriage preparation, recruiting, trainings for jurists and mediators; the armed forces, society, officers, and politicians; intercultural trainings, naturopathy and order therapy (also known as mind-body medicine), burnout prevention, and supervision. Additionally, PPT is utilised in coaching, family counselling, and general counselling.
Treatment
Practice
Positive psychotherapy is utilised for the treatment of various mental health conditions, including mood (affective) disorders, neurotic disorders, stress-related disorders, somatoform disorders, and certain behavioural syndromes as classified in the ICD-10 (chapters F3-5). It has also shown promise in addressing personality disorders to some extent (chapter F6). PPT has been successfully integrated with traditional individual therapy and has been found beneficial in couple, family, and group therapy settings. Additionally, PPT has been applied in the field of psychiatry, demonstrating its effectiveness when working with (post)psychotic patients and in group settings within psychiatric hospitals, where the utilisation of stories and anecdotes has proven to be particularly impactful.
Self-Help
Peseschkian’s books are specifically intended for non-experts seeking self-help. His works, like “The Psychotherapy of Everyday Life” (1977 German, 1986 English), are designed to assist individuals in handling misunderstandings. Similarly, In Search of Meaning (1983 German and 1985 English) provides guidance on navigating life crises. Furthermore, books like If You Want Something You Never Had, Then Do Something You Never Did (2011) concentrate on resolving interpersonal conflicts. Moreover, individuals can pursue specialised courses to become certified counsellors in Positive Psychotherapy, enabling them to facilitate conflict moderation and promote self-help during challenging situations.
Trainings
PPT Trainings
WAPP’s main postgraduate training programme is divided into three parts. These parts are designed in a sequential order, i.e. they need to be completed successively starting with the lowest level.
Basic Consultant of Positive Psychotherapy (200 h – incl. theory and self-discovery).
Candidate Certified Positive Psychotherapist (710 h – incl. theory, supervision, and self-discovery).
European Certified Positive Psychotherapist (1400 h – incl. theory, practice, supervision, and self-discovery).
The courses are split up into modules of 3 or 4 days each, spread over several months depending on the kind of course. Training of Positive and Transcultural Psychotherapy consist of three content parts:
Theory. Learning all basic concepts and tools of Positive and Transcultural Psychotherapy.
Self-discovery/self-experience. Primarily, educational self-experience should assist students (candidates, residents, trainees) in developing a psychodynamic psychotherapeutic identity. The self-reflection of the student should be strengthened and developed. They should encounter their own central inner conflict and their own personality structure. They should experience themselves how psychotherapy works, and how challenging it can be. The personal experience of the unconscious is the central aspect of psychodynamic self-discovery. Even educational self-discovery deals with personal issues, it is not personal therapy. The student is not a patient, but a future colleague and a future psychotherapist. If during the educational self-discovery the student and/or his trainer find out that there are many personal unsolved issues, then the student should go into personal therapy. This further means that a personal therapy cannot be counted as an educational self-experience.
Supervision is an essential component of Positive Psychotherapy, encompassing both individual and group formats. In PPT, supervision goes beyond simply understanding the therapeutic situation and aims to develop the supervisee’s skills and capabilities based on their own needs and those of their patients. Group supervision is common in PPT, as the structured process lends itself well to practical benefits and a didactic effect. The most frequent format involves focusing on one case during a session with one supervisee, with the rest of the group acting as participants, including the supervisor. This approach allows the supervisor to engage the other participants as co-supervisors, enriching the supervisee’s perspective on the case with additional viewpoints and diverse perspectives from the entire group.
PPT Certification
After successful completion of each PPT course the participant receives a certificate issued by the World Association for Positive and Transcultural Psychotherapy (WAPP), signed by the main trainer of the course and the President of the Association. WAPP certifies trainers of Positive Psychotherapy. Only trainers who are accredited trainers of WAPP are permitted to sign and hand out official WAPP certificates.
Training Standards
WAPP has developed universal Training Standards for the postgraduate trainings in Positive Psychotherapy. These standards are obligatory for everyone. The standards may differ in some countries. But the WAPP defined standards are the minimum requirements, which need to be fulfilled.
Trainer Education
WAPP trains and certifies trainers for Basic and Master Courses (p.26):
Basic Course Trainer for Positive Psychotherapy
Master Course Trainer for Positive Psychotherapy
Certified Positive Psychotherapists who would like to become trainers for PPT themselves can participate in a training programme for trainers including an examination and the accompaniment of a complete course as a candidate-trainer.
International Gatherings and Training Projects
The World Association for Positive Psychotherapy organises regular national and international gatherings, e.g., conferences, trainer seminars and world congresses. Since the year 2000, annual International Training Seminars and since 1997 seven World Congresses have taken place.
Development and International Network
The main emphasis of positive psychotherapy during the past 40 years has been treatment, training and publication.
In 1979, the Wiesbaden Postgraduate Training Institute for Psychotherapy and Family Therapy was established as a postgraduate training for physicians in Wiesbaden, Germany. In 1999, the Wiesbaden Academy for Psychotherapy (WIAP), a state-licensed, postgraduate psychotherapy academy with a large outpatient clinic, was established for the training of psychologists and educational scientists.
The international head office is based in Wiesbaden, Germany. Positive psychotherapy is represented internationally by the World Association of Positive and Transcultural Psychotherapy (WAPP). Its international governing board of directors is elected every two years. There are national and regional associations in some ten countries.
PPT and its therapists have been engaged in the international development of psychotherapy, and are active members of international and continental associations.
Research
Research Advances and Applications
The first publications in the area of PPT date back to 1974. Since then, this method has been presented in numerous books, scientific works, and other publications. PPT fulfils the four principles postulated by Grawe for the effectiveness of psychotherapy:
Activation of resources;
Actualisation;
Management of problems; and
Therapeutic clarification.
A study on the effectiveness and quality assurance of Positive Psychotherapy was conducted between 1994 and 1997 by 32 members of the German Association for Positive Psychotherapy under the guidance of Nossrat Peseschkian, Karin Tritt, and Birgit Werner. The study aimed to substantiate the claim that PPT is a classical, integrative form of therapy (p.9) based on Grawe’s model. It was conducted under controlled conditions and was the first of its kind and the results show PPT short-term method to be effective.
The longitudinal effectiveness study conducted by the German Association for Positive Psychotherapy examined the efficacy of PPT in daily clinical practice. A total of 402 patients with various mental health disorders were treated by 22 therapists trained in PPT, including physicians, psychologists, and teachers. The patients were compared to a control group of 771 individuals on a waiting list for therapy due to somatic illnesses. The percentages represent the proportion of patients with different types of disorders: 23.6% had depressive disorders, 19.8% had anxiety and panic disorders, 21.2% had somatoform disorders, 20.5% had adjustment disorders, 8.2% had personality disorders, 3.4% had addictions, and 3.4% were newly diagnosed with somatic disorders. The study employed a battery of psychometric tests, including SCL-90R, VEV, Gießen-Test, WIPPF, IPC, IIP-D, GAS, and BIKEB, to measure the effectiveness of PPT. The study also included a retrospective interrogation of patients after the termination of PPT at intervals of 3 months to 5 years in three groups of 84, 91, and 46 patients. The study found positive results in terms of the effectiveness of PPT in treating various mental health disorders. This means that the positive effects of PPT were maintained even after a significant amount of time had passed since the end of therapy. The study also found that patients treated with PPT reported a significant improvement in their quality of life, as measured by the Gießen-Test (p ≤ 0.005), and in their interpersonal relationships, as measured by the Interpersonal Check List (IPC) and Inventory of Interpersonal Problems (IIP-D) (p ≤ 0.005). In addition, patients treated with PPT showed a significant increase in their coping ability, as measured by the Coping Capacity Scale (BIKEB) (p ≤ 0.005). Overall, the study demonstrated that PPT is an effective form of therapy for a range of mental health disorders, and that its positive effects can be maintained over time (p ≥ 0.05; VEV: F = 1179; SCL-90-R: F = 2473)[107]
During the discussion, the researchers explored the dilemma of choosing between an experimental design that prioritises internal validity versus one conducted under controlled conditions to achieve high external validity. They acknowledged the unfortunate lack of effectiveness studies and highlighted that the experimental design employed in this study could be viewed as a significant strength. The computer-assisted quality assurance study on Positive Psychotherapy (PPT) received the Richard Merten Prize in 1997, which is one of the most prestigious prizes in the healthcare sector in Europe. The prize has been awarded by the trustees since 1992 with the aim of recognising exceptional work that contributes to the improvement of medical, pharmaceutical, or nursing treatment and represents a noteworthy advancement in medical, social, sociopolitical, or economic progress within the healthcare industry.
Academic Works
The widespread applicability and cultural suitability of PPT are attributed to the numerous colleagues who are motivated and supported to conduct scientific research. Furthermore, many practitioners who have been exposed to PPT find their interest in publishing rekindled since they are no longer bound by the limitations and requirements of a particular school. There is evidence that around 5 postdoctoral dissertations and nearly twenty doctoral dissertations have been published on PPT, mainly from Germany, Russia, Bulgaria, and Ukraine. Additionally, approximately 50 bachelor’s and master’s theses have been written on the subject.
Most of the research on PPT has centred on its applications in psychosomatic, medical, psychiatric, psychological, and pedagogical fields. This focus provides a glimpse into the potential areas of future scientific inquiry. A review of the topics covered in these academic works indicates that PPT has a wide range of clinical and non-clinical applications, with particular attention given to certain models.
In addition to research on psychosomatics in different organ systems, there are also comparative and transcultural studies. These studies have focused on the unique aspects of the therapeutic relationship and how it can be applied to educational contexts. Some of the research has been conducted within the social-pedagogical framework, highlighting the potential applications and possibilities of “Positive Pedagogy.”
Publications
Publications on positive psychotherapy consist of the wide-ranging source material written by its founder and of the work of his students. These scholarly publications have been joined by works of popular science that have appeared in diverse periodicals and do not appear in lists of scientific literature. Peseschkian wrote 29 books that have been translated into as many as 23 languages. The most widespread book is Oriental Stories as Tools in Positive Psychotherapy: The Merchant and the Parrot. Other core books are Psychotherapy of Everyday Life, Positive Psychotherapy, Positive Family Therapy, and Positive Psychotherapy in Psychosomatic Medicine. In his final years, Peseschkian published a number of self-help books dedicated to various areas of life.
Starting with the founding of the German Journal of Positive Psychotherapy in 1977, colleagues in PPT have been encouraged to publish the results of their research and share their cases. Additionally, the source publications of Peseschkian began to accrue secondary publications beginning in the 1990s. As new national associations for positive psychotherapy have been formed in various countries during the last 20 years, journals of PPT have been founded in Russia, Ukraine, Bulgaria, and Romania.
List of some of the main PPT publications are:
Peseschkian, Nossrat (1987). Positive Psychotherapy – Theory and Practice of a New Method. Berlin: Springer-Verlag. ISBN 978-0-387-15794-8. (translated) (first German edition 1977)
Peseschkian, Nossrat (2016). Oriental Stories as Techniques in Positive Psychotherapy. Bloomington, USA: AuthorHouse. ISBN 978-1524660871. (first German edition 1977)
Peseschkian, Nossrat (2016). In Search of Meaning: Positive Psychotherapy Step by Step. Bloomington, USA: AuthorHouse. ISBN 978-1524631611. (first German edition 1983)
Peseschkian, Nossrat (2016). Positive Family Therapy: Positive Psychotherapy Manual for Therapists and Families. Bloomington, USA: AuthorHouse. ISBN 978-1524662042. (first German edition 1980)
Peseschkian, Nossrat (2016). Positive Psychosomatics: Clinical Manual of Positive Psychotherapy. Bloomington, USA: AuthorHouse. ISBN 978-1524636616.
Peseschkian, Nossrat (2016). Positive Psychotherapy of Everyday Life: A Self-Help Guide for Individuals, Couples and Families with 250 Case Stories. Bloomington, USA: AuthorHouse. ISBN 978-1524631437.(first German edition 1974)
The Global Psychotherapist (JGP) is a digital journal that focuses on positive psychotherapy, following the principles established by Peseschkian since 1977. It serves as an interdisciplinary platform for publishing articles related to the practice and utilization of the humanistic-psychodynamic approach of positive and transcultural psychotherapy. The journal operates on a semi-annual basis, releasing issues in January and July. Articles submitted to JGP undergo a rigorous double-blind peer review process to ensure the quality and integrity of the publication. The journal accepts articles in English, Russian and Ukrainian languages.
ISSN: 2710-1460 (online)
DOI: 10.52982/197700
The Global Psychotherapist adheres to an open access policy that promotes the free dissemination of scientific information and encourages global knowledge exchange, with the ultimate aim of fostering social progress. The journal firmly believes in providing unrestricted access to its content to benefit the wider community. Authors have the freedom to choose the license under which their work is published, while retaining full rights to their content.
Furthermore, the editorial policy of the journal allows authors to deposit any version of their published articles in a repository of their choosing, whether it be an institutional repository or any other suitable platform, without any embargo period. This ensures that the research output remains accessible and readily available for the benefit of the scholarly community.
This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Positive_psychotherapy >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.
First a fear-hierarchy is created: the patient is asked a series of questions to determine the level of discomfort the fear causes in various conditions. Can the patient talk about the object of their fear, can the patient tolerate a picture of it or watch a movie which has the object of their fear, can they be in the same room with the object of their fear, and/or can they be in physical contact with it?
Once these questions have been ordered beginning with least discomfort to most discomfort, the patient is taught a relaxation exercise. Such an exercise might be tensing all the muscles in the patient’s body then relaxing them and saying “relax”, and then repeating this process until the patient is calm.
Next, the patient is exposed to the object of their fear in a condition with which they are most comfortable – such as merely talking about the object of their fear. Then, while in such an environment, the patient performs the relaxation exercise until they are comfortable at that level.
After that, the patient moves up the hierarchy to the next condition, such as a picture or movie of the object of fear, and then to the next level in the hierarchy and so on until the patient is able to cope with the fear directly.
This specific therapy can create a safe space, where individuals are able to become comfortable with their fears, anxieties or traumatic experiences. One may say it is linked to exposure, as the patient is immersed into an experience until they eventually become much more relaxed in it.
Although it may take several sessions to achieve a resolution, the technique is regarded as successful. Many research studies are being conducted in regard to achieving immersion therapy goals in a virtual computer based programme, although results are not conclusive.
‘Immersive therapy through virtual reality represents a novel strategy used in psychological interventions, but there is still a need to strengthen the evidence on its effects on health professionals’ mental health’ (Linares-Chamorro et al., 2022).
Virtual Therapy
As mentioned previously, Immersion Therapy can occur in the form of a virtual reality (VR) therapy. This usually involves transporting the user to a simulated environment, creating a realistic real life setting, and combining video, audio, haptic and motion sensory input to create an immersive experience. Virtual therapy may use videos in either a 2D or 3D immersion using a head-mounted display (Hodges et al., 2002).
There have been many studies looking at this type of therapy and combatting anxiety and phobias, such as acrophobia. It assesses a patient’s cognitive, emotional and physiological functioning. It can be useful for both prevention and treatment of psychiatric conditions. This method goes beyond the simple exposure therapy, as it can be a more comprehensive treatment compared to other interventions. A study conducted in Olot, Spain aimed to look at levels of anxiety and the wellbeing of female hospital staff. A sample size of 35 female health professionals undertook immersive therapy for 8 weeks. The way the anxiety levels were measured was through the Hamilton scale and well-being through the Eudemon scale. This specific immersive therapy was executed through Virtual Reality, in which the VR experience used a projection device with light and sound control that provided an immersive experience, creating an environment that enhanced self awareness to approach anxiety management. Results suggested that a significant improvement was found in anxiety and wellbeing, both statistically and clinically.
Another study in the UK looking at helping acrophobia. Researchers recruited 100 adults with a fear of heights, if they scored more than 29 on the heights interpretation questionnaire, suggested they had a fear of heights. Participants were randomly allocated by computer to either an automated VR delivered in roughly six 30 minute sessions, administered about 2-3 times a week over 2 weeks and a control group was present which received no treatment. The virtual coach worked alongside the VR programmed and would mention things like “We’re discovering what happens when we venture into a situation we’d normally try to avoid.” The aim of the virtual coach was to put the participants’ expectations to the test and experiencing citations where they would usually feel anxious. Then the tasks began, where they underwent different levels of heights in different activities. Overall, participants in the control group compared to the VR group had reduced fear of heights by the end of the treatment.
Although, this is evidence to suggest how virtual computer based immersion therapy works, the research within this area of psychology is scare, thus more testing needs to occur, to fully implement this type of technology.
Advantages
Immersive virtual reality may be identified as something that is a potentially revolutionary tool for psychological treatment of mental disorders, which may gradually be adopted in regular clinical practice in the coming years. (Geraets et al., 2021). Virtual reality has significantly been evolving over the last few years due to many advancements in technology, thus enabling us to understand the constant need for new research to take place.
The benefits of Immersive virtual reality therapy could significantly enhance effective psychological interventions. Treatments can be given automatically, without a therapist’s physical presence, resulting in a more low cost route. Another benefit of VR is that it can offer ‘direct therapeutic intervention’, which is often lacking in conventional clinical settings, allowing for treatments to be delivered faster and more efficiently. Patients can be placed in simulated environments whilst wearing a VR headset, teaching them how to react more effectively. Additionally, patients are more open to experimenting with new therapies because they are aware they are in a secure stimulation setting, in which the exposure to the stimuli can occur in different stages and not just one go.
VR has been used successfully over the past 25 years for assessment, understanding, and treatment of mental health disorders. The increased accessibility and affordability of VR mean that this technique is now ready to move from specialist laboratories into clinics (Freeman et al., 2018).
Immersive therapy can provide a distinctive and engaging experience that allows for overcoming fears, gaining self-confidence and creating coping strategies. It allows people to experience real life situations in a controlled and safe setting. It is much more interactive and rather than just talking about their phobia or anxiety, they can actually relive it but overcome it too, generating a greater sense of self-confidence, reducing the feelings of anxieties and managing their feelings during stressful situations.
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Flooding, in psychology terms, sometimes referred to as in vivo exposure therapy, is a form of behaviour therapy and desensitisation — or exposure therapy—based on the principles of respondent conditioning. As a psychotherapeutic technique, it is used to treat phobia and anxiety disorders including post-traumatic stress disorder (PTSD). It works by exposing the patient to their painful memories, with the goal of reintegrating their repressed emotions with their current awareness. Flooding was invented by psychologist Thomas Stampfl in 1967. It is still used in behaviour therapy today.
Flooding is a psychotherapeutic method for overcoming phobias. In order to demonstrate the irrationality of the fear, a psychologist would put a person in a situation where they would face their phobia. Under controlled conditions and using psychologically-proven relaxation techniques, the subject attempts to replace their fear with relaxation. The experience can often be traumatic for a person, but may be necessary if the phobia is causing them significant life disturbances. The advantage to flooding is that it is quick and usually effective. There is, however, a possibility that a fear may spontaneously recur. This can be made less likely with systematic desensitisation, another form of a classical condition procedure for the elimination of phobias.
How it Works
“Flooding” works on the principles of classical conditioning or respondent conditioning—a form of Pavlov’s classical conditioning—where patients change their behaviours to avoid negative stimuli. According to Pavlov, people can learn through associations, so if one has a phobia, it is because one associates the feared stimulus with a negative outcome.
Flooding uses a technique based on Pavlov’s classical conditioning that uses exposure. There are different forms of exposure, such as imaginal exposure, virtual reality exposure, and in vivo exposure. While systematic desensitisation may use these other types of exposure, flooding uses in vivo exposure, actual exposure to the feared stimulus. A patient is confronted with a situation in which the stimulus that provoked the original trauma is present. The psychologist there usually offers very little assistance or reassurance other than to help the patient to use relaxation techniques in order to calm themselves. Relaxation techniques such as progressive muscle relaxation are common in these kinds of classical conditioning procedures. The theory is that the adrenaline and fear response has a time limit, so a person should eventually have to calm down and realize that their phobia is unwarranted. Flooding can be done through the use of virtual reality and has been shown to be fairly effective in patients with flight phobia.
Psychiatrist Joseph Wolpe (1973) carried out an experiment which demonstrated flooding. He took a girl who was scared of cars, and drove her around for hours. Initially the girl was panicky but she eventually calmed down when she realized that her situation was safe. From then on she associated a sense of ease with cars. Psychologist Aletha Solter used flooding successfully with a 5-month-old infant who showed symptoms of post-traumatic stress following surgery.
Flooding therapy is not for every individual, and the therapist will discuss with the patient the levels of anxiety they are prepared to endure during the session. It may also be true that exposure is not for every therapist and therapists seem to shy away from use of the technique.
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Systematic desensitisation, or graduated exposure therapy, is a behaviour therapy developed by the psychiatristJoseph Wolpe. It is used when a phobia or anxiety disorder is maintained by classical conditioning. It shares the same elements of both cognitive-behavioural therapy and applied behaviour analysis. When used in applied behaviour analysis, it is based on radical behaviourism as it incorporates counterconditioning principles. These include meditation (a private behaviour or covert conditioning) and breathing (a public behaviour or overt conditioning). From the cognitive psychology perspective, cognitions and feelings precede behaviour, so it initially uses cognitive restructuring.
The goal of the therapy is for the individual to learn how to cope with and overcome their fear in each level of an exposure hierarchy. The process of systematic desensitisation occurs in three steps. The first step is to identify the hierarchy of fears. The second step is to learn relaxation or coping techniques. Finally, the individual uses these techniques to manage their fear during a situation from the hierarchy. The third step is repeated for each level of the hierarchy, starting from the least fear-inducing situation.
In 1947, Wolpe discovered that the cats of Wits University could overcome their fears through gradual and systematic exposure. Wolpe studied Ivan Pavlov’s work on artificial neuroses and the research done on elimination of children’s fears by Watson and Jones. In 1958, Wolpe did a series of experiments on the artificial induction of neurotic disturbance in cats. He found that gradually deconditioning the neurotic animals was the best way to treat them of their neurotic disturbances. Wolpe deconditioned the neurotic cats through different feeding environments. Wolpe knew that this treatment of feeding would not generalize to humans and he instead substituted relaxation as a treatment to relieve the anxiety symptoms.
Wolpe found that if he presented a client with the actual anxiety inducing stimulus, the relaxation techniques did not work. It was difficult to bring all of the objects into his office because not all anxiety inducing stimuli are physical objects, but instead are concepts. Wolpe instead began to have his clients imagine the anxiety inducing stimulus or look at pictures of the anxiety inducing stimulus, much like the process that is done today.
Three steps of desensitisation
There are three main steps that Wolpe identified to successfully desensitize an individual.
Establish anxiety stimulus hierarchy
1. The individual should first identify the items that are causing the anxiety problems. 2. Each item that causes anxiety is given a subjective ranking on the severity of induced anxiety. 3. If the individual is experiencing great anxiety to many different triggers, each item is dealt with separately. 4. For each trigger or stimulus, a list is created to rank the events from least anxiety-provoking to most anxiety-provoking.
Learn the mechanism response
1. Relaxation training, such as meditation, is one type of best coping strategies. 2. Wolpe taught his patients relaxation responses because it is not possible to be both relaxed and anxious at the same time. 3. In this method, patients practice tensing and relaxing different parts of the body until the patient reaches a state of serenity. 4. This is necessary because it provides the patient with a means of controlling their fear, rather than letting it increase to intolerable levels. 5. Only a few sessions are needed for a patient to learn appropriate coping mechanisms. 6.Additional coping strategies include anti-anxiety medicine and breathing exercises. 7. Another example of relaxation is cognitive reappraisal of imagined outcomes. 8. The therapist might encourage patients to examine what they imagine happening when exposed to the anxiety-inducing stimulus and then allowing for the client to replace the imagined catastrophic situation with any of the imagined positive outcomes.
Connect stimulus to the incompatible response or coping method by counter conditioning
1. In this step the client completely relaxes and is then presented with the lowest item that was placed on their hierarchy of severity of anxiety phobias. 2. When the patient has reached a state of serenity again after being presented with the first stimuli, the second stimuli that should present a higher level of anxiety is presented. 3. This will help the patient overcome their phobia. This activity is repeated until all the items of the hierarchy of severity anxiety is completed without inducing any anxiety in the client at all. 4. If at any time during the exercise the coping mechanisms fail or became a failure, or the patient fails to complete the coping mechanism due to the severe anxiety, the exercise is then stopped. 5. When the individual is calm, the last stimuli that is presented without inducing anxiety is presented again and the exercise is then continued depending on the patient outcomes.
Example
A client may approach a therapist due to their great phobia of snakes. This is how the therapist would help the client using the three steps of systematic desensitisation:
Establish anxiety stimulus hierarchy
1. A therapist may begin by asking the patient to identify a fear hierarchy. 2. This fear hierarchy would list the relative unpleasantness of various levels of exposure to a snake. 3. For example, seeing a picture of a snake might elicit a low fear rating, compared to live snakes crawling on the individual—the latter scenario becoming highest on the fear hierarchy.
Learn coping mechanisms or incompatible responses
1. The therapist would work with the client to learn appropriate coping and relaxation techniques such as meditation and deep muscle relaxation responses.
Connect the stimulus to the incompatible response or coping method
1. The client would be presented with increasingly unpleasant levels of the feared stimuli, from lowest to highest—while utilising the deep relaxation techniques (i.e. progressive muscle relaxation) previously learned. 2. The imagined stimuli to help with a phobia of snakes may include: a picture of a snake; a small snake in a nearby room; a snake in full view; touching of the snake, etc. 3. At each step in the imagined progression, the patient is desensitised to the phobia through exposure to the stimulus while in a state of relaxation. 4. As the fear hierarchy is unlearned, anxiety gradually becomes extinguished.
Uses
Specific Phobias
Specific phobias are one class of mental disorder often treated via systematic desensitisation. When persons experience such phobias (for example fears of heights, dogs, snakes, closed spaces, etc.), they tend to avoid the feared stimuli; this avoidance, in turn, can temporarily reduce anxiety but is not necessarily an adaptive way of coping with it. In this regard, patients’ avoidance behaviours can become reinforced – a concept defined by the tenets of operant conditioning. Thus, the goal of systematic desensitisation is to overcome avoidance by gradually exposing patients to the phobic stimulus, until that stimulus can be tolerated. Wolpe found that systematic desensitisation was successful 90% of the time when treating phobias.
Test Anxiety
Between 25 and 40 percent of students experience test anxiety. Children can suffer from low self-esteem and stress-induced symptoms as a result of test anxiety. The principles of systematic desensitisation can be used by children to help reduce their test anxiety. Children can practice the muscle relaxation techniques by tensing and relaxing different muscle groups. With older children and college students, an explanation of desensitisation can help to increase the effectiveness of the process. After these students learn the relaxation techniques, they can create an anxiety inducing hierarchy. For test anxiety these items could include not understanding directions, finishing on time, marking the answers properly, spending too little time on tasks, or underperforming. Teachers, school counsellors or school psychologists could instruct children on the methods of systematic desensitisation.
Recent Use
Desensitisation is widely known as one of the most effective therapy techniques. In recent decades, systematic desensitisation has become less commonly used as a treatment of choice for anxiety disorders. Since 1970 academic research on systematic desensitisation has declined, and the current focus has been on other therapies. In addition, the number of clinicians using systematic desensitisation has also declined since 1980. Those clinicians that continue to regularly use systematic desensitisation were trained before 1986. It is believed that the decrease of systematic desensitisation by practicing psychologist is due to the increase in other techniques such as flooding, implosive therapy, and participant modelling.
This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Systematic_desensitization >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.
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