Strengths-Based Cognitive-Behavioral Therapy

Strengths-based practice offers a “new paradigm” that focuses on resources and resilience, opportunities and solutions, rather than on problems or pathologies (Hammond, 2010, p. 3). Especially efficacious for young adults like Ifemelu, strengths-based practice is grounded in resiliency theory. Resiliency theory shows how building assets like self-esteem and self-confidence, plus leveraging external resources like social networks in the community, helps reduce risk and promote desired outcomes (Zimmerman, 2013). Ifemelu can benefit from a strengths-based approach for several reasons. For one, she would respond best to a therapeutic intervention that focuses less on the past due to the persistency of trauma and how it has fueled her depression and social detachment. Focusing on the trauma may encourage Ifemelu to engage in self-destructive habits like self-blame. Using a strengths-based approach, Ifemelu can focus more on how she can move forward and envision her future, perhaps becoming an advocate for women in Nigeria.
There are several different types of strengths-based treatment interventions, one of which is strengths-based cognitive-behavioral therapy. Padesky & Mooney (2012) offer the strengths-based cognitive behavioral therapy model to “help clients build positive qualities” and “build and strengthen personal resilience,” (p. 283). The emphasis with strengths-based cognitive behavioral therapy is on resiliency and other internal factors, rather than focusing on resolving specific external problems (Padesky & Mooney, 2012). Given Ifemelu’s uncertain future, it would be feasible for her to focus on cultivating core strengths and psychological resilience, including self-efficacy and self-confidence. When she travels to Nigeria, she can then leverage her internal strengths in any situation that might arise, leading her to forge strategic alliances with members of the community and support groups to help engender a sense of trust she may have lost since experiencing trauma.
Research has shown that strengths-based therapeutic interventions as a whole are effective at alleviating the symptoms and depression and promoting peace of mind and happiness (Gander, Proyer, Ruch, et al., 2012). When therapists are uncertain about the efficacy of a specific strengths-based model, they can use instruments like the Strengths-Based Practices Inventory (SBPI), which tests for cultural competency and other issues that might impede the ability for an intervention to help the client (Green, McAllister, & Tarte, 2004). The use of the Patient Health Questionnaire (PHQ)-9 also makes sense for Ifemelu because this instrument has been evaluated for its construct validity and reliability (Kroenke, Spitzer, Williams, et al., 2010). However, the relevance of the PHQ-9 on diverse populations necessitates the use of alternative means of assessment during Ifemelu’s treatment. Strengths-based approaches in general, though, have been successful when used with a “wide range of populations,” (Pattoni, 2012, p. 1). Therefore, the combination of strengths-based cognitive-behavioral therapy with carefully chosen assessments will be appropriate for Ifemelu.
Strengths-based approaches generally involve three stages including the identification of talents, skills, or assets, followed by a change in self-concept, finally followed by behavioral change (Hodges, n.d.). The identification of skills is something that encourages Ifemelu to build on her strength of self-awareness, which she exemplifies on her blog and in her interactions with therapists thus far. Verbalizing or writing down her strengths will help her to re-introduce those concepts into her overall sense of self-, thereby replacing any negative self-talk she might have acquired over the years since the trauma. Behavioral change is in Ifemelu’s case not the main focus, but certainly the client wishes to be more socially engaged with renewed enthusiasm for her life and the future.
Combining the strengths-based approach with cognitive-behavioral therapy, which also aims ultimately for changes in behavior, therefore makes sense. In Ifemelu’s case, the behaviors themselves are not necessarily problematic: she is not a substance abuser and remains inspired by academia and her professional path. However, her depression and anxiety have been described by the client as overwhelming and threatening to come in the way of her life. For example, she sees that she lacks the motivation even to do chores. She has been externalizing by crying, but is mainly isolated, her sole social contacts through her church. Estranged from her family, Ifemelu still longs for social contact. Strengths-based cognitive behavioral therapy will help Ifemelu assess her strengths and plan how to apply them in her life to build resilience. The therapist can work with Ifemelu to help her recognize how to leverage her strengths, while the recommended group CBT therapy will also offer Ifemelu the social interactions she craves.
Using a strengths-based approach will also help Ifemelu rebuild trust in the community. The strengths-based approach focuses on “trusting relationships,” which allow the client to consider how she can build on her assets to construct a new identity liberated from the debilitating anxiety and depression in her life (Hammond, n.d.). Furthermore, the strengths-based approach will help Ifemelu recognize she is not alone; her strength is rooted in community and social support. By empowering her with options, opening up opportunities for her to participate in social organizations beyond the confines of her school and church, Ifemelu may discover opportunities for leadership that inspire her. By helping others, she may also discover a sense of personal empowerment that helps her to heal as well as maintain resilience.
Modifications
Strengths-based cognitive-behavioral interventions are inherently flexible, allowing the therapist to tailor treatment according to individual needs and assets. In Ifemelu’s case, the intervention should be modified to focus on social networking and relationships. Ifemelu needs to draw support through supportive friendships and alliances. In addition to group therapy, Ifemelu would benefit tremendously from expanding opportunities for social interactions in other ways such as through her blog and social media, through her work and school, through any hobbies she might have such as sports or music, through Nigerian expatriate organizations, and also from working with women’s groups. Indeed, “family empowerment” and “social support” are integral to the efficacy of strengths-based approaches (Green, McAllister, & Tarte, 2004, p. 326). The therapist can help Ifemelu to brainstorm opportunities for social engagement, which would increase her resilience and naturally alleviate some of the primary symptoms of her depression like isolation and being withdrawn.
Another modification to the strengths-based cognitive behavioral interventions would be to focus less on behavioral outcomes and more on resilience. The “constructive therapy methods” and client-therapist interactions should also be grounded in classic humanistic principles like unconditional positive regard (Padesky & Mooney, 2012, p. 283). A client-centered approach is generally expected from strengths-based methods. Also, Gander, Proyer, Ruch, et al. (2012) suggest alternating therapeutic themes such as including a “gratitude visit” and a “three good things” session, which encourage Ifemelu to focus on what she is grateful for or what she has in her life, instead of what she lacks (p. 283). If her thought processes have been fixated on the past: on her perceived failures or her emotional struggles with her parents, then a strengths-based approach will help shift her attention on what she can do now to construct a more favorable future.
Conclusion
As Ifemelu’s therapist, I would most certainly persist in using the strengths-based approach, and strengths-based cognitive-behavioral therapy specifically. Empirical evidence supports the use of these interventions, plus their corresponding methods of assessing Ifemelu’s progress in therapy, such as the PHQ-9. Given her cultural background and gender, Ifemelu will also benefit from the inherent flexibility of the strengths-based approach, which encourages the client to play an active role in setting and pursuing therapeutic goals. Building resilience will also help to empower Ifemelu, who can construct a new sense of self through a recognition of her core strengths.



References
Gander, F., Proyer, R.T., Ruch, W., et al. (2012). Strength-based positive interventions. Journal of Happiness Studies 14(4): 1241-1259.
Green, B., McAlister, C. & Tarte, J. (2004). The strengths-based practice inventory. The Journal of Contemporary Social Services 85(3): 326-334.
Hammond, W. (2010). Principles of strengths-based practice. http://www.ayscbc.org/Principles%20of%20Strength-2.pdf
Hodges, T.D. (n.d.). Strengths-based development in practice. https://www.weber.edu/WSUImages/leadership/docs/sq/development-in-practice.pdf
Kroenke, K., Spitzer, R.L., Williams, J.B.W., et al. (2010). Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. General Hospital Psychiatry 32(4): 345-359
Padesky, C.A. & Mooney, K.A. (2012). Strengths-based cognitive-behavioral therapy. A four-step model to build resilience. Clinical Psychology and Psychotherapy 19(4): 283-290.
Pattoni, L. (2012). Strengths-based approaches for working with individuals. https://www.iriss.org.uk/resources/insights/strengths-based-approaches-working-individuals
Zimmerman, M.A. (2013). Resiliency theory. Health Education & Behavior 40(4): 381-383.