Chapter 31
Strength-Based Assessment
TAYYAB RASHID
Assessment, whether formal or informal, objective or projective, psycho-emotional or sociocultural, intrapersonal or interpersonal, is an inherent part of good clinical practice (Butcher, 2006). Traditionally, clinical assessment has explored underpinning of deficits, disorders, symptoms, syndrome, weaknesses, and vulnerabilities. Expanding the scope of clinical assessment, the chapter describes a strength-based approach within the clinical context. First, the chapter discusses the limitations of deficit-oriented assessment. Second, it defines and describes, with illustrations, a strengths-based clinical assessment and proposes a theoretical framework to understand clinical concerns not only as the presence of symptoms but also as a lack or excess of strengths. Third, the chapter ends with concrete suggestions about incorporating strengths into clinical practice.
A strength-based assessment (SBA) explores a rich diversity of attributes, experiences, and processes that are positive and adaptive within their context. SBA explores psychological abilities, assets, and strategies that can further be nurtured in order to encounter and potentially buffer against psychological disorders. SBA, despite its name and explicit emphasis on strengths, is not only about strengths. By giving equal attention and importance to strengths, SBA integrates symptoms and skills, risk and resource, and vulnerability and resilience to yield complex yet realistic portrayals of clients, thereby offering multiple routes toward obtaining and sustaining healthy psychological functioning.
Clinical assessment has almost exclusively focused on deficits for plausible reasons. Negatives are far more pervasive and more potent than positives. By one estimate, for one positive emotional term there are 10 negatives (Nesse, 1991). Their potency and prevalence forms the undercurrent of negativity bias, which has influenced literary, religious, and cultural sources, as well as psychological domains including learning, attention, impression formation, contagion, moral judgment, development, and memory. Negativity bias has a number of clinical implications, including (a) negatives stand out in clients' experiences of equal valence; (b) negative experiences are approached more rapidly in time and space in clinical settings than are positive ones; (c) while weighing the combination of negative and positive experiences, negative experiences tend to dominate clients' emotions; and (d) compared to positive, negative experiences may invite more complex and deeper clinical discourse—for clients and clinicians. Therefore, it is not surprising that clients seeking clinical services easily recall negative events, setbacks, and failures and clinicians readily assess, elaborate, and interpret stories of conflict, ambivalence, deceit, personal, or interpersonal deficits. Because of their apparent greater informational value, clinicians pay greater attention to negatives and engage in complex cognitive processing (e.g., Peeters & Czapinski, 1990). Thus, clinical assessment is typically conducted to explore presence or absence of disorder.
Deficit-based clinical assessment has helped to decipher both the global and granular aspects of psychopathology. A number of personality and behavioral measures have been widely researched and have substantially helped psychotherapy through the mechanism of feedback to be more effective (Lambert, 2007). Yet, clinical assessment has three serious shortcomings.
First, it assumes that only symptoms are valid and central ingredients that ought to be assessed carefully, whereas positives are by-products of symptomatic relief lying on clinical peripheries that do not need to be assessed. So entrenched is this assumption that traditionally positive attributes are considered defenses. For example, anxiety has been theorized as a driving force behind a work ethic that characterized the Reformation (Weber, 2002). Depression has been theorized as process that dealt by feeling guilty, and out of this guilt comes compassion (McWilliams, 1994). By contrast, in SBA, strengths are as real as human weaknesses, as old as time, and valued in every culture (Peterson & Seligman, 2004). In clinical assessment and treatment, strengths are as critical in evaluating and treating psychopathology as are symptoms. Strengths are not considered defenses, by-products, or compensations. They are valued in their own right and weighed independent of weaknesses in the assessment procedure.
Second, deficit-oriented assessment reduces clients and may compartmentalize them into synthetic labels carefully ascertained within the synthetic categories of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V; American Psychiatric Association, 2013). The use of these labels is so widespread that some clients, courtesy of a Google search, seek clinical services with expectations of fitting themselves in these categories. A psychiatric diagnosis, otherwise a careful and discerning process, frequently becomes an exercise in confirming or ruling out a diagnostic label. Labeling, itself, is not undesirable. Labels categorize and organize the world, but reducing or objectifying clients to labels of psychopathology may strip clients of their rich complexity (Szasz, 1961). In turn, clients may think of themselves as deeply disturbed, anxious, or depressed—the content of these labels. Thus, labels describe but also restrict clinical experience.
Finally, a deficit-based assessment inadvertently exposes clinicians to disproportionately more negatives. Eliciting, discussing, and interpreting nuances of traumas, hurts, resentments, deceits, and disappointments likely leads to emotional exhaustion, depersonalization, and a lessened sense of personal accomplishment (Jenaro, Flores, & Arias, 2007). Idiosyncratic details of negatives may trigger, among some clinicians, recall of their personal trauma, or they may experience negative reactions toward some clients (Pope & Tabachinick, 1994).
Deficit-based assessment paints an incomplete and skewed portrayal of clients, with reduced clarity, lacking important information that could be critical in treatment planning. Clinical assessment ought be a hybrid process that explores strengths as well as weaknesses. The focus of assessment should be collecting not only stories of unmet needs but also tales of fulfillment. Assessment should explore not just conflicts but also compromises, transgressions as well as acts of compassion, selfishness of others but also genuine actions of sharing, grudges as well as expressions of gratitude, and episodes of vengeance as well instances of forgiveness. It is about exploring in an authentic way hubris as well as humility, haste as well as self-restraint, hate as well as love, pain of trauma as well as growth from it. SBA is not about dismissing negatives. It is about fine tuning of clinical assessment toward balance.
Strength-Based Assessment
Emphasis on SBA is consistent with the contemporary thrust in positive psychology, which studies conditions and processes that enable individuals, communities, and institutions to flourish. Positive psychology explores what works, what is right, and what can be nurtured (Rashid, Summers, & Seligman, in press). Although strengths are not a standard feature of a typical clinical assessment, they are not alien to humanistic, educational, solution-focused, and family-based approaches (e.g., Epstein & Sharma, 1998; Friedman & MacDonald, 2006; Iveson, 1994; Saleebey, 1996). Unfortunately, because of political and economic factors, and the uncritical embrace of medical models by clinical psychology, the assessment and treatment of deficits has traditionally been the primary function of clinical practice (Maddux, 2002). Career-driven pragmatic specializations and tightening of disciplinary boundaries further phased strengths (as well as ethics) out from the social and clinical realms into philosophical discourse (Sloan, 1980). Following the psychiatric instructional model, training of clinicians, especially in hospitals, medical clinics, and community health centers—which operate on the deficit model—further entrenched deficit-oriented assessment in clinical practice.
Current clinical assessment is largely geared toward uncovering childhood traumas, evaluating distorted thoughts, and assessing interpersonal difficulties. People avoid seeking clinical services because they fear being stigmatized if their challenges are formulated into a psychiatric diagnosis (Corrigan, 2004). Portrayal of individuals with mental health illnesses in the popular media, using diagnostic labels such as paranoid schizophrenia, borderline personality disorder, obsessive-compulsive disorder, psychopath, and antisocial personality disorder, maintain the stigma against mental health. Moreover, increasingly diverse and cosmopolitan patrons do not readily subscribe with Eurocentric diagnostic labels.
Assessing strengths can provide the clinician with a powerful tool to understand a client's intact repertoires, which can be effectively utilized in treatment planning, enabling clients and clinicians to intervene and evaluate treatment through multiple avenues (reduction in symptoms, increase in positive emotions, improved social relationships, better work–life balance, etc.). Considering what strengths a client brings to effectively deal with troubles stimulates a very different discussion and therapeutic relationship from a deficit-oriented inquiry probing, “What weaknesses have led to your symptoms?”
Strength-based assessment offers distinct advantages. Assessing strengths changes the orientation of clinical services from remediation to nurturance of resilience and well-being. Knowledge of strengths offers clients an additional but important strategy to solve their problems, which likely increases their self-efficacy. Assessment and deployment of strengths such as optimism, hope, zest, curiosity, creativity, social intelligence, and gratitude cultivates positive emotions.
Strength awareness also builds a cumulative advantage. Evidence shows that people who are aware of their strengths can build self-confidence at a young age and tend to reap a “cumulative advantage” that continues to grow over a lifetime (Judge & Hurst, 2008). The broaden-and-build theory of positive emotions (Fredrickson, 2001) applied to clinical practice argues that strengths broaden the repertoire of action potentials in the present and build resources in the future. A strength- and not deficit-based assessment approach is more likely to meet contemporary needs. By refocusing and incorporating strengths, clinical assessment becomes more inclusive, innovative, open-minded, and adaptable to contemporary real-time digital zeitgeist.
Theoretical Threads
Theoretical underpinnings of strengths, although sparingly, have been discussed in the psychological literature (e.g., Cawley, Martin, & Johnson, 2000; Jahoda, 1958; Maslow, 1959; Rokeach, 1973; Ryff & Singer, 1996). But these notions have not evolved in an organized system of clinical assessment and intervention. The emergence of positive psychology since 2000, as a movement to refocus and redirect psychological attention and efforts to positives as well as negatives, has sparked interest in SBA. However, the notions have been echoed previously. Evans (1993), more than two decades ago, postulated negative behaviors or symptoms have alternative positive forms. To some extent, this reciprocity is a matter of semantics. Symptoms are defined in everyday language that can always be translated into their simple opposites, although not all symptoms or disorders lend themselves naturally to this reciprocity. For example, courage could be conceptualized as the antithesis of anxiety, yet not all anxious individuals lack courage. Evans (1993) has argued that most constructs in psychopathology could be scaled into two parallel dimensions:
- Pathological or undesirable attribute moving from severe deviance through some neutral point to its positive nonoccurrence
- The antithetical attribute, moving from nonoccurrence through some neutral point to its desirable form
Peterson and Seligman's (2004) Classification of Virtues and Strengths (CVS) spearheaded the first comprehensive, coherent, and systematic effort in psychology to classify 24 core human strengths. The definitions of these core strengths, subsumed under six broader categories called virtues, are listed in Table 31.1.
Table 31.1 Classification of Virtues and Character Strengths (Peterson & Seligman, 2004)
| The VIA Classification of Character Strengths |
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© Copyright 2014, VIA Institute on Character, www.viacharacter.org
According to Peterson and Seligman (2004), character strengths are ubiquitous traits that are valued in their own right and not necessarily tied to tangible outcomes. Character strengths, for the most part, do not diminish others; rather, they elevate those who witness the strength, producing admiration rather than jealousy. There are tremendous individual variations in the patterns of strengths that individuals possess. Societal institutions, through rituals, attempt to cultivate these character strengths. However, the CVS classification is descriptive rather than prescriptive, and character strengths can be studied like other behavioral variables. Character strengths are expressed in combinations (rather than singularly) and viewed within the context in which they are used. For example, strengths such as kindness and forgiveness can cement social bonds, but if used in excess, these strengths can be taken for granted. In this classification scheme, character strengths (e.g., kindness, teamwork, zest) are distinct from talents and abilities. Athletic prowess, photographic memory, perfect pitch, manual dexterity, and physical agility are examples of talents and abilities. Strengths have moral features, whereas talents and abilities do not.
Consistent with Evans's notion of parallel dimensions, Peterson (2006) has proposed a model for evaluating psychopathology along the spectrum of strengths, instead of symptoms. Peterson proposes that psychological disorders could be considered as an absence of strength—a state or trait that signifies its opposite or a state or trait that displays its exaggeration. A disorder may result from the absence of a given character strength, but it can also result from its presence in extreme forms. Peterson (2006) argues absence of character strengths is hallmark of real psychopathology. Like Evans, Peterson acknowledges that absence of character strengths may not necessarily apply to disorders such as schizophrenia and bipolar disorder, which have clear biological markers. However, many psychologically based disorders (e.g., depression, anxiety, attention and conduct problems, and personality disorders) may be more holistically understood in terms of presence of symptoms as well as the absence character strengths. It is also important to note that the presence of specific strengths, categorically or dimensionally, doesn't guarantee optimal functioning. Extrapolating from a 24 strengths scores (based on CVS model of strengths) of 83,576 adults, McGrath, Rashid, Park, and Peterson (2010) found that no matter how data is analyzed, no matter what strengths are considered, the results unanimously support a dimensional structure than a categorical view of character strengths. Therefore, it is important to keep in mind that much like diagnostic categories aren't sufficient to characterize an individual as completely insane, strengths should not be used to exemplify an individual as completely sane. In short, a dimensional approach, although less conducive to convenience of categorizing individuals based on scores, could more effective.
Joseph and Wood (2010) have articulated a somewhat similar dimensional approach. Illustrating two widely assessed affective states in clinical practice, depression and anxiety, Joseph and Wood posit that even widely used measures of depression (Center for Epidemiologic Studies Depression Scale—Revised [CES-D]; Radloff, 1977) and anxiety (Spielberger State-Trait Anxiety Inventory [STAI]; Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983)—both of which consist of equal balance of positively and negatively worded items—could be adopted toward a dimensional approach, such as depression to happiness and anxiety to relaxation. Instead of focusing on evaluating negative categories—the usual focus of clinical assessment—it could evolve into a more informative, inclusive, and balanced process by adopting a dimensional approach suggested by independent but converging lines, parallel dimensions (Evans, 1993), and strength continuum including absence, opposite, or excess (AOE) of strengths (Peterson, 2006), or a continuum approach (Joseph & Wood, 2010).
Extending these arguments, I have listed symptoms of major psychological disorders in terms of lack or excess of strengths (Table 31.2). For example, depression can result, in part, because of lack of hope, optimism, and zest, among other variables; likewise, a lack of grit and patience can explain some aspects of anxiety and a lack of fairness, equity, and justice might underscore conduct disorders. The notion of lack of character strengths as a plausible cause of psychopathology is gathering empirical support. In a longitudinal study of 5,500 people, individuals low on positive characteristics such as self-acceptance, autonomy, purpose in life, positive relationships with others, environmental mastery, and personal growth were up to 7 times more likely to experience depressive symptoms in the clinical range (Wood & Joseph, 2010), the cluster of interpersonal strengths (e.g., social intelligence, love, kindness, citizenship) that play a key role in mortality. Holt-Lunstad, Smith, and Layton, (2010) in their meta-analysis of 148 studies (308,849 participants) have found a 50% increased likelihood for participants with stronger social relationships. Similarly, Wood and Joseph (2010) have found that absence of positive characteristics independently forms a risk factor for disorder above the presence of numerous negative aspects, including current and previous depression, neuroticism, and physical ill-health. Moreover, not only more negative life events but also low or lack of positive attributions are associated with increased risk of suicide (Johnson, Gooding, Wood, & Tarrier, 2010).
Table 31.2 Major Psychology Disorder and Dysregulation of Strengths
| Lack = diminished capacity to exercise/use a character strength | |
| Excess = excess of strength, not to be considered as excess of symptoms | |
| Presence of Symptoms | Dysregulation of Strengths Lack or Excess |
| Major Depressive Disorder | |
| Depressed mood, feeling sad, hopeless (observed by others; e.g., appears tearful), helpless, slow, fidgety, bored | Lack of joy, delight, hope and optimism, playfulness, spontaneity, goal orientation Excess: prudence, modesty |
| Diminished pleasure | Lack of savoring, zest, curiosity Excess: self-regulation, contentment |
| Fatigued, slow | Lack of zest, alertness Excess: relaxation, slacking |
| Diminished ability to think or concentrate and indecisiveness, brooding | Lack of determination and resolution winnowing, divergent thinking, Excess: being overanalytical |
| Suicidal Ideation/plan | Lack of meaning, hope, social connectivity, resolution and winnowing, divergent thinking, resourcefulness Excess: carefreeness (defensive pessimism) |
| Disruptive Mood Dysregulation Disorder | |
| Severe temper outbursts (verbal and physical) | Lack of self-regulation, prudence |
| Persistent irritability and anger | Excess: enthusiasm |
| Unspecified Depressive Disorder With Anxious Distress | |
| Feeling keyed up or tense, feeling unusually restless | Lack of contentment (distress tolerance), gratitude, relaxation, prudence Lack of openness to new and novel ideas (curiosity) Excess: zest, gusto, eagerness |
| Bipolar Disorder | |
| Elevated, expensive, irritable mood | Lack of equanimity, even-temperedness and level-headedness Excess: composure, passion |
| Inflated self-esteem or grandiosity | Lack of humility, self and social intelligence Excess: willpower, introspection |
| More talkative than usual | Lack of reflection and contemplation Excess: zest, passion |
| Excessive involvement in pleasurable activities (e.g., unrestrained buying sprees, sexual indiscretions, thoughtless business/career choices) | Lack of moderation, prudence, simplicity Excess: passion (obsession), self-indulgence |
| Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) | Lack of self-regulation, perspective, balance, humility, emotional regulation Excess: self-care (self-indulgence), zeal, gratification |
| Generalized Anxiety Disorder | |
| Worrying excessively about real or perceived danger | Lack of perspective, wisdom, critical thinking Excess: caution, attentiveness |
| Feeling restless, fatigued, fidgety, jittery, edgy, difficulty concentrating and sleeping | Lack of equanimity, mindfulness, spontaneity Excess: farsightedness, composure |
| Separation Anxiety Disorder | |
| Persistent and excessive worry about losing major attachment figures | Lack of capacity to love and be loved, social trust, optimism, bonding Excess: affection, self-regulation |
| Selective Mutism | |
| Failure to speak in specific social situations in which there is an expectation to speak | Lack of initiative, personal and social intelligence, social skills Excess: prudence, self-scrutiny |
| Specific Phobia | |
| Marked anxiety about a specific object or situation | Lack of courage, creativity Excess: sensitivity, cautious reactivity |
| Active avoidance or endured with intense fear or anxiety; out-of-proportion fear | Lack of relaxation, mindfulness, courage to withstand social judgment, rational self-talk (reflection and introspection) Excess: observance, awareness, caution |
| Feeling restless, fidgety, jittery, edgy | Lack of equanimity, self-intelligence, self-evaluation, monitoring, relaxation, mindfulness, level-headedness, self-composure Excess: caution, sensitivity, reactivity, critical evaluation |
| Social Phobia | |
| Fear of social or performance situation | Lack of courage, extemporaneity, trust in others Excess: social intelligence (self seen as audience, rather than part of the social picture), critical appraisal and evaluation |
| Agoraphobia | |
| Marked fear or anxiety using public transportation, parking lots, bridges, shops, theaters, standing or being in a crowd Being outside of the home alone |
Lack of courage, extemporaneity, open-mindedness, flexibility Excess: sensitivity, caution about a situation |
| Panic Disorder | |
| Intense fear of “going crazy” marked by heart pounding, feeling dizzy, unsteady, or light-headed Derealization and depersonalization Persistence concern about additional attacks |
Lack of composure, social and personal intelligence, creativity and curiosity to explore the environment/situation beyond the surface, optimism (expecting unexpected adverse outcomes) Excess: sensitivity, reactivity to environmental cues, awareness |
| Obsessive-Compulsive Disorder | |
| Recurrent, persistent, intrusive, unwanted thoughts, urges, or images | Lack of mindfulness and letting go, curiosity, perspective Excess: reflection and introspection, morality or fairness, |
| Repetitive behaviors or mental acts individual feels compelled to do to prevent anxiety | Lack of contentment with less than perfect objects and performance, creativity, flexibility, ability to restrain Excess: reflection and introspection, planning |
| Body Dysmorphic Disorder | |
| Preoccupation with perceived defects in physical appearance that are not observable to others | Lack of contentment with less than perfect self-image, acknowledgment of personal character strengths, modesty Excess: personal intelligence, self-care, self-worth |
| Hoarding Disorders | |
| Persistent difficulty discarding or parting with possessions, regardless of actual values | Lack of perspective of what is important and meaningful, distinct self-image (identity melded with objects), relationship more with object and artifacts than with people and experiences, inability to override one's perceived needs (lack of compassion) Excess: optimism, caution |
| Posttraumatic Stress Disorder | |
| Recurrent, involuntary, and intrusive distressing memories of a traumatic event | Lack of resilience, ability to bounce back, lack of personal intelligence to process emotions or to seek support to process emotions, lack of ability to take risks/creativity to explore various coping mechanisms, lack of persistence, optimism, hope, lacking social support Lack of the ability to make meaning of the traumatic event or putting things in perspective Excess: reflection (rumination), viewing or perceiving the event only through negative lens or perspective, adherence (to the traumatic experience) |
| Intense or prolonged psychological distress and fear of external cues that symbolize the traumatic event | Lack of ability to self-soothe or relax, or regain composure, creativity and courage to experience the distressing objection or situation in a different or adaptive manner, self-determination Excess: composure, caution, keeping the status quo |
| Avoidance of distressing memories (people, places, conversational activities, objects, situations) | Lack of resolve to handle distressing memories head-on (emotional bravery) Excess: self-preservation at the cost of not yielding to spontaneous experiences, or taking necessary risks |
| Attention-Deficit/Hyperactivity Disorder | |
| Failing to give close attention to details, not seeming to listen when spoken to directly | Lack of vigilance, social intelligence Excess: excessive watchfulness |
| Difficulty organizing tasks and activities | Lack of discipline, managing Excess: gusto, eagerness |
| Avoiding or disliking tasks requiring sustained attention or mental effort | Lack of grit and patience Excess: hedonic pleasures |
| Excessive fidgeting, motor activity, running, pacing | Lack of calmness, composure Excess: agility, fervor |
| Talking excessively, interrupting or intruding others, difficulty awaiting turn | Lack of social intelligence, self-awareness Excess: zest, initiative, curiosity |
| Oppositional Defiant Disorder | |
| Annoying people deliberately | Lack of kindness, empathy, fairness Excess: clemency |
| Often being angry, resentful, spiteful, or vindictive | Lack of forgiveness, gratitude, level-headedness Excess: fairness, equality |
| Disruptive, Impulse-Control, and Conduct Disorder and Antisocial Personality Disorder | |
| Bullying, threatening, intimidating others | Lack of kindness and citizenship Excess: leadership, control, governance |
| Stealing, destroying other's property | Lack of honesty, fairness, justice Excess: courage, fairness |
| Personality Disorders | |
| Paranoid Personality Disorder | |
| Suspicion without sufficient basis that others are exploiting, harming, or deceiving | Lack of social intelligence, trust in others, open-mindedness, curiosity Excess: caution, diligence |
| Doubts loyalty or trustworthiness of others, reluctant to confide in others, reading hidden demeaning or threatening meaning into benign remarks or events | Lack of personal intelligence, giving or receiving love, deep and secure attachment Excess: social intelligence, open-mindedness |
| Borderline Personality Disorder | |
| Pervasive relationship instability, imagined or real abandonment | Lack of capacity to love and be loved in deep and sustained one-to-one relationships, lack of secure attachment, emotional intimacy and reciprocity in relationships, relational prudence and kindness, empathy |
Excess: curiosity and zest that phase out quickly, excess of attachment, emotional intelligence |
|
| Idealization and devaluation | Lack of authenticity and trust in close relationships, moderation, prudence and open-mindedness (swaying by a single event), reality orientation, perspective Excess: judgment, spontaneity |
| Self-damaging impulsivity (e.g., spending, reckless driving, binge eating) and anger outburst | Lack of self-regulation (tolerance), moderation, prudence Excess: bravery without prudence (actions without prudence), risk taking |
| Narcissistic Personality Disorder | |
| Pattern of grandiosity, arrogance, need for admiration, sense of self-importance | Lack of authenticity, humility Excess: self-deprecation, criticism |
| Lack of empathy | Lack of social intelligence and kindness (being genuinely interested in others) Excess: personal intelligence (personal needs or wants are prioritized) |
| Fantasies of unlimited success, power, brilliance, beauty, or ideal love | Lack of humility, perspective, personal intelligence Excess: creativity (fantasizing), rationalizing, intellectualizing, |
| Sense of entitlement, expectations of unreasonably favorable treatment, requires excessive admiration | Lack of humility, citizenship and fairness Excess: leadership, need for appreciation |
| Interpersonal exploitation | Lack of fairness, equity and justice Excess: righteousness, despotism, bossiness |
| Envious of others | Lack of generosity and appreciation Excess: self-preservation |
| Histrionic Personality Disorder | |
| Excessive emotionality and attention seeking | Lack of equanimity and modesty Excess: personal and emotional intelligence |
| Easily suggestible (i.e., easily influenced by others or circumstances) | Lack of persistence, determination, goal orientation Excess: efficiency of concentration |
| Inappropriate sexual seduction, overemphasis on physical appearance | Lack of discretion and self-regulation Excess: emotional disinhibition |
| Shallow and hasty emotional expression | Lack of mindfulness and social intelligence Excess: spontaneity |
| Self-dramatization, theatricality, and exaggerated and shallow expression of emotion | Lack of authenticity, lack of authentically expressing one's needs, emotions, and interests, moderation, mindfulness Excess: emotional intelligence, enthusiasm |
| Overvaluing relationships | Lack of social intelligence Excess: tending and befriending |
| Obsessive Compulsive Disorder | |
| Preoccupation with details, orderliness and perfectionism | Lack of perspective as to what is more important, lack of spontaneity Excess: persistence, orderliness |
| Interpersonal control at the expense of flexibility, openness, and efficiency | Lack of kindness, empathy, ability to follow Excess: submission, leniency |
| Preoccupation with details, rules, lists, organizations, or schedules to the extent that primary aim of the activity is overshadowed | Lack of flexibility, creativity in thinking of novel and productive ways to do things Excess: perfection, organization |
| Excessively devoted to work at the expense of leisure and friendships | Lack of balance, savoring, appreciation for relationships Excess: self-indulgence |
| Rigidity and stubbornness | Lack of adaptability, flexibility, creative problem-solving Excess: discipline, prudence |
| Overconscientious, scrupulous, and inflexible about morality, ethics, or values | Lack of perspective, consideration of implication of decision, adaptability, flexibility, creative problem-solving Excess: self-righteousness |
| Avoidant Personality Disorder | |
| Avoiding activities with others due to fear of criticism, disapproval, or rejection | Lack of interpersonal courage to take risks, lack of critical reasoning to put criticism or disapproval of others in perspective, courage Excess: self-awareness, caution |
| Social isolation, avoiding people, inhibition in new interpersonal situation because of feelings of inadequacy | Lack of interpersonal strengths, melding one's identity with others/group Excess: prudence, critical thinking |
| Views self as socially inept, personally unappealing, and inferior to others | Lack of self-assurance, self-efficacy, hope and optimism Excess: humility, authenticity |
| Reluctance to take risks to engage in any new activities | Lack of bravery and curiosity Excess: self-regulation, compliance |
| Dependent Personality Disorder | |
| Excessive need to be taken care of, fear of being left alone | Lack of independence, initiative and leadership Excess: seclusion |
| Difficulty making everyday decisions, lack of perspective | Lack of determination and perspective Excess: critical analysis, focusing on details |
| Difficulty expressing disagreements with others | Lack of bravery, not being able to speak up for what is right, lack of judgment Excess: uncompromising |
| Difficulty initiating | Lack of self-efficacy, optimism, curiosity Excess: organization, autonomy |
| Anti-Social Personality Disorder | |
| Failure to conform to social norms or laws | Lack of citizenship, lack of communal purpose, lack of respect for authority, kindness, mercy, forgiveness, less giving but demanding more Excess: courage (risk taking), vitality |
| Deceitfulness, repeated lying, conning others for personal profits | Lack of honesty, integrity, fairness, moral compass, empathy Excess: self-centered personal intelligence |
| Irritability, impulsivity, aggressiveness as indicated by physical fights or assaults | Lack of equanimity, mindfulness, tolerance, kindness and consideration, knowledge of others, self-control, perspective (inability to anticipate consequences) Excess: mental and physical vigor, passion, ambition, courage, too ready to go out of zone of comfort |
Note. Italic entries represent virtues, while character strengths are listed alphabetically within each virtue.
While negative attributes are causally linked with psychopathology, not only does a lack of positive characteristics independently predict psychological disorder, but their presence also facilitates in recovery. Huta & Hawley (2010) have found that character strengths such as optimism, appreciation of beauty, and spirituality facilitates recovery from depression. Summarizing more than a decade of research and practice of character strengths, Niemiec (2013) has found that presence of character strengths is strongly linked with well-being and inversely linked—both correlationally as well as causally—with psychological distress. Therefore, clinical assessment devoid of positive characteristics yields a narrow and primarily negative picture of clients, with limited treatment options.
Empirical Evidence
Assessment of strengths, especially within the burgeoning field of positive psychology, has attracted both empirical and clinical attention. A systematic review of SBA by Bird et al. (2012) identified 12 strengths assessments (five quantitative, seven qualitative). These assessments varied as to whether they focused primarily on strengths, for example, Value in Action Inventory of Strengths (VIA-IS; Peterson & Seligman, 2004), or a combination of strengths and challenges, for example, Strengths Assessment Worksheet (SAW; Rapp & Goscha, 2006) or the four-front model (Lopez & Snyder, 2003). The systematic review identified a total of 39 themes to operationalize strengths across assessments. The most common themes were personal attributes, interpersonal relationships, skills, talents, capabilities, resilience and coping, and community and social supports. These themes could be organized into three categories; individual, interpersonal, and environmental. Bird et al.'s (2012) review also found 10 evaluations of SBA including three randomized controlled trials (RCT), four quasi-experimental studies, and three nonexperimental designs providing supportive evidence for the effectiveness of SBA, although it was stressed that further rigorous studies are needed.
By adopting a dimensional approach, SBA offers the option that psychological interventions that are effective in reducing symptoms could also be adapted to include cultivation of well-being. Connectedness, hope and optimism, identity, meaning and purpose, and empowerment have been identified as five key processes underlying the recovery process (Leamy, Bird, Le Boutillier, Williams, & Slade, 2011). Within the core category of empowerment, “focusing on strengths” is considered vital to individual's personal recovery. A strength-based approach to case management (SBCM) has been devised and empirically evaluated (Rapp & Goscha, 2006). SBCM focuses on the relationships between staff and consumers and prioritizes strengths over deficits. Studies of SBCM including a limited number of RCTs and quasi-experimental designs have reported a range of positive outcomes including reduced hospitalization and increased social support. A growing number of studies, including RCTs, have shown that interventions that incorporate strengths, along with other active therapeutic exercises, are effective in clinical settings, reducing symptoms of psychiatric distress and increasing well-being (e.g., Flückiger, Caspar, Grosse, & Willutzki, 2009; Goodwin, 2010; Kahler et al., 2014; Seligman, Rashid, & Parks, 2006).
Illustrations of Strength-Based Assessment in Clinical Settings
Strengths in clinical practice are mostly assessed through quantitative, self-report measures such as VIA-IS (Peterson & Seligman, 2004), Realise2 (Linley, Willars, & Biswas-Diener, 2010), and Adult Needs and Strengths Assessment (Nelson & Johnston, 2008), and Quality of Life Inventory (QOLI; Frisch, 2013). Typically a straightforward strategy of “identity and use and your strengths” is used, and the top five scores are regarded as signature strengths. Clients are then asked to find new ways to use their signature strengths. This approach, although useful and effective in nonclinical setting, may not meet critical clinical needs. For example, exclusive focus on top-ranked strength scores could give an inadvertent message to clients that their top five strengths carry more therapeutic potential when it may not be the case for every client, as illustrated in case scenarios later in this chapter. The most critical aspect of a strength-based therapeutic approach is contextualized use of strengths, keeping presenting problems (symptoms) front and center.
The clinical setting may require a more nuanced and theoretically driven approach (Biswas-Diener, Kashdan, & Minhas, 2011) of using strengths. To overcome this shortcoming, a comprehensive strength assessment approach is suggested (Rashid & Seligman, 2013; see Table 31.3). In this approach, the clients are first provided a sheet with brief descriptions (approximately 20 to 25 words per strength) of core strengths (based on the CVS model), and are asked to identify (not rank) up to five strengths that best illustrate their personality. Identical collateral data is collected from a friend or family member. Clients are then provided descriptions with titles to give strengths names and specific contexts. Next, clients are encouraged to share memories, experiences, real-life stories, anecdotes, accomplishments, and skills that illustrate the use of these strengths in specific situations. Clients then complete a self-report measure of strengths (e.g., VIA-IS). Collaboratively, with therapists, clients set specific, attainable, behavioral, and measurable goals that target their presenting concerns and adaptive use of their signature strengths.
Table 31.3 Comprehensive Strengths Process
| Character Strength | 1 Self | 2 Family | 3 Friend | 4 SSQ-72 | 5 Composite | 6 Under/Over | 7 Desired | |
| 1 | Appreciation of beauty and excellence | |||||||
| 2 | Authenticity and honesty | |||||||
| 3 | Bravery and valor | |||||||
| 4 | Creativity and originality | |||||||
| 5 | Curiosity, interest in the world, and openness to experience | |||||||
| 6 | Fairness, equity, and justice | |||||||
| 7 | Forgiveness and mercy | |||||||
| 8 | Gratitude | |||||||
| 9 | Hope, optimism, and future-mindedness | |||||||
| 10 | Humor and playfulness | |||||||
| 11 | Kindness and generosity | |||||||
| 12 | Leadership | |||||||
| 13 | Capacity to love and be loved | |||||||
| 14 | Love of learning | |||||||
| 15 | Modesty and humility | |||||||
| 16 | Open-mindedness and critical thinking | |||||||
| 17 | Perseverance, diligence and industry | |||||||
| 18 | Perspective (wisdom) | |||||||
| 19 | Prudence, caution, and discretion | |||||||
| 20 | Religiousness and spirituality | |||||||
| 21 | Self-regulation and self-control | |||||||
| 22 | Social intelligence | |||||||
| 23 | Teamwork, citizenship, and loyalty | |||||||
| 24 | Zest, enthusiasm, and energy | |||||||
| Strengths not listed above | ||||||||
Directions: Compile your signature strengths profile using this worksheet.
Each column is independent from the other.
Column 1 (Self): Clients record the five positive character attributes illustrated in their strength narratives/positive introduction. Client place a check mark inside the box that correspond to the attributes that most often characterize clients.
Column 2 (Family): Clients record attributes, identified by a family member.
Column 3 (Friend): Clients record attributes, identified by a close friend.
Column 4 (Signature Strengths Questionnaire [SSI-72; www.tayyabrashid.com] or VIA-IS; www.viacharacter.org): Clients complete an online self-report measure and record their top five strengths.
Column 5 (Composite): Clients add the number of times that each attribute was checked in the previous four columns.
Column 6 (Under/Overuse): Clients identify five strengths that they feel they lack (underuse) or use in excess (overuse). They denote the strength with either X-O (Over) or X-U (under).
Column 7 (Desired): Clients identify five strengths that they desire to have and denote these with D
It is important that goals are personally meaningful as well as adaptive in the interpersonal context of clients. For example, if the goal is that clients use their curiosity more, an optimal balance of curiosity through concrete actions is discussed so that it doesn't become intrusiveness (excess/overuse) or boredom (lack/underuse). While setting goals, clients are also taught to use their strengths in a calibrated and flexible way that could adaptively meet situational challenges (Biswas-Diener et al., 2011; Schwartz & Sharpe, 2006; see also Kauffman, Joseph, & Scoular, Chapter 23, this volume). In doing so, specific actions or habits are highlighted that may explain symptoms or troubles as either lack or excess of strengths. Some illustrations include depressed mood and feeling hopeless or slow, as lack of zest and playfulness; worrying excessively, as lack of gratitude or inability to let go; indecision, as lack of determination; repetitive, intrusive thoughts, as lack of mindfulness; narcissism, as lack of modesty; feeling inadequate, as lack of self-efficacy; or difficulty making decisions, as excess of prudence. Furthermore, therapists also discuss that sometimes clients get into trouble for overuse of love and forgiveness (being taken for granted), underuse of self-regulation in a specific domain of life (indulgence), fairness only in a few situations or teamwork only with preferred groups (bias and discrimination). Throughout the course of treatment, clients and clinicians continuously explore the nuances and subtleties of strengths, especially about encountering their challenges through strengths. The following case scenario is from a client I saw as an individual at a university counseling center, illustrating an adaptive use of strengths linked with presenting problems (Rashid & Ostermann, 2009).
A 29-year-old, Caucasian, single female, with presenting symptoms of depression and anxiety, reported doing things halfway or halfheartedly, not feeling alive, and being unable to approach life with excitement and feeling tired. The comprehensive strength assessment process, described earlier, uncovered creativity, curiosity, love of learning, kindness, and spirituality as her signature strengths. She shared with the therapist that she used to be very good at graphic designing and, during college, worked part time for an agency that designed various brochures. Despite experiencing depressive symptoms, she kept up with nonfiction reading on her topic of interest, although with less enthusiasm. The therapeutic process focused on helping her to recall previous accomplishments, improving her self-efficacy moderately. She struggled financially. To reignite her creativity, she was encouraged to think creatively to make cost-effective, small but personally meaningful changes in her apartment. Although she has heard from others previously that she is creative, the act of naming the attribute as her signature strength changed her orientation toward her own strengths. At the same time, she started thinking of alternative ways of solving her problems. For instance, she realized that her strength of loving and being loved tended to be unconditional—often sacrificing her legitimate needs for others who had been taking her for granted. Her therapeutic goals were to set healthy boundaries through creative ways. Furthermore, she coped with her symptoms of depression and anxiety through emotional eating. A discussion on using creativity with self-regulation helped her to generate a list of adaptive and accessible activities she could engage in easily to cope with her distress.
I saw a young-adult male for crisis intervention. He has significant emotional dysregulation challenges. After four individual therapy sessions, which focused developing adaptive coping to deal with the crisis, he was transitioned into a Positive Psychotherapy (PPT; Rashid et al., 2013) group. PPT is a strength-based approach; clients identity their strengths from multiple perspectives. Following this process, social intelligence, love, forgiveness, humility, and prudence were identified as this client's signature strengths. Reflecting and appraising the adaptive usage of these strengths, the client realized that his emotional dysregulation was closely linked with dysregulation of his strengths. For instance, he invariably used his signature strengths excessively. He loved his partner unconditionally and forgave her at repeated transgressions of the same nature. He realized that his humility and prudence prevented him from asserting himself and clearly expressing his frustrations and needs. The group discussion helped him to learn a calibrated use of strengths and incorporate strengths that, although not his signature strengths, may still facilitate his meeting his needs. For example, he opted to work on bravery from the perspective of standing up for himself. His work is still in progress, and continues to go through the ebb and flow of emotions. However, the assessment of strengths from the perspective of a lack or excess helped him to understand his challenges as well as his strengths from a more inclusive, malleable, and less stigmatizing place.
In addition to illustrations of SBA described above, there are other approaches. One such approach is the four-front assessment (Wright & Lopez, 2002; Magyar-Moe, 2009). At the core of this approach, the clinician gathers information about four fronts by asking questions: (1) What deficiencies do clients contribute to their problems? (2) What strengths do clients bring to deal effectively with their lives? (3) What environmental factors serve as impediments to healthy functioning? (4) What environmental resources accentuate positive functioning of clients? Methods include solution-focused interviews and structured tests of psychology and negative symptomatology, individual strengths positive attributions, and environment. After assessing the four fronts, results are shared with clients (as well as colleagues and others who may provide support and care to clients) and documented in progress notes and written reports with equal space, time, and emphasis placed on each of the four dimensions.
Strength-based assessment also invites interesting alternative hypotheses in clinical settings regarding the course an treatment of psychopathology. For example, assessment of depression may not just be a cluster of symptoms described in the DSM-V, but it could also identify a lack of positive emotions and meaning in a client's life. With a depressed client, the clinician can explore and work on strengths like perspective, zest, and gratitude. Shoring up social strengths of the client such as teamwork, social intelligence, and kindness could be a viable way of counteracting depression. Similarly, anxiety might represent excess of worrying, feeling restless, fidgety and impulsive behavior, and lacking focus, and be a lack of purposeful goals, actions, and habits that utilize the client's strengths and absorb him or her immensely. SBA approach also draws our attention that absence of weaknesses is the only clinical goal, but presence of well-being—facilitated by strengths, is equally important for treatment and further prevention of psychological disorders (Keyes, 2013). Some clinicians may concerned that assessment of strengths may either reinforce narcissistic attitudes for some clients or distract them from serious problems that need immediate attention. The goal of an SBA is neither to create Pollyannaish or Panglossian caricatures of clients, nor is it to inflate grandiose egos of clients. Of course, in assessing strengths, the goal is never to minimize or mask negative experiences such as abuse, neglect, and suffering.
Clinicians can choose validated instruments to assess specific positive constructs listed in two volumes that discuss their usage, psychometric properties, and relevant research (Lopez & Snyder, 2003; Simmons & Lehmann, 2013). In addition, Ong and Van Dulmen (2006) describe SBA issues. Also, Levak, Siegel, and Nichols (2011) offer useful insights into using one of the most widely used and validated measures of psychopathology, the Minnesota Multiphasic Personality Inventory—2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) within the context of SBA.
Strength-Based Assessment: Recommendations for Clinical Practice
The following eight concrete strategies, my own extracted clinical experience, and the experience of others can help clinicians to integrate strengths in their practice:
1. Most measures of psychopathology are expensive and require completion in clinical settings. Valid and reliable strength measures, developed by practitioners and researchers of positive psychology, are readily available online without any charge. For example, the Authentic Happiness website (www.authentichappiness.sas.upenn.edu; affiliated with the University of Pennsylvania) and the Values in Action website (www.viacharacter.org) offer these measures. Clients can complete these measures at home and can bring printouts of results to therapy. For instance, one of the most widely used measures to assess strengths is the VIA-IS (Peterson & Seligman, 2004; www.viacharacter.org). The VIA-IS is a 240-item, self-report measuring 24 character strengths. A 72-item brief version (Rashid et al., 2013) with feedback options is available (at www.tayyabrashid.com). These measures could also be used to track changes over the course of psychotherapy. All three of previously mentioned websites provide these measures without any charge and also provide instantaneous feedback about strengths and other positive attributes
2. Many existing measures of psychopathology also assess some aspects of well-being and strengths. As mentioned earlier, CES-D (depression) and STAI (anxiety) also capture elements of well-being and relaxation, respectively. Clinicians can reinterpret these existing measures to widen scope of their assessment (Joseph & Wood, 2010). Measures of reverse coding positive items could be used in two versions: with and without reverse coding. This may help clinicians to compare construct and incremental validity of two versions and may also help in examining alternative theoretical perspective regarding course and treatment of psychopathology.
3. In addition to self-report measures, interviews guided by research can also be used to assess strengths. If a clinician prefers not to use formal assessment, then he or she can use questions during intake or ongoing therapy to elicit strengths, positive emotions, and meaning. Some sample questions could be, “What gives your life a sense of meaning?” “Let's pause here and talk about what you are good at.” “Tell me what you are good at.” “What are your initial thoughts and feelings when you see someone doing an act of kindness or courage?” Flückiger and colleagues (2009) have used the clinical interview to elicit clients' strengths in the therapeutic process. Following are several of their resource activation questions that can be readily incorporated into a Life History Questionnaire or clinical interview in routine practice:
- What do you enjoy most? Please describe your most enjoyable experiences.
- What are you good at? Please describe experiences that brought out the best in you.
- What are your inspirations for the future?
- What makes a satisfying day for you?
- What experiences give you a sense of authenticity?
- Please describe a time when you felt “the real you.”
4. Not all strengths are within the awareness of clients, and others can spot them better. Clinicians can also seek collateral information from family members, colleagues, and friends about the strengths of their client as well as strengths of concerned individuals as they relate to the client. This is particularly helpful in assessing and identifying social and communal buffers. For example, in addition to inquiring about problems with family members, clinicians may also assess attachment, love, and nurturance from the primary support group. Instead of looking for problems related to social environment, a clinician can ask clients to describe humor and playful interactions, connectedness, and empathetic relationships at work.
5. To help clients to discern and identify their own strengths, clinicians can also use icons of certain strengths (e.g., Malala Yusuf Zai, Gandhi, Mother Theresa, Nelson Mandela, Martin Luther King Jr., Albert Einstein, Aung San Suu Kyi, Ken Saro-Wiwa) real-life narratives, and popular films (Life of Pi, Hugo, Precious, Pay It Forward, Forrest Gump, My Left Foot). By using strengths displayed by specific icons and film characters, the clinician can discuss with clients whether they partly or fully identify with these icons and characters and, if so, which conditions clients see that display these strengths maximally and what might be consequences of displaying these strengths. (For a comprehensive list of films, please see Niemiec & Wedding, 2014).
6. Assess strengths early in the therapeutic process. After establishing rapport and empathically listening to the concerns that brought the client to therapy, the clinician can mindfully explore strengths. I reckon that during the course of treatment as usual, most clinicians become aware of their clients' strengths. But it is also possible that this vital information never becomes available during a crisis, and most clients don't know how to use their strengths to cope with the challenging situation.
7. Assessment of strengths provides the clinician with a powerful mechanism with which to encourage clients to pursue absorption and deep engagement. Clients could be encouraged to pursue concrete activities that use their strengths, such as creativity, curiosity, appreciation of beauty, love of learning, and social intelligence, or they can tweak activities to experience more engagement. Engagement can be especially beneficial for clients who have concentration difficulties, boredom, and listlessness. In addition, strengths-based engaging activities are also likely to reduce brooding and rumination.
8. Clinicians who, for practical and clinical reasons, prefer not to use formal measures of strengths, can use a narrative strategy, which I have found to be very helpful in eliciting strengths. It is called positive introduction. In this assessment strategy, after listening to the account of troubles, the clinician encourages the client to introduce him- or herself through a real-life story (about 300 words, with a beginning, a middle, and a positive end) that shows the client at his or her best or during a peak moment of life. The clinician discusses the story with the client in detail in terms of what strengths are displayed and whether they are accurate descriptions of the client's current functioning. Clients having difficulty writing a story or identifying specific strengths may be encouraged to ask family members and friends to tell a story depicting their strengths. This strategy reveals the client's strengths to the clinician as well as to significant others.
Finally, clinicians can assess whether the client is currently able to translate the abstract strengths into concrete actions, behaviors, and habits. This assessment is important because real-life challenges rarely come in neat packages with labeled instructions such as, “When depressed, use zest and vitality.” Challenges and hassles often occur amid a dizzying jumble of emotions, actions, and their effects. The role of clinician is to assess and gently guide the client to use her or his strengths to solve a problem. Strengths elicited from the positive introduction or from the VIA-IS are used to refine and reframe problems solving. This narrative becomes dynamic and can assist clients to visualize their optimal selves. For instance, a clinician may say to a client, “Let's discuss the strengths that you displayed in your positive introduction. What role might they play in this challenging situation?” This exercise provides rich data on the client's past and current strengths and weaknesses.
Conclusion
When weaknesses and strengths are assessed through strength-based assessment in an authentic and integrative manner, clients are likely to find therapeutic process self-efficacious, affirming, and empowering. They are likely to view themselves as more than sum of symptoms, and clinicians can foster a healthier and egalitarian relationship, which is perhaps the bedrock of therapeutic change.
Summary Points
- Traditionally, assessment has been concerned with deficits and disorder, whereas SBA gives equal attention to positive attributes and processes to make clinical services more effective.
- Identifying, measuring, and further building strengths changes the scope of clinical services from remediation to nurturance of resilience and well-being.
- SBA invites clinicians to reconceptualize psychological disorders such as absence, excess, and opposites of strengths or on dimensions of a lack or excess of strengths.
- A number of approaches have been incorporated in clinical settings. These approaches often incorporate collateral data from close family and friends.
- SBA invites alternative hypothesis regarding the course and treatment of psychopathology.
- SBA does not dismiss or deny negatives. Neither is its goal is to create Pollyannaish caricatures of clients. The goal is to yield a realistic and balanced picture of clients.
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