Positive Psychotherapy

N ossrat Peseschkian

Theory and Practice of a N ew Method

With 33 Figures

Springer-Verlag Berlin Heidelberg NewYork London Paris Tokyo Dr. med. Nossrat Peseschkian Facharzt für Neurologie Psychiatrie und Psychotherapie An den Quellen 1, FRG 6200 Wiesbaden

Translated by Dr. Robert Walker

Library of Congress Cataloging-in-Publication Data Peseschkian, Nossrat, Positive psychotherapy. Translation of: Positive Psychotherapie. Bibliography: p. IncIudes indexes. 1. Psychotherapy. 2. Interpersonal relations. 3. Self-care, Health. I. Tide. RC480.5.P45213 1987 616.89'14 86-31596

ISBN-13: 978-3-540-15794-6 e-ISBN-13: 978-3-642-70715-5 001: 10.1007/978-3-642-70715-5

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the German Copyright Law of September 9, 1965, in its version of June 24,1985, and a copyright fee must always be paid. Viola• tions fall under the prosecution act of the German Copyright Law. © Springer-Verlag Berlin Heidelberg 1987

Illustrations by Reinhold Henkel 2119/3140-543210 /fyou give sorneone a fish, he can feed hirnself only once. /fyou teach hirn to fish, he will always be able to feed hirnself Oriental saying This book is dedicated to my parents Foreword

The union of Eastern and European points of view in an effective psycho• therapy, such as is described by the author, is very salutary. Especially the parables portray, in attractive symbolism, the wisdom ofthe East, in which psychological insights are represented in what seems to be the simplest way. The author understands how to bring his heritage to bear upon psy• chotherapy. Although the categories of his psychological system, for ex• ample basic capacities and actual capacities, certainly represent only one of many possible theoretical conceptions, we must conclude from his re• port that they can be used effectively in treatment. To be sure, such a sy• stem of categories, such a metapsychology, will be of greater assistance to the therapist than to the patient in explanation and clarification. In the fi• nal analysis the only essential thing for the patient who seeks out the psy• chotherapist for help is whether the physician or psychologist is candid with hirn and accepts hirn unconditionally, no matter what he is like. Peseschkian's "positive psychotherapy" and the author's lucid personal conduct transmit to the reader the impression that a born psychotherapist, with a special motivation to assist professionally those who consult hirn in the resolution of their conflicts, is at work. I wish the author complete suc• cess with this book.

Prof. Raymond Battegay, M. D. Psychiatrische Universitätspoliklinik Basel Preface to the English Edition

One shouldn 't throw old habits out the window all at once, but rather accompany them to the door like an amiable guest. Oriental proverb

Since the publication of the German edition, my psychotherapeutic approach has continued to develop; it has proven itself as an effective method in psychotherapy, and has been presented at a large number of national and international congresses and in numerous periodicals, Psy• chological research studies on Positive Psychotherapy (questionnaires, semantic differential, etc.) have, to the degree that they have already been evaluated, substantiated my views, which had already been verified theo• retically and practically. The reaction of specialists, journals, and readers to my books has been a source of positive motivation for me. The expression "positive" in Positive Psychotherapy should be taken to mean that the therapy is not primarily directed toward resolving an exist• ing disturbance, but rather toward first mobilizing the available capacities and self-help potential. "Positive" means, in accordance with its original definition ("positum "), the "real," the "given." Real and given facts are not necessarily just conflicts and disturbances, but also capacities which every human being has within hirn. It is taken for granted that about 50% of a11 i11nesses remain in the extramedical sphere; thus, only 50% of cases are dealt with in any way by physicians, whether in or out of clinics. Many patients receive counseling and treatment in the "lay system," as medical sociologists call it, i. e., from neighbors, acquaintances, relatives, so-ca11ed lay people, but also from pharmacists, teachers, nurses (hospital and private), cosmetologists, etc. In this book, the main psychological and psychosomatic disturbances are presented. In addition, basic models for psychotherapeutic treatment of these disturbances are introduced. In Positive Psychotherapy, treatment is not limited to the immediate doctor-patient relations hip but rather includes strategies of self-help and preventive measures in rearing. The goal is to familiarize even the physician without psychotherapeutic train• ing with practicable procedures, and to enable the layman to take a differ- IX entiated view of the mental illnesses, which are the object of a great deal of prejudice. To each ofthe thematic groups treated is appended, as an aid to understanding, an Oriental story with critical interpretation. By means of a multitude of different methods, cases, and examples, Positive Psychotherapy is presented as a new form of psychotherapy. Especially noteworthy is the continuity of illness-culture-family-rearing and psychotherapy. Positive Psychotherapy is not to be conceived of as an isolated form of treatment; rather, it is closely intertwined with rearing, which is mostly conducted by the reference person; self-help, which is mostly conducted by the patient; and psychotherapy, which is mostly conducted by the psy• chotherapist. New possibilities for psychotherapy are pointed out which not only have asound economic basis but also are profoundly effective and, in addition, closely related to other psychotherapeutic methods. The well-known therapeutic schools of psychoanalysis, individual psychology, behavior therapy, logotherapy, transaction analysis, analytical psychology, and group psychotherapy are discussed and compared with Positive Psy• chotherapy. Starting from a model of the etiology of psychological and psychoso• matic ailments, a practicable model of psychotherapeutic procedure is developed: the five-stage treatment strategy of Positive Psychotherapy, with modifications of this strategy for the domain of self-help being pointed out. Furthermore, the dynamic interconnections among partnershipl, pro• fession, and religion are interpreted in the light of examples and cases, as are achievement norms and the relationship one has with one's own future and with the meaning of life. Special attention is paid to attitudes and expectations in the domains of "trust," "hope," and "faith." The mother• child relationship, as weil as the father-mother-child relationship, is pre• sented in terms of its significance for the development of capacities. The individual relationship with the near and distant future is compared with the institutions which claim to transmit universally valid meaning con• tents. In this way, the significance of the churches and religions is addressed from the viewpoint of the dimension of time. I am grateful to colleagues and patients for the insights with which they have provided me during the course of my psychiatric and psychothera• peutic activity. I would like to refer those readers who are interested in a systematic presentation of Positive Psychotherapy within the framework

1 The relationship between a "partner" and his or her "reference person"; espe• cially the relationship between husband and wife. x of family therapy and self-help to my books Positive Family Therapy; Psy• chotherapy 0/ Everyday Life; Oriental Stories as Tools in Psychotherapy: The Merchant and the Parrot; and In Search 0/ Meaning: A Psychotherapy 0/ Small Steps (published by Springer-Verlag).

Wiesbaden, Spring, 1987 Nossrat Peseschkian Acknowledgments

This book could not have been written if it had not been for the coopera• tion and openness of my patients who have so willingly allowed me to inc1ude their case histories in this publication. Naturally I have changed names and dates to preserve their anonymity. Nevertheless, to maintain the documentary value of the cases, I have inc1uded the oral and written reports word for word insofar as this was possible. Special gratitude goes to my colleague Dieter Schön, M. D., for his help• ful suggestions. I also thank my colleague Mr. Hans Deidenbach, beavior• al therapist and psychotherapist in Wiesbaden. My secretaries, Mrs. Krie• ger, Mrs. Hofmann, and Mrs. Berdjis-Schaefer have provided valuable help through their untiring and meticulous work. I would like to express my warm thanks to the translator, Dr. Robert Walker. Loving appreciation goes to friends and colleagues; their wisdom and encouragement have on many occasions been like the bread of life. Finally, I am thankful to my wife Manije and sons Hamid and Nawid, who ins pi red so much of this book.

Wiesbaden, 1987 Nossrat Peseschkian Contents

Introduction ...... 1

Chapter 1 Approaching Positive Psychotherapy . 8

1. The Maze of Psychotherapy . 8 2. Health-Illness ...... 14 3. Neurosis and Neurotics .. . 17 4. Are You in Tune with the Situation? 19 5. Caricatures ofPsychotherapy 27 6. Positive Psychotherapy ...... 38

Chapter 2 Introduction to Differentiation Analysis 41

The Actual Capacities ...... 48 Theory of Positive Psychotherapy 53 Microtraumas ...... 79 Selective Susceptibility to Conflict . 82 Functions of the Actual Capacities 89

Chapter3 Basic Capacities 93

What 00 All People Have in Common? . 93 Basic Capacities in the Literature 96 1. What Is the Capacity to Know? .... 98 XIV

2. What Is the Capacity to Love? ...... · 114 Interaction Analysis ...... · 135 Positive Psychotherapy and the Etiology of Disease · 144

Chapter4 Reaction TYpes - Concepts - Misunderstandings · 152

1. Three Reaction Types · 152 2. Concepts and Myths · 174 3. Misunderstandings . . · 197

Chapter5 The First Interview in Positive Psychotherapy...... 226

Chapter6 The Five Stages ofTreatment in Positive Psychotherapy · 271

First Stage: Observation/Distancing .. .275 Second Stage: Making an Inventory . . . .285 Third Stage: Situational Encouragement .297 Fourth Stage: Verbalization ... · 315 Fifth Stage: Broadening of Goals . . . . .332

Chapter 7 Positive Psychotherapy and Other Psychotherapies . · 365

Critique and Possibilities for Cooperation . . 365 Positive Psychotherapy as BriefTherapy . . . 373 Positive Psychotherapy and OtherTheories . . 375 Psychoanalysis - Behavior Therapy - Individual Psychology - Ana• lytical Psychology - Logotherapy - Conversation Therapy - Gestalt Therapy - Primal Therapy - Transactional Analysis Positive Psychotherapy and Its Practical Application ...... 400 Translation of Conventional Expressions for Illness Academic difficulties - Adiposity - Alcoholism and drug abuse - Anorexia nervosa - Attention-getting behavior - Bedwetting - Bronchial asthma - xv

Change of Life - Colitis ulcerativa - Compulsive neurosis - Criminality - Degeneracy - Depression - Disobedience, insolence - Essential hypertension - Exhibitionism - Existential anxiety - Fear of groups - Fear of solitude - Fetishism - Frigidity - Heart infarct - Homosexuality - Hypochondria - Hysterical reaction - Irritability - Jealousy mania - Kleptomania - Laziness - Mania - Masturbation - Narcissism - Paranoia - Phobias - Premature ejaculation - Rheumatism - Schizophrenia - Sibling rivalry - Stornach ulcers - Stress - Vertigo

;fJJ~nciir ...... 413

The Individual Actual Capacities ...... 413 Statistical Investigations in Positive Psychotherapy .428

References ...... 431

Index ofNames anciSubjects ...... 437

About the Author ...... 443 List of Cases

I don't know who I should turn to. 10 Just a scoundrel .. 18 Always wait and see 31 The uncertain future 33 Sit and wait . . . . . 35 I feit shit upon . . . 35 Feelings of omnibus-omnipotence 36 You will be systematically desensitized . 37 Who has complexes? . . . 37 I need more time ...... 37 I didn't want to be impolite 42 Affect psychosis? . . . . . 80 First eat something! . . . . 101 If Mommy says 'yes,' then it's so . 104 Love at first sight! ...... 105 Fear of changes...... 106 How beautiful it could have been! 109 How was I supposed to know? . . 112 Why do I have to serve my husband? . 113 What will people say? ...... 113 I can still hear her voice! ...... 118 His peace was more important to hirn 120 He who believes is blessed . 122 Loss of one's task in life 124 She thinks I'm a failure! . . 147 I'm useless! ...... 147 Meaninglessness because ofunfaithfulness 147 What does muscular atrophy have to do with justice? ...... 149 If only I had known! . . . . . 155 Yes-man! ...... 156 What am I supposed to do? 156 My God is unjust...... 158 The compulsion to succeed 160 XVII

Regarding organizational cIimate ...... 161 Sexual intercourse as a logical consequence . 163 Notrne! ...... 164 Praying in bed ...... 164 Mommy, what are you trying to tell me? 167 Do I know my wife at all? ...... 168 Does my wife know what she's like? ... 168 He who doesn't listen to the soft voice must feel the big stick 169 I make a good job of it ...... 170 It's just my luck to have two wives 171 The others and I ...... 173 Outside rosy, inside rotten . . . . 174 My husband doesn't smell good 174 To take a shower or a bath ? 175 To each his own ...... 177 Everyone is alone ...... 179 How many more times may I die? . 181 My son wears his heart on his sleeve 182 Liberation: step by step ...... 187 I have no time ...... 192 My child must achieve what I have not achieved . 194 A complete flip-flop from one day to the next! . 196 There's got to be order . 203 I can't manage anymore 204 Overburdening . . . . . 205 I don't know who I am! 206 He gets that way all at onee 207 Thank your parents! . . . . 209 Family tradition ...... 210 One must always be nice to strangers 210 I've sacrificed myself for her .. . 212 Never again! ...... 213 A weakness for black-haired men . 214 Being a woman as punishment . . 214 What you do unto me, I do unto you 216 I'm looking for the right man 217 Love as a training center ...... 218 ... then I got smart ...... 219 The person who imagines himselfto be siek . 220 God - father ...... 221 You die anyway, you know 222 IfI were dead...... 223 My husband is a tyrant! 224 It's all my fault ... . 288 I find it so hard! ... . 302 I'm hungry for praise! . 302 What about learning how to live together? . 311 XVIII

You'lI never make it! . 312 I can't stand hearing it anymore ...... 312 My wife can hold out for a long time ...... 312 Optimistic outlook ...... 312 How could he do it ... ?" ...... 313 Sexuality and punctuality ...... 354 I finally stood up for my own interests in an objective way ...... 355 My son a sex offender? ...... 402 List of Stories

(Mythologies - Concepts - Counterconcepts)

The Eager Spectators and the Elephant...... 8 The Hakim Knows Everything ...... 14 A Sure Sign of Stupidity ...... 17 Not Everything at Once ...... 19 The Perfect Camel ...... 27 Some Day the Verdict Will Have to Be Overturned ...... 31 The Astrologer ...... 34 Shadows on the Sundial ...... 38 The Parrot and the Sugar Sack ...... 41 The Right Price ...... 81 The Sun Caller ...... 93 The Cured Delusion ...... 108 The Burden ofUncertainty ...... 152 HalfFull and Half Empty ...... 181 The Long Trek ...... 184 Expensive Thrift ...... 190 The Merchant and the Parrot ...... 194 Overdoing It ...... 196 The Prophet and the Long Spoons ...... 197 The Magician...... 226 Easy Cure...... 231 About the Courage to Risk aChallenge ...... 271 The Story ofthe Turban ...... 282 The Divided Commandments ...... 289 The Division of Labor ...... 293 The Crow and the Peacock ...... 301 The Mullah in a Strange City ...... 303 The Caliph's "Primal Scream" ...... 309 A Reason to Be Grateful ...... 320 Other People's Cares...... 357 The Puppet Show ...... 365