Finding Balance via Positive Psychological Assessment and Conceptualization

Abstract

This article provides an integrated review of positive psychological assessment and conceptualization methods and tools currently available to practitioners within the framework of a new assessment model—the Comprehensive Model of Positive Psychological Assessment. Cultural considerations stemming from the Culturally Appropriate Assessment Model were incorporated into the Practice Model of Positive Psychological Assessment to provide a comprehensive positive psychological assessment model. Furthermore, practice recommendations grounded in the positive psychological literature are provided to enhance the implementation of this model at various assessment stages. In addition, specific tools are provided to fill the gaps within the literature and guide clinicians in the formulation of a balanced assessment and conceptualization, including the Comprehensive Model of Positive Psychological Assessment Intake–Adult and Child/Adolescent Forms, the Comprehensive Model of Positive Psychological Assessment Semistructured Clinical Interview, the Comprehensive Model of Positive Psychological Assessment Report Template, and a new diagnostic approach—the Balanced Diagnostic Impressions (DICE-PM) Model.

Keywords

assessment positive psychology prevention/well-being conceptualization strengths

Psychological assessment is a fundamental practice within the work of counseling psychologists, guiding client conceptualization and diagnostic decisions, informing treatment planning, and providing the means to evaluate the ongoing process and outcomes of therapy. Assessment can take multiple forms, such as clinical interviewing, standardized testing (e.g., intelligence testing, personality testing), or utilization of measures of states and traits (e.g., hope, positive and negative emotions). Whether a client is seeking out counseling services or a psychological evaluation, thorough assessment is essential and can be crucial to client outcomes.

Assessment is an ongoing and cyclical process that does not end after the initial interview or testing session. Rather, various assessment techniques inform the clinician’s conceptualizations and diagnoses, which then inform treatment. The assessment process continues throughout treatment delivery to determine its effectiveness and whether the initial conceptualizations and diagnoses remain accurate (Snyder et al., 2003).

A focus on assets, strengths, and optimal functioning has long been a core, distinctive feature of the field of counseling psychology (Gelso & Fretz, 2001; Gelso, Nutt Williams, & Fretz, 2014). Of all the core values, it is this emphasis on strengths and optimal functioning that has been identified as the primary identity of counseling psychologists (Gelso et al., 2014). Unfortunately, in both research and practice, attention to strengths has not lived up to the philosophical perspective that is central to counseling psychology (Gelso & Fassinger, 1992; Magyar-Moe, Owens, & Scheel, 2015). Rather, it has been argued that pathology tends to be the primary focus in practice (Chazin, Kaplan, & Terio, 2000; Gelso & Woodhouse, 2003), with the majority of session time being spent identifying the problem, attending to the problem, and resolving the problem. As such, traditional practices have resulted in assessment methods and client conceptualizations that are skewed toward negative traits and functioning (Lopez & Snyder, 2003; Seligman & Csikszentmihalyi, 2000).

There has been a substantial shift in this practice with the growing body of positive psychology research, resulting in a handbook of positive psychological assessment and many validated measures of positive psychological constructs and processes (see Harbin, Gelso, & Perez Rojas, 2013; Lopez & Snyder, 2003; Magyar-Moe, 2009). Despite these advances, traditional pathology-based methods continue to pervade, given a lack of explicit training in positive psychological practices (Gelso & Woodhouse, 2003; Magyar-Moe, Owens, & Scheel, 2015) and the inherent challenges faced with long-standing practices and external demands (Gelso et al., 2014). Examples include the primary use of the Diagnostic and Statistical Manual of Mental Disorders (DSM), deficit-based interviewing and measures, and the pressures of insurance reimbursement and managed care.

Although clinicians attend to strengths to some extent (Harbin et al., 2013; Scheel, Klentz Davis, & Henderson, 2012), there is still much room for growth among counseling psychologists (Magyar-Moe, Owens, & Conoley, 2015; Magyar-Moe, Owens, & Scheel, 2015). In a recent study, a phenomenological examination of how strengths are used in therapy across major theoretical orientations revealed that the identification of strengths (e.g., questions about strengths included in intake interviews) was one of many recurring processes (Scheel, Klentz Davis, & Henderson, 2012). It is encouraging that strengths are being purposefully identified in the assessment process, yet there are many other mechanisms and tools available to enhance current practices. Furthermore, although a number of tools are available, a comprehensive system of assessing strengths and assets based on empirical research is lacking (Lopez, Snyder, & Rasmussen, 2003).

Counseling psychologists can put this primary value into practice during the assessment process by assuming that all clients, despite levels of pathology, distress, or impairment, possess strengths that are valuable to the therapeutic process (Gelso et al., 2014; Wright & Lopez, 2002). Therapists can also engage in ongoing self-examination by assessing the degree to which they identify and work with strengths (see the Inventory of Therapist Work With Client Assets and Strengths [Harbin et al., 2013], and the Strengths-Based Competence Continuum for Therapists [Smith, 2006]). Lastly, and the primary focus of this article, clinicians can use research from positive psychology to inform all stages of the assessment process to balance the deficit perspective.

The Comprehensive Model of Positive Psychological Assessment (CMPPA)

Originally, the Practice Model of Positive Psychological Assessment (Lopez et al., 2003) was designed to address a significant void in traditional assessment methods. It explicitly includes individual and environmental strengths and assets in addition to weaknesses and deficits (Lopez et al., 2003; Pepinsky & Pepinsky, 1954; Spengler, Strohmer, Dixon, & Shiva, 1995). It is important to note that although the Practice Model of Positive Psychological Assessment addresses counseling psychology’s core value of attending to assets and strengths, another key value of the profession is lacking from this assessment model—specific attention to cultural context (Gelso et al., 2014). Indeed, the literature in positive psychology has been criticized for failing to be inclusive of diversity and lacking in attention to multicultural considerations (Becker & Marecek, 2008; Christopher & Hickinbottom, 2008; Christopher, Richardson, & Slife, 2008; D’Andrea, 2005; Downey & Chang, 2012; Lopez et al., 2002; Sandage & Hill, 2001).

Downey and Chang (2012) noted that training of practitioners to date has not sufficiently, regularly, or explicitly incorporated positive psychology, multiculturalism, and lifespan perspectives. In response to this problem, these authors proposed the concept of multidimensional clinical competence, defined as

the ability to work collaboratively and constructively with clients of diverse groups, cultures, developmental stages, and levels of functioning, to recognize, utilize, and develop their existing and potential strengths in the service of reducing existing or potential dysfunction in themselves or within their social systems. (p. 373)

Thus, in this article the authors aim to enhance current positive psychological assessment models and, in turn, increase multidimensional clinical competence by incorporating the Practice Model of Positive Psychological Assessment (Lopez et al., 2003) and the Culturally Appropriate Assessment Model (Flores & Obasi, 2003), as well as several other culturally sensitive models and processes from counseling psychology and positive psychology scholarship. This combined model has been titled the CMPPA. The CMPPA includes seven steps: (a) acknowledge practitioner background, values, and biases; (b) assume that all people and environments are both strong and weak, and that you have the tools to conduct a comprehensive assessment; (c) construct an implicit theory of client functioning; (d) gather complementary data; (e) test complementary hypotheses in the context of care provided to the client; (f) develop a flexible, comprehensive conceptualization; and (g) share a balanced report of the client’s strengths/resources and weaknesses/deficits. Recommendations for practice that summarize each step of the CMPPA are described in the sections that follow, and a summary can be found in Table 1.

Table 1.

Comprehensive Model of Positive Psychological Assessment Practice Recommendations.

Step	Assessment strategies/processes/tools	Recommendation
1	Cultural self-awareness	Strive to enhance one’s self-awareness and openness as well as decrease biases through ongoing self-reflection, consultation, knowledge, and understanding of multicultural competencies, and diverse cultural interaction experiences.
2	Awareness of balanced perspectives and resources	Continuously revisit perspectives of clients to ensure a balanced viewpoint is maintained. Seek out and use positive psychological resources to diversify traditional assessment methods to complete a more comprehensive assessment.
3	Intake paperwork	Include in the initial paperwork a general statement regarding the importance of knowing information about both the weaknesses and strengths clients possess and the role of strengths identification in helping clients to overcome areas of struggle without invalidating or negating problems that may have led clients to seek out therapy services. (An example can be seen in Appendix A.)
3	Intake paperwork	Provide greater balance to standard intake questions by explicitly including open-ended questions regarding: inclusive demographics, individual and environmental strengths, positive emotions, areas of well-being, hope, and other relevant positive psychological constructs (see the CMPPAI—Adult and Child/Adolescent versions in Appendix A).
3	Past records; intake paperwork; clinical interview; in-person interactions	When first reviewing information about clients from past records and intake paperwork and later gathering data during in-person interactions, establish a balanced perspective. The Four-Front Approach and Balanced Diagnostic Impressions (DICE-PM) Model can be used to assist with this process.
4	In-person interactions	Aim to enhance the therapeutic relationship by utilizing positive empathic statements and hope-bonding upon first meeting clients and beyond.
4	Clinical interview	Spend time during the clinical interview to collaboratively work with all clients to clearly identify and expand upon strengths, positive emotions, areas of well-being, hope, other relevant positive psychological constructs, and cultural factors. (The CMPPASCI in Appendix B can guide this approach.)
4	Tests and measures	Supplement existing psychological tests, batteries, and measures with appropriate positive psychological instruments to provide a more comprehensive assessment (see Table 2). Select culturally appropriate measures when available.
4	Behavior observations	Intentionally identify instances of positive behaviors, skills, abilities, and emotions when interacting with clients throughout an evaluation or therapy session. Include balanced behavior observations in written notes and reports.
5	Client hypotheses	Strive to develop and test several balanced hypotheses about clients’ functioning in all contexts of care, taking into account strengths and weaknesses as well as the individuality of clients.
6	Conceptualization	When conceptualizing clients’ treatment goals, keep in mind the symptoms of mental illness as well as well-being, and the degree of those symptoms. Consider where clients fall within the Complete State Model of Mental Health.
6	Conceptualization	When providing clinical impressions verbally or in writing, utilize the DICE-PM Model.
7	Feedback	When providing assessment results in all capacities, utilize a balanced comprehensive approach. Give equal time, space, and emphasis to strengths and weaknesses in both written reports and provision of oral feedback. (The CMPPART in Appendix C can guide this approach.)

Note. CMPPAI = Comprehensive Model of Positive Psychological Assessment Intake; DICE-PM = Balanced Diagnostic Impressions (DICE-PM) Model; CMPPASCI = Comprehensive Model of Positive Psychological Assessment Semistructured Clinical Interview; CMPPART = Comprehensive Model of Positive Psychological Assessment Report Template.

CMPPA Step 1: Acknowledge Practitioner Background, Values, and Biases

In Step 1, therapists engage in self-examination. Clinicians’ background and personal experiences influence their values and biases, which ultimately affect their assessment process (Lopez et al., 2003). For instance, biases, stereotypes, and prejudices can affect the language and labels chosen to describe others. Labels are quite powerful and can result in a negative self-image or inaccurate perceptions from others (Snyder et al., 2003). Ultimately, this creates many barriers both in and out of the therapeutic context. (The power of labels is further discussed in Magyar-Moe, Owens, & Conoley, 2015.) Although it is impossible to completely remove the influence of one’s background, values, and biases, the CMPPA encourages practitioner self-awareness and an openness to clients’ perspectives and cultural identities prior to and during interactions with clients for the betterment of ourselves and our clients.

Early on, recognition of the complexities of culture as well as cultural influences on assessment is vital. Whether it be “assessment-as-usual” or positive psychological assessment, assessment must be culturally appropriate (Flores & Obasi, 2003). Cultural and societal factors affect how people pursue and experience happiness as well as what traits, strengths, and goals are considered positive within their own contexts (Lopez et al., 2002). In other words, a single definition of happiness, well-being, or what constitutes a strength cannot be applied to all people in the exact same way because “culture counts as a primary influence on the development and manifestation of human strengths and optimal human functioning” (Lopez et al., 2006, p. 224).

CMPPA Step 2: Assume All People and Environments Are Both Strong and Weak and That You Have Tools to Conduct a Comprehensive Assessment

At this stage of CMPPA, the therapist is charged with first recognizing that all individuals and environments possess both strengths (sometimes referred to as virtues, assets, or resources) and weaknesses. This assumption is key to future stages of CMPPA, as “people only search for things they believe to exist” (Lopez et al., 2003, p. 13). Without acknowledgment of the assets clients possess, both internally and externally, a tremendous amount of resources for both clients and therapists will be overlooked and underutilized. At this stage, no interaction with clients takes place. Rather, the clinicians’ internalized views regarding clients’ possession of strengths and weaknesses are reflected upon. In addition, therapists adopt the assumption that the tools and techniques necessary to conduct a balanced assessment exist (Lopez et al., 2003). Throughout this article, the authors provide a solid foundation of models, techniques, and recommendations grounded in positive psychology to support this assumption.

CMPPA Step 3: Construct an Implicit Theory of Client Functioning

Prior to any direct contact with clients, theories about clients and their levels of functioning are formed through a review of records and information shared as part of the intake paperwork (Lopez et al., 2003). Even with the best intentions, therapists often generate assumptions about clients that are heavily skewed toward the negative side of functioning as a result of the fundamental negative bias. The fundamental negative bias is typically formed if something is salient, regarded as negative, and the context is vague (Wright, 1988). As a result, “The negative value assigned to the object will be the major factor in guiding perception, thinking and feeling to fit its negative character” (Wright, 1988, p. 5). For instance, if on the intake paperwork only pathology (e.g., depressed mood, social isolation) is described in detail without context (e.g., death of a loved one, adjustment to a major stressor), an overarching negative view of the client is likely to be generated and influence how additional information will be viewed and what questions therapists will ask. Therefore, if only negative factors are assessed, this will likely guide future interactions to remain negatively focused (e.g., remediating pathology, resolving family conflict). However, there is hope in that a fundamental positive bias also exists and operates similar to the fundamental negative bias (Wright, 1988). If an effort is made on the part of the therapist to be inclusive of strengths and positive variables in the ways initial information is gathered and categorized, a more balanced implicit perspective will likely be generated. This implicit theory, in turn, will later help facilitate a more systematic, balanced assessment (Lopez et al., 2003). At this initial stage, adjusting intake paperwork to include positive psychological constructs that apply across presenting concerns and utilizing the Four-Front Approach (Wright, 1988; Wright & Lopez, 2002; see the “Four-Front Approach” section) as an initial data-gathering organizational tool are two methods that will help achieve a more balanced assessment.

Intake paperwork

Information gathered from intake paperwork sets the stage for the rest of the assessment and counseling process. Not only does this paperwork provide therapists with information about clients, it also offers clients a first impression of the services they will receive based on the information requested. Therefore, careful attention to the content of the intake material is necessary to set the stage for positive psychological assessment to unfold. Furthermore, given that strengths and resources are so often overlooked in counseling services, the assessment of strengths may strike some clients as odd, especially if they have been in therapy in the past with therapists who did not practice from a positive psychology perspective. Hence, providing a rationale to clients for why the clinician is asking about areas of personal strength and environmental resources is imperative, so as to not minimize or invalidate the client’s concerns (Magyar-Moe, 2009).

Putting positive psychological constructs to paper

Traditionally, intake paperwork only provides opportunities to report distress or endorse symptoms of pathology. The inclusion of positive psychological constructs on intake paperwork is a clear way for therapists to demonstrate to clients that they have internalized the assumption that all clients possess positive characteristics and seeking therapeutic services does not solely involve a focus on pathology and weakness. An initial assessment of strengths will likely help begin the conversation of CMPPA, which can later be supplemented by additional structured strength-based tools, such as the Four-Front Approach (Wright, 1988; Wright & Lopez, 2002) and standardized measures (see the “Standardized Positive Psychological Measures” section). In addition to assessing individual strengths, the intake paperwork can help identify information related to positive psychological constructs relevant to all clients (i.e., positive emotions, well-being, and hope; see Magyar-Moe, Owens, & Conoley, 2015, for more details).

Inclusive demographics

The process of “culturally encompassing information gathering” from the Culturally Appropriate Assessment Model (Flores & Obasi, 2003, p. 48) should also begin with the intake paperwork. Although intake paperwork typically includes questions regarding demographic information, it is important to be inclusive and comprehensive, beyond the basic variables (i.e., gender, race, and age). The ADDRESSING model by Hays (2008) is an assessment tool from the counseling psychology literature that can be utilized to better ensure more culturally sensitive assessment of a client’s cultural identities. This model was designed to help therapists recognize an individual’s identities across multiple life domains. ADDRESSING is an acronym, with each letter representing one aspect of culture as follows: Age and generational influences, Disability status (developmental), Disability status (acquired), Religion and spiritual orientation, Ethnicity, Sexual orientation, Socioeconomic status, Indigenous heritage, National origin, and Gender. Open-ended questions allow clients to determine how they identify regarding these variables based on their values.

The Four-Front Approach

When reviewing known client information and developing early hypotheses, the Four-Front Approach (Wright, 1988; Wright & Lopez, 2002) is an organizational tool that helps remind clinicians to equally consider and gather data related to the person as well as the person within their environmental context. Specifically, therapists strive to categorize information into four categories—individual strengths (e.g., creativity, leadership) and weaknesses (e.g., anxiety, disorganization) as well as environmental resources (e.g., job, family support) and deficits (e.g., homelessness, dangerous neighborhood; Wright & Lopez, 2002). Failure to begin the therapeutic process with the goal of assessing all four fronts is likely to result in the therapist overlooking, or failing to fully utilize, the individual strengths and environmental resources of the client (Magyar-Moe, 2009). In contrast, clinicians who gather information from each category of the Four-Front Approach are more likely to go on to develop more complex, formal hypotheses that can be directly tested (Lopez et al., 2003).

By beginning the process of identifying strengths, positive emotions, well-being, hopeful thinking, and cultural variables at the initial stage of assessment—before even meeting the client—a strong foundation based on positive psychological principles can be established. This, in turn, will provide a springboard to further implement positive psychological assessment in the next stages of the psychological services provided.

CMPPA Step 4: Gather Complementary Data

Following the inferences that are formed during the previous stage, the clinician’s theory of client functioning is confirmed or modified based on strategic and formal methods of data collection (Lopez et al., 2003). By using structured methods, explicit views of clients become more apparent and hypotheses can be directly tested (hypothesis testing is discussed in the “CMPPA Step 5: Test Complementary Hypotheses in the Context of Care Provided to the Client” section). Formal data collection methods include semistructured clinical interviews, symptom checklists, and validated measures (Lopez et al., 2003). From a CMPPA view, a balance of strengths and struggles should be assessed when using these tools.

The clinical interview

The first meeting with clients is critical because it provides clinicians the opportunity to begin the development of the therapeutic relationship and to build upon the foundation that was laid by exploring information from the intake paperwork in greater depth.

Enhancing the therapeutic relationship through positive psychological principles

Developing the therapeutic alliance is crucial to all forms of clinical services (Wampold, 2001), including assessment. From a CMPPA perspective, implementation of positive empathy—a subtype of therapeutic empathy—often results in positive outcomes, as it facilitates approach goals, increases positive emotions, and assists in identifying strengths (see Conoley & Conoley, 2009; Magyar-Moe, Owens, & Conoley, 2015, for more information regarding positive empathy). For example, if clients express concerns that they are not currently in a romantic relationship, the therapist could say, “It seems you desire a close relationship—someone you can trust and share positive life experiences with.” This is in contrast to a more traditional empathy statement such as “You are worried about what the future holds for you in terms of finding love. That can be very scary.”

Hope is another positive psychological construct that also enhances the therapeutic relationship. Lopez, Floyd, Ulven, and Snyder (2000) initially suggested that hope pathways correspond to the working alliance tasks accomplished in therapy, whereas the working alliance bond between the client and the therapist translates to the agency component of hope. Research supports this hypothesis (Magyar-Moe, Edwards, & Lopez, 2001), suggesting that increasing hope will enhance the working alliance and vice versa. Lopez and colleagues (2004) identified several methods therapists can use to develop a hopeful alliance or hope-bonding: (a) be flexible and respectful in establishing therapeutic goals, (b) establish a diverse number of pathways, and (c) utilize the connection between the client and the therapist to fuel the mental energy needed to work toward goals.

Positive psychological constructs as core elements in the clinical interview

Whereas the intake paperwork sets the groundwork of CMPPA for clients, the clinical interview provides the space to explore all areas of client functioning, including strengths and struggles, in much greater depth. Establishment of treatment goals also occurs during the clinical interview and guides the next steps of service. Lopez et al. (2003) have noted an absence of a comprehensive, strengths-based, semistructured interview. Such a tool would provide the structure for how to approach a balanced clinical interview for clinicians and trainees. The authors present the Comprehensive Model of Positive Psychological Assessment Semistructured Clinical Interview (CMPPASCI; see Appendix B) to address this gap.

During the clinical interview, clients may be asked to describe how they use strengths in various contexts (e.g., home, school, in relationships). This description provides a greater fund of knowledge for the therapist to later draw upon. It may also increase clients’ self-efficacy related to help-seeking behavior or help establish a stronger therapeutic relationship, given that weaknesses are not the sole focus in the clinical interview and subsequent clinical services. Clinicians can also ask their clients to elaborate on their answers from the intake paperwork related to the sources of positive emotions and well-being. Sources of positive emotions can serve as agentic factors and facilitate upward spirals of positive emotions (Fredrickson, 1998, 2001, 2003) and can be drawn upon when making treatment recommendations.

In addition, hope finding (see Lopez et al., 2004) is a practice that is encouraged early in clinical services with all clients, as it helps prepare clients for the change process and identification of goal pursuits. Hope can also be identified via the use of validated hope measures. (Possible options are found in Table 2.) Other hope finding strategies that can be implemented during the clinical interview and beyond include the generation of hope narratives—stories of fictional and real characters that require clients to generate goals and agentic and pathways thinking—written by clients, as well as the use of questions specifically developed to elicit hope themes in those narratives (e.g., “How attainable or realistic were the goals?” For a list of other specific questions, see Lopez et al., 2004, pp. 391-392). Although the constructs selected and included in the CMPPASCI are appropriate for all clients, additional positive psychological constructs can also be addressed when relevant to the client.

Table 2.

Positive Psychological Measures.

Positive psychological construct and name of measure	Author(s)
Attachment
Adult attachment	Brennan, Clark, and Shaver (1998)
Adult Attachment Scale	Collins and Read (1990)
Relationship Questionnaire	Bartholomew and Horowitz (1991)
Career assessments
Career Self-Efficacy Scale	Betz and Luzzo (1996)
Occupational Engagement Scale–Student	Cox, Krieshok, Bjornsen, and Zumbo (2015)
Work and Meaning Inventory	Steger, Dik, and Duffy (2012)
Work Hope Scale	Juntunen and Wettersten (2006)
Coping
Problem-Focused Style of Coping	Heppner, Cook, Wright, and Johnson (1995)
Emotions
Oxford Happiness Questionnaire	Hills and Argyle (2002)
Orientation to Happiness measure	Peterson, Park, and Seligman (2005b)
Positive and Negative Affect Scale	Watson, Clark, and Tellegen (1988)
Positive and Negative Affect Scale for Children	Laurent et al. (1999)
Positive Psychotherapy Inventory	Rashid (2008)
Positive Psychotherapy Inventory for Children	Rashid and Anjum (2007)
Scale of Positive and Negative Affect	Diener et al. (2010)
Steen Happiness Index	Seligman, Steen, Park, and Peterson (2005)
Subjective Happiness Scale	Lyubomirsky and Lepper (1999)
Forgiveness
Enright Forgiveness Inventory	Subkoviak et al. (1995)
Forgiveness of Self and Forgiveness of Others	Mauger et al. (1992)
Hartland Forgiveness Scale	Thompson et al. (2005)
Interpersonal Relationship Resolution Scale	Hargrave and Sells (1997)
Transgression-Related Interpersonal Motivations Inventory	McCullough et al. (1998)
Grit
Short Grit Scale	Duckworth and Quinn (2009)
Gratitude
Gratitude Questionnaire	McCullough, Emmons, and Tsang (2002)
Hope
Adult State Hope Scale	Snyder et al. (1996)
Adult Trait Hope Scale	Snyder et al. (1991)
Children’s Hope Scale	Snyder et al. (1997)
Domain-Specific Hope Scale	Sympson (1999)
Humor
Multidimensional Sense of Humor Scale	Thorson and Powell (1993)
Mindfulness
Mindful Attention Awareness Scale	Brown and Ryan (2003)
Optimism
Life Orientation Test-Revised	Scheier, Carver, and Bridges (1994)
Personal Growth Initiative
Personal Growth Initiative Scale–II	Robitschek et al. (2012)
Purpose/meaning
Meaning in Life Questionnaire	Steger, Frazier, Oishi, and Kaler (2006)
Reasons of Living Inventory for Young Adults	Gutierrez et al. (2002)
Quality of life
Quality of Life Inventory	Frisch (1994)
Religion and spirituality
Santa Clara Strength of Religious Faith Questionnaire	Plante and Boccaccini (1997)
Spiritual Involvement and Beliefs Scale	Hatch, Burg, Naberhaus, and Hellmich (1998)
Spiritual Transcendence Scale	Piedmont (1999)
Satisfaction
Brief Multidimensional Student Life Satisfaction Scale	Seligson, Huebner, and Valois (2003)
Satisfaction With Life Scale	Diener, Emmons, Larsen, and Griffin (1985)
Students’ Life Satisfaction Scale	Huebner (1991)
Self-compassion
Self-Compassion Scale	Neff (2003)
Self-efficacy
New General Self-Efficacy Scale	Chen, Gully, and Eden (2001)
Self-esteem/Self-competence
Harter Self-Competence Scale	Harter (1982)
State Self-Esteem Scale	Heatherton and Polivy (1991)
Strengths
Child and Adolescent Needs and Strengths	Lyons (1999)
Clifton StrengthsFinder	Asplund, Lopez, Hodges, and Harter (2007)
Clifton Youth StrengthsExplorer	Lopez, Harter, Juszkiewicz, and Carr (2007)
Devereux Early Childhood Assessment	LeBuffe and Naglieri (1999)
Preschool Strengths Inventory	Owens (2011)
Search Institute’s 40 Developmental Assets	Benson, Leffert, Scales, and Blyth (1998)
VIA Inventory of Strengths	Peterson, Park, and Seligman (2005a)
VIA Inventory of Strengths–Youth	Park and Peterson (2006)
Well-being
Flourishing Scale (psychological well-being)	Diener et al. (2010)
Ryff Scales of Psychological Well-Being	Ryff (1989); Ryff and Keyes (1995)
Therapy processes and outcomes
Inventory of Therapist Work With Client Assets and Strengths	Harbin, Gelso, and Perez Rojas (2013)
Mental Health Continuum–Long Form (emotional, psychological, and social well-being)	Keyes (2002, 2005)
Outcome Questionnaire–45.2 (subjective discomfort, problems in interpersonal relations, and social role performance problems)	Lambert et al. (1996)

Note. This table is not an exhaustive list of all positive psychological measures.

Exploring cultural diversity respectfully

During the clinical interview, three tools can be used to expand upon culturally encompassing information gathering (Flores & Obasi, 2003) in greater depth—the ADDRESSING model (Hays, 2008), the RESPECTFUL counseling framework (D’Andrea & Daniels, 2001), and the community genogram (Ivey & Ivey, 1999). The ADDRESSING model (discussed previously) can be examined more thoroughly during the interview for a richer description. Clients can explore both strengths and weaknesses associated with each of the 10 components of the model (Hays, 2008). In addition, because the practice of conducting culturally appropriate assessment entails that therapists have a thorough understanding of how their own cultural background affects their belief systems and worldviews, clinicians are encouraged to complete and examine the ADDRESSING model for themselves prior to engaging in work with clients.

Practitioners are advised to be careful when asking questions about clients’ identities, as the phrasing of questions can influence responses (Hays, 2001). Hays (2001) provided specific phrasing for questions to ask clients on the 10 dimensions of the ADDRESSING model, as well as questions for the therapist to consider when seeking to better understand clients’ identities. Examples include “Would you tell me about your cultural heritage or background?” “What did it mean to grow up as a girl (boy) in your culture and family?” and “How are my salient identities interacting with those of the client?” (Hays, 2001, p. 60).

The RESPECTFUL counseling model is comprised of an acronym with each letter representing a key aspect of cultural identity: Religion and spirituality, Economic/class background, Sexual identity, Personal style, Ethnicity/racial identity, Chronological/lifespan challenges, Trauma, Family background, Unique physical characteristics, and Location of residence and language (D’Andrea & Daniels, 2001). Use of the RESPECTFUL model in a therapeutic context should focus on both the demands and resources, as well as stressors and strengths, to empower clients to take action to reduce stress and strengthen their resources and personal power (D’Andrea & Daniels, 2001).

The goal for the use of the community genogram is to bring cultural issues to the forefront in the assessment process and to focus on the positive resources that come from understanding the multiple components of cultural experiences (Ivey & Ivey, 1999). Ivey and Ivey explicitly recommended that when helping clients construct community genograms, therapists should focus on stories of strength rather than on problems. Such a focus often leads to clients’ recollections of useful strategies they had relied upon in the past that can be implemented to help solve current issues.

Standardized positive psychological measures

Psychological tests and validated measures are standardized means of gathering complementary data. The use of positive psychological measures alongside traditional psychological batteries can help provide a more comprehensive and holistic picture of clients. Much progress has been made in the area of positive psychological assessment, with the generation of many specific positive psychological measures of states and traits for children, adolescents, and adults. Table 2 provides an extensive, but not exhaustive, list of measures available, largely from the 1990s to the present. Depending on the specific needs of the therapist and the client, instruments can be selected to gather more in-depth information about a number of positive psychological constructs at various time points (e.g., as part of an evaluation, pretreatment, concurrent with treatment, and posttreatment).

For instance, as part of an evaluation or pretreatment, a therapist may ask clients to take the VIA Inventory of Strengths (VIA-IS; Peterson & Seligman, 2004) to help identify their strengths. This particular classification system was created to serve as a balance to the DSM (Peterson & Seligman, 2004). The VIA-IS may also be used to guide recommendations as part of an evaluation or next steps for treatment. A therapist may also give the Hope Scale (Snyder et al., 1991) at pretreatment to determine if there are any barriers related to achieving goals in therapy. Perhaps the client is high in pathways and provides several ideas to cope with anxiety symptoms, but is lacking in agency, and therefore has difficulty implementing plans set in session. Instruments may also be administered prior to treatment to identify current levels of the construct of interest (e.g., positive emotions, life satisfaction) and then administered at subsequent times to track progress in therapy.

Selecting and administering culturally appropriate instruments

Careful consideration is necessary to select instruments in a culturally appropriate way. Foremost, the clinician must ensure that the development, psychometric properties, and norming samples of each measure and test are appropriate for the individuals being assessed (Flores & Obasi, 2003). Special attention to the preferred language of the client and whether the constructs measured reflect the same meaning in the culture of interest are also important considerations. Several well-established cross-cultural positive psychology measures have been identified, such as the Hope Scale (Snyder et al., 1991), Children’s Hope Scale (Snyder et al., 1997), and the Problem-Solving Inventory (Heppner & Peterson, 1982); however, greater advancements in this area are needed (Lopez et al., 2002).

Balanced behavioral observations

Traditionally, when reporting behavioral observations, abnormal or negative behaviors (e.g., fidgeting, perseverating on a task), difficulties in abilities or skills (e.g., language impairments, difficulty with recognizing patterns), and negative emotions are noted. At best, terms such as intact, unremarkable, or within normal limits are used to highlight that there is no deficiency. However, little attention is paid to positive behaviors, skills, abilities, or emotions. For instance, most practitioners fail to note the positive emotions a client exhibits when talking about a supportive friend or an upcoming event to which they are looking forward. Similarly, many fail to notate when a client is particularly skilled at solving problems during testing or demonstrating high social intelligence during a couples therapy session. Thus, clinicians are encouraged to note balanced observations to strengthen positive psychological assessment strategies used.

CMPPA Step 5: Test Complementary Hypotheses in the Context of Care Provided to the Client

The primary goal of this step of assessment is to ensure the testing of unbiased and balanced hypotheses about clients’ presenting concerns and ongoing functioning. A multiple-hypotheses testing strategy is used, which requires openness to and documentation of data that both confirm and disconfirm the generated hypotheses regarding both areas of strength and struggle (Lopez et al., 2003). For example, a client presents with symptoms of anxiety, including excessive worrying and difficulties sleeping. Naturally, the therapist will consider and inquire about what factors may be influencing the degree to which a client feels anxious. For instance, the therapist may consider that the client has an anxiety disorder or a neurotic personality style. Upon further inquiry, the therapist disconfirms an anxiety disorder and an anxious personality style. Rather, the primary source of her anxiety is related to an upcoming presentation at work, which the client has been informed will have a significant impact on her future project assignments. This has exacerbated the level of anxiety that she is accustomed to handling on her own. Simultaneously, the therapist considers what factors may be influencing the client’s level of well-being. Hypotheses include a lack of self-efficacy at work, strong social support, and moderate awareness of strengths. The hypotheses that are confirmed include the presence of a supportive partner in the client’s life who encouraged her to introduce her novel idea during her work presentation. Hypotheses disconfirmed are low self-efficacy, as the client is quite confident in her abilities, but simply wishes that she had more experience. The client’s awareness of her strengths was much greater than the therapist had anticipated, as the client was able to articulate how she has been using her strengths of creativity and persistence to cope. Each client experiences symptoms of disorders and well-being differently. In this case, for the client, anxiety means the inability to sleep well and frequent rumination about possible negative outcomes. Well-being represents support by her loved ones and adaptive coping mechanisms.

CMPPA Step 6: Develop a Flexible, Comprehensive Conceptualization

The hypotheses generated and data collected about clients from the previous stages need to be organized and integrated in a cohesive fashion, resulting in a comprehensive conceptualization (Lopez et al., 2003). The hypotheses previously generated will either be supported or refuted during all stages of assessment, highlighting the need for flexible conceptualizations. The Complete State Model of Mental Health (Keyes & Lopez, 2002), the Four-Front Approach (Wright, 1988; Wright & Lopez, 2002, previously discussed), and the Balanced Diagnostic Impressions Model (see “The Balanced Diagnostic Impressions (DICE-PM) Model” section) are valuable tools that can aid in the process of developing a comprehensive conceptualization.

The Complete State Model of Mental Health

The Complete State Model of Mental Health can assist in developing balanced client perspectives at the case conceptualization stage (Keyes & Lopez, 2002). It defines mental health and mental illness as existing on two separate continua. From this perspective, the absence of mental illness is not equal to the presence of mental health (Keyes & Lopez, 2002). Rather, clients are assessed according to the degree of symptoms of mental illness they are experiencing (high to low), as well as the degree of symptoms of well-being they are experiencing (high to low). Combining these continua together, a client can be conceptualized as (a) completely mentally healthy or flourishing (low symptoms of mental illness and high symptoms of well-being), (b) completely mentally ill or floundering (high symptoms of mental illness and low symptoms of well-being, (c) incompletely mentally healthy or languishing (low symptoms of mental illness and low symptoms of well-being), or (d) incompletely mentally ill or struggling (high symptoms of mental illness and high symptoms of well-being; Keyes & Lopez, 2002).

Whereas many therapists and clients consider therapy successful when clients have reached a baseline level of functioning, the Complete State Model of Mental Health reveals that there is much more to life than just feeling neutral or functioning at baseline. For those with unrelenting mental illness, complete mental health may not be possible; however, rather than simply accepting that life will include ongoing issues related to pathology, the client can be assisted by the therapist to see that despite this, a life full of symptoms of well-being is still possible (Magyar-Moe, 2009).

There are a variety of ways to assess symptoms of mental illness and symptoms of well-being. One way to do so is to have clients complete a measure of symptoms of mental illness and a measure of symptoms of well-being, and then plot the scores from these measures on the appropriate continua. Then, those scores can be connected to determine which category of the Complete State Model of Mental Health best fits the client (Magyar-Moe, 2009). Two exemplary measures for use within this model are the Outcome Questionnaire–45.2 (OQ-45.2; Lambert et al., 1996), a measure of symptom distress, and the Mental Health Continuum–Long Form (MHC-LF; Keyes, 2002, 2005), a measure of subjective well-being.

The Balanced Diagnostic Impressions (DICE-PM) Model

Many believe that when a person is assigned a label, others can better understand the person. This can be particularly detrimental when labeling weaknesses or deficits. However, by explicitly naming human strengths, the person labeled, as well as those who are informed of the label, come to find merit in the label (Snyder et al., 2003). Hence, a therapist who indicates, for example, that in addition to meeting criteria for a DSM diagnosis of major depressive disorder, the client also has high levels of resilience, hope, and social support assists the client in seeing himself or herself as more than just the symptoms of pathology that are present. As a result of the therapist explicitly labeling the clients’ strengths, clients will become more cognizant of and confident in their strengths, rather than assuming that everyone has those qualities or simply failing to realize that they have strengths. Clients will also be more likely to have an increased interest in using and developing their strengths.

Although no longer a formal component of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013), the five-axis assessment model from previous iterations of the DSM created a pervasive practice of focusing on pathology while failing to hold therapists accountable for finding client strengths and resources. In particular, Axes I (clinical syndromes and other conditions that may be a focus of clinical attention) and II (personality disorders and mental retardation) provided ample opportunities for therapists to document the weaknesses of clients, whereas Axis IV allowed for psychosocial and environmental problems to be noted. Axis V, the Global Assessment of Functioning Scale, focused exclusively on pathology with a score of 1 representing extremely severe pathology, and the highest score of 100 simply indicating the absence of symptomology (APA, 2000).

With the elimination of the five-axis system, non-axial documentation (i.e., listing disorders) has become the new practice. A new system based on CMPPA can help provide a balanced, comprehensive clinical conceptualization. The proposed system, the Balanced Diagnostic Impressions (DICE-PM) Model, developed by the authors of this article, integrates the strengths of all previous models discussed, while addressing their weaknesses to provide a more explicit, inclusive, and comprehensive conceptualization. The components of this model can be recalled with the acronym DICE-PM—Diagnosis, Individual Strengths and Weaknesses, Cultural Assets and Struggles, Environmental Resources and Deficits, Physical Wellness and Health Concerns, and Mental Health Category (a category from the Complete State Model of Mental Health to summarize overall functioning; flourishing, floundering, languishing, or struggling). An example of this model is as follows:

Balanced Diagnostic Impressions (DICE-PM):

Diagnosis: Generalized Anxiety Disorder

Individual Strengths: persistent, open-minded

Individual Weaknesses: disorganized, impulsive

Cultural Assets: bi-cultural flexibility, privileged gender and age status

Cultural Struggles: underprivileged racial and sexual orientation status

Environmental Resources: supportive partner, safe living conditions

Environmental Deficits: lack of current employment, conflict with parents

Physical Wellness: avid runner, healthy diet

Physical Health Concerns: hyperthyroidism, allergies

Mental Health Category: incomplete mental illness, struggling

CMPPA Step 7: Share a Balanced Report of the Client’s Strengths/Resources and Weaknesses/Deficits

The interpretation of results is important to share with clients, as it provides the opportunity for feedback and may require the adjustment of previous hypotheses as well as the need to go back to previous stages of assessment (Flores & Obasi, 2003). There are many avenues to share information about clients, such as through oral presentations, provision of client feedback, or written reports (e.g., case presentations to colleagues, feedback following a clinical interview, therapy notes). In each context, incorporating a balanced, comprehensive approach is advised. A guiding rule can help assure this—“equal space, equal time, equal emphasis” (Lopez et al., 2003, p. 17). For instance, when discussing a case during staffing or a case presentation, the clinician could follow the DICE-PM Model to guide what information is covered ensuring that an equal amount of data is shared for each variable. The DICE-PM Model can also be used as a guide for the background information section of an assessment report. In the “Test Results” section, strengths and weaknesses from each test can be highlighted, and supplemental positive psychological instruments (see Table 2) can be used to ensure an equal focus on strengths. In the “Summary” section, an equal amount of space can again be dedicated to strengths and weaknesses. In addition, clinicians are advised to follow the “Summary” section with Balanced Diagnostic Impressions (DICE-PM). Finally, recommendations should also stem from clients’ strengths/resources and weaknesses/deficits. The Comprehensive Model of Positive Psychological Assessment Report Template (CMPPART) is provided to guide the format of a balanced written report (see Appendix C).

Summary

This article provides an integrated review of positive psychological assessment, conceptualization methods, and tools available to practitioners within the framework of the CMPPA. Cultural considerations and recommendations stemming from the Culturally Appropriate Assessment Model (Flores & Obasi, 2003) were incorporated into the Practice Model of Positive Psychological Assessment (Lopez et al., 2003) to enhance its applicability. Furthermore, additional recommendations grounded in the positive psychological literature were provided to guide and enhance the implementation of this model at various stages of positive psychological assessment. In addition, specific tools were provided to fill the gaps within positive psychological assessment and guide clinicians in the formulation of a balanced assessment, including the CMPPAI-A, CMPPAI-C/A, CMPPASCI, CMPPART, and a new diagnostic approach—the DICE-PM Model. It is our hope that these practices and resources can be implemented more readily than traditional deficit-based approaches and help advance some of the core goals of counseling psychology and positive psychology—promoting optimal functioning and identifying and nurturing strengths for all individuals (Gelso et al., 2014; Seligman & Csikszentmihalyi, 2000).

Footnotes

Appendix A

Appendix B

Appendix C

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Rhea L. Owens is an assistant professor of psychology at the University of Wisconsin–Stevens Point. Her research interests include strength identification and development, positive child development, and clinical applications of positive psychology. She is the Chair of the Division 17 Positive Psychology Section.

Jeana L. Magyar-Moe is a Katz Distinguished Professor of Psychology at the University of Wisconsin–Stevens Point, and a practicing licensed psychologist. She specializes in positive psychology and social justice issues within counseling, teaching, training, and scholarship contexts. She is a Past-Chair of the Division 17 Positive Psychology Section.

Shane J. Lopez is a Gallup Senior Scientist and Research Director of the Clifton Strengths Institute. He researches the links between hope, strength development, academic success, and overall well-being. He is the developer and first Chair of the Division 17 Positive Psychology Section.

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