Handbook of Positive Psychology Phần 9 potx

The clinical child, school, and pediatric psychology litera-tures frequently address concepts of stress and coping, generally accepting that coping is a pos-itive response to the stress

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Positive Psychology for Children

Development, Prevention, and Promotion

Michael C Roberts, Keri J Brown, Rebecca J Johnson, &

Janette Reinke

You have brains in your head

You have feet in your shoes

You can steer yourself

Any direction you choose.

—Dr Seuss

Although the specialties of psychology

deal-ing with children recognize the serious

prob-lems encountered during their development,

much of the recent orientation involves moving

away from viewing the psychological and

be-havioral deﬁcits resulting from a developmental

challenge Instead, the focus increasingly has

become one of perceiving the competence of the

child and his or her family and enhancing

growth in psychological domains The clinical

child, school, and pediatric psychology

litera-tures frequently address concepts of stress and

coping, generally accepting that coping is a

pos-itive response to the stress of a negative

envi-ronmental situation or life event such as a

chronic illness or parental divorce

As noted by Siegel (1992),

“individual-differences factors can inﬂuence both a child’s

response to stress and his or her use of copingstrategies” (p 4) He called for increased atten-tion to the individual differences in children’sbehavioral, emotional, and physiological re-sponsiveness to their environment Siegel indi-cated that each child may respond quite dif-ferently to an environmental stressor Animportant aspect of coping is that the samemechanisms of responding to stress are involved

in life events that are not as signiﬁcant as vorce or disease but are the daily hassles of hu-man existence For example, in pediatric psy-chology, several resilience and coping modelshave emerged to frame issues of children whohave a chronic illness such as diabetes, cysticﬁbrosis, or sickle-cell disease In much of theearlier literature and still to some extent today,coping or resilience concepts are thought ofonly as responses to a stressor, usually a majorone, not as a positive behavioral style of ad-justing, adapting, accommodating, and assimi-lating to an ever-changing environment in achild’s life In a positive psychology orientation,however, a comprehensive and inclusive concep-tualization of coping views these adaptations as

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di-664 P A R T I X S P E C I A L P O P U L A T I O N S A N D S E T T I N G S

normal developmental events with much

com-mon origin and function Additionally, there is

an increasing recognition that growth and

en-hancement to achieve physical and

psychologi-cal well-being occur through these adaptations

Others have noted the need, particularly

working with adolescents, to examine the

strengths and positive assets of the

develop-mental stage rather than focusing on the

mul-titude of stressors and potential negative

out-comes (Johnson, Roberts, & Worell, 1999)

Johnson and Roberts (1999) recognized that

“looking at strengths rather than deﬁcits,

op-portunities rather than risks, assets rather than

liabilities is slowly becoming an increasing

pres-ence in the psychotherapy, education, and

par-enting literature” (p 5) Similarly, Dryfoos

(1998) reviewed the programs aimed at assisting

adolescents and concluded that successful ones

emphasized optimism and hope and were

growth-enhancing for the adolescents and their

families

All too often, a “pathology model” has been

applied to studying how children develop That

is, children with signiﬁcant behavior disorders

pose major problems for parents, teachers, and

peers, such that their pathology gets the

greatest attention More recent

conceptualiza-tions have focused attention on more “normal”

development for most children, but also to

con-sidering how pathology might be avoided

through early intervention and enhanced

envi-ronments for all children Frequently the focus

has been on taking children with problems and

doing something to change them Positive

psy-chology has something to offer this process, but

a larger application of positive psychology

would be to view it in terms of prevention and

promotion Additionally, the pathology model

typically takes an adult-oriented perspective By

assuming that the goal of all human

develop-ment and any intervention is intended to

pro-duce a fully functioning adult, only adult

out-comes are considered important The positive

psychology alternative is to focus on the child

while a child is in development and attempt to

enhance functioning, competence, and overall

mental health at any particular time

Further-more, psychological conceptualizations of

pa-thology have historically been formulated for

adults and then, in a downward extension,

applied to children and adolescents (Maddux,

Roberts, Sledden, & Wright, 1986) This

ap-plication, all too frequently, does not ﬁt

Adult-oriented theories and intervention techniques

“have never sufﬁced in other areas of mentalhealth intervention work with children re-quires a developmental perspective which rec-ognizes the process of continual change overtime in the psychology of children” (Roberts

& Peterson, 1984, p 3) In our view, formulated positive psychology literature takes

well-a developmentwell-al perspective

In this chapter, we will describe the three jor conceptualizations of optimism, hope, andquality of life as related to positive psychologyfor children and adolescents This examination

ma-of the extant literature is descriptive and notexhaustive, but it does illustrate the potentialutility of positive psychology in child develop-ment In the ﬁnal section, we propose that in-tegrating a positive psychology orientation with

a developmental perspective creates a catalystfor prevention

as temporary, conﬁned to a particular case, andnot his or her direct fault (Seligman, 1991) Apessimist, on the other hand, believes badevents will last a long time and undermineeverything he or she does, and that these eventswere his or her fault Thus, the way that a per-son explains positive or negative events to him

or herself determines whether he or she is timistic or pessimistic This explanatory style isevident in how an individual thinks about thecauses of events A pessimist dwells on the mostcatastrophic causes for the event, whereas anoptimist can see that there are other possible,less catastrophic causes for the same event Forexample, two children may receive poor grades

op-on a test The pessimistic child might say tohimself, “I’m stupid and can’t get anythingright,” whereas the optimistic child might say

to herself “I need to study a little harder nexttime.” In summary, Seligman stated that theway in which a person explains events has threedimensions: permanent versus temporary, uni-versal versus speciﬁc, and internal versus exter-nal These dimensions determine whether aperson is pessimistic or optimistic This explan-atory style can be acquired by children and

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C H A P T E R 4 8 P O S I T I V E P S Y C H O L O G Y F O R C H I L D R E N 665

adults and has been labeled learned optimism.

Seligman and his colleagues have studied the

concept of learned optimism with children as

well as adults

Considerable research has been conducted on

the beneﬁts of optimism and the costs of

pes-simism Optimists tend to do better in school

and college than pessimists Optimists also

per-form well at work and in sports The physical

and mental health of optimists tends to be

bet-ter, and optimists may even live longer than

pessimists (Seligman, 1991) Optimists also

tend to cope with adverse situations in more

adaptive ways (Scheier & Carver, 1993)

Ado-lescents who are optimistic tend to be less angry

(Puskar, Sereika, Lamb, Tusaie-Mumford, &

McGuiness, 1999) and abuse substances less

of-ten (Carvajal, Clair, Nash, & Evans, 1998)

Con-versely, pessimists tend to give up more easily,

get depressed more often, have poorer health,

be more passive (Seligman, 1991), have more

failure in work and school, and have more social

problems (Peterson, 2000)

Seligman, Reivich, Jaycox, and Gillham

(1995) described four sources for the origins of

optimism The ﬁrst possible source is genetics

(Schulman, Keith, & Seligman, 1993; Seligman

et al., 1995) A second source is the child’s

en-vironment, in which parents seem to be a strong

inﬂuence on the level of optimism in their

chil-dren Researchers have found that there is a

strong relationship between a mother’s

explan-atory style and that of her child (Seligman et

al., 1995) Children may imitate parents’

ex-planatory style A third source for optimism is

also an environmental inﬂuence, in the form of

criticism that a child receives from parents,

teachers, coaches, or other adults If an adult

criticizes a rather permanent ability of a child

(e.g., “You just can’t learn this”), the child is

more likely to develop a pessimistic explanatory

style A fourth way in which optimism develops

is through life experiences that promote either

mastery or helplessness Life events such as

di-vorce, death in the family, or abuse can affect

how a child describes causes to him- or herself

Events such as these tend to be permanent, and

many times the child is unable to stop or

re-verse the event

In light of all the beneﬁts of being optimistic

and the costs of being pessimistic, is it best for

a child to be optimistic all the time? Seligman

and other researchers have not advocated that

parents mold their children to be the more

ex-treme “Pollyanna.” Instead, Seligman et al

(1995) noted that there are limits to optimism.Children must see themselves in a realistic light

in order for them to successfully challenge theirautomatic negative thoughts Teaching children

to be realistic helps them perceive the nings of negative self-attribution (e.g., “Iﬂunked the test because I am stupid”) and chal-lenge that thought, and also to see where theymight be able to overcome a fault (e.g., “Iﬂunked the test because I didn’t study enough.Next time I’ll study harder”) Disputing auto-matic thoughts only works when the thoughtscan be checked against reality

begin-MeasurementOne assessment tool for measuring optimism inchildren is the Children’s Attributional StyleQuestionnaire (CASQ; Seligman et al., 1995).This instrument is a 48-item forced-choicequestionnaire that assesses explanatory style forboth positive and negative hypothetical events.The questions measure whether the child’s at-tributions about positive or negative events arestable or unstable, global or speciﬁc, and inter-nal or external Example items include: “Youget good grades: (A) School work is simple; or(B) I am a hard worker.” The CASQ gives anoverall picture of the child’s explanatory styleand whether that style is positive or negative

The book The Optimistic Child (1995), by

Se-ligman et al., contains an in-depth description

of the CASQ, including administration, scoring,and interpretation The Life Orientation Test(Scheier & Carver, 1985) is a measure developedfor assessing optimism of adults and has beenused with adolescents (e.g., Carvajal et al., 1998;Puskar et al., 1999)

InterventionsThe Penn Prevention Program is an inter-vention-oriented research project that has in-vestigated the costs of pessimism in children(Jaycox, Reivich, Gillham, & Seligman, 1994;Gillham, Reivich, Jaycox, & Seligman, 1995).The goal of this program has been to preventdepressive symptoms in children at risk for thispathology using a treatment that addresses thechild’s explanatory style and social-problem-solving skills The children in the preventiongroup were taught to identify negative beliefs,

to evaluate those beliefs by examining evidencefor and against them, and to generate more re-alistic alternatives They were also taught to

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identify pessimistic explanations for events and

to generate alternative explanations that were

more optimistic These children also learned

so-cial problem solving, as well as ways to cope

with parental conﬂict, and behavioral techniques

to enhance negotiations, assertiveness, and

re-laxation The results of this project are

encour-aging The researchers found that the children

who were in the prevention condition had half

the rate of depression as the control group

Im-mediately after the prevention program, the

control group had more depressed symptoms

than the treated group Also of considerable

in-terest is the ﬁnding that the beneﬁts of the

pro-gram seemed to maintain over time Children

who completed the prevention program in

pre-adolescence were able to deal with the

chal-lenges they faced in adolescence more

effec-tively and had less depression than children in

the control group This study demonstrates the

importance of teaching children the skills of

learned optimism before they reach puberty,

but late enough in childhood for them to

un-derstand the concepts

The study of optimism in children is fairly

new, and many areas have yet to be researched

Results thus far seem to indicate that optimism

can be taught, and learned optimism can be

helpful in alleviating and even preventing some

of the problems of childhood and adolescence

Optimism may be a very valuable tool that

chil-dren can use to negotiate the challenges and

ad-versity they are sure to face

Hope

Deﬁnition and Concept

Snyder and his colleagues have deﬁned hope as

a cognitive set involving an individual’s beliefs

in his or her capability to produce workable

routes to goals (waypower or pathways) and

be-liefs in his or her own ability to initiate and

sustain movement toward those goals

(will-power or agency; Snyder, 1994; Snyder et al.,

1991; Snyder, Hoza, et al., 1997) With this

def-inition they have suggested that hope is an

important construct in understanding how

chil-dren deal with stressors in their lives, avoid

be-coming mired down in problem behaviors, and

use past experiences to develop strategies for

working toward goals in an adaptive, effective

manner

Hope is not correlated with intelligence, andSnyder, Hoza, et al (1997) have proposed thatmost children have the intellectual capacity touse hopeful, goal-directed thinking Children’shope does appear to moderately predict cogni-tive and school-related achievement Boys andgirls have similar levels of hope Children tend

to be biased somewhat positively in their ceptions of the future, although it has been ar-gued that this is typical and rather adaptive(Snyder, Hoza, et al., 1997) This bias may beappropriate to help children develop and sustainpositive outcome thoughts even if they are re-alistically untenable, because it appears thathigh-hope children do this as they successfullydeal with stressful events in childhood The re-search thus far indicates that, for most children,hope is relatively high, and that even childrenwith comparatively low hope rarely indicatethat they have no hope, and they tend to havehope in at least some of their thoughts (Snyder,McDermott, Cook, & Rapoff, 1997) Measures

per-of children’s hope correlate positively with reported competency, and children with higherlevels of hope report feeling more positivelyabout themselves and less depressed than chil-dren with lower levels of hope Snyder, Feld-man, Taylor, Schroeder, and Adams (2000)present some experimental evidence to supportthe idea that self-esteem results from the de-velopment of hope (through identiﬁcation ofgoals and pathways)

self-Measurement

A measure of children’s hope, the Children’sHope Scale (CHS), was developed by Snyder,Hoza, et al (1997) The guiding assumption be-hind the development of the CHS and subse-quent versions of the scale (Snyder, Hoza, et al.,1997) was that the acquisition and usage ofgoal-directed thinking are critical for effectivefunctioning in children and adolescents.Therefore, the purpose of the measure is toidentify children who need nurturance and ed-ucation in order to improve their hopeful think-ing, especially during times of illness and stress(Snyder, McDermott, et al., 1997) The scalealso identiﬁes children who exhibit hope at highlevels and who can serve as models for otherchildren Several versions of the CHS have beendesigned for different age-groups and for dif-ferent purposes These versions include theYoung Children’s Hope Scale (YCHS) Story

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Form (aged 5–8 years); the Young Children’s

Hope Scale (YCHS) Self-Report Form (aged 5–

9 years); the Young Children’s Hope Scale

(YCHS) Observer Rating Form (for teachers,

parents, and other adults), the Children’s Hope

Scale (CHS) Self-Report Form (aged 9–16

years); and the Children’s Hope Scale (CHS)

Observer Rating Form Adolescents aged 16 and

over can complete the Trait Hope Scale or the

State Hope Scale, which have been designed for

adults and also come with observer rating

forms

Data collected during the development of the

original Children’s Hope Scale indicate that the

CHS demonstrates high test-retest reliability

for intervals up to 1 month (Snyder, Hoza, et

al., 1997) Research with the hope scales for

children has shown that the agency (willpower)

and pathways (waypower) subscales tend to

cor-relate 50 to 70 Snyder, McDermott, et al

(1997) have labeled four different patterns of

scores that tend to describe children’s hope

based on the combination of their agency and

pathways subscores: small hope (low agency

and low pathways), half hope (one low and one

high), and high or large hope (high agency and

high pathways) It has been suggested that

in-terventions may be tailored to address either

low agency or low pathways, or both, but

re-search has not addressed this possibility

(Sny-der, McDermott, et al., 1997)

Increasingly more research has explored hope

in children In particular, hope has been

intro-duced as a useful concept to examine in pediatric

populations, because children who are seriously

ill or injured are often required to cope with or

adjust to difﬁcult conditions In this section, we

will examine the handful of studies that have

investigated hope in children

In the ﬁrst study, Lewis and Kliewer (1996)

investigated the role that coping strategies play

in the relationship between hope and

adjust-ment in a group of children with sickle-cell

dis-ease (SCD) Results revealed that hope was

neg-atively related to anxiety, but that coping

strategies moderated this relationship

Speciﬁ-cally, hope was negatively related to anxiety

when active support and distraction coping

strategies were high In other words, children

with SCD who had high levels of hope and who

reported using primarily active, support, and

distraction coping strategies reported less

anxi-ety Hope did not appear to be associated with

a reduction in anxiety by affecting coping

ef-forts Hope and coping were related to anxietybut did not make unique contributions to func-tional adjustment or depression once controlvariables were considered The authors con-cluded that knowing both a child’s level of hopeand the types of coping behaviors he or she isusing may be important for understanding var-iations in psychological adjustment, especiallywhen talking about a disorder like SCD, wherestress and anxiety can exacerbate physical con-ditions

In the second study, Barnum, Snyder, Rapoff,Mani, and Thompson (1998) hypothesized thathigh-hope thinking may serve a protectivefunction, allowing children to function effec-tively in spite of obstacles and challenges intheir lives They examined predictors of adjust-ment in adolescents who suffered burns as chil-dren and their matched controls Variables thatwere selected as possible predictors of adjust-ment included social support, family environ-ment, burn characteristics, demographics, andhope There were few differences between theburn survivors and the comparison group Forboth groups, hope was the only signiﬁcant pre-dictor of externalizing behavior problem scores:Higher hope scores predicted lower externaliz-ing behavior scores In addition, social supportand hope both signiﬁcantly contributed to theprediction of global self-worth Barnum et al.suggested that adolescents who report higherlevels of hope may think in ways that generatepositive solutions, and they may feel more ca-pable of enacting a variety of behaviors to solveproblems, possibly reducing the need to act out

in problematic ways

In a third study using the CHS, Nelson, Roberts, and Snyder (1996) gatheredinformation from junior high students attend-ing a school in close proximity to a high crimearea in order to explore the relationship be-tween stressful life experiences, hope, and per-ceived vulnerability In addition to measuringthe children’s hope, they also measured thechildren’s exposure to violence and their per-ceptions of their vulnerability to victimization.Hinton-Nelson et al hypothesized that childrenwho had been exposed to violence would havelower levels of hope, but this was not the case.The children in this study reported levels ofhope similar to that of other groups Adoles-cents who had witnessed violence around thembut had less personal or direct experience withviolence reported the highest levels of hope, and

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Hinton-668 P A R T I X S P E C I A L P O P U L A T I O N S A N D S E T T I N G S

adolescents with higher hope perceived that

they would be less likely to die a violent death

Adolescents with direct exposure to violence

tended to predict violent deaths for themselves

The authors concluded that, while these young

people acknowledged the violence surrounding

them, they were able to sustain high hope as

long as they did not experience violence

di-rectly

Intervention

A few preliminary projects are being reported

in which an intervention has been designed to

inﬂuence children’s hope Snyder, McDermott,

et al (1997) proposed that hopeful stories are

important for constructing and maintaining a

sense of hope in children They viewed hopeful

stories as reﬂections of past experiences and

ar-gued that these stories are used to guide future

action McDermott et al (1996; and described in

McDermott & Hastings, 2000) discussed a

pro-gram in which schoolchildren (grades 1–6) were

read stories of high-hope children, and

class-room discussions addressed how these children

might incorporate hope into their own lives

Modest positive changes were found on

mea-sures of hope These authors noted that a more

comprehensive inclusion of teaching hope in the

classroom might have greater effect Lopez

(2000) conducted another pilot project in a

jun-ior high school in which hopeful stories (e.g.,

from a Harry Potter book) were read Children

were engaged in structured exercises,

goal-oriented discussions, and the assignment of a

“Hope Buddy” to discuss goals, pathways to

achieve goals, and ways to navigate around

bar-riers Future research needs to examine the

use-fulness of hope-ﬁlled curriculum as an

inter-vention technique

Other projects have examined whether

psy-chosocial interventions are associated with

chil-dren’s hope (but where hope was not the prime

target of the intervention) McNeal (1998)

con-ducted a study of children and adolescents’ hope

before and after they had been in psychological

treatment in a residential setting over 6 months

He found that signiﬁcantly higher levels of

hope were developed over that period In

an-other study of hope with children in an

inter-vention program, Brown and Roberts (2000)

as-sessed hope in children who were participants

in a summer day camp after being identiﬁed as

being at risk for a number of psychosocial

prob-lems In the 6-week camp, the children were

given intensive training in dance and ing arts They also participated in group ses-sions on a variety of psychosocial issues related

perform-to their life experiences During the day camp,the participants wrote essays answering ques-tions similar to those proposed by Snyder,McDermott et al (1997) The results during thecamp and afterward indicated that hope scoresincreased signiﬁcantly as a result of the 6-weekexperience Mean hope scores remained elevatedand stable at a 4-month follow-up The studycould not isolate what contributed to the hopechanges, so the comprehensive camp experience

as a whole may be viewed as an intervention.These types of intervention can indicate the vi-ability of hope as a dependent measure indicat-ing change as a result Most important, thesestudies into children’s hope demonstrate thathope in children is an essential element of de-velopment

Quality of Life

Deﬁnition and ConceptThe concept of quality of life (QOL) takes amultidimensional view of well-being and in-cludes physical, mental, spiritual, and social as-pects (Institute for the Future, 2000) However,QOL has not been well deﬁned or consistentlyutilized in the literature Other terms, such as

psychological well-being or adjustment are also

used to represent constructs similar to QOL.Walker and Rosser (1988) deﬁned QOL as “aconcept encompassing a broad range of physicaland psychological characteristics and limitationswhich describes an individual’s ability to func-tion and derive satisfaction from doing so”(p xv) One QOL measure for pediatric cancerpatients includes ﬁve domains: disease andtreatment-related symptoms, physical function-ing, social functioning, cognitive functioning,and psychological functioning (Varni, Seid, &Rode, 1999)

In addition to exploring QOL as a generalconcept, research has examined health-relatedquality of life (e.g., determination of whethernew and invasive treatments to increase chances

of survival are worthwhile given the deleteriousnature of the treatment side effects) Health-related QOL reﬂects an individual’s personalperceptions of his or her own well-being Forexample, a child with asthma may successfullypass a pulmonary function test but may have

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fears of an attack and thus limit the physical

activities he or she is willing to try Those

in-terested in the delegation of limited health

re-sources also have recognized the utility of

mea-suring health-related QOL Meamea-suring QOL in

the medical setting may assist health

profes-sionals in demonstrating to third-party payers

the effectiveness of particular interventions

In addition to measuring QOL in health

sit-uations, QOL measures are used to assess

im-pact of health-related diseases and procedures

on one’s daily life However, one of the most

frequently noted concerns is that the various

QOL measures lack theoretical foundations

Much of the philosophy behind the

measure-ment of health-related QOL has been based on

the notion that the medical treatment itself is

the primary determinant of a patient’s QOL

Varni (1983) suggested that this biomedical

model does not encompass all aspects of a

pe-diatric patient’s life or situation that might

af-fect his or her perceptions of QOL Varni

pro-posed that, in addition to the traditional

biomedical model, a biobehavioral

conceptuali-zation should guide assessment In this model,

a patient’s problem-solving skills and ongoing

level of symptom control are important Kaplan,

Sallis, and Patterson (1993) proposed a

biopsy-chosocial model that emphasizes the important

roles of social, psychological, and biological

fac-tors in the conceptualization of health-related

QOL To date, conceptualization and

measure-ment of health-related QOL in children has

lagged behind that of adults (Spieth & Harris,

1996)

Measurement

QOL measures were developed for adults, so

many of the measures cover domains not

ap-plicable to children (e.g., economic

indepen-dence, infertility) or base the psychometrics on

adult responses Thus, there is little information

regarding the validity or reliability of these

measures for use with children When assessing

a child’s QOL, age and development should be

considered In addition, there is a lack of

con-sensus in the literature regarding who is the

best informant of a child’s health-related QOL

Early measures did not take into account a

child’s perceptions, for example Instead,

par-ents, teachers, nurses, and doctors provided

sub-jective information to deﬁne children’s QOL

While some studies have suggested that proxy

informants are similar to a child’s own

percep-tions of his or her QOL, the majority of theresearch provides limited evidence for concor-dance between respondents (Vogels et al., 1998).Additionally, considerable difference in ob-server ratings provided by parents and teachersand the children’s own self-ratings of health at-titudes and behaviors has been reported (Pantell

& Lewis, 1987)

Using parents to rate QOL is a widely mented strategy in the literature, yet parentsmay not report all important aspects of theirchildren’s well-being For example, parents ofadolescents might underestimate the importantrole of peers Health personnel also may serve

imple-as reporters for a child’s QOL One advantage

of hospital staff is that these individuals can useother patients as points of reference However,they may have limited knowledge regarding thechild’s functioning in other arenas of life, such

as at home, in school, or with peers In addition,they may overemphasize the importance of pos-itive health outcomes versus social, psycholog-ical, or spiritual outcomes

Guyatt and colleagues (1997) suggested thatinformation should be obtained regarding per-ceived QOL from the children themselves Al-though age-appropriate modifications are nec-essary, self-report QOL information can bereliably obtained from children as young as 7(Feeny, Juniper, Ferry, Griffith, & Guyatt,1998) Guyatt et al noted that younger childrenhave difficulty recalling events that occurredmore than a week earlier In addition, theyfound that the feeling thermometer, a measureoften used to assess children’s QOL, seemedmore difficult for children to understand thaninterview-administered questionnaires Theysuggested that feeling thermometers shouldonly be used with children at a reading level ofage 8 or grade 3

One frequently used measure assesses bothchild and parent perceptions of health-relatedQOL The Pediatric Cancer Quality of Life In-ventory (PCQL) contains two parallel forms de-signed to deﬁne health-related QOL in terms ofthe impact of the disease and treatment on thechild’s physical, social, psychological, and cog-nitive functioning and disease or treatment-related symptoms as perceived by parent andchild patient (Varni et al., 1998) In addition toissues of who is the best informant, a clinicianmust decide between general and disease-speciﬁc QOL measures General measures ofQOL can be used in many other instances aswell, such as for children with low-incidence

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childhood diseases Additionally, these general

measures allow for cross-condition

compari-sons These measures include the Child Health

and Illness Proﬁle—Adolescent Edition

(Star-ﬁeld et al., 1995); Child Health Questionnaire

(Landgraf, Abetz, & Ware, 1996); Functional

Status II-R (Stein & Jessop, 1990); and Play

Performance Scale for Children (Mulhern,

Fair-cough, Friedman, & Leigh, 1990)

Disease-speciﬁc measures of QOL may be

more sensitive in determining the differential

effects of treatments within one illness domain

Consequently, different QOL measures have

been developed for use with various childhood

conditions including pediatric cancer (Varni et

al., 1998), diabetes (Diabetes Control and

Com-plications Trial Research Group, 1988), asthma

(Mishoe et al., 1998; Townsend et al., 1991), and

children born with limb deﬁciencies (Pruitt,

Seid, Varni, & Setoguchi, 1999) These

mea-sures demonstrate some utility in detecting

changes in patients whose health status has

changed due to ﬂuctuations of their disease or

as a result of treatment In the case of children’s

asthma, a multidisciplinary team assesses QOL

in the domains of symptomatology, activity

limitations, and emotional functioning

(Town-send et al., 1991) The QOL measure for

dia-betes assesses disease impact as well as school

life and relationships with peers (Ingersoll &

Marrero, 1991) Most of the better measures

ap-pear to use this multidimensional approach to

assess not only physical symptoms but also

health status, psychological and adaptive

func-tioning, and family functioning

Interventions

One purpose of studies examining QOL is to

add clinical relevance to the results of outcome

studies following medical or psychological

in-terventions Drotar and colleagues (1998)

sug-gested that the use of health-related QOL

mea-sures could aid in the identiﬁcation of children

with chronic illness who may need additional

psychological assessment and intervention The

use of these measures early in the initial

iden-tiﬁcation of an illness may help improve

par-ents’ ability to report information regarding

their child’s mental and physical health earlier

and more thoroughly For example, for children

diagnosed with cancer, Boggs and Durning

(1998) reported using the Pediatric Oncology

Quality of Life Scale as a screening measure to

determine which children would be most likely

to beneﬁt from psychological services Anotherpurpose of QOL studies is to identify the chil-dren who are experiencing health problems whoare less likely to adhere to a treatment protocol(Drotar et al., 1998) For some children, the sideeffects of a treatment regimen may be seen asvery aversive and may affect QOL Informationcollected through the use of QOL measuresmay lead to additional support or interventionfor the child Psychosocial interventions de-signed to improve the adjustment and function-ing of children undergoing medical treatmentmay also impact reported QOL

Related Concepts of Positive Psychology

There are several psychological concepts related

to positive psychology in children in addition tothe concepts reviewed here The movement inpediatric psychology away from an exclusive fo-cus on children’s deficits or pathology to a moreaffirming and strength-building approach ex-emplifies a positive psychology orientation(whether acknowledged or not) Clinicians andresearchers are increasingly focused on enhanc-ing and facilitating children’s developmentwhatever the setting or circumstances In thepsychosocial care of children with cancer, Nolland Kazak (1997) emphasized that while diag-nosis and treatment “can be overwhelming,they can be managed in positive ways that en-courage families to continue to function in thebest possible fashion and facilitate personalgrowth” (p 263) They recommended that inorder to promote positive adaptations, certainpsychologically directed actions can be taken byprofessionals, parents, and children themselves.Other aspects related to enhancing the psycho-social growth of children in medical settings in-volve making changes in the hospital architec-ture that welcome and support children andfamilies, training staff to recognize and facilitatechildren’s needs and development at all times,and following medical procedures that allowchildren appropriate input and control regardingwhat is done to them (Johnson, Jeppson, & Red-burn, 1992)

Similarly, schools can be envisioned as tings where children can experience empower-ment and enhanced development rather thanplaces where the focus is on stresses and chal-lenges (Donnelly, 1997; Schorr, 1997) For ex-ample, Spivack and Shure have developed and

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set-C H A P T E R 4 8 P O S I T I V E P S Y set-C H O L O G Y F O R set-C H I L D R E N 671

tested a model of teaching children and teachers

to use interpersonal cognitive problem-solving

skills in interactions (Shure, 1996) These skills

enhance positive growth and development

with-out focusing on any of a child’s deﬁciencies

Social support is also viewed as a potential

element of positive psychology for children

fac-ing the challenges of stressful events as well as

coping and adjusting in everyday living

Quitt-ner (1992) noted that the accepted deﬁnition of

social support includes several aspects such as

“provision of direct assistance, information,

emotional concern, and afﬁrmation” (p 87)

So-cial support has not been fully conceptualized

within a positive psychology framework but

re-lates to it very well

Faith is another aspect of positive psychology

that has not been given signiﬁcant attention As

noted by health researchers, “Spiritual factors

promote good health and contribute to the

state of wellness that characterizes health”

(In-stitute for the Future, 2000, p 190) Additional

consideration of faith and religion in the lives

of children and adolescents may be an important

aspect of positive psychology research

Developmental Perspective

Because positive psychology is a newly

devel-oping ﬁeld of research and application, there

re-main a large number of issues for children and

adolescents that deserve greater attention

Al-though it is encouraging to have any research,

the relative lack of empirical studies to review

in this chapter indicates that there is much to

be done We strongly urge that positive

psy-chology theorists and researchers consider a

de-velopmental perspective rather than focusing

only on adults (and children as “smaller

hu-mans”) or give minimal attention to

develop-ment by considering childhood only as a period

preceding adulthood Maddux et al (1986)

sug-gested that two elements are important to a

de-velopmental approach The ﬁrst is a future

ori-entation in which any effort at intervention or

change is considered important because of its

relationship to improving future health status

(i.e., in adulthood) The second, and perhaps

most neglected, element in a developmental

per-spective requires that “each period of life receive

attention to the particular problems evident in

that period” (p 25) Thus, there should be a

fo-cus on the health status of children while they

are children rather than recognizing children’s

importance only because the children will come adults in the future We think both ele-ments are important in the positive psychologymovement, but we want to emphasize the latterpoint The uniqueness of children’s develop-ment needs to be recognized in all theories,measurements, and application of positive psy-chology concepts

be-Prevention and Promotion

Interlinked with the developmental perspective

is a view that childhood may be the optimaltime to promote healthy attitudes, behavior, ad-justment, and prevention of problems (Roberts

& Peterson, 1984) Roberts (1991) stated, vention is basically taking action to avoid de-velopment of a problem and/or identify prob-lems early enough in their development tominimize potential negative outcomes Healthpromotion refers to increasing individuals’ abil-ities to adopt health-enhancing life styles”(p 95) Prevention and promotion efforts inchildhood attempt to improve the quality of life

“Pre-for the child during childhood and “Pre-for that child’s later adulthood As noted by Peterson

and Roberts (1986), prevention efforts oftentake a developmental perspective and focus oncompetency enhancement that “is likely to bemost effective when applied during the time ofgreatest competency acquisition, which is dur-ing childhood for many skills such as language,social abilities, or self-efﬁcacy beliefs” (p 623).Such enhancement of positive psychologythinking, such as encouraging hope, would sim-ilarly be most effective at these early stages ofhuman development

Future Research Directions

Studies of the positive psychology topics of hopeand optimism, as examples, have typically util-ized cross-sectional designs Longitudinal mod-els would elucidate the sequence of developmentand what inﬂuences change over time Interven-tions and evaluations of programs to promotehope or optimism are also prime areas for fur-ther work Interventions may enhance the posi-tive frames for all children or for those withspecial stresses In the latter case, applicationsmay be necessary with children who have achronic illness or with those experiencing psy-chological problems or disruptive life events,

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such as divorce, death, or relocation Most

im-portant, because positive psychology seems

in-herently linked to preventive efforts to improve

children’s lives, these concepts need to be

inte-grated into prevention theory and programming

Behavioral measures of positive psychology

con-cepts, such as hope, need to be developed and

in-tegrated into the theories These behaviors can

then be used as afﬁrmative outcome measures in

prevention and intervention programs

More research needs to be done with children

with regard to happiness and positive

well-being So far, outcome measures in the study of

optimism in children assess whether negative

states are present or absent Instruments need

to be developed that also measure the positive

aspects that children possess, like happiness,

in-stead of just the absence of any negatives

An-other area for future research is in pediatric

psychology Does enhancing hope and teaching

children with a chronic illness the skills of

learned optimism improve the course of their

illness or the quality of their lives? Does a

pos-itive psychology approach help the family to

cope with the child’s illness?

Research is needed to determine more

pre-cisely when hope becomes a stable personality

trait and whether hope is stable during

child-hood and adolescence Additional research

should determine what types of experiences are

related to high or low hope, and under what

circumstances children’s levels of hope may be

malleable to negative or positive circumstances

Further research may explore what types of

in-terventions may help children to increase their

level of hope or optimism McNeal (1998) and

Brown and Roberts (2000) found evidence

sug-gesting that children and adolescents reported

higher levels of hope after psychosocial

inter-ventions (but these interinter-ventions were not

di-rectly attempting to affect the children’s hope)

Pilot projects by Lopez (2000) and McDermott

et al (1996) are promising investigations

di-rectly targeting changes in children’s hope

Whether such changes in hope subsequently

af-fect other signiﬁcant outcomes in children will

be important to measure As suggested by

Sny-der et al (2000), ensuring that children have

“hope coaches” early and consistently in their

lives seems important to the development of

hope Books for parents and other caregivers

that teach hope coaching skills, such as

Mc-Dermott and Snyder, The Great Big Book of

Hope (2000), should be empirically evaluated to

assess their effectiveness

Research is needed to examine whether othertypes of psychotherapy or psychosocial inter-ventions might affect children’s levels of hope

or learned optimism (or whether these variablespredict the inﬂuence of the psychological/be-havioral interventions) Finally, future researchneeds to address the relationship between hope,coping, and adjustment Studies need to exam-ine whether preexisting levels of hope may in-ﬂuence the impact of life events on children’sadjustment

In their study of the effects of violence onhope, Hinton-Nelson et al (1996) suggestedthat future research should investigate whetherhope and perceptions of the future differentiatethose young people who commit violent actsfrom those who do not They also suggestedthat future research examine the relationshipbetween hope and resiliency

Quality-of-life issues are important when one

is considering a multidimensional view of how

a child (or adult) perceives the world and his orher functioning within it Further refinement ofthe conceptual bases and measurement tools isclearly needed Measurement of QOL in itsgeneral and situation-specific forms will aid inthe conceptualization of how children developtheir perspectives on their lives, what they de-fine as important, and how they rate what theyvalue In its development the QOL concept de-rived from a deficit view, for example, negativelife events diminish QOL In newer conceptu-alizations, measuring QOL perceptions in chil-dren and adolescents may provide evidence ofthe positive effects of even negative life events(Cohen & Park, 1992) Thus, future researchshould also examine the adaptive and resiliencyfeatures in a child that may lead to greater sat-isfaction and enhanced or increased QOL.The many benefits of a positive psychologyorientation with children have been hinted at bythe research thus far The full contribution will

be demonstrated through a better ing of children’s development and more effec-tive interventions that also address prevention,treatment of problems, and the promotion ofwell-being

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Getting old is something most people dread

be-cause they believe it portends the loss of

func-tional capacities and the enjoyable aspects of

life But, as my grandfather often said in the

last years of his life, “Being old is better than

the only available alternative.” Thus, if we are

fortunate, we will age Our best option, then, is

to remain as vital as we can for as long as

pos-sible In the last two decades, there has been a

movement toward deﬁning and fostering

“suc-cessful aging” that, to judge by recent

profes-sional and popular press publications, has

lit-erally exploded

It is a credit to our society that we are more

concerned about old people than ever before On

the other hand, there never have been as many

old people about whom to be concerned An

even greater worry is that the number of older

Americans will increase dramatically in the next

10 years and beyond, as will their percentage of

the population Indeed, this demographic shift

is the most salient explanation for the

mush-rooming interest in gerontological science

History of Aging and Outlook for the Future

The population is “graying.”1Put simply, ple are living longer Life expectancy in 1900was 47 years; today, it is closer to 76 years.Over two thirds of people now live to at leastage 65 (a threefold increase from 1900) And thefastest growing segment of the population is inthe over age 85 category—4% in 1900 to over10% today (e.g., Rowe & Kahn, 1998; U.S De-partment of Health and Human Services[DHHS], 1992; Volz, 2000) Moreover, the ﬁrstwave of the 76 million baby boomers born be-tween 1946 and 1964 will approach traditionalretirement age in 2010 (Binstock, 1999) In 30years, there will be twice as many people 65years of age and older, and these oldsters willconstitute at least 20% of the total population(e.g., Hobbs, 1996) By 2050, the number ofcentenarians (those over age 100) in the UnitedStates may be as high as 4.2 million (Volz,2000)

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peo-C H A P T E R 4 9 A G I N G W E L L 677

Historically, attitudes about aging have been

fraught with mythical thinking, a

shortsight-edness we have yet to overcome To give a few

examples, old people are viewed as sick,

cogni-tively inept, isolated, a ﬁnancial drain on

soci-ety, and depressed by their circumstances (e.g.,

Center for the Advancement of Health [CAH],

1998; Palmore, 1990; Rowe & Kahn, 1998)

Tra-ditional attitudes and the projected increase in

elderly people within the next few years have

seduced scholars, commentators, and policy

makers into the doomsday philosophy that our

society is about to be overwhelmed by people

who are disabled, requiring constant care, and

not making worthwhile contributions With

fewer children per capita than previous

gener-ations, a major concern is that when the baby

boomers age into disability, there will be fewer

adult children available to provide care, creating

a demand for formal care that may severely (if

not impossibly) tax the rest of societal

re-sources

Are we, in fact, on the brink of geriatric

Ar-mageddon? As with any substantial

demo-graphic shift, there are problems to be

ad-dressed The central purpose of this chapter,

however, is to summarize evidence that

indi-cates things are not as grim as they might

ap-pear, and, indeed, that there are offsetting

par-allel, positive arguments to these catastrophic

predictions Many solutions revolve around

ac-tions that should be taken and, in some cases,

already are being taken at governmental and

so-cietal levels But I also argue that aging

individ-uals and their immediate social networks can

solve many problems without resorting to

pub-lic assistance The solution lies in changing their

behaviors so that they can continue to engage

in valued normal activities with each advancing

year First, however, we need to take a realistic

look at today’s elders and what future

genera-tions can expect as they age

Are Old People Sick People?

An important truth, albeit persistently denied

by much of the population, is that most adults

over age 65 are remarkably healthy Rates of

disability, even among the very old (i.e., those

over age 95), are steadily declining Only 5.2%

of older adults live in nursing homes and

sim-ilar facilities, a drop of 1.1% since 1982 (CAH,

1998) In 1994, 73% of adults 78 to 84 years of

age reported no disabling conditions, and among

the “oldest old” (i.e., those over age 85), fully

40% had no functional disabilities (Manton,Stallard, & Corder, 1995)

Along with increasingly widespread publicknowledge and acceptance of the behavioral as-pects of chronic illness, advances in medicaltechnology forecast an even rosier old age forbaby boomers and subsequent generations(DHHS, 1992) Although no solution is insight for the fact that, with age, physiologicalsystems slow down and become less efﬁcient(Birren & Birren, 1990), older adults are quiteskilled in making gradual lifestyle changes toaccommodate diminishing physical abilities(Williamson & Dooley, 2001) Through medi-cal and psychological research, we also knowthat “nature is remarkably forgiving” (CAH,1998) In other words, it is never too late to be-gin a healthful lifestyle For example, regard-less of age, duration of smoking, and magni-tude of tobacco consumption, after 5 years ofabstinence, ex-smokers have about the samerisk for heart disease as those who neversmoked The same is true for a variety of otherrisk factors, including obesity and a sedentarylifestyle

Are Old People Cognitively Deﬁcient?

As with physiological functions, in the mal” course of events, cognitive abilities slowdown with increasing age (Horn & Hofer, 1992;Schaie, 1996) The “use it or lose it” adageabout sexual functioning, however, applies tolearning and memory abilities as well Short oforganic disorders (e.g., Alzheimer’s disease) thatincrease with age (e.g., Gatz & Smyer, 1992),older adults in cognitively challenging environ-ments show minimal, if any, declines in think-ing and learning abilities Similar to any otherage group, when elderly people are less men-tally challenged, their cognitive performancedeclines (e.g., CAH, 1998; Lawton & Nahemow,1973) Although older adults may routinely en-counter such challenges less frequently than thecollege students to whom they typically arecompared (Williamson & Dooley, 2001), underthe right conditions, they can learn newthings—and learn them quite well (e.g., Schaie,1996; also see Volz, 2000, for a review) More-

“nor-over, whether people believe they can learn and

remember is crucial (Cavanaugh, 1996) Thelesson here is that aging adults bear some re-sponsibility for making sure that they engage

in cognitively challenging activities (West,Crook, & Barron, 1992)

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What about future generations? Being able to

use current and emerging technologies should

improve cognitive capacities of seniors, but

those who make the effort to gain technological

expertise will beneﬁt most from these advances

The ﬁrst step may involve no more than

learn-ing to use an ATM machine, but that effort can

promote subsequent skills (Rogers, Fisk, Mead,

Walker, & Cabrera, 1996) In addition,

“neu-robic exercises” both preserve and improve

brain and memory functions (Katz, Rubin, &

Suter, 1999) Routine activities that require

lit-tle cognitive effort can exacerbate cognitive

de-cline Accordingly, Katz and colleagues

recom-mend seeking offbeat and, simultaneously, fun

experiences—not because they are difﬁcult but

because they are different

Are Old People Isolated and Lonely?

Rowe and Kahn (1998) assert that “the

com-mon view of old age as a prolonged period of

demanding support from an ever-diminishing

number of overworked providers is wrong”

(pp 159–160) Citing evidence from the

Mac-Arthur Foundation Study of Aging in America,

these researchers argue that social networks

remain remarkably stable in size throughout

the life span, with the number of close

rela-tionships among noninstitutionalized older

adults equaling those of younger people Some

elders are isolated and lonely, but people fail to

realize that the same is true for other age

groups as well Network losses do occur over

the life span through death, relocation, and

re-tirement, but even among very old people, new

social relationships are formed to replace lost

ones

What does the future bode for the baby

boomers? Will they, with fewer offspring, be

lonelier and more isolated than previous

gen-erations? Probably not They should be just as

capable of dealing with changes in network size

as are today’s elders In addition, they will have

the advantages afforded by technology and

cy-berspace With their computer competencies,

the majority of aging baby boomers will use

e-mail to stay in touch with family members

and friends Furthermore, we already have

ev-idence that they are more likely than their

younger counterparts to access Internet

infor-mation and support from a wide spectrum of

people who share their needs and concerns

(Ki-yak & Hooyman, 1999)

Do Old People Drain Society’sResources?

According to the CAH report (1998), the mon belief that old people drain society’s re-sources is based on the assumption that “every-body who works for pay is pulling his or herweight, and those who do not are a burden”(p 5) Contrary to past attitudes, the beneﬁts el-ders receive are being scrutinized as potentiallywasted and taking away from “more needy”groups and the overall economic well-being(Hendricks, Hatch, & Cutler, 1999) How accu-rate is the “emerging social construction of olderAmericans as ‘greedy geezers’ who are advan-taged relative to younger age groups and who donot deserve such a large slice of the governmentpie” (Hendricks et al., 1999, p 15; also see Hew-itt, 1997; Steckenrider & Parrott, 1998)?Evidence does not support such sweeping in-terpretations First, lumping older adults into ahomogeneous group is inappropriate They vary

com-as widely com-as their younger counterparts inhealth, financial security, and willingness to ac-cept public support Second, senior citizen ben-efits depend on social status and past work ex-perience, favoring high-income earners with acontinuous work history, that is, white middle-class men (Hendricks et al., 1999) The stereo-type of these “advantaged” oldsters is used tojustify reforms aimed at decreasing old-age ben-efits for all elders Let us look at the actual sce-nario The standard for living at or below thepoverty level changes between age 64 and age65; people 64 and younger qualify for povertybenefits with less income than do those 65 andolder Today, 12% of people over age 65 live ingovernmentally defined poverty (U.S SenateSpecial Committee on Aging, 1997) WithoutSocial Security, this percentage would increase

to 50% or more (Moon & Mulvey, 1996) Thus,cuts in Social Security would hit hardest thosewho need it most

Moreover, older adults do not drain societalresources They may not engage in work forpay, but “paid” work tends to be overvalued inour society (e.g., CAH, 1998) By contrast, un-paid (e.g., in the home, volunteer efforts) andunderpaid (e.g., working in fast-food restau-rants and bagging groceries) activities contrib-ute a great deal to the social enterprise In fact,when given the opportunity, large numbers ofseniors are eager to do volunteer work and take

on low-paying part-time jobs

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C H A P T E R 4 9 A G I N G W E L L 679

The baby boomers and subsequent

genera-tions should be more advantaged in the work

domain relative to the current cohort of

old-sters Attitudes about older workers are

chang-ing More important, because of post–baby

boom declines in birth rates, as the baby

boom-ers age, the number of employable adults will

decrease relative to the number of new jobs

(DHHS, 1992; Kiyak & Hooyman, 1999)

Fol-lowing the law of supply and demand, older

workers will be more valued and sought-after,

and those who do not feel ready to retire are

less likely to be compelled to do so Many policy

makers advocate raising the normal retirement

age to 70 The reasoning is that, in terms of

health and life expectancy, age 70 today is

roughly the equivalent of age 65 in the 1930s

when Social Security was established (e.g.,

Chen, 1994) Indeed, changing health status and

attitudes have led to age 65 no longer being

considered “old” (Kiyak & Hooyman, 1999)

Although most individuals who have adequate

(or better) ﬁnancial resources will retire at the

usual time or follow the trend toward early

re-tirement (e.g., Quinn & Burkhauser, 1990),

physically healthy elders will be able to choose

to continue working either because they want

to or because they feel the need to supplement

their retirement beneﬁts

But the critical prerequisite for continuing to

live as one pleases is good health What about

older adults who both are physically unable to

continue working for pay and do not have the

ﬁnancial resources to live in a satisfactory

fash-ion without working—that is, those whose

pri-mary, perhaps only, source of income is Social

Security? Recognizing the needs of these people

in an ever-aging population has fostered

nu-merous governmental initiatives (U.S

Depart-ment of Housing and Urban DevelopDepart-ment,

1999; also see Hendricks et al., 1999)

The point to be made here revolves around

personal choice People who feel in control, who

can make choices about the important aspects of

their lives, are both physically healthier and less

depressed than those who perceive that they

lack personal control (e.g., Peterson, Seligman,

& Vaillant, 1988; Taylor, 1983; Taylor &

Brown, 1988)

Are Old People Depressed?

Despite Rowe and Kahn’s (1998) allegation that

“depression is terribly prevalent in older

people” (p 106), the evidence is to the contrary

In fact, clinically diagnosable depression is less

prevalent in older than younger adults (e.g.,Rybash, Roodin, & Hoyer, 1995; Schulz &Ewen, 1993) Indeed, elders often cope more ef-fectively with stressful life events than doyounger adults (McCrae, 1989) Over the lifecourse, through life experiences and successes incoping with a variety of stressors, the typicaladult builds adaptive attitudes and beliefs thatgeneralize to coping with new stressors (seeWilliamson & Dooley, 2001) Regardless of age,people are motivated to exercise personal con-trol over the important aspects of their lives(Schulz & Heckhausen, 1996) Solving theproblems that go along with getting older (e.g.,death of a spouse, declines in health status),however, simply may not be possible Conse-quently, those who adapt well will shift theirfocus from actively trying to change the situa-tion to managing stress-related emotional re-actions by, for example, accepting the situationand continuing to function as normally as pos-sible

Personal control often is limited by social andcultural expectations about appropriate roles forspeciﬁc segments of the population Today’strend toward less stigmatization of older adultsshould offer seniors more choices Other soci-etal changes will add impetus to this movement.For example, economic prosperity has createdﬁnancial security for many current and futureolder Americans, enabling them to exercise con-trol over how they spend their retirement years.The construct of personal control constitutes animportant part of the foundation underlying themodel described in the next sections

The Activity Restriction Model of Depressed Affect

Activity restriction is the inability to continuenormal activities (e.g., self-care, care of others,doing household chores, going shopping, visit-ing friends, working on hobbies, and maintain-ing friendships) that often follows stressful lifeevents such as debilitating illness (e.g., William-son & Schulz, 1992) According to the ActivityRestriction Model of Depressed Affect, majorlife stressors lead to poorer mental health out-

comes because they disrupt normal activities

(e.g., Williamson, 1998) In other words, ity restriction mediates the association between

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activ-680 P A R T I X S P E C I A L P O P U L A T I O N S A N D S E T T I N G S

stress and mental health (Walters &

William-son, 1999; WilliamWilliam-son, 2000; Williamson &

Dooley, 2001; Williamson & Schulz, 1992,

1995; Williamson, Schulz, Bridges, & Behan,

1994; Williamson & Shaffer, 2000; Williamson,

Shaffer, & Schulz, 1998; Williamson, Shaffer,

and the Family Relationships in Late Life

Proj-ect, 2000)

Individual Differences in Activity

Restriction

Stressful life circumstances are not the only

contributors to activity restriction Rather,

in-dividual differences are important factors as

well Age is one of the ways that individuals

differ For example, older adults tolerate similar

levels of pain better than do younger adults

(Cassileth et al., 1984; Foley, 1985), a

phenom-enon most commonly attributed to the

in-creased exposure to pain and disabling

condi-tions that older people experience Indeed, my

colleagues and I have found that experience,

rather than chronological age, matters more in

terms of predicting those who will restrict their

activities in the wake of stressful events

(Wal-ters & Williamson, 1999; Williamson & Schulz,

1995; Williamson et al., 1998) In other words,

old age does not necessarily foster activity

re-striction or depression

Another potentially important contributor to

coping with stress is ﬁnancial resources

Inade-quate income interferes with normal activities

(Merluzzi & Martinez Sanchez, 1997)

More-over, if ﬁnancial resources are merely perceived

as being less than adequate, activities are more

restricted (see Williamson, 1998, for a review)

Thus, when life becomes stressful, an

under-standable ﬁrst line of defense may be to cut back

on normal activities that involve spending

money, for example, shopping, recreation, and

hobbies (Williamson & Dooley, 2001)

Aside from demographic factors, aspects of

the individual’s personality also contribute to

activity restriction Some people cope in

mal-adaptive ways across all situations throughout

their lives In contrast, there are those who are

dispositionally inclined to face the situation,

ra-tionally evaluate possible solutions, seek help

and information as appropriate, and, if all else

fails, accept that the problem has occurred, deal

with their emotional reactions (perhaps with

help from others), and make every effort to

re-sume life as usual

As an example of how personality can affectadjustment, consider public self-consciousness

as it relates to activity restriction and depressionwhen an illness condition results in bodily dis-figurement Public self-consciousness is the sta-ble tendency to be highly concerned about as-pects of the self that are evident to others andfrom which others form impressions (Scheier &Carver, 1985) People high in this trait worry agreat deal about their personal appearance andactively avoid disapproval and rejection fromothers As would be expected, limb amputationand breast cancer patients who are high in pub-lic self-consciousness restrict their public activ-ities (e.g., shopping, visiting friends) and expe-rience more depression than their counterpartswho are low in public self-consciousness (Wil-liamson, 1995, 2000) Moreover, highly self-conscious individuals also restrict nonpublic ac-tivities such as household chores (Williamson,1995) Thus, it appears that giving up activitiesconducted in the presence of others may gen-eralize to acts conducted in private, thereby fos-tering an unnecessary “spread” of the disability.Reminiscent of findings in the self-presentationliterature on anticipatory excuse-making (Sny-der, Higgins, & Stucky, 1983), when confront-ing stressful life events, some people may forgotheir usual activities because they have a justi-fication for doing so (e.g., Parmelee, Katz, &Lawton, 1991) But this is not an adaptive strat-egy (Snyder & Higgins, 1988; Williamson &Dooley, 2001) Even after controlling for a widevariety of other factors, activity restriction re-mains the most proximal predictor of depression(e.g., Williamson, 1998)

Another important individual difference issocial support resources People with strongersocial support networks cope better with alltypes of stressful life events (Mutran, Reitzes,Mossey, & Fernandez, 1995; Oxman & Hull,1997), and routine activities are facilitated bysocial support (Williamson et al., 1994) Socialsupport, however, appears to be a function ofpersonality variables that, in turn, inﬂuence ac-tivity restriction (e.g., Williamson & Dooley,2001) Those with more socially desirable ormore socially proactive characteristics also havemore supportive social ties and less activity re-striction Comparable beneﬁts are seen in people

who merely perceive that social support is

avail-able if it is needed, and the beneﬁts of ing that one has supportive others remain aftercontrolling for demographics (e.g., age, ﬁnancialresources), illness severity, and personality vari-

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perceiv-C H A P T E R 4 9 A G I N G W E L L 681

ables such as public self-consciousness

(Wil-liamson, 2000)

Summary of Current Research Findings

The forecast for our aging population is that,

more than ever before, older adults will be

physically, cognitively, psychologically, and

so-cially healthy Still, substantial numbers of the

elderly population will be disabled, socially

iso-lated, and depressed From accumulating

evi-dence, it is now clear that people consistently

become depressed in the wake of stressful life

events largely because those events disrupt their

ability to go about life as usual (see Williamson,

1998, 2000, for reviews), and that illness

sever-ity, younger age (or lack of experience),

inade-quate income, less social support, and higher

public self-consciousness contribute to this

ef-fect (e.g., Walters & Williamson, 1999;

Wil-liamson, 1998, 2000; Williamson & Schulz,

1992, 1995; Williamson et al., 1998)

In their acclaimed book, Successful Aging,

Rowe and Kahn (1998) propose that there are

three components of successful aging: (a)

avoid-ing disease, (b) engagement with life, and (c)

maintaining high cognitive and physical

func-tion They further propose that each of these

factors is “to some extent independent of the

others” (p 38) My colleagues and I do not

dis-agree with this categorization of contributors to

successful aging However, we argue that these

factors are less inclusive and independent than

Rowe and Kahn suggest Not only do numerous

other factors inﬂuence how well one ages, but

also Rowe and Kahn’s three components can be

subsumed by the construct of maintaining a

lifestyle that involves normal, valued, and

ben-eﬁcial activities

Our ﬁrst counterargument is that avoiding

disease is largely a function of routine activities

Temperance in detrimental behaviors (e.g.,

smoking, drinking alcohol, eating a high-fat

diet) is related to better physical health, less

dis-ability, and greater longevity (e.g., Cohen,

Tyr-rell, Russell, Jarvis, & Smith, 1993; McGinnis

& Foege, 1993) Second, “engagement with life”

(Rowe & Kahn, 1998) is virtually synonymous

with continuing valued personal activities

Peo-ple who feel engaged with life are those who

engage in personally meaningful activities, but

what qualiﬁes as meaningful will vary according

to each person’s history In the Activity

Restric-tion Model, it is postulated that continuing to

be involved in personally relevant activities(whether intellectual, physical, or social) is whatmatters most

Finally, Rowe and Kahn (1998) advocatemaintaining high cognitive and physical func-tioning as the third key to aging successfully.When a person is confronted with seeminglyoverwhelming life events, the telling factor maywell be the extent to which at least a semblance

of normal activities can continue What doesthis mean when, for example, disability pre-cludes playing several sets of tennis every day?

If this activity was driven by love of the sport,then the aging tennis addict can still participate

by watching matches or, even better, by ing others in the ﬁner aspects of playing thegame

coach-Interventions to Increase Activity and Decrease Depression

In the Activity Restriction Model, coping withstress is posited to be a complex, multifacetedprocess that is inﬂuenced by numerous factors.Stressors vary in nature across the life span,with those faced by older adults being at least

as threatening as those confronted by youngadults Because physical and psychological stressdiffer (e.g., in terms of controllability) with in-creasing age, however, coping successfully mayrequire replacing previously adaptive strategieswith ones better suited to the demands of ad-vancing age Therefore, interventions may re-quire convincing elders to shift from problem-focused to emotion-focused coping mechanisms(see Stanton, Parsa, & Austenfeld, this volume)

By acknowledging that depressed affect is afunction of restricted normal activities, we candesign interventions that reduce both activityrestriction and depression Simply encouragingolder adults to engage in more of their normalactivities, however, probably is not the beststrategy Rather, efforts to increase activitymight take three (and probably several more)forms First, therapists should carefully considerthe (likely multiple) reasons that activities havebecome restricted and design their interventionsaccordingly Second, they should target the in-dividuals most at risk for poor adaptation.Third, identifying manageable activities andavailable resources means that programs can beimplemented to engage aging adults in pastimesthat not only meet their speciﬁc interests andneeds but also ﬁt their functional capacities

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As with younger adults, older adults’

ﬁnan-cial resources vary widely, but higher costs for

insurance and health care in late life can sap

the resources of even the most ﬁnancially

pre-pared seniors Still, there are substantial

indi-vidual differences in how ﬁnancial

circum-stances impact activity restriction (Williamson,

1998) Those with low incomes do not

neces-sarily see their ﬁnancial resources as

inade-quate; likewise, people with higher incomes do

not uniformly report that their ﬁnancial

re-sources are adequate (Williamson & Shaffer,

2000) Thus, perceptions of income adequacy

appear to matter more than actual dollar

amounts Either way, older adults can be

di-rected toward the community-based and

inex-pensive social and recreational resources that

are available to them

In addition to evaluating demographic

char-acteristics such as age and ﬁnancial resources, it

is important to assess relevant personality

di-mensions Although most personality traits are

quite stable across the life span (Costa &

Mc-Crae, 1993; McCrae & Costa, 1986) and,

con-sequently, should be difﬁcult to change,

iden-tifying the traits that predispose people to

restrict their normal activities can help

deter-mine those who are at risk for poor adaptation

For example, when an illness involves body

disﬁgurement (e.g., limb amputation or breast

cancer surgery), patients high in public

self-consciousness can be targeted for interventions

to improve self-esteem and sense of efﬁcacy

such as hope enhancement (see Snyder, Rand,

& Sigmon, this volume), training in adaptive

coping skills, and support groups

Other personality traits also warrant

consid-eration For instance, people low in optimism

do not cope effectively or adjust well to stress

(Carver et al., 1993) and may be vulnerable to

activity restriction High levels of neuroticism

are related to a maladaptive coping style

(Mc-Crae & Costa, 1986) that may include forgoing

pleasurable activities When faced with

disrup-tive life events, individuals who are less

agent-ically oriented and do not have a strong sense

of mastery will have more difﬁculty ﬁnding

ways to avoid restricting their rewarding

activ-ities (e.g., Femia, Zarit, & Johansson, 1997;

Herzog, Franks, Markus, & Holmberg, 1998)

In addition, those who are low in the

disposi-tional predilection to hope for positive

outcomes are less likely to conceptualize ways

to continue (or replace) valued activities or to

persist in their efforts to do so, particularly

when pathways to achieving these goals areblocked (e.g., Snyder, 1998) Although research

in this area is in its infancy, personality factorsshould not be ignored—particularly when thegoal is to identify those who are at risk for re-stricting their usual activities, are adaptingpoorly to stress, and are in need of early inter-vention

Social support, like personality traits and perience with illness, interacts with health-related variables to inﬂuence normal activities.With stronger social support networks, activityrestriction is less likely (Williamson et al.,1994) For example, disabled elders will attendchurch and visit friends more often if other peo-ple help with walking, transportation, andwords of encouragement Maintaining usual ac-tivities in the face of stress, in turn, reduces thepossibility of negative emotional responses andfurther decrements in health and functioning.Thus, identifying community-residing olderadults with deﬁcits in social support is a goodstarting point for intervention Before interven-ing, however, we need to specify which aspects

ex-of social support are absent or most distressingand target treatment accordingly (Oxman &Hull, 1997) Some older people may be de-pressed simply because they do not haveenough social interaction Others may haveconcrete needs for assistance that are not beingmet (e.g., getting out of bed or grocery shop-ping) Still others may be exposed to exploita-tive or abusive social contacts (Cohen & McKay,1983; Suls, 1982; Williamson et al., 2000; Wort-man, 1984)

Directions for Future Research

The Activity Restriction Model of DepressedAffect, like other models of stress and coping(e.g., Lazarus & Folkman, 1984), implies thatthe causal path is unidirectional—that is, thatstress causes activity restriction, which, in turn,causes negative affect Without doubt, this is aninadequate representation Consider pain anddepression as an example According to unidi-rectional models, depression is an outcome of

an inability to adjust to chronic pain Yet stantial research suggests that depression fostershigher levels of reported pain (e.g., Lefebvre,1981; Mathew, Weinman, & Mirabi, 1981; Par-melee et al., 1991) Similarly, the Activity Re-striction Model of Depressed Affect can beturned on its head such that, as clinicians have

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50

Positive Growth Following Acquired

Physical Disability

Timothy R Elliott, Monica Kurylo, & Patricia Rivera

People acquire physical disabilities through

ag-ing and a multitude of mishaps, diseases, and

infections Although clinicians have offered

many different explanations for the diverse

psy-chological reactions that occur in the wake of

physical disabilities, few have applied scientiﬁc

tools to study these behaviors, and fewer still

have presented heuristic and testable theoretical

explanations Moreover, most observers have

overlooked the potentially valuable experience

of acquiring a physical disability Writers have

given only scant attention to positive growth

and optimal living with chronic health

prob-lems, as well as the related searches for

mean-ing, purpose, and fulﬁllment

In this chapter, we ﬁrst will review the

his-torical perspectives regarding adjustment to the

onset of physical disability We then will

pre-sent a model for understanding such adjustment,

along with supporting evidence Finally, we will

discuss relevant measures and intervention

practices that merit use in practice and research

and will propose directions for future study

Historical Perspectives

In most conceptualizations of psychological

ad-justment following the onset of physical

disa-bility, researchers have focused primarily on thenegative emotional reactions; rarely have theymentioned the potential for psychologicalgrowth For many years, the prevailing models

of adjustment were Freudian ones in which ple were presumed to pass through predictablestages in reaction to severe loss (Grzesiak & Hi-cock, 1994) With the losses accompanying thedisability, the individual was posited to sustain

peo-a severe blow, peo-and only with the ppeo-asspeo-age of timecould the ego permit recognition of that loss.Thus, a person purportedly would manifest de-nial to defend against the anxiety precipitated

by the disability and thereafter would graduallyprogress through depression, anger, and bar-gaining phases until the ego could rationally ac-cept the permanence and severity of thedisability (Mueller, 1962) Thus, optimal ad-justment was conceptualized as the ﬁnal accep-tance of the reality of permanent disability

In contrast to this rather fatalistic perspective,students of Kurt Lewin (1939) observed greatvariation in reactions to physical disability.They recognized that many people manage thenegative implications of the disability by shift-ing their values so as to experience increasedpersonal worth (Barker, Wright, Meyerson, &Gonick, 1953; Dembo, Leviton, & Wright, 1956;Meyerson, 1948) Additionally, these research-

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ers demonstrated how physical settings and

so-cietal attitudes impede personal growth and

adjustment following the onset of a disability

These views facilitated the recognition of the

potential for optimal positive adjustment

fol-lowing physical disability; moreover, they

inﬂu-enced a generation of psychologists, counselors,

physicians, and policy makers Finally, these

views shed light on the limitations imposed by

the physical environment and the ways in

which the environment can deﬁne a person as

“handicapped” (Shontz & Wright, 1980)

Learning principles also have been applied to

identify environmental contingencies that

re-inforce and shape “disabled” behaviors and

pro-duce impairment that is beyond what can be

di-rectly attributable to a physical condition

(Fordyce, 1976) These applications have been

expanded to take into account speciﬁc beliefs

people develop in interactions with the

environ-ment, and the way people ﬁnd meaning in their

daily experiences (Fordyce, 1988) In other

models steeped in a learning tradition, the

the-orists consider the interactions of both the

char-acteristics of the disability and personal coping

behaviors in inﬂuencing adjustment

(Thomp-son, Gil, Burbach, Keith, & Kinney, 1993;

Wal-lander & Varni, 1989)

In much of the available empirical research,

the approaches have been largely descriptive,

detached from overarching theoretical models,

and centered upon the measurement of distress

and other negative emotional reactions (Livneh

& Antonak, 1997) Unfortunately, this work

does not increase our understanding of how

people can experience positive growth and

meaning following disability Indeed,

psycho-logical models in which persons with a disability

are portrayed as recipients of care or victims of

misfortune preoccupied with matters of health

cannot inform us about positive growth

follow-ing disability (Fine & Asch, 1988a)

Positive Growth Following Disability

Several theorists now acknowledge that stress

does not always result in negative outcomes;

some people may experience positive shifts in

values, attitudes, and beliefs that were generated

in part by the changes imposed by a stressful

event (Somerﬁeld & McCrae, 2000) These

changes have been described as positive illusions

(Taylor & Brown, 1988), beneﬁt-ﬁnding

(Ten-nen & Afﬂeck, 1999), positive reinterpretation

(Scheier, Weintraub, & Carver, 1986), and traumatic growth (Tedeschi, Park, & Calhoun,1998) These concepts signify the possible oc-currence of positive growth in response to astressful incident, but at times the labels anddeﬁnitions of these constructs seem condescend-ing, suggesting that observed behaviors maynot be “real” or reﬂective of genuine change

post-As early as 1956, Dembo and her colleaguespointed out that for some persons, disability isneither the “core” of their self-worth nor thecenter of their daily activities In fact, many be-lieve that their disabilities have helped them toﬁnd meaning or to take a more adaptive per-spective of life (Wright, 1983) These individu-als reported (a) appreciating personal worth re-gardless of appearance or ability; (b) valuingtime spent in family activities; and (c) becomingmore spiritual, thoughtful, or understanding(Taylor, 1983; Wright, 1983) According toWright (1983), persons who have developedgreater acceptance of disability will demonstrate

a sense of meaning in their circumstances, valuetheir selfhood, and maintain positive beliefsabout themselves Such changes may be con-strued as both process and outcome and may bereﬂected in a heightened sense of priorities, agreater appreciation of the preciousness of life,and an inner strength and meaning that per-meates daily decisions and activities (Tedeschi

et al., 1998) Thus, individuals who incur aphysical disability may do more than “survive”their condition; their resilience and clarity ofpurpose may result in a greater resolve for pur-suing personal goals (Snyder, 1998) and an at-tainment of spiritual awareness and psycholog-ical adjustment that surpasses their previouslevel of adaptation (Wright, 1983)

Families, too, may experience positivechanges in the wake of disability Olkin (1999)observes that acquired disability can force fam-ily members to directly confront issues of trust,mortality, and values, which in turn compelthem to develop deeper commitments and re-structure the meaning of marriage or kinship.Some family members report a greater sense ofcloseness, a greater emphasis on family and per-sonal relationships, and positive changes inshared family values (Crewe, 1993)

Positive growth can be reﬂected in a greatersense of well-being and satisfaction with life andalso may be associated with fewer psychologicalproblems such as depression, anxiety, social iso-lation, and loneliness Presumably, positivegrowth should be associated with a decreased

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C H A P T E R 5 0 G R O W T H F O L L O W I N G D I S A B I L I T Y 689

risk and infrequent occurrence of secondary

complications (e.g., pressure sores, urinary tract

infections, respiratory problems), that may be

prevented in part by observing regimens for

personal care, avoidance of possible damaging

stimuli, and other health-promoting behaviors

We believe that persons who attain a greater

degree of positive growth following disability

would be more likely to engage in behaviors

conducive to general well-being and optimal

physical health

An Integrative and Dynamic Model

To appreciate the potential for positive growth

and optimal adjustment following physical

dis-ability, it is necessary to review several basic

tenets in rehabilitation psychology First,

disa-bility does not occur in a vacuum: It is deﬁned

in part by the immediate environment and the

historical and societal context in which it occurs

According to the Lewinian equation, B ⫽ f(P,E),

observed behavior following disability (e.g.,

pas-sivity, aggression, well-being, search for

mean-ing) is a function of the person and the

envi-ronment (Wright, 1983) Stage models, learning

principles, and ﬁeld-theory perspectives also

ac-knowledge that dynamic processes occur in

on-going interactions between the person and the

environment Through transactional models in

which the focus is on the interplay between the

person and the environment, we have increased

our understanding of stress and coping

pro-cesses (Lazarus & Folkman, 1984)

Unfortu-nately, researchers and clinicians often have

failed to attend to within-person dynamic

growth that may occur with aging

(Triesch-mann, 1987), the cognitive adaptations to a

physical condition over time (Rape, Bush, &

Slavin, 1992), as well as the interpersonal world

changes that follow a disability (Frank et al.,

1998) This dynamic, developmental aspect is a

powerful, albeit long neglected element of the

adjustment process following disability

Second, in stage theories and Lewinian

con-cepts it is assumed that the unique

characteris-tics of the individual are involved in the

ad-justment process Whereas in Lewinian

psychology, individual characteristics are

con-ceptualized as “the person” in the previous

equation, competing stage models identify an

individual difference construct (i.e., the “ego”)

as having a bearing on adjustment In

contem-porary parlance, these constructs represent the

domain of enduring personality characteristicsthat can predispose an individual toward certainbehaviors

As depicted in Figure 50.1, we conceptualizeadjustment following disability in severalbroad-based domains, each of which has consid-erable inﬂuence on two areas of adjustment.The primary components involve individualcharacteristics and the immediate social and in-terpersonal environment (see left side of Figure50.1) These inﬂuence the phenomenologicaland appraisal processes that constitute elements

of positive growth and, in turn, predict logical and physical health outcomes (see farright side of Figure 50.1) These components areframed within the developmental continuumthat flows left to right and is shown at the bot-tom of the figure The dynamic continuum en-compasses changes in any of the aforemen-tioned five areas as people age, as technologiesadvance, as relationships shift, and as health andpublic policies evolve This continuum reflectsthe ongoing process of growth, adaptation, anddevelopment in the person and the environ-ment, and the subsequent alterations in inter-actions between these entities Thus, in ourmodel, we adopt a collectivistic approach inwhich behavior results from the combined in-teractions of individual, situational, and envi-ronmental factors that function in an integratedand fluid manner

psycho-Enduring Characteristics and IndividualDifferences

Many variables are subsumed within this aspect

of the model Enduring characteristics are ﬁned as demographic characteristics, disability-related characteristics (e.g., level of injury andpain), predisability behavioral patterns, and per-sonality characteristics

de-Demographic Characteristics

Few researchers have taken a priori theoreticalperspectives in examining racial, gender, age, orsocioeconomic status (SES) differences as theyrelate to adjustment following disability (Elliott

& Uswatte, 2000; Fine & Asch, 1988b) Mostdemographic characteristics are included in clin-ical studies for descriptive purposes only, andtheir relation usually is examined within thecontext of maladjustment Of those studies thatincluded analyses of race, gender, age, and SES,these variables appeared to account for a very

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Figure 50.1 Model for understanding positive growth following disability

small portion of variance in adjustment

follow-ing disability It should be noted that the

so-cially deﬁned constructs such as race, gender,

ethnicity, SES, and age share considerable

over-lap with the social and environment component

of our model

Disability-Related Characteristics

Aspects of any speciﬁc disability (e.g., level of

spinal cord injury) do not reliably predict

sub-sequent adjustment, although some differences

may be observed between groups of people with

different types of disabilities Changes in the

physical condition itself can inﬂuence routine

activities, available resources, and ongoing

be-havioral patterns, thereby affecting adjustment

For example, research has demonstrated that the

presence of chronic, unresolved pain can be

dis-tressing to persons with physical disability, and

it can compromise their abilities to come to

terms with their condition and ﬁnd meaning

and purpose in life (Li & Moore, 1998;

Sum-mers, Rapoff, Varghese, Porter, & Palmer,

1991)

Predisability Behavioral Patterns

People who engage in health-compromising

be-haviors and have problems in interpersonal

ad-justment prior to their disabilities often have

difﬁculty coming to terms with disability vious researchers have demonstrated a link be-tween these characteristics and behavior, but atheoretical model has not been developed to fa-cilitate understanding of this relationshipwithin the context of disability Some personshave complicated histories of alcohol and sub-stance abuse that may have contributed to theinjury (Bombardier, 2000) These persons are atrisk for developing secondary complications(e.g., urinary tract infections, pressure sores)that might be prevented in part by behavioralself-care regimens (Hawkins & Heinemann,1998; Kurylo, Elliott, & Crawford, 2000)

Pre-Personality Characteristics

Many psychological constructs have been lated to adjustment following disability For ex-ample, persons who have an internal locus ofcontrol often report less distress than those withmore external expectancies (Frank et al., 1987).Persons with a disability who have effectivesocial-problem-solving skills and who have pos-itive orientations toward solving problems aremore assertive, more psychosocially mobile,more accepting of their disability, and less de-pressed than their counterparts who lack theseskills (Elliott, 1999; Elliott, Godshall, Herrick,Witty, & Spruell, 1991) There also is evidencethat people with a physical disability who de-

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re-C H A P T E R 5 0 G R O W T H F O L L O W I N G D I S A B I L I T Y 691

velop preventable medical complications

second-ary to the disability lack effective

problem-solving skills (Herrick, Elliott, & Crow, 1994)

Snyder’s (1989) conceptualization of hope,

which incorporates one’s perceived ability to

identify and pursue personally meaningful

goals under times of duress, also is a useful

con-struct in understanding positive growth after

acquired disability (see Snyder, Rand, &

Sig-mon, this volume) Persons who are hopeful

se-lectively attend to certain aspects of their

situ-ation following the onset of disability (Elliott,

Witty, Herrick, & Hoffman, 1991) Moreover,

persons who have higher levels of hope seem to

have a greater sense of control over their

symp-toms and report a greater sense of personal,

positive growth in reaction to their condition

(Tennen & Afﬂeck, 1999) Higher levels of hope

and goal-directed energy are associated with less

distress, greater use of more conﬁdent and

so-ciable coping styles, and higher self-reported

functional abilities (Elliott & Kurylo, 2000;

El-liott, Witty, et al., 1991; Jackson, Taylor,

Pal-matier, Elliott, & Elliott, 1998; Laird, Snyder, &

Green, 2001) Generally, people who have

greater tendencies to utilize denial and who

have greater psychological defensiveness are

less distressed and less angry and have fewer

handicaps throughout the ﬁrst year of acquired

disability (Elliott & Richards, 1999)

Snyder (1989; Snyder, Rand, & Sigmon, this

volume) has repeatedly emphasized that hope is

goal-oriented and goal-based Goal orientation

is also signiﬁcant in contemporary neo-Freudian

conceptualizations of the self and personal

ad-justment A greater goal orientation is

associ-ated with less depression, greater acceptance of

disability, and increased life satisfaction 1 year

later among persons with recent-onset physical

disability Goal orientation also is associated

with less perceived social stigma and increased

mobility among these persons (Elliott, Uswatte,

Lewis, & Palmatier, 2000) Among persons with

chronic disabilities, those who have many

rather than few goals evidence more optimal

ad-justment (Kemp & Vash, 1971)

Other personality traits are predictive of

ad-justment as well Krause and Rohe (1998) found

that elements of neuroticism and extraversion

were associated with life satisfaction among

community-residing persons with spinal cord

injuries Speciﬁcally, a greater proclivity for

negative emotions and decreased tendency for

positive emotions were predictive of less life

sat-isfaction Similarly, Rivera and Elliott (2000)

found that lower neuroticism and higher ableness (measured by the NEO; Costa &McRae, 1991) were predictive of greater accep-tance of disability among persons with a spinalcord injury after controlling for level of injury,completeness of injury, depression, and demo-graphic variables Thus, the personality traitsthat are stable and unlikely to change over timeappear to be signiﬁcant correlates of depressionand acceptance of disability in persons with anacquired spinal cord injury

agree-Social and Interpersonal EnvironmentElements of interest within the interpersonaland social environment portion of our model in-clude social support, environmental barriers,and social stereotypes Social support has beenassociated with well-being among persons withacquired disabilities (Rintala, Young, Hart,Clearman, & Fuhrer, 1992) The fluid nature ofsocial support may reflect the various types ofassistance (e.g., informational, emotional) re-quired to complement specific coping efforts(McColl, Lei, & Skinner, 1995) Family mem-bers may shift in their own adjustments andabilities to cope with the caregiving demands,thereby affecting the care recipients’ abilities tocope (Chaney, Mullins, Frank, & Peterson,1997; Frank et al., 1998) There also is evidencethat elements of social support can have positiveand negative effects on other aspects of adjust-ment For example, assertive persons may beable to marshal available social support in cer-tain situations; however, this direct style alsomay alienate others in the social support system(Elliott, Herrick, et al., 1991) Similarly, goal-directed persons who voice their aspirations and

do not assume a passive role in rehabilitationmight encounter negative and resistant attitudesfrom professional staff (Elliott & Kurylo, 2000).Marital satisfaction following disability is as-sociated with greater satisfaction in leisure ac-tivities (Urey & Henggeler, 1987), and satisfac-tion with recreational activities is a majorcomponent of overall life satisfaction followingdisability (Kinney & Coyle, 1992; Krause &Crewe, 1987) But signiﬁcant others also canhave a negative impact in the way they mayreinforce disabled behaviors, undermine self-care efforts, restrict activity, and compromisethe health of a person with disability (Turk,Kerns, & Rosenberg, 1992) In some situations,family members have to make a consciouschoice between the personal goals of the person

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with a disability and contradictory goals

es-poused by health care professionals (Elliott &

Kurylo, 2000) In other cases, family members

may be unable to adjust to the changes imposed

by the disability and display more distress than

the person with the condition (Elliott &

Shew-chuk, in press)

We also are learning that family members in

caregiving roles can have an impact on the

psy-chological and physical adjustments of persons

with disabilities In a recent study, caregiver

tendencies to solve problems carelessly and

im-pulsively were signiﬁcantly predictive of lower

acceptance of disability among patients who

were leaving a rehabilitation hospital (Elliott,

Shewchuk, & Richards, 1999) When a group of

these patients were evaluated a year later for the

occurrence of pressure sores, caregiver

impul-sive and careless styles assessed 1 year earlier

correctly classiﬁed 87.88% of those persons

with and without a sore It is conceivable that

the persons with disabilities were aware of their

caregivers’ problem-solving styles and

recog-nized that their caregivers could care less about

working to help them in adhering to self-care

regimens

The social environment can yield

considera-ble stress because persons with disabilities are

impeded from being integrated and mobile in

society at large Factors ranging from

architec-tural barriers to negative social stereotypes

con-tribute to this stress Perceived independence,

personal transportation, and personal living

ar-rangements are strong predictors of good

self-concepts among persons with a physical

dis-ability who reside in a community (Green,

Pratt, & Grigsby, 1984) Some persons with

dis-abilities may become very uncomfortable in

an-ticipation of potentially embarrassing situations

associated with interacting and resuming social

roles (Dunn, 1977) To compound the problems,

these concerns may be internalized as social

stigmas On this point, persons with higher

lev-els of perceived stigma report more problems

coming to terms with their disabilities (Li &

Moore, 1998; Rybarczyk, Nyenhuis, Nicholas,

Cash, & Kaiser, 1995)

Phenomenological and Appraisal

Processes

We must understand the unique perspective of

the person with disability In contemporary

per-spectives of adjustment, an emphasis is placed

on the importance of appraisals in

understand-ing individual experiences For example, there is

a focus on the primary appraisal of events asthe mediators of stress effects in transactionalmodels of stress and coping In concert withthese views, rather than the disability itself, theresearch focus has shifted to the person’s per-ceptions of disability and interference with per-sonal goals and desired activities as the source

of stress (Williamson, 1998; see also son, this volume) Thus, we focus on the per-ception and appraisal of stress in our model and

William-do not make assumptions about the discrete ture of stressful incidents among people withdisabilities

na-The appraisal component, then, is the piece of our model because its processes haveconsiderable inﬂuence on subsequent adjust-ment We believe that elements of positivegrowth are ﬁrst evident in how people evaluateand interpret their situation and circumstances.Following disabilities, adaptive people often lookinward to exercise control over internal statesrather than trying to exert behavioral controlover external events, some of which they real-istically cannot affect (Heckenhausen & Schulz,1995) Individuals then actively process aspects

center-of their situations to find positive meanings andside benefits (Dunn, 1996, 2000) We can ob-serve how people try to accept, positively rein-terpret, and seek personal growth soon after theonset of disabilities (Kennedy et al., 2000).Those who are successful in realizing these as-pects will have better adjustment (Thompson,1991) Appraisal processes also may help to ex-plain why persons with disabilities who are dis-tressed exhibit many different coping behaviors,whereas those who are less distressed reportedfewer coping efforts and a greater sense of in-ternal locus of control (Frank et al., 1987) Thisalso may account for the beneficial sequelae ofacceptance coping and cognitive restructuring

on the adjustments of persons with spinal cordinjuries who are returning to their communities(Hanson, Buckelew, Hewitt, & O’Neal, 1993;Kennedy, Lowe, Grey, & Short, 1995).Speciﬁc beliefs about the disability (e.g., “Iwill walk again”) and attributions of responsi-bility and blame are unstable over time andhave been found not to be consistently related

to objective and subjective measures of ment (Elliott & Richards, 1999; Hanson et al.,1993; Reidy & Caplan, 1994; Richards, Elliott,Shewchuk, & Fine, 1997; Schulz & Decker,1985) People who ruminate about their per-ceived victimization, however, may do so at the

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adjust-C H A P T E R 5 0 G R O W T H F O L L O W I N G D I S A B I L I T Y 693

expense of ﬁnding meaning and direction in

their circumstances Thus, they may

compro-mise their adjustments (Davis, Lehman,

Wort-man, Silver, & Thompson, 1995) Yet others

may interpret information in a manner that

ex-acerbates their problems (Smith, Peck, Milano,

& Ward, 1988) Dunn (1994) observes that

adaptive personality and interpersonal

charac-teristics predispose some individuals toward

more functional cognitive appraisals, and that

people lacking in these personal and social

re-sources will be more likely to exhibit difﬁculties

in accepting their condition and their

circum-stances

Dynamic and Developmental Processes

Changes in a person’s belief system,

interper-sonal environment, and physical health may

oc-cur over time Advances in medical therapies

and public policy can facilitate adjustment One

hundred years ago, Helen Keller gave

Ameri-cans an example of functional adaptation to

multiple “limitations” (blindness, deafness, and

gender) Were it not for the zeitgeist, her

suc-cess as a speaker and educator may not have

been realized The sociopolitical climate at the

time, including the suffragist movement,

sup-ported her efforts to integrate and prosper in

mainstream society Other examples of social

advocacy led to the passage of the Rehabilitation

Act of 1973 and the Americans with Disabilities

Act of 1990 More recently, attention has

turned to actor Christopher Reeve, resulting in

increased public awareness about—and federal

and private funding for—spinal cord injury

re-search Today’s advocacy movement demands

consideration for the relationship between

in-dividuals and their physical, social, and cultural

environments

People typically navigate developmental

changes with the intention of minimizing their

discomforts and activity restrictions and

main-taining or improving ability levels, senses of

well-being, and volitions (Williamson, 1998)

Persons with physical disabilities may grow

positively over time as they develop adaptive

beliefs and experience shifts in their values

Some of these positive aspects may take time to

be realized or appreciated All of these changes

represent developmental processes that can be

understood within the context of our model

Observations of such adjustments can be made

with tools that are sensitive to individual

tra-jectories of adaptation over time

There are many different measures of speciﬁcbeliefs, values, and attitudes that represent cer-tain appraisal processes, but we advocate the use

of instruments such as the Acceptance of ability Scale (Linkowski, 1971), which was de-veloped to assess acceptance as deﬁned byWright (1983) Other instruments that assessaspects of positive growth are available (e.g., thePosttraumatic Growth Scale; Tedeschi & Cal-houn, 1996), but we are unaware of any pre-vious application of these among persons withphysical disability To understand speciﬁc andphenomenological processes that underpin pos-itive growth and subsequent adjustment, we be-lieve sophisticated qualitative devices (e.g.,Q-sorts, focus groups, structured interviews)are required

Dis-Adjustment Following DisabilityParalleling the indices of adjustment for people

in general, we posit two broad areas of optimaladjustment for persons with physical disability:psychological and physical health These do-mains share considerable overlap Traditionally,researchers have attended to negative indicators

of adjustment by using measures of distress, pression, anxiety, psychosocial impairment, anddivorce Some measures of physical health alsoare construed in fairly negative terms (e.g.,Sickness Impact Proﬁle; Bergner, Bobbitt, Car-ter, & Gilson, 1981) Some outcomes—return-ing to work or receiving vocational rehabilita-tion services—are associated with reports ofwell-being For those persons who have theseoptions, these are important, discrete indicators

de-of psychological adjustment (Szymanski, 2000).Meaningful social and leisure activities also areimportant indicators of adjustment that ﬁtwithin this domain (Krause & Crewe, 1987)

We advocate using measures that draw onpositive aspects of adjustment after acquiredphysical disability In this regard, we wouldsuggest the Satisfaction With Life Scale (Diener,Emmons, Larsen, & Grifﬁn, 1985) and the LifeSatisfaction Index (Adams, 1969), where the re-spondent is provided with an opportunity toconsider positive growth and meaning in theface of signiﬁcant personal change

In sum, the individual, social, environmental,and phenomenological factors in our model arelikely to have signiﬁcant effects on psychologi-cal and physical health Overall health, in turn,appears to contribute signiﬁcantly to variation

in positively valenced outcomes such as

Trang 32

self-694 P A R T I X S P E C I A L P O P U L A T I O N S A N D S E T T I N G S

esteem, acceptance of disability, and life

satis-faction Greater recognition and attention to the

factors in this model will aid our understanding

of the potential for optimal adjustment among

persons with acquired physical disabilities

Psychological Interventions

With the decreasing ﬁnancial support for

psy-chosocial programs for persons with disabilities

in the last decade, there has been a shift in

in-tervention policies (Frank, 1997) The opinions,

goals, and aspirations of the person with

dis-ability must be primary in developing strategic

interventions (Wright, 1983) When these

per-sonal goals and aims are addressed,

interven-tions are more likely to be effective (Glueckauf

& Quittner, 1992; Webb & Glueckauf, 1994)

Wright (1983) recommended that services to

people with disabilities include efforts to

elim-inate societal barriers, increase accommodations,

improve medical and psychosocial services

where indicated, develop and provide assistive

devices and technologies, and aid in the learning

of new skills For example, programs such as

interpersonal and social-skills training and

in-novative interventions such as aerobic exercise

training have led to an increase in abilities,

sense of well-being, and acceptance of

disabili-ties among persons with physical disabilidisabili-ties

(Coyle & Santiago, 1995; Dunn, Van Horn, &

Herman, 1981; Glueckauf & Quittner, 1992;

Morgan & Leung, 1980) Cognitive-behavioral

interventions designed to enhance coping

ef-fectiveness may have beneﬁcial effects on

peo-ple’s ability to positively reappraise their

situ-ations and to increase their senses of hope, with

corresponding improvements in psychological

adjustment (King & Kennedy, 1999) Strategies

that include family members as an integral part

of the rehabilitation process may be particularly

effective (Moore, 1989); moreover, these

ap-proaches may be couched within

cognitive-behavioral frameworks and delivered in

inno-vative, home-based programs (e.g., Roberts et

al., 1995) Formal vocational rehabilitation

in-tervention programs that support a return to

career-related activities—broadly deﬁned to

in-clude support for independent living, assistive

devices, and meaningful social

activities—re-main important despite the constant threat of

decreasing federal and state funding

To appreciate the unique perspectives of

per-sons living with disabilities, it is prudent to hire

staff members who have disabilities This notonly will enhance service provisions but alsowill model professionalism, independence, andself-sufﬁciency for the individuals served Ad-ditionally, clinicians should solicit input frompersons with disabilities and their families sothat useful and desired services are developed(Shewchuk & Elliott, 2000) With qualitative as-sessment devices, we can measure participants’goals and needs and expedite their inclusion inthe evaluations of the intervention programs.Health professionals also must advocate legis-lation and seek new funding sources in order tocreate accessible and affordable community-based programs (e.g., support groups, educa-tional interventions, recreational activities, andtraining for individuals with disabilities) Like-wise, clinicians should strengthen their multi-disciplinary collaboration so as to offercommunity-based services, including respiteand home health care For example, profession-als can work together to develop neighborhoodcenters in rural, underserved areas or use tech-nology such as telecommunication devices todeliver a variety of services and therapies toparticipants at home (Temkin & Jones, 1999).Other technologies and assistive devices canhave immense effects on positive growth(Scherer, 2000) Virtual-reality technologies can

be used to help individuals learn speciﬁc copingskills (e.g., coping with persistent pain; Hoff-man, Doctor, Patterson, Carrougher, & Furness,2000) and attain greater mobility and indepen-dence (learning driving skills; Schultheis &Rizzo, in press) These technologies will even-tually prove to be cost-effective and, accord-ingly, should be subsidized by health insurance,state or federal funds, or a combination ofsources

As increasing numbers of Americans are fected by the need to care for an older adultrelative, states are feeling the burden of ﬁnanc-ing long-term care services Fortunately, policymakers are beginning to recognize the value ofsupporting family caregivers as an extension ofthe formal health care system In fact, in a re-cent study by California’s Family Caregiver Al-liance, it was found that ﬁve states (California,New Jersey, New York, Oregon, and Pennsyl-vania) now offer a variety of innovative andcost-effective services to support caregivers offamily members with dementia (Feinberg & Pil-isuk, 1999) Similar solutions may decrease theconcerns that rehabilitation professionals haveregarding the lack of input and choice of health

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af-C H A P T E R 5 0 G R O W T H F O L L O W I N G D I S A B I L I T Y 695

care services available to persons with

disabili-ties Likewise, a more consumer-oriented

sys-tem of care may evolve (Kosciulek, 2000)

Future Directions

Many correlates of adjustment following

dis-ability have been identiﬁed in research to date

This work should continue so that we can

iden-tify those persons who are at risk for poor

ad-justment; moreover, we need to recognize the

characteristics of those persons with disabilities

who should experience greater satisfaction,

health, and well-being over time Nevertheless,

several issues warrant our attention in future

research programs pertaining to beneﬁcial

in-terventions, service delivery, and policy

for-mation

First, participants’ perspectives, opinions,

be-liefs, and appraisals have not been consistently

taken into account in research and practice To

assess and use this rich but subjective

infor-mation, more sophisticated qualitative

measure-ments are necessary Too often researchers and

clinicians eschew this approach, opting to bind

participants’ life experiences to some a priori

Procrustean bed of theory and lore To

under-stand the cognitive mechanisms underlying

op-timal adjustment—and the precursors of such

processes—it is imperative that we develop and

use qualitative devices that are sensitive to the

perceptions and beliefs through which people

ﬁnd meaning rather than despair following

dis-ability We have yet to determine what kind of

value shifts occur following disability, how and

why these occur, and the relationship of such

shifts to a sense of acceptance and well-being

(Keany & Glueckauf, 1993)

Second, through more sophisticated statistical

methods we now can uncover the dynamic

pro-cesses of adjustment as they unfold over time

Designs that incorporate constructs from our

model can be used to predict individual

trajec-tories of adaptation Included in this statistical

armamentarium are hierarchical linear

model-ing, structural equation modelmodel-ing, and other

complex multilevel modeling techniques that

trace various characteristics and measures over

time, as well as intraindividual change

trajec-tories in intervention research (Drotar, 1997;

Elliott & Shewchuk, in press) These elegant

tools are particularly attractive for theory

build-ing and program evaluation because they can

accommodate dichotomous and ordinal-level

variables Additionally, these techniques allow

us to revisit old notions of adjustment thatnever have truly been tested (e.g., Do peopleexperience a series of stagelike processes in re-action to the disability onset?) and reﬁne pre-dictive models that are essential for resource al-location (e.g., What are the psychologicalcharacteristics of those who beneﬁt optimallyfrom interventions? Who is at greatest risk forrehospitalizations?)

By using these new statistical procedures intandem with qualitative devices, we also mayilluminate how people cognitively process in-formation about their disabling conditions, theirlives, and their environments; likewise, we maybetter appreciate how such changes in percep-tions relate to long-term adjustment This in-formation is crucial for improving our theoret-ical understanding of life beyond disability andfor developing policies and service delivery sys-tems to ensure that persons with disabilitiesmay participate fully in a positive psychology

in the 21st century Everyone deserves a chance

at “the good life,” and this is the spirit in which

we have advocated new and better science, terventions, and environs for persons with dis-abilities

in-Acknowledgments This chapter was supported

in part by the National Center for Injury vention and Control and the Disabilities Pre-vention Program, National Center for Environ-mental Health Grant R49/CCR412718-01, theNational Institute on Disability and Rehabili-tation Research Grant H133B980016A, and theNational Center for Medical Rehabilitation Re-search, National Institute of Child Health andHuman Development, National Institutes ofHealth, Grant T32 HD07420 The contents ofthis article are solely the authors’ responsibilityand do not necessarily represent the ofﬁcialviews of the funding agencies

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51

Putting Positive Psychology in a

Multicultural Context

Shane J Lopez, Ellie C Prosser, Lisa M Edwards,

Jeana L Magyar-Moe, Jason E Neufeld, &

Heather N Rasmussen

“Competition and prejudice clutter the

land-scape of virtually every town Imagine,

how-ever, if we had more people of all races,

ethnic-ities, or cultures, who were allowed to

contribute Imagine the enormous advances we

could make in enhancing communication and

increasing knowledge, and in realizing our basic

needs for connectedness Together, by drawing

on the strengths of each other, we can build an

American community where the word ‘equality’

truly can be applied to the abilities of all citizens

to pursue their goals” (Lopez et al., 2000,

p 238) Behavioral scientists and practitioners

who identify the strengths of all people and

value diverse meanings of the good life can

en-courage optimal functioning of individuals and

communities

In this chapter, we examine cognitive,

philo-sophical, emotional, and interpersonal

frame-works that can be used to understand and foster

healthy functioning We also discuss a diversity

of speciﬁc coping approaches This critical

re-view of literature places positive psychology in

a multicultural context and identiﬁes the diverse

psychological strengths of individuals and tural groups We also call on scientists and prac-titioners to examine the magnitude and equiv-alence of constructs across cultures, to recognizethe value of religious practices, spirituality, anddiverse constructions of life meaning, to searchfor the clues to the good life that cultural ex-periences might provide, to ﬁnd exemplars (in-dividuals or subgroups) who function withinpositive psychological frameworks, and to clar-ify what works in the lives of people

cul-The Wise Man of the Gulf

The following story sets the stage for discussingpositive psychology as it exists in a multicul-tural society:

An American businessman, Woody, was atthe pier of a small Mexican village when aboat with just one ﬁsherman docked Insidethe boat were many pounds of large gulfshrimp

Trang 39

C H A P T E R 5 1 M U L T I C U L T U R A L C O N T E X T 701

The American complimented the Mexican

on the quality of his catch and asked about

the mesh of his cast net, “Why is the mesh

so large? Couldn’t you catch more with a

tighter weave?” Hector, the ﬁsherman,

re-plied, “I catch what I need sen˜or And the

net, the net is a ﬁne net I was taught how

to weave this net by my father, who was

taught by his father I work on the net

every-day to keep it strong.”

Woody then asked how long it took to

seine for his catch Hector replied, “Only a

little while.” The American questioned, “So

what do you do with the rest of your

time?” The Mexican ﬁsherman said, “I sleep

late, I pray, go shrimping for a while, play

with my children, take siesta with my wife,

Maria, examine and repair the net, stroll

into the village each evening to sip wine

and play guitar with my amigos On

Sun-days, I go to mass and spend the rest of the

day with la familia I have a full and busy

life sen˜or I am very happy.”

After hearing the ﬁsherman’s account of

his week, Woody scoffed, “I am a Harvard

MBA and could help you be more

success-ful You should use a net with a smaller

weave and spend more time ﬁshing and,

with the proceeds, buy a bigger boat with a

larger net you could troll for many miles

With the proﬁts from the bigger boat you

could buy several boats; eventually you

would have a ﬂeet of boats Instead of

sell-ing your catch to a middle man, you would

sell directly to the processor and then open

your own plant You would control the

product, processing, and distribution You

would need to leave the small coastal ﬁshing

village and move to Mexico City, then

Houston and then Los Angeles There you

will run your expanding enterprise.”

Hector was somewhat taken aback by the

complicated plan and asked, “But sen˜or,

how long will all this take?” Woody replied,

“Fifteen to 20 years.” “But what then,

se-n˜or?” The American laughed and said,

“That’s the best part When the time is

right, you would sell your company stock to

the public and become very rich; you would

make millions.” “Millions, sen˜or? Then

what?” Hector questioned The American

said, “Then you would retire, move to a

small coastal ﬁshing village where you

would sleep late, pray, ﬁsh a little, play

with your grandkids, take a siesta with your

wife, stroll in the village in the evenings to

sip wine and spend time with la familia.”

Positive Psychology in a Multicultural Context

Positive psychology’s emphasis on the scientiﬁcpursuit of optimal human functioning drawsscientists’ attention to protective factors, assets,resources, and strengths To date, however,there has been little effort to highlight the cul-tural factors that inﬂuence health and the mean-ing of the good life Researchers and practition-ers must remember that the societal andcultural context of life affects how individualspursue identity development, goals, and happi-ness The Basic Behavioral Science Task Force

of the National Advisory Mental Health cil (1996) highlighted the context within whichmental health exists, stating that “social, cul-tural, and environmental forces shape who weare and how well we function in the everydayworld Together, those contextual factors,interacting with our individual biological andpsychological characteristics, color our experi-ence, limit or enhance our options, and even af-fect our conceptions of mental illness and men-tal health” (p 722)

Coun-Psychological models and diagnostic works provide clinicians and scientists withmeans to conceptualize observations and com-municate about functioning Models and frame-works also provide schema through which pro-fessionals discern differences and similaritiesand offer perspectives on diversity Not all theseexplanatory models have incorporated positiveand negative views of difference, however.More recent models are increasingly culturallyresponsive because they highlight the diversity

frame-of strengths and weaknesses Thus, as a ﬁeld weare beginning to understand how culture relates

to health, but there is still a need to developnew conceptual frameworks recognizing andcapitalizing on individual and group strengths(Chin, 1993; Sue, 1996)

Models of Inferiority to Models Recognizing Strengths in Diversity

Early psychological models examined ences from a deﬁciency perspective Deviationfrom the characteristics of the dominant culturewere viewed through an ethnocentric lens that

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differ-702 P A R T I X S P E C I A L P O P U L A T I O N S A N D S E T T I N G S

interpreted any differences negatively and as

in-dicative of weakness

Inferiority Model

An early paradigm used to explain ethnic

dif-ferences was based on a history of racist

ration-alization This model (as described in a review

by Kaplan & Sue, 1997) attributed variability in

functioning to biological differences The

“nat-ural inferiority” argument contended that if

members of ethnic groups were inherently

in-capable of advancing in society, it was useless

to attempt to adjust the existing environment

to provide equal or favorable opportunities Of

course, the fundamental attribution errors

in-herent in this model were illuminated when

bi-ological explanations for racial and ethnic

dif-ferences were not supported by human genetic

research (see reviews of related research in

Jack-son, 1992; Zuckerman, 1990)

Deﬁcit Model

In the deﬁcit model it was proposed that ethnic

differences were the result of immutable

envi-ronmental mechanisms rather than biological

factors (Allport, 1954) Prejudice was purported

to be a key factor in creating stress that

ad-versely affected minority group members’

abil-ity to excel (Sue, 1983) Higher rates of distress

in minorities were attributed to hostile

environ-mental circumstances (Carter, 1994), which

elic-ited inferior or self-destructive coping

strate-gies Although this model focused greater

attention on the effects of prejudice and unequal

social conditions, it still cast minority group

members in the shadow of inferiority (Kaplan

& Sue, 1997) and did not adequately address the

complexity of individual differences

Cultural Pluralism

The ﬁeld of psychology moved away from

de-ﬁciency or inferiority models to explanatory

models that recognized the importance of

cul-ture These models acknowledge that speciﬁc

cultural experiences contribute to healthy

func-tioning and engender unique strengths

In the cultural pluralism model, it is proposed

that ethnic groups should remain distinct

cul-tural entities, while simultaneously promoting

traditional American values such as

individual-ism This is not a reﬂection of the melting pot

idea (i.e., ethnic groups combine with the

dom-inant American culture to produce a universalAmerican identity) Instead this model cham-pions a “unity in diversity” position, which, ac-cording to Kaplan and Sue (1997), succeedsmore as an idealized description of culturalgroup relations than as an explanatory modelfor viewing and working with multiculturalpopulations

Cultural GridPedersen and Pedersen (1989) proposed that,rather than characterizing cultural groups inrigid categories, there is a need to combine the

many different cultural identities each person

presents in distinct situations The cultural grid

is an open-ended model that matches social tem variables (i.e., demographics, status, and af-ﬁliation) with patterns of cognitive variables(i.e., expectations and values) It was developed

sys-to help identify and describe the cultural aspects

of a situation, assisting researchers and cians in forming hypotheses that include com-plex cultural perspectives, as well as intercul-tural differences and explanations The result is

clini-an orientation that allows group variables to becombined with individual cognitive perspectives

in a single framework for the purpose of ipating an individual’s “personal cultural” re-sponse to speciﬁc situations

antic-Human DiversityThe emerging model in ethnic psychology es-tablishes that each person has a unique culture,both independently and connected to the largersociety (Chin, 1993) The human diversitymodel broadens the focus of research beyondmerely racial, ethnic, and cultural issues to in-clude varied groups and populations withunique differences, strengths, and histories Theumbrella of human diversity allows researchers

to focus on patterns unique to speciﬁc groups

or populations, and/or universal group cesses This expands conceptualization optionsunequivocally, allowing recognition of the im-portance of cultural variables upon functioning.Chin (1993) makes strides in the direction ofunderstanding diversity by elucidating a “psy-chology of difference” to invoke changes in as-sumptive models to develop a more comprehen-sive framework, valuing differences and thecontext of culture This requires that cliniciansand researchers actively engage in (a) displaying

pro-a positive presentpro-ation of vpro-alues, potentipro-als, pro-and

Tiêu đề	Positive Psychology for Children Development, Prevention, and Promotion
Tác giả	Michael C. Roberts, Keri J. Brown, Rebecca J. Johnson, Janette Reinke
Trường học	Unknown University
Chuyên ngành	Psychology
Thể loại	Chương trình Đào tạo Đại học

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Số trang	82
Dung lượng	455,88 KB