Elsevier

Clinical Psychology Review

Volume 30, Issue 7, November 2010, Pages 819-829
Clinical Psychology Review

Positive Clinical Psychology: A new vision and strategy for integrated research and practice

https://doi.org/10.1016/j.cpr.2010.06.003Get rights and content

Abstract

This review argues for the development of a Positive Clinical Psychology, which has an integrated and equally weighted focus on both positive and negative functioning in all areas of research and practice. Positive characteristics (such as gratitude, flexibility, and positive emotions) can uniquely predict disorder beyond the predictive power of the presence of negative characteristics, and buffer the impact of negative life events, potentially preventing the development of disorder. Increased study of these characteristics can rapidly expand the knowledge base of clinical psychology and utilize the promising new interventions to treat disorder through promoting the positive. Further, positive and negative characteristics cannot logically be studied or changed in isolation as (a) they interact to predict clinical outcomes, (b) characteristics are neither “positive” or “negative”, with outcomes depending on specific situation and concomitant goals and motivations, and (c) positive and negative well-being often exist on the same continuum. Responding to criticisms of the Positive Psychology movement, we do not suggest the study of positive functioning as a separate field of clinical psychology, but rather that clinical psychology itself changes to become a more integrative discipline. An agenda for research and practice is proposed including reconceptualizing well-being, forming stronger collaborations with allied disciplines, rigorously evaluating the new positive interventions, and considering a role for clinical psychologists in promoting well-being as well as treating distress.

Introduction

We suggest the development of a Positive Clinical Psychology in which the understanding and treatment of clinical levels of distress is based on a balanced and equally weighted focus on the positive and negative aspect of life. We argue that a focus on the positive must equally compliment a focus on the negative in clinical psychology because positive characteristics (a) can predict disorder above and beyond the predictive power of the presence of negative characteristics, (b) buffer the impact of negative life events on distress, potentially preventing the development of disorder, (c) can be promoted in non-clinical populations to promote resilience, (d) can be fostered to treat clinical disorder, (e) offer opportunity for clinical psychologists to use their unique skills in new domains of life, and (f) have the potential to rapidly expand the knowledge base of clinical psychology.

We draw a distinction between previous positive psychology research (which has huge implications for understanding distress) and the now decade old positive psychology movement (Seligman & Csikszentmihalyi, 2000) (which has separatist implications and has attracted criticism). We suggest that positive psychology research can best impact on the scientific knowledge base of psychology, and be utilized to improve people's lives, if it avoids becoming embroiled in a movement and rather becomes fully integrated with the daily research and practice of mainstream disciplines (so that positive functioning is included alongside negative functioning in research designs, and increasing the positive is as important a focus of therapy as decreasing the negative). Clinical psychology is uniquely positioned to both take advantage of this integration (thorough improved understanding of disorder and the use novel treatments), and to become a vehicle through which positive psychology research can contribute to psychological science and practice. Clinical psychology contains the infrastructure that the positive psychology movement lacked, and can achieve an integrated focus on both the positive and the negative in a way that the positive psychology movement could not, due to an exclusive focus on the positive. The positive psychology movement has made a great contribution to psychology through increasing the focus on the positive (see Linley, Joseph, Harrington, & Wood, 2006). However, if the impact is to last, a second wave of research and practice is needed which addresses the criticisms leveled at the movement. Clinical Psychology is ideally placed to implement this second wave and we suggest a distinct agenda through which this can happen. To clarify what is meant by Positive Clinical Psychology; we do not in any way suggest that positive characteristics are emphasized over negative ones, or that a focus on the negative is removed. Quite the converse, we suggest that the field fully integrates the study and fostering of positive and negative characteristics equally; the positivity comes from developing a better and more integrated field rather than narrowly focusing on only one domain of life. This mirrors clinical practice in which new positive behavioral repertoires are created to displace behavior and affect associated with psychopathology.

In making this call we draw on the excellent contributions to this special issue, which have highlighted the relevance to clinical psychology of positive emotions (Garland et al., 2010-this issue), positive affect (Watson & Naragon-Gainey, 2010-this issue), psychological flexibility (Kashdan & Rottenberg, 2010-this issue), optimism (Carver, Scheier, & Segerstrom, 2010-this issue), and gratitude (Joseph & Wood, 2010-this issue), as well as how positive functioning can be conceptualized, measured, and assessed (Joseph & Wood, 2010-this issue). Such research is at the forefront of the study of positive functioning and clinical distress and offers a sound bedrock from on which Positive Clinical Psychology can stand.

Section snippets

Benefits of a Positive Clinical Psychology

We argue there are five key benefits of a Positive Clinical Psychology. First, this would involve a more balanced research field, with a more thorough understanding of clinical disorder and distress. Second, the field would be better able to predict, explain, and conceptualize disorder. The absence of positive characteristics has been shown to be a robust risk factor for distress (Wood & Joseph, 2010a), with longitudinal evidence suggesting this relationship may be causal (Brissette et al., 2002

Integration with and separation from the Positive Psychology Movement

In developing a Positive Clinical Psychology, much can be learnt from the positive psychology movement (see Gable and Haidt, 2005, Linley et al., 2006, Seligman and Csikszentmihalyi, 2000, Sheldon and King, 2001). Many of the messages of this now decade old movement are as relevant to clinical psychology today as they were to psychology in 2000. Whilst the movement aimed to take its message equally to all areas of psychology, the impact appears to have been concentrated on personality/social

A research, practice, and political agenda for Positive Clinical Psychology

We suggest that Positive Clinical Psychology builds on many of the messages and successes of the positive psychology movement, but remains a separate entity, existing as part of clinical psychology. Specifically, we are not suggesting the development of a new fragment of clinical psychology, but rather a change or reorientation of clinical psychology itself, so that positive and negative functioning are considered equally when predicting, understanding, and treating distress. Thus we avoid many

Conclusion

Studying positive functioning has great potential to improve the prediction, understanding, and conceptualization of psychological distress. It is not logical to study either negative or positive functioning in isolation, as (a) this reduces the prediction of important outcomes (as in the prediction of the development of disorder), (b) positive and negative functioning can interact to predict outcomes (as in the buffering of negative life events and disorder), (c) any designation of a

References (109)

  • J. Johnson et al.

    Resilience to suicidal ideation in psychosis: Positive self-appraisals buffer the impact of hopelessness

    Behaviour Research and Therapy

    (2010)
  • S. Joseph et al.

    Growth following adversity: Theoretical perspectives and implications for clinical practice

    Clinical Psychology Review

    (2006)
  • S. Joseph et al.

    Assessment of positive functioning in clinical psychology: Theoretical and practical issues

    Clinical Psychology Review

    (2010)
  • T.B. Kashdan et al.

    Psychological flexibility as a fundamental aspect of health

    Clinical Psychology Review

    (2010)
  • T.B. Kashdan et al.

    Gratitude and hedonic and eudaimonic well-being in Vietnam war veterans

    Behaviour Research and Therapy

    (2006)
  • J. Maltby et al.

    Personality predictors of levels of forgiveness two and a half years after the transgression

    Journal of Research in Personality

    (2008)
  • M. Panagioti et al.

    Post-traumatic stress disorder and suicidal behavior: A narrative review

    Clinical Psychology Review

    (2009)
  • G.M. Rosen et al.

    Posttraumatic stress disorder: An empirical evaluation of core assumptions

    Clinical Psychology Review

    (2008)
  • P.J. Taylor et al.

    Defeat and entrapment in schizophrenia: The relationship with suicidal ideation and positive psychotic symptoms

    Psychiatry Research

    (2010)
  • P.J. Taylor et al.

    Are defeat and entrapment best defined as a single construct?

    Personality and Individual Differences

    (2009)
  • D. Watson et al.

    On the specificity of positive emotional dysfunction in psychopathology: Evidence from the mood and anxiety disorders and schizophrenia/schizotypy

    Clinical Psychology Review

    (2010)
  • B.E. Wisco

    Depressive cognition: Self-reference and depth of processing

    Clinical Psychology Review

    (2009)
  • A.M. Wood et al.

    Gratitude and well-being: A review and theoretical intergration

    Clinical Psychology Review

    (2010)
  • H.N. Ahn et al.

    Where oh where are the specific ingredients? A meta-analysis of component studies in counseling and psychotherapy

    Journal of Counseling Psychology

    (2001)
  • M. Argyle et al.

    Happiness as a function of personality and social encounters

  • M.R. Barrick et al.

    Relating member ability and personality to work-team processes and team effectiveness

    The Journal of Applied Psychology

    (1998)
  • C. Barrowclough et al.

    Self esteem in schizophrenia: The relationships between self evaluation, family attitudes and symptomatology

    Journal of Abnormal Psychology

    (2003)
  • A.C. Bohart

    Focusing on the positive. Focusing on the negative: Implications for psychotherapy

    Journal of Clinical Psychology

    (2002)
  • A.C. Bohart et al.

    Humanistic psychology and positive psychology

    The American Psychologist

    (2001)
  • Boyce, C. and Wood, A.M. (in press). Money or mental health: The cost of alleviating psychological distress with...
  • I. Brissette et al.

    The role of optimism in social network development, coping, and psychological adjustment during a life transition

    Journal of Personality and Social Psychology

    (2002)
  • E.L. Cowen et al.

    “Positive psychology”: Some plusses and some open issues

    Journal of Community Psychology

    (2002)
  • C.G. Davis et al.

    Making sense of loss and benefiting from the experience: Two construals of meaning

    Journal of Personality and Social Psychology

    (1998)
  • K.M. DeNeve et al.

    The happy personality: A meta-analysis of 137 personality traits and subjective well-being

    Psychological Bulletin

    (1998)
  • A.L. Duckworth et al.

    Positive psychology in clinical practice

    Annual Review of Clinical Psychology

    (2005)
  • Emmons, R.A. (2007). Thanks! Recent developments in the science of gratitude. Paper presented at the 9th International...
  • G.A. Fava et al.

    Well-being therapy. A novel psychotherapeutic approach for residual symptoms of affective disorders

    Psychological Medicine

    (1998)
  • G.A. Fava et al.

    Well-being therapy of generalized anxiety disorder

    Psychotherapy and Psychosomatics

    (2005)
  • M.W. Fordyce

    Development of a program to increase personal happiness

    Journal of Counseling Psychology

    (1977)
  • M.W. Fordyce

    A program to increase happiness—Further-studies

    Journal of Counseling Psychology

    (1983)
  • B.L. Fredrickson

    What good are positive emotions?

    Review of General Psychology

    (1998)
  • B.L. Fredrickson

    The role of positive emotions in positive psychology—The broaden-and-build theory of positive emotions

    The American Psychologist

    (2001)
  • B.L. Fredrickson et al.

    The undoing effect of positive emotions

    Motivation and Emotion

    (2000)
  • S.L. Gable et al.

    What (and why) is positive psychology?

    Review of General Psychology

    (2005)
  • S.L. Gable et al.

    What do you do when things go right? The intrapersonal and interpersonal benefits of sharing positive events

    Journal of Personality and Social Psychology

    (2004)
  • B.S. Held

    The tyranny of the positive attitude in America: Observation and speculation

    Journal of Clinical Psychology

    (2002)
  • B.S. Held

    The negative side of positive psychology

    Journal of Humanistic Psychology

    (2004)
  • Higginson, S., Mansell, W., & Wood, A. M. (in press). An integrative mechanistic account of psychological distress,...
  • K. Holeva et al.

    Prevalence and prediction of PTSD following road traffic accidents (RTAs)

    Behavior Therapy

    (2001)
  • K. Horney

    Neurosis and human growth

    (1951)
  • Cited by (318)

    View all citing articles on Scopus
    View full text