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Balanced Conceptualizations of Mental Health and Behavior
During the 1950s, psychology addressed the full spectrum of human behavior through
its scholarship and practice. In 1955, Erich Fromm explored the "sane society;' defining
mental health as "the ability to love and to create" (Fromm, p. 69). During the same
period, social psychologist Marie Jahoda (1958) characterized mental health as the
positive condition that is driven by a person's psychological resources and desires for
personal growth. She described these six characteristics of the mentally healthy person:
1) A personal attitude toward self that includes self-acceptance, self-esteem, and
accuracy of self-perception
2) The pursuit of one's potentials
3) Focused drives that are integrated into one's personality
4) An identity and values that contribute to a sense of autonomy
5) World perceptions that are accurate and not distorted because of subjective
needs
6) Mastery of the environment an~ enjoyment of love, work, and play
Why have the efforts to conceptualize positive mental health and ptimal human
functioning lagged behind the work on mental illness? One explanation is that the
attainment of positive mental health is a passive process, whereas the remediation of
mental illness is an active process that demands more resources. Another explanation
is that the maintenance of mental health does not warrant the same careful attention
(from theorists and practitioners) as does the alleviation of suffering.
Moving Toward Balanced Conceptualizations
We emphasize the need to address the following issues that contribute to less-than-
optimal mental health care:
Abnormal behavior seems to more easily gain the attention of the clinician, and
aspects of normal behavior and healthy functioning
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(i.e., what is working in person's life) may not be considered meaningful in the
diagnostic and treatment process.
Attributions for behavior may overemphasize the internal characteristics of a
person, whereas the environmental influences on behavior are not adequately
addressed.
Weaknesses and negative emotions often are deemed more salient to the
diagnostic and treatment process than are strengths and positive emotions.
Current behavior may not be considered in light of developmental history and
milestones. Specifically, we may not address thoroughly the question, "Is this
person's behavior consistent with expectations for his or her developmental
history and age?"
Behaviors often are interpreted without attention to information about the cultural
contexts that could influence whether the behaviors are considered adaptive or
maladaptive.
By resolving these challenges, we can produce more balanced views of People and
how they change.
Our Fascination with Abnormal Behavior
Three criteria commonly serve as markers of abnormal behavior in a social context.
First, the behavior is atypical or aberrant, which means that it deviates from what is
considered standard or expected. Second, the behavior is considered maladaptive that
is, the behavior does not typically lead to socially sanctioned goals. Third, the behavior
often is accompanied by psychological distress worry, rumination, and uncomfortable
thoughts and feelings.
Our preoccupation with abnormal behaviors may serve positive functions such as
promoting understanding of the world and helping to keep people safe. But this
preoccupation seldom leads to a dear answer to the question, Is that normal?" More
times than not our response to the question is, "It depends." Indeed, as just discussed,
it depends on the context of the behavior.
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Neglect of the Environment and of the Positive
When trying to explain the behavior of others in social situations, we are prone to ignore
external situational or environmental factors, and instead
We attribute the behavior to the other person's internal characteristics (e.g., personality
or abilities). This occurs even when the diagnosing clinician knows little about the
person and how that person views the environment.
This flawed tendency is referred to as the fundamental attribution error (Nisbett, Caputo,
Legant, & Maracek, 1973). On the other hand, when we explain our own behavior, we
are more comprehensive in our conceptualization in that we probably take the
environmental variables into account.
For example, have you ever received a bad grade on an examination in school?
Whereas an outside observer might conclude that you did poorly because you are
stupid, you would hasten to make more situation-based explanations, such as the
teacher's poor explanation of the material or the instructor's tricky, misleading wording
of the test questions.
The fundamental negative bias involves the saliency (stands out vs. does not stand
out), the value (negative vs. positive), and the context (vague vs. well-defined) of any
given behavior (Wright, 1988). Specifically, when a behavior stands out, is considered
negative, and occurs in a vague context, the primary factor guiding the perception of the
behavior is its negative quality.
By addressing these biases in our views of behavior, we can create an understanding of
the influence of environmental stressors on our functioning. With our increased attention
to the environment, we also become more aware of environmental resources that may
interact with strengths and result in positive functioning.
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ASKING QUESTIONS: THE FOUR-FRONT APPROACH
In Beatrice Wright's four-front approach (1991; Wright & Lopez, 2002) to developing a
comprehensive conceptualization about a person's weaknesses and strengths, as well
as in regard to the influence of environmental stressors and resources, she encourages
observers to gather information about the following four fronts of behavior:
1) Deficiencies and undermining characteristics of the person
2) Strengths and assets of the person
3) Lacks and destructive factors in the environment
4) Resources and opportunities in the environment
THE CASE OF MICHAEL
Throughout the remainder of this chapter, one of the authors (S}L) tells you about
Michael, a 41-year-old, Caucasian male client who was seen in counseling for 4 years.
Michael, who was referred by a physician who was treating him for AIDS, reported that
he had moderate depression. This depression not only produced sadness, it also
caused problems in maintaining relationships and cooperating with his care providers.
He started our lengthy relationship with the statement, "I desperately need help with my
life." I responded, "What kind of help do you need?" About 100 sessions later, Michael's
life story remained intriguing, and I learned some-thing new about him at every meeting.
I give a glimpse into Michael's life here and in three other places in this chapter. Michael
told me that he needed help with "everything." I encouraged him to be more specific,
and he reached into his jeans pocket and pulled out two pages of handwritten notes
about his struggles. He was very descriptive about each and every concern and their
effects. It was clear why Michael felt that the world was against him. His car had been
totaled, he was having major side effects from medications, the heat was not working in
his apartment, and so forth. Although his depression was quite complicated (due to his
family history, illness, and side effects of treatment),
It was clear that aspects of his situation, and to some extent the quality of his
environment, were exacerbating his symptoms.
Showing Page:
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Near the middle of our first session, I said, "These problems would be overwhelming for
anyone. How do you cope?" He looked at me as if he were uncertain about how to
respond. Then, I asked him how he handled a particular problem on his list. He was just
as descriptive in his story-telling about coping as he was in his accounting of his
struggles. At the very end of the session, I said, "Next time, we will talk about your
strengths." Part of me knew that he would bring a list of strengths to the next session,
and he did. With pages of notes about Michael's strengths and struggles and his
environmental stressors and resources, I was able to develop a basic understanding of
his depression, his battle with AIDS, and the vitality that kept him moving toward a more
positive future.
NORMALIZING NEGATIVE AND POSITIVE BEHAVIOR
In Chickering's (1969; Chickering & Reisser, 1993) theory of the development of college
students, the focus is on a circumscribed time period (years in college for traditional and
nontraditional learners) and a specific environment (the college academic and social
setting). Beyond survival, Chickering proposed that the primary human goal involves the
establishment of an identity, the refinement of a unique way of being (called
individuation). Within the Chickering model, students move toward these goals via
seven pathways, or vectors; moreover, Chickering makes the point that movement
along multiple pathways at one time is quite likely. Developing competence (moving
from low-level competence in intellectual, physical, and inter-personal domains to high
competence in each area) is identified as a primary developmental driver for young
people. (Acquiring competency and developing human strengths are interchangeable
and serve as foundations for future growth.) With increased confidence in their
resourcefulness, students can pursue Chickering's six other developmental goals.
These goals include
1) Managing emotions, or growing from little awareness of feelings and limited
control over disruptive emotions to increased under-standing of feelings and
flexible control and constructive expression
Showing Page:
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2) Moving through autonomy toward interdependence, or moving from poor self-
direction and emotional dependence to instrumen-tal independence and limited
need for reassurance
3) Developing mature interpersonal relationships, or growing from intolerance of
differences and few relationships to an appreciation of differences and healthy
relationships
4) Establishing identity, or changing from personal confusion and low self-
confidence to a self-concept clarified through lifestyle and self-acceptance
5) Developing purpose, or transitioning from unclear vocational goals and
distracting self-interests to clear goals and more communal activities
6) Developing integrity, or changing from unclear beliefs and values to clear and
humanizing values
Difficulties Understanding Behavior in a Cultural Context
Mental Health: Culture, Race, Ethnicity (U.S. Department of Health and Human
Services, 2001), emphasizes the importance of acknowledging that there are culture-
bound syndromes, that culture influences coping strategies and social supports, and
that individuals may have multiple cultural identities. Indeed, "culture counts:' as it plays
a crucial role in determining an individual's thoughts and actions. Clinicians engaging in
diagnosis must pay keen attention to the cultural context in forming impressions of any
person. This view, which we strongly endorse, runs counter to the universality
assumption, which holds that what is deemed true for one group may be considered
true for other people, irrespective of cultural differences.
DETERMINING HOW "CULTURE COUNTS"
Awareness of cultural nuances lends insight into how people of varied backgrounds
generate psychological well-being. In addition, examining how adverse experiences
could promote adaptive psychological function-ing in all people might provide vital clues
about how optimal human functioning develops. Cultural values provide the context in
which behaviors, thoughts, and feelings are deemed normal or abnormal (Banerjee &
Banerjee, 1995; Constantine, Myers, Kindaichi, & Moore, 2004); these values and their
Showing Page:
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influence on meaning making of experiences contribute to optimal human functioning
(Sue & Constantine, 2003).
CONSIDERING NEW PERSONALITY DIMENSIONS
Given the general limitations of a categorical system and the neglect of positive
behaviors in the current categorical systems, alternative conceptualizations might
advance our understanding of psychological phenomena.
In this regard, the dimensional approach puts human behavior on a continuum, thereby
allowing the examination of individual differences in negative and positive behavior. It is
important to clarify here that viewing psychological behavior does not involve
juxtaposing "good" and "evil" on the same continuum. Such a use of dimensional
systems may only lead backto the categorizing of behaviors. One view is that it is more
informative to consider the degree to which behaviors are adaptive or maladaptive.
Another use of the dimension system involves examining negative and positive
behaviors on separate dimensions. Indeed, such an approach is supported by related
research. Scores on measures of positive behaviors (e.g., life satisfaction) and scores
on measures of negative behaviors
Showing Page:
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UNDERSTANDING AND CHANGING HUMAN BEHAVIOR
Showing Page:
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The Oldham and Morris (1995) conceptualization leaves room for individuals to be
diagnosed according to the degree of dysfunction as well as the degree of positive use
of resources. In addition, it may provide more client-friendly terminology for discussion
of personality disorder diagnoses during sessions, as well as allowing clinicians to help
clients identify strengths and weaknesses in their set of behaviors.
Going Beyond the DSM-IV Framework
Traditionally, conceptualizations of behavior have focused on symptomatology and
dysfunction-those things that are not "working" in a person's life. This focus on negative
aspects has occurred at the expense of identifying strengths, and it has not helped
people in their pursuit of optimal human functioning. This limited view of psychology
undermines the ultimate goal of any psycho diagnostic system: to understand the
person's needs and resources and to facilitate the implementation of helpful therapeutic
interventions
By asking about strengths, the diagnostician is fostering several positive reactions in the
client. First, the client can see that the helper is trying to understand the whole person.
Second, the client is shown that she or he is not being equated with the problem. Third,
the client is not rein-forced for "having a problem" but rather is encouraged to look at
her or his assets. Fourth, the client can recall and reclaim some of the personal worth
that may have been depleted prior to coming to the mental health profession. Fifth, a
consideration of the client's strengths can facilitate an alliance of trust and mutuality with
the mental health professional; in turn, the client is open and giving of information that
may yield a maximally productive diagnosis. By asking about strengths, therefore, a
positive assessment is at once healing and buoyant in its focus.
Determining "what is not working" and "what is working" for a person honors the client's
life experiences and guides clinicians to treatment approaches that make sense . With
the ongoing development of positive psychology research and practice, clinicians will be
able to link balanced conceptualizations to applications that will help clients achieve
optimal mental health.
Showing Page:
10/10
ATTENDING TO ALL BEHAVIOR
We find out not only that abnormal behavior is fascinating but that all behavior is
intriguing. Contextualizing what you see by considering the influences of develop-
mental processes, environmental conditions, and cultural nuances helps create a more
balanced, accurate picture of a person and his or her struggles and triumphs. So, next
time someone asks you, "Is that normal?" answer, "It depends." Ask a few more
questions, and remember to put yourself in the shoes of the person being judged. This
is what we try to do in working with people.

Unformatted Attachment Preview

Balanced Conceptualizations of Mental Health and Behavior During the 1950s, psychology addressed the full spectrum of human behavior through its scholarship and practice. In 1955, Erich Fromm explored the "sane society;' defining mental health as "the ability to love and to create" (Fromm, p. 69). During the same period, social psychologist Marie Jahoda (1958) characterized mental health as the positive condition that is driven by a person's psychological resources and desires for personal growth. She described these six characteristics of the mentally healthy person: 1) A personal attitude toward self that includes self-acceptance, self-esteem, and accuracy of self-perception 2) The pursuit of one's potentials 3) Focused drives that are integrated into one's personality 4) An identity and values that contribute to a sense of autonomy 5) World perceptions that are accurate and not distorted because of subjective needs 6) Mastery of the environment an~ enjoyment of love, work, and play Why have the efforts to conceptualize positive mental health and ptimal human functioning lagged behind the work on mental illness? One explanation is that the attainment of positive mental health is a passive process, whereas the remediation of mental illness is an active process that demands more resources. Another explanation is that the maintenance of mental health does not warrant the same careful attention (from theorists and practitioners) as does the alleviation of suffering. Moving Toward Balanced Conceptualizations We emphasize the need to address the following issues that contribute to less-thanoptimal mental health care: • Abnormal behavior seems to more easily gain the attention of the clinician, and aspects of normal behavior and healthy functioning • (i.e., what is working in person's life) may not be considered meaningful in the diagnostic and treatment process. • Attributions for behavior may overemphasize the internal characteristics of a person, whereas the environmental influences on behavior are not adequately addressed. • Weaknesses and negative emotions often are deemed more salient to the diagnostic and treatment process than are strengths and positive emotions. • Current behavior may not be considered in light of developmental history and milestones. Specifically, we may not address thoroughly the question, "Is this person's behavior consistent with expectations for his or her developmental history and age?" • Behaviors often are interpreted without attention to information about the cultural contexts that could influence whether the behaviors are considered adaptive or maladaptive. By resolving these challenges, we can produce more balanced views of People and how they change. Our Fascination with Abnormal Behavior Three criteria commonly serve as markers of abnormal behavior in a social context. First, the behavior is atypical or aberrant, which means that it deviates from what is considered standard or expected. Second, the behavior is considered maladaptive that is, the behavior does not typically lead to socially sanctioned goals. Third, the behavior often is accompanied by psychological distress worry, rumination, and uncomfortable thoughts and feelings. Our preoccupation with abnormal behaviors may serve positive functions such as promoting understanding of the world and helping to keep people safe. But this preoccupation seldom leads to a dear answer to the question, Is that normal?" More times than not our response to the question is, "It depends." Indeed, as just discussed, it depends on the context of the behavior. Neglect of the Environment and of the Positive When trying to explain the behavior of others in social situations, we are prone to ignore external situational or environmental factors, and instead We attribute the behavior to the other person's internal characteristics (e.g., personality or abilities). This occurs even when the diagnosing clinician knows little about the person and how that person views the environment. This flawed tendency is referred to as the fundamental attribution error (Nisbett, Caputo, Legant, & Maracek, 1973). On the other hand, when we explain our own behavior, we are more comprehensive in our conceptualization in that we probably take the environmental variables into account. For example, have you ever received a bad grade on an examination in school? Whereas an outside observer might conclude that you did poorly because you are stupid, you would hasten to make more situation-based explanations, such as the teacher's poor explanation of the material or the instructor's tricky, misleading wording of the test questions. The fundamental negative bias involves the saliency (stands out vs. does not stand out), the value (negative vs. positive), and the context (vague vs. well-defined) of any given behavior (Wright, 1988). Specifically, when a behavior stands out, is considered negative, and occurs in a vague context, the primary factor guiding the perception of the behavior is its negative quality. By addressing these biases in our views of behavior, we can create an understanding of the influence of environmental stressors on our functioning. With our increased attention to the environment, we also become more aware of environmental resources that may interact with strengths and result in positive functioning. ASKING QUESTIONS: THE FOUR-FRONT APPROACH In Beatrice Wright's four-front approach (1991; Wright & Lopez, 2002) to developing a comprehensive conceptualization about a person's weaknesses and strengths, as well as in regard to the influence of environmental stressors and resources, she encourages observers to gather information about the following four fronts of behavior: 1) Deficiencies and undermining characteristics of the person 2) Strengths and assets of the person 3) Lacks and destructive factors in the environment 4) Resources and opportunities in the environment THE CASE OF MICHAEL Throughout the remainder of this chapter, one of the authors (S}L) tells you about Michael, a 41-year-old, Caucasian male client who was seen in counseling for 4 years. Michael, who was referred by a physician who was treating him for AIDS, reported that he had moderate depression. This depression not only produced sadness, it also caused problems in maintaining relationships and cooperating with his care providers. He started our lengthy relationship with the statement, "I desperately need help with my life." I responded, "What kind of help do you need?" About 100 sessions later, Michael's life story remained intriguing, and I learned some-thing new about him at every meeting. I give a glimpse into Michael's life here and in three other places in this chapter. Michael told me that he needed help with "everything." I encouraged him to be more specific, and he reached into his jeans pocket and pulled out two pages of handwritten notes about his struggles. He was very descriptive about each and every concern and their effects. It was clear why Michael felt that the world was against him. His car had been totaled, he was having major side effects from medications, the heat was not working in his apartment, and so forth. Although his depression was quite complicated (due to his family history, illness, and side effects of treatment), It was clear that aspects of his situation, and to some extent the quality of his environment, were exacerbating his symptoms. Near the middle of our first session, I said, "These problems would be overwhelming for anyone. How do you cope?" He looked at me as if he were uncertain about how to respond. Then, I asked him how he handled a particular problem on his list. He was just as descriptive in his story-telling about coping as he was in his accounting of his struggles. At the very end of the session, I said, "Next time, we will talk about your strengths." Part of me knew that he would bring a list of strengths to the next session, and he did. With pages of notes about Michael's strengths and struggles and his environmental stressors and resources, I was able to develop a basic understanding of his depression, his battle with AIDS, and the vitality that kept him moving toward a more positive future. NORMALIZING NEGATIVE AND POSITIVE BEHAVIOR In Chickering's (1969; Chickering & Reisser, 1993) theory of the development of college students, the focus is on a circumscribed time period (years in college for traditional and nontraditional learners) and a specific environment (the college academic and social setting). Beyond survival, Chickering proposed that the primary human goal involves the establishment of an identity, the refinement of a unique way of being (called individuation). Within the Chickering model, students move toward these goals via seven pathways, or vectors; moreover, Chickering makes the point that movement along multiple pathways at one time is quite likely. Developing competence (moving from low-level competence in intellectual, physical, and inter-personal domains to high competence in each area) is identified as a primary developmental driver for young people. (Acquiring competency and developing human strengths are interchangeable and serve as foundations for future growth.) With increased confidence in their resourcefulness, students can pursue Chickering's six other developmental goals. These goals include 1) Managing emotions, or growing from little awareness of feelings and limited control over disruptive emotions to increased under-standing of feelings and flexible control and constructive expression 2) Moving through autonomy toward interdependence, or moving from poor selfdirection and emotional dependence to instrumen-tal independence and limited need for reassurance 3) Developing mature interpersonal relationships, or growing from intolerance of differences and few relationships to an appreciation of differences and healthy relationships 4) Establishing identity, or changing from personal confusion and low selfconfidence to a self-concept clarified through lifestyle and self-acceptance 5) Developing purpose, or transitioning from unclear vocational goals and distracting self-interests to clear goals and more communal activities 6) Developing integrity, or changing from unclear beliefs and values to clear and humanizing values Difficulties Understanding Behavior in a Cultural Context Mental Health: Culture, Race, Ethnicity (U.S. Department of Health and Human Services, 2001), emphasizes the importance of acknowledging that there are culturebound syndromes, that culture influences coping strategies and social supports, and that individuals may have multiple cultural identities. Indeed, "culture counts:' as it plays a crucial role in determining an individual's thoughts and actions. Clinicians engaging in diagnosis must pay keen attention to the cultural context in forming impressions of any person. This view, which we strongly endorse, runs counter to the universality assumption, which holds that what is deemed true for one group may be considered true for other people, irrespective of cultural differences. DETERMINING HOW "CULTURE COUNTS" Awareness of cultural nuances lends insight into how people of varied backgrounds generate psychological well-being. In addition, examining how adverse experiences could promote adaptive psychological function-ing in all people might provide vital clues about how optimal human functioning develops. Cultural values provide the context in which behaviors, thoughts, and feelings are deemed normal or abnormal (Banerjee & Banerjee, 1995; Constantine, Myers, Kindaichi, & Moore, 2004); these values and their influence on meaning making of experiences contribute to optimal human functioning (Sue & Constantine, 2003). CONSIDERING NEW PERSONALITY DIMENSIONS Given the general limitations of a categorical system and the neglect of positive behaviors in the current categorical systems, alternative conceptualizations might advance our understanding of psychological phenomena. In this regard, the dimensional approach puts human behavior on a continuum, thereby allowing the examination of individual differences in negative and positive behavior. It is important to clarify here that viewing psychological behavior does not involve juxtaposing "good" and "evil" on the same continuum. Such a use of dimensional systems may only lead backto the categorizing of behaviors. One view is that it is more informative to consider the degree to which behaviors are adaptive or maladaptive. Another use of the dimension system involves examining negative and positive behaviors on separate dimensions. Indeed, such an approach is supported by related research. Scores on measures of positive behaviors (e.g., life satisfaction) and scores on measures of negative behaviors UNDERSTANDING AND CHANGING HUMAN BEHAVIOR The Oldham and Morris (1995) conceptualization leaves room for individuals to be diagnosed according to the degree of dysfunction as well as the degree of positive use of resources. In addition, it may provide more client-friendly terminology for discussion of personality disorder diagnoses during sessions, as well as allowing clinicians to help clients identify strengths and weaknesses in their set of behaviors. Going Beyond the DSM-IV Framework Traditionally, conceptualizations of behavior have focused on symptomatology and dysfunction-those things that are not "working" in a person's life. This focus on negative aspects has occurred at the expense of identifying strengths, and it has not helped people in their pursuit of optimal human functioning. This limited view of psychology undermines the ultimate goal of any psycho diagnostic system: to understand the person's needs and resources and to facilitate the implementation of helpful therapeutic interventions By asking about strengths, the diagnostician is fostering several positive reactions in the client. First, the client can see that the helper is trying to understand the whole person. Second, the client is shown that she or he is not being equated with the problem. Third, the client is not rein-forced for "having a problem" but rather is encouraged to look at her or his assets. Fourth, the client can recall and reclaim some of the personal worth that may have been depleted prior to coming to the mental health profession. Fifth, a consideration of the client's strengths can facilitate an alliance of trust and mutuality with the mental health professional; in turn, the client is open and giving of information that may yield a maximally productive diagnosis. By asking about strengths, therefore, a positive assessment is at once healing and buoyant in its focus. Determining "what is not working" and "what is working" for a person honors the client's life experiences and guides clinicians to treatment approaches that make sense . With the ongoing development of positive psychology research and practice, clinicians will be able to link balanced conceptualizations to applications that will help clients achieve optimal mental health. ATTENDING TO ALL BEHAVIOR We find out not only that abnormal behavior is fascinating but that all behavior is intriguing. Contextualizing what you see by considering the influences of developmental processes, environmental conditions, and cultural nuances helps create a more balanced, accurate picture of a person and his or her struggles and triumphs. So, next time someone asks you, "Is that normal?" answer, "It depends." Ask a few more questions, and remember to put yourself in the shoes of the person being judged. This is what we try to do in working with people. Name: Description: ...
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