Seventh Session

The session focuses on introducing the concept of psychological well-being as a new target of treatment. The therapist, however, refrains from providing a description of Ryff's model and leaves the meaning to the patient. The therapist praises the patient for the successful completion of the first segment of therapy and encourages him/her to increase gains by working on psychological well-being. The session marks the first homework concerned with monitoring psychological well-being.

GOALS

Review of Homework. As before, the therapist asks whether the patient encountered any difficulty in completing the homework. If so, troubleshooting is done to identify obstacles to completion. The patient should be praised for efforts in employing CT techniques on his/her own. The thera pist should emphasize the long-term importance of being able to employ such techniques to eliminate residual symptoms and reduce the risk for relapse. Therapist and patient note what types of situations/activities are associated with high mastery and pleasure ratings.

Introduction of a Well-Being Approach. The therapist uses an introduction such as the following:

"During the last six sessions you have learned and practiced cognitive techniques to help you feel better during times of distress. In our work so far we have focused on your major problem areas. In addition to this we will now spend four sessions examining feelings of well-being and how to increase such feelings. Increasing your psychological well-being is important for making you less vulnerable to future life situations and stressors."

This introduction can be modified, as necessary, but the essential message should remain: The patient is now engaged in important work that is complementary to the first phase of treatment.

Ryff's (1989) Psychological Well-Being Scales, a self-rating scale for measuring autonomy, environmental mastery, personal growth, purpose in life, self-acceptance and positive relations with others, may also be given to patients to fill out at home. Completion of this scale takes approximately 10-20 minutes and provides additional information as to attitudes of well-being.

HOMEWORK ASSIGNMENT

The patient is asked to use the assessment diary to record circumstances surrounding episodes of well-being. As with recording episodes of distress, the patient is asked to rate the intensity of feelings of well-being on a 0- to 100-point scale (0 indicates the complete absence of well-being, whereas 100 indicates the most intense well-being that the patient could possibly experience). It is important to emphasize to the patient that moments of well-being will likely vary in length. However, the patient is instructed to record even the most brief moments of well-being. At this juncture it is important to anticipate with the patient any difficulties he/she might experience in completing the above assignment.

Meehl (1975, p. 305) described "how people with low hedonic capacity should pay greater attention to the 'hedonic book keeping' of their activities than would be necessary for people located midway or high on the hedonic capacity continuum. That is, it matters more to someone cursed with an inborn hedonic defect whether he is efficient and sagacious in selecting friends, jobs, cities, tasks, hobbies, and activities in general."

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