Positive Psychotherapy (session by session plan) for a patient with PTSD

Positive Psychotherapy- therapeutic session

(T represents therapist and P refers to patient)

Positive psychotherapy was used to create the following intervention plan for a patient
suffering from Post-Traumatic Stress Disorder. Positive psychotherapy is focused on positive
psychology concepts that emphasise positive occurrences and effects in life like happiness,
joy, love, inspiration, and more, as well as positive attributes and emotions such as gratitude,
resilience, and compassion. The session focuses on a 19-year-old boy who was actively
tormented in school and suffered periods of trauma as a result of how he was treated while
being bullied.

First session (Orientation to positive psychotherapy)

T: Hello, Paras! Please have a seat. I’m Dr. Verma. I was informed about your referral and I
also had the chance to go through the file regarding your earlier therapy sessions. How are
you doing today?

P: Thank you, well, I’m doing ok or at least trying to be ok.

T: Great. It’s the efforts that count! So, it would be nice to understand what exactly made you
come here today?

P: I was in a boarding school, junior wing specifically, when I was bullied by a bunch of
seniors numerous times. They always called me to do their work or for that matter sneaking
something from the mess. They called me names that felt disgraceful. They embarrassed me
many times in front of my classmates and even thrashed me a couple of times. Today, I am at
a position where I am still experiencing these traumas in forms of nightmares, palpitations
and flashes. I was going to a clinical psychologist before this. I was diagnosed with Post-
Traumatic Stress Disorder. My therapist made me do certain relaxation exercises but it’s all
so stressful to handle.

T: Having such an experience, this early in childhood must be really overwhelming. I’m
really sorry for what you had to go through while I additionally also appreciate the fact that
you have opened up to me about it. So, according to you most of these nightmares and
palpitations centre on the experience you had in school, right?

P: yes, mostly!

T: Along with the relaxation techniques, I feel that certain aspects of positive psychotherapy
may work well for you in recovering from the trauma you have experienced. So let us work
through using positive psychotherapy which is a 14 session therapeutic-program. It not only
deals with the current issue but will also help you imbibe certain coping strategies and skills
that may help you deal with the trauma in a healthy way. You will also be able to reflect upon
your character strengths.

P: I hope that it works, would like to know about my character strengths though!
T: following certain simple techniques often help to ameliorate negative emotions while also
act as a good strategy to gain skills that help to enhance one’s own character strengths in the
long run. Earlier you were mentioning about having these nightmares and palpitations, I
wonder as to how you have been dealing when those happen?

P: well, I haven’t really been dealing well with them to put it across. When they happen all I
experience is terror and sadness. There are these negative thoughts that start to run in my
head along with flashes and I just don’t know what to do then. I think that I was really dumb
and that is why I deserved all that!

T: dealing with such an experience does take time to heal and negative thoughts, emotions
and feelings are likely to accompany all that. Well, I think that this would be a good start- to
have a positive outlook towards ourselves first.

P: it’s difficult but, ok. How are we going to do that?

T: It’s quite simple. Lets’ align our focus first by writing a positive introduction (a narrative
basically) about ourselves. In this, it would be great if you could focus upon writing about
your strengths or all the things you feel are positive about you and really make you, “you.”

P: well, it seems kind of difficult to talk positively about myself at this juncture but I’ll give
it a try.

T: That’s great. Let’s hear about it in the next session.

P: Thank You, Dr.

Second Session

T: Hello, Paras!

P: Hello, Doctor.

T: So how have you been doing?

P: I have been ok

T: Good, so were you able to take out some time for the homework?

P: Well, yes! I did try working on it, it’s here.

T: That’s great! Thank you (patient hands over the homework sheet). You’ve done a great
job with the work. Is there something you found difficult while working on it?

P: yes, actually, there was this constant conflict in my head where I wanted to describe
myself as being positive and resilient.

T: Okay, that’s not an issue if you don’t mind can you explain that further for me.

P: I really don’t know how to do that but what I meant was that I was not able to think
anything positive about myself as such.

T: Okay, let us set an agenda that will help to attain the therapeutic-goals that we are aiming
for.

P: well, what I wanted to attain from the therapy was to develop a more resilient and
optimistic version of myself. One that stays strong when other people try to dominate me and
yes of course, there’s the nightmares and flashes, I want to discard.

T: Your goals do make sense! Let’s take it one step at a time. Traits like resilience and
strengths are great character strengths, so let us try to work upon those at first. How does this
sound to you?

P: Yes, it’s fine.

T: Character strengths are imperative for our growth and well-being. Strengths like resilience
and optimism are important character strengths that help to elicit positive emotions like
happiness and to try and imbibe them and learn more about our character strengths we use the
Value-in-action Inventory. So let’s complete this online inventory that will help to identify
your character strengths. Feel free to ask me any doubts you face while working on it.

P: Okay.

T: Thank you for completing the survey. I will have look into the inventory results and later
describe about your crucial character strengths. Apart from this, I want you to practice this
little exercise which is called “three good things” or a blessing journal. It’s quite simple, you
just have to record three good things (can be big or small) every night in a journal or
notebook and you can bring your journal in the next session and we can discuss those here.
What is your take on this?
P: It seems like a routine thing but I’ll try to do the same.

T: Great, so, I’ll see you in the next session with the blessing journal.

P: Thank you, doctor!

Third session

P: Good morning, Doctor

T: Good morning Paras! Please have a seat. How are you doing today?

P: I’m doing fine. Thank you for sending me my results from the character strengths
inventory. I was glad to learn about a few of my character strengths.

T: would you like to share some of those here?

P: Yes, they are:

Honesty, kindness, sense of humour, curiosity and self-regulation.

T: well, that’s great. How do you feel about it?

P: I feel good, apart from what I have been feeling, there seems to be some good in me too.

T: Well, it goes without saying that there’s the strength of optimism that I may seem to have
notice in your response. Would you like to work on certain ways to utilize these strengths a
little more in your life?

P: yes, that would be great!

T: so, I think it would be great that the next time we meet, you could discuss at least one
creative way as to how you could use any of your character strengths in your daily life. You
don’t have to really stress upon it, once you go back home, you can sit with yourself in your
free time and simply contemplate about your strengths and how to utilise it in your life.

P: Ok, will try, thanks doctor.

Fourth session

P: Good afternoon, doctor.

T: Good afternoon, Paras. How did your week go?

P: it was good. I was able to work on my homework.

T: That’s wonderful to hear. Would you like to share as to how you were able to utilize the
character strengths?

P: yeah. So, I kind of tried to be kind to someone and also to myself. I had gone out on
Sunday with my friends when we stopped on the way to buy a few things from this store.
Over there, a young girl walked up to me saying she was really hungry, she seemed very poor
and I thought that I could offer her a meal. So I brought her something to eat and rather than
giving money I thought of giving her food. Apart from that, I was just glancing through my
sports trophies in that I won in school and I appreciated myself for the achievement.

T: well, that’s quite a kind gesture. It’s appreciative that you also thought about being kind to
yourself. Let’s talk about your memories today. Good memories always bring us happiness
and whenever we recall a bad memory it’s usually that we want to try avoiding reliving the
bad ones. It’s necessary to acknowledge all emotions, be it good or bad. Hence, let us do an
exercise for your homework where we unpack some of the memories and the emotions
associated with it.

P: I hope I can do that. What exactly do I need to do?

T: don’t worry; let’s just give it a try. So, you need to write about a bad memory that may
have made you feel angry and bitter. You can also mention how the memory impacts you and
makes you feel emotionally distressed.

P: Ok, doctor. I will try to work on the homework by the next session.

Fifth Session

T: Good morning, Paras

P: Good morning, doctor. I did try working on the last homework and it unwrapped certain
difficult emotions.

T: How did you feel about it?

P: Well, I thought about my worst memory, which was when I was being mocked at by my
seniors for not being able to defend the opposing teammate from making a basket in the
basketball tournament. It made me feel useless and angry upon myself and also upon my
seniors. I just stopped writing after two lines.

T: You must be hurt. Sometimes, not all bad things really happen to make us feel bad. “pain
does not last forever”, see how far you have come since that incident, be it gradual but you
have progressed and that’s what matters. You have become resilient and as far as the negative
emotions go, it is totally normal to feel hurt in such a scenario.

P: well, yeah there is progress but even the thought of those seniors brings so much pain and
anger in me that I want to avenge.

T: Let’s talk about forgiveness today. Sometimes it’s important to forgive those who have
done quite wrong with us, not because what they did was something that should be long
forgotten but simply for us so that we can move on in life. In relation to that, how about you
write a forgiveness letter where you try to forgive your senior for how they treated you.

P: I really don’t think that they deserve forgiveness, but I also understand your point about
moving on. So, I’m going to try and give it a try.

T: Great, so I’ll see you in the next week.

P: Ok, thank you, doctor.

Sixth Session

P: Good morning, doctor

T: Good morning, Paras. I think we left the last session where we were discussing
forgiveness and its importance.

P: Yes, doctor. You told me to write a forgiveness letter where I was to forgive my seniors
for how they behaved with me in school.

T: Oh yes, how did that come along for you?

P: well, I did write a letter, a short one though, but I’ll be honest here that I did feel a sense
of relief after forgiving the ones I wanted to.
T: very well, I’m really glad to hear about your progress. Let’s talk about the strength of
gratitude today. Do you have any idea about gratitude?

P: Sort of, is it something to do with being thankful to others?

T: That’s correct! It involves being thankful for anything or any person in your life. It can be
as trivial as being thankful that your mom woke you up on time and you didn’t get late for the
first class.

P: ok, but so do I have to say thank you to someone now?

T: well, that’s where I’ll be talking about your next homework. You have to write a gratitude
journal to someone you feel has really made a difference in your life, someone you feel really
grateful for. It can be anyone and the letter does not have to be necessarily long. It can be
short and crisp. You think you would be able to do that?

P: ok, it requires a little thinking.

T: Yes but once you start writing; I feel it wouldn’t be that difficult. Do you want to work
upon something else instead of this?

P: no, I think, I’ll try this one only.

T: great, well, see you then in the next session.

P: thank you, doctor.

Seventh Session

P: Good afternoon, Doctor

T: Good afternoon, Paras. How are you feeling today?

P: I am feeling good. I handed over the gratitude letter to my mother. She’s really been
supportive throughout my life and has motivated me no matter what.

T: That’s wonderful. I’m so glad that you have been working on your homework so well. I
was able to go through your blessings journal, forgiveness letter and also the gratitude
journal. It’s also evident as to how your character strengths are growing through these
exercises.
P: thank you, doctor, yes it has been quite helpful!

T: you’re welcome, so today’s session was all about your progress and maximising your
character strengths. I would really like to hear from you about how you have been feeling
about these sessions, have they been helpful to you in any way?

P: well, the sessions have been quite helpful to me. Earlier I used to be haunted by the
thoughts of my past, how I was treated, I was even scared of talking to people but now I have
started to feel positive about myself, I feel good when I write the blessings journal; like even
though the day didn’t go well, I do feel good when at least the weather did or for that matter
the trivial things that happened. It does make a difference. I ‘m still trying to move on though,
in terms of the flashes and the nightmares.

T: that is definitely some progress. Yes, you did tell me about the nightmares before and in
relation to that I would like you to try meditation. It’s quite simple; it involves taking deep
breaths while you align your consciousness with your body. It will help you to relax and stop
from catastrophizing an event. You could try this before sleeping and we can see how this
works out for you in the next session.

P: sure doctor, I will try it out.

Eighth Session

The patient’s progress was discussed in terms of how he dealt with his nightmares. He
practised meditation, while at first it seemed difficult for him, it did later workout. According
to him, the nightmares became less frequent and he also started to stay calm during the day.
The next thing that we worked upon is enhancing his other character strengths like resilience
and curiosity. For the same, he was asked to take up on difficult task and tell how he tackled
it and get back to one of his hobbies.

Ninth Session

P: Hello, Dr. Verma.

T: Hello, Paras. How are you?

P: I’m good, thank you, Dr.

T: well, today’s session really aligns with one of our previous goals, which is to become
more optimistic. Along with this, we will also focus on hope. There might have been certain
times when you must have felt that you were just about to grab a great opportunity but
something happened and you couldn’t and then things might have turned out differently for
you. I want you to tell three such things where the door was closed for you and where you
could not grab the opportunity but something more positive happened.

P: Well, the very first one would be when I did not get admission in the best day school in
the city and my parents put me in a boarding.

T: so how did that make you feel?

P: I felt quite useless and that a great opportunity slipped away from my hand.

T: It must have been difficult! Was going to a boarding school really a bad option then?

P: I wouldn’t call it a bad option. Despite the fact, that I was rigorously bullied in school, I
was involved in a number of extra-curricular activities, my communication skills were
unbeatable and I was growing at academics too!

T: you see, that’s the idea of this exercise, “one door closes, another opens.” Now, even if
you did not get admission into the day school, your parents put you in a boarding and see
how that turned out for you, you became an all-rounder. Am I making sense here?

P: Yes, Dr. Thank you for making me look at this from a more optimistic perspective.

T: Today’s homework will be based on the same exercise. It would be great if you could
think about two more such instances where you felt that things did not turn out the way you
might have wanted but it did open another door to a much better opportunity per se.

P: Alright, Dr.

Tenth Session

To inculcate more optimism into the patient’s life the patient was further explained about
another positive psychology technique called ‘active constructive responding.’ We all go
through different experiences in life and it’s important to have all kinds of experiences, be it
good or bad, what matters is how we interpret and respond to those experiences. The patient
was asked to try to respond to people in an active constructive manner. This involves
listening actively to others while maintaining a good eye contact and smile. It can often
provide a boost in wellbeing to both people involved in the conversation. In relation to this,
the patient was assigned it as his homework.

Eleventh session

P: Good afternoon, doctor

T: Good afternoon, Paras. So far we have really progressed well with all exercises of positive
psychotherapy that are inclined to enhance our well-being and inculcate more character
strengths. Well, how about today we discuss about the character strengths of the close ones in
our life.

P: Oh, I haven’t really reflected on it ever, how will that help though?

T: well, sometimes it’s necessary to notice the good around us. How we respond to the
environment is also influenced by how our environment responds to us and this further helps
to build positive relationships which actually enhance well-being. It’s a reciprocal approach.

P: True that.

T: so, let’s start by making a family tree of your family and further on we will talk about a
good or positive trait that you find in each of your family members. Does that work?

P: yeah, I’ll give it a try, would need a little help with the family tree though.

T: no worries, we can work on it together.

Ok, so now that we have made the family tree, today’s homework will be to additionally talk
about a positive trait of each of your family member.

P: ok, dr. thank you for the session.

Twelfth Session

The last session was followed-up and the patient was asked how his conversation went with
his family members and how did he feel after that. He gave a positive response to the
exercise. Today’s session focused on a savouring activity. ‘Savouring’ basically means use of
thoughts and actions to enhance the intensity, duration and appreciation of a positive
experience. The patient described how he had left playing basketball after the incident in
school. He was encouraged to try playing basketball as his homework and talk about how he
felt about it.

Thirteenth session

This session was focused on how the act of being altruistic. Being altruism involves selflessly
helping others without any ulterior motive. Many researchers have found that when we help
others, it actually improves our own psychological and emotional health. Being altruistic also
helps to relieve stress, hence the next activity centered on how the patient would be giving his
time to someone. A collaborative homework was discussed where the patient would be sitting
with his sister for a while and simply talk about how things are going for her in general. This
is because he barely spends time with her. The patient was also subtly informed about the
therapy coming to an end.

Fourteenth session

T: Good morning, Paras.

P: Good morning Doctor.

T: How have you been?

P: well, I have been pretty well actually and I wanted to tell you that spending time with my
sister was a really memorable experience. I wish I had approached her earlier.

T: well, that is amazing to hear! How are you doing in general, as in, how do you feel about
yourself now? How are you dealing with the nightmares and all?

P: well, to be honest, I have actually started working upon myself, I am going back to the
things I love to do and moreover I like to sit with my family at the end of the day. I do feel
good. In terms of the nightmares, I have to say that the meditation and savouring technique
have been really helpful in curbing those.

T: I am so glad to hear this, and I can see how these techniques and using your character
strengths have played a profound role in making you more optimistic, which was in fact one
of our major goals. Well, as you know we have now come to the end of this therapy session
and I can see how much you have progressed. I would like to keep this last session about this
technique called “full-life.”
P: yes, I am aware that this is the last session, would like to know more about “full-life”, it
seems like an interesting concept.

T: yes, it is quite interesting and wholesome. The concept of full-life implies the integration
of positive emotions, engagement, positive relationships, meaning and accomplishment.

P: that seems interesting and heavy at the same time!

T: Well, it’s not really heavy once you become habitual to it and in fact, we have kind of
achieved most of these things during therapy. So, for example in terms of positive emotions, I
am observing that you have started to feel more confident and optimistic about yourself; with
relation to positive relationships, ‘the signature strengths of others, ’session has really helped
you out to engage more positively with others and also to actively and constructively respond
with others. You are also engaging well in terms of your sports. Now for meaning and
accomplishment, I think you have been working at your favourite hobby which is playing
basketball, hence you have been meaningful in that ways towards your life and last but not
the least, your sense of accomplishment can simply be mapped by how far you have come in
terms of the trauma you experienced and that you really work on enhancing your potential
which is much appreciated. I hope that you will continue to practice ‘full-life.’

P: Wow, I never realized all of this. Thank you so much for always motivating me doctor,
you have been really helpful throughout. Yes, I will inculcate it in my routine, as much as
possible.

T: Well, it was great working with you, Paras. I wish you the best in all your endeavours.
With this, we shall close this therapy session. In case, you feel any difficulty, you may
contact the clinic and we will have a follow-up session to see how you are doing. Thank you
very much for being so cooperative during the therapy.

P: Thank you so much, Dr. Verma!

End of Therapy