a psychological work aimed at improving psychological well-being appeared to be quite difficult and I did not know how it could be achieved. In 1954, Parloff et al. [16] suggested that the goals of psychotherapy were not necessarily the reduction of symptoms, but instead increased personal comfort and effectiveness. However, there had been a very limited response to these needs in subsequent years. Notable exceptions were Ellis and Becker's A Guide to Personal Happiness [17], a modification of rationale-emotive therapy for removing the main blocks to personal happiness (shyness, feeling of inadequacy, feeling of guilt, etc.), Fordyce's program to increase happiness [18], Padesky's work on schema change processes [19], Frisch's quality of life therapy [20], and Horowitz and Kaltreider's work on positive states of mind [21]. Unfortunately, these approaches had not undergone sufficient clinical validation and did not seem to target what I had in mind in terms of psychological well-being.
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13 Bech P: Clinical Psychometrics. Chichester, Wiley, 2012.
14 Ryff CD: Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 1989;6:1069-1081.
15 Jahoda M: Current Concepts of Positive Mental Health. New York, Basic Books, 1958. https://archive.org/details/currentconceptso-00jaho
16 Parloff MB, Kelman HC, Frank JD: Comfort, effectiveness, and self-awareness as criteria of improvement in psychotherapy. Am J Psychiatry 1954;11:343-351.
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The Philosophy Student and the Pursuit of a Well-Being-Enhancing Strategy
I was wondering about developing a form of psychotherapy based on psychological well-being, but the idea did not seem to materialize. One day, I evaluated Tom, a 23-year-old philosophy student suffering from a severe form of obsessive-compulsive disorder. The disorder was mainly characterized by obsessions related to his girlfriend Laura and had started about a year before. Since then, Tom was unable to study, did not take any examinations, and stopped going to the university. His social life had also been affected. Aside from Laura, whom he kept on pestering with questions about her past, he stopped seeing friends. Tom went to see a psychiatrist, who prescribed fluvoxamine, a selective serotonin reuptake inhibitor. However, the medication did not yield any relief and the psychiatrist switched him to clomipramine, a tricyclic antidepressant drug. Yet, again, no response was observed. These medications were reasonable and appropriate prescriptions on the basis of the available literature. He then underwent cognitive behavior therapy (CBT), but he dropped out of treatment after 6 sessions because he felt he was getting worse. The latter event attracted my attention.
Generally, in the clinical literature no response and deterioration are considered to be the same thing. Yet they are different. In the 1990s, a group of Yale investigators headed by Ralph Horwitz [1] reanalyzed the data of a larger randomized controlled trial that involved the use of a β-blocker after myocardial infarction. Randomized controlled trials are not intended to answer questions about the treatment of individual patients, but to compare the efficacy of a treatment for the average patient who is randomly assigned to one of the groups. Horwitz et al. [1] analyzed the trial in a