Strengths Assessments as Clinical Interventions

Strengths assessments as interventions:

Bringing Positive Psychology into clinical practice

Positive Psychology has made great strides in changing the way we think about psychology and how we conceptualize its goals and purpose. The focus on well-being, happiness, flourishing and general positivity as well as on generating research into how people thrive benefits not only those looking to increase performance or optimize living, but those same methods, outcomes and studies may be used to further those purposes we imagine to be psychology’s more traditional focus of interest, mentally unhealthy behaviors and thoughts. Although the popular branding, if you will, of Positive Psychology focuses on “happiness” and its proponents are often seen on Oprah or giving seminars to corporate executives to maximize their leadership potential, the scholarly research has certainly had far more depth and substance for a new and still emerging sub-discipline. But how does that research fit into the work of clinical treatment? Does it? Can clinical psychologists use Positive Psychology in their practice? Is there evidence for its effectiveness? What about for inpatient treatment? And what methods are used and for what clinical populations, and in what diagnostic categories? Are those even relevant questions for Positive Psychology?

        Because I work in mental health treatment in residential and outpatient settings, I wanted to look at this question more closely. To do so, I took one specific set of exercises or methodologies from Positive Psychology, strengths assessments, to see if and how such a practice could be used with clients or patients with traditionally recognized mental health disorders.  Was there research and what did it say? In order to do so, I specifically looked at the VIA-IS assessment, Values in Action Inventory of Strengths, since it is an assessment that demonstrates acceptable validity, stability and reliability, is publicly available rather than proprietary and thus widely researched. Developed by Martin Seligman and Christopher Peterson, the VIA-IS is a cross-culturally validated self-survey of 24 psychological character strengths in 6 core areas. It has been modified and validated for use in youths as well (Kobau, et. al., 2011).

        An initial study of positive psychology interventions including the use of the VIA-IS was conducted in 2005 by Seligman and others (Seligman, et. al., 2005). Subjects were recruited through Seligman’s Authentic Happiness website, and then the interventions were administered over the course of a week online. The two interventions involving signature strengths were either to simply identify signature strength or to use an identified signature strength in a new way every day for a week. The intervention that involved using a strength in novel ways throughout the week was found to increase happiness and decrease depressive symptoms for up to six months post-intervention by the measures used in the study. Other interventions were found to have shorter effects, but the identification and subsequent use of character strengths on the VIA-IS was one of the more significant interventions they found. Their sample population was not a clinical sample, but rather a convenience sample of people who had visited the website and who apparently wanted to “become happier” (Seligman, et. al., 2005). As such, the question remained whether the effects on depressive symptoms could be generalized to a more depressed population.

        Mongrain and Anselmo-Matthews (2012) attempted to replicate the Seligman, et. al (2005) study but they reconceptualized the control placebo intervention based on their desire to tease out the effects of the positive psychology exercises versus the effects of just accessing positive self-representations. Their results did verify the same results as Seligman, et. al (2005) for increased happiness. However, Mongrain and Anselmo-Matthews did not see the same decrease in depressive symptoms. A couple of factors to note: their population was more depressed to begin with, and may have been lower functioning. The earlier study’s sample, because recruited from a population seeking out a happiness website, may have been more motivated to “become happier,” as evidenced by a dropout rate three times lower than that in the later study. Mongrain and Anselmo-Matthews recruited their sample from Facebook ads to “feel better.” Given how Facebook raises anxiety in most users and leads us all to imagine that everyone else is having a better life, no wonder the sample was more depressed!

        In neither case cited above, despite the use of depressive symptom surveys, was the assessment used in a clinical setting. Tayyab Rashid and Robert Ostermann (2009) presented a case study using positive psychology exercises in an outpatient setting with a client diagnosed with major depressive disorder. Although they ascribe casusality to the positive psychology interventions, the client participated in 20 sessions of some form of cognitive based therapy. It would be surprising if she did not show some improvement in that time with or without the positive psychology interventions. Regardless, they describe a number of ways that positive psychology can be integrated into clinical practice. In the case of strengths assessments in particular, Rashid and Ostermann (2009) are particularly articulate in describing how and why clinical practice “forgot” about strengths:

During the last century, the study of character strengths was phased out because of increasingly pragmatic specializations and tightening of disciplinary boundaries. These factors combined to push strengths out of the clinical picture and training of clinicians, especially in psychiatric facilities run on the deficit-model, which focused on honing diagnostic skills to uncover deficits…Assessing strengths can provide the clinician with a powerful tool to understand a client’s intact repertoires, which can be effectively utilized to counter troubles.