Life Balance with Positive

Psychotherapy 8
Hamid Peseschkian and Arno Remmers

Many people seem to think that success in one area and is used in different settings. It is also known
can compensate for failure in other areas.
But can it really?... True effectiveness requires
as the “rhombus model”, the “four qualities of
balance. life”, the “four ways or medians of the capacity of
— Stephen R. Covey [2] recognition,” the “four areas of life,” the “four
ways of conflict resolution,” or the “diamond
model” (see Fig. 8.1).
Introduction The balance model is based on the concept that
there are essentially four areas of life in which a
Inspired by a concept in the Bahá’í Writings about human being lives and functions. These areas
“The Four Criteria of Comprehension” Nossrat influence one’s satisfaction with life, one’s feel-
Peseschkian developed the balance model as an ings of self-worth, and the way in which one deals
integral part of his psychotherapeutic method [1]. with conflicts and challenges. They are the hall-
Here, the influence of the positive view of man is marks of one’s personality in the here and now.
seen to be renewed, a concept of a healthy person This model describes and connects the biological–
is presented and the ways through which such physical, rational–intellectual, socio-emotional,
health can be attained are shown. This means that and imaginative–spiritual spheres and capacities
a health-oriented conceptualization can proceed of human beings in everyday life. Although the
from concepts of salutogenesis rather than patho- potential for all four areas and capacities can exist
genesis. It was important for Nossrat Peseschkian in every human being, some are emphasized and
to tell patients not only what they had done wrong, others neglected through differences in culture,
but above all to offer them a concept of life for family, education, time, and environment. The
their own orientation. Peseschkian’s concept of four areas of life, energy, activities, and reactions
the balance model [8] is known as the very heart are:
of positive psychotherapy (PPT after Peseschkian)
1. Physical activities and perceptions, such as
eating, drinking, tenderness, sexuality, sleep,
relaxation, sports, appearance, and clothing
H. Peseschkian (*) · A. Remmers 2. Professional achievement and activities, such
Wiesbaden Academy of Psychotherapy (WIAP),
as a job, studying, household duties, garden-
World Association for Positive and Transcultural
Psychotherapy (WAPP), Wiesbaden, Germany ing, basic and advanced education, and money
e-mail: [email protected]; [email protected] management

© Springer Nature Switzerland AG 2020 91

E. Messias et al. (eds.), Positive Psychiatry, Psychotherapy and Psychology,
https://doi.org/10.1007/978-3-030-33264-8_8
92 H. Peseschkian and A. Remmers

Fig. 8.1 The balance

Life Balance
model of positive -The Balance Model of Positive Psychotherapy-
psychotherapy
Body/Health
(„PHYSICAL“)

Future/Meaning/Goals Work/Achievement
(„SPIRITUAL“) („MENTAL“)

Relationships/Contacts
(„EMOTIONAL“)

3. Relationship styles and contact with partner, One-sidedness that goes on far too long can
family, friends, colleagues, acquaintances, lead to conflicts and disorders, among other things.
and strangers; social engagement “The four areas call to mind a rider who, being
4. Future plans include religious/spiritual prac- motivated toward achievement (Achievement),
tices, purpose/meaning, life goals, meditation, strives to reach a goal (Meaning/Future). For this
self-reflection, death, belief, and the develop- he needs a good horse which is well-groomed
ment of vision or imagination–fantasy (Body), and just in case the horse should throw
him off, helpers who will assist him to remount
Nossrat Peseschkian sees a balance of the (Relationships). This means that therapy cannot
energy of life distributed among the four areas deal only with one area, for example, the rider, but
as favorable conditions for health and resilience: must consider all related areas.” [8].
“According to the concept of Positive Consideration of the uniqueness of the
Psychotherapy, a healthy person is not one who patient is important so that he/she can reach an
has no conflicts, but rather one who has learned equilibrium within the framework of the “four
to deal adequately with these conflicts. Here areas,” that are agreeable to him/her. To put it
“adequately” means not to neglect any of the simply: every person should be in balance by
four areas of life, but to distribute one’s energy not neglecting any area of life for a long time;
(not necessarily time!) approximately evenly however, the manner of this balance is specific
into the four areas of life.” ([4], p. 99). The goal to individuals, families, and cultures. For exam-
is to achieve balance in the four areas. ple, although individualistic cultures such as
Accordingly, one objective of psychotherapeu- Western Europe and North America value the
tic engagement is to help the patient to recog- areas of body/health and achievement/job more
nize his own resources and mobilize them with importantly, in collectivistic cultures such as the
the goal of bringing them into a dynamic equi- Near East, the area of relationships (family,
librium. This places particular value on a bal- friends, relatives) and questions about the
anced distribution of energy (approximately future, the meaning of life, and about one’s
25% to each area), not an equal distribution of worldview (area of future/meaning) are more
time (see Fig. 8.2). significant to them (see Fig. 8.3):
8 Life Balance with Positive Psychotherapy 93

Fig. 8.2 Energy Body, Health

distribution in the
balance model
50

25

50 25 Achievement
Future/
Meaning
25 50

25

50

Relationships

Fig. 8.3 Balance model The Balance Model in Different Cultures

in different cultures [6]
Body/Health

Goals/
Work/Achievement
Meaning

Relationships

Western Europe,
Southern and Russia, China
USA
Eastern cultures

From Work–Life Balance to Life are emphasized and encouraged. His/her weakest
Balance feeling of self-worth is strengthened to create a
basis for the analysis of the areas with deficits.
The positive conception of human beings For example, a person who places a high value on
becomes particularly obvious when seen in the achievement and works long hours every day is
interpretation of the individual life balance. not confronted at an early stage with the fact that
Instead of pointing out a deficit to the patient or he or she should spend more time with the family
his/her family, and giving some immediate (see Fig. 8.4). At the outset, his inclination for
advice, the positive aspects of the one-sidedness achievement and his motivation to work are seen
94 H. Peseschkian and A. Remmers

Fig. 8.4 Life balance of Body/Health

a work-oriented person

50

25

50 25 Work/Job
Meaning/
Future
25 50

25

50

Relationships

and identified as a capacity. This is an encourag- the patient falls into a deep hole. There is too
ing experience for the patient and is important much energy that cannot be invested; thus, it goes
and fruitful for building the relationship between into full-blown inner unrest. A feeling of low
the therapist and the patient. At the same time, self-esteem (“nobody needs me”) is only one of
the patient and his family are told that the patient its consequences, but perhaps the most
is not suffering because he/she works so much, important.
but rather that he/she has neglected other areas of During the past 25 years, the term “work–life
life and not developed them. Often patients and balance” has become part of society’s daily con-
clients are very surprised and say, “You are the versation and goal in life. Thanks to this concept,
first one who tells me that working so much is a people started to give importance to other areas
capability and not only negative.” of life. Unfortunately, the term “work–life bal-
In this context, a positive image of human ance” itself causes stress, as it suggests that there
beings means a resource-oriented process, which might be work and that there might be life. In
means that this patient has the capacity for bal- many countries, it is neither possible nor desir-
ance, but, owing to his/her socialization and the able to separate between work and other areas of
circumstances of his/her life, he/she has not life, owing to technology, home office, different
developed certain areas of life until now. This settings, etc. Many patients report that they feel
process also prevents the phenomenon that in guilty and are under enormous pressure not to
psychiatry is called relief depression. Thanks to think or speak about work at home. Therefore,
the therapy, he/she reduces his/her workload, we use the term “life balance” in positive psycho-
goes on forced leave with his/her partner and therapy instead of “work–life balance.” The goal
children, paces back and forth the whole day at is to integrate all spheres of life into one’s life.
the beach, and spends the whole day on the cel- After all, the two are parts of one person. Thus,
lular phone or the computer until his/her partner we need more work–life integration than work–
cannot stand it anymore and sends him/her home life balance.
early. In positive psychotherapy, the therapist draws
Areas in which we have invested a great deal the attention of the patient to his/her strong areas
are generally our greatest sources of self-worth and to those not yet developed. While the patient
and affirmation. When such an area is diminished continues with his/her old lifestyle, the back-
before another one has been positively filled in, ground of his/her one-sidedness is worked on.
8 Life Balance with Positive Psychotherapy 95

New areas are being filled with desire, so that Each person develops his own preferences
they can affirm his/her self-esteem. consciously, or mostly unconsciously, as to how
The following questions may help one to to deal with conflicts that appear.
reflect on one’s own balance: The model of the four qualities of life also presents
the basis for the conceptualization of typical conflict
1. How much energy do you use for your body, models. We flee into illness (somatization) or exces-
sive body-building, into activity and achievement
for example, for sports, clothes, relaxation, (rationalization in the sense of disturbances of over-
rest, sexuality? How important to you is this burdening and adaptation), into refusal to perform,
area and how much of your self-esteem is into loneliness or gregariousness (accompanied by
obtained from it? idealization or deprecation, which lead to affective
disturbances and changes in social behavior) and
2. How much energy do you use each day for into fantasy and the world of thought (denial in the
education, profession, homework or other sense of anxieties, phobias, panic attacks and distur-
capabilities? Could you imagine a life without bances of illusion, addictive behavior, for example,
work, if you were financially secure? How into lack of imagination. ([4], pp. 99 ff).
much of your confirmation do you obtain Which form of conflict resolution one chooses
from your profession? depends largely on one’s experiences, especially
3. How much significance do family, acquain- those from one’s childhood. The balance model
tances or friends have in your life? How great is used in such a way in the presentation and dif-
is your need for contact? Do your partner or ferentiation of the four areas of conflict reaction
children give you confirmation of your self- as to describe disturbances of illness and symp-
worth or do you receive your confirmation toms. In this way, Nossrat Peseschkian differenti-
from other areas of life? ates between those areas that are over-emphasized
4. How much space does fantasy take up, for and over-differentiated in dealing with conflicts
example, reading, music or painting, or just from those that have been pushed into the shad-
thinking about life, beliefs, your own future or ows in an effort to deal with the conflict.
humanity? Do you occupy yourself much with
these questions or only with specific events?
Do you think often about the meaning of your The Balance Model in Practice
own life?
The balance model can be applied in a variety of
areas, such as psychotherapy, coaching, counsel-
Four Ways of Coping with Conflicts ling, mediation, professional assessment, preven-
and Conflict Resolution tion, personal and professional goal setting,
management training, stress management, psy-
Despite all cultural and social differences and the chotherapy education, and in choosing a partner
uniqueness of each person, we can observe that and marriage preparation.
all people resort to typical forms of working
through conflicts to cope with their problems. Here is an example of how the symptoms,
When we have a problem, we feel angry, bur- conflict reactions and resources can be docu-
dened or misunderstood, we feel stressed all the mented using the balance model during an inter-
time, or can see no meaning in our lives. We can view (see Fig. 8.5):
find expression for these difficulties in the four
forms of working with conflicts according to how • The patient’s individual goals, available
they are mapped out in the balance model. They resources and developed areas can be allocated
let us know how we perceive ourselves and the to the areas of the balance model and discussed
world around us and also through which method with the patient. This also promotes insight
of acquiring knowledge the reality check into correlations and the motivation to change.
succeeds. Negatively formulated goals, such as “not
96 H. Peseschkian and A. Remmers

Fig. 8.5 Example of a Body

documentation sheet Functional complaints, physical symptoms and disorders,
during the first interview physical impairments, substance abuse, disturbances of perception,
physical vitality, unrest, disturbances of sleep, food and libido

Future Achievement
Panic, anxiety, hopelessness, Disturbances of concentration,
loss of meaning, loss of pleasure, inability to work, stress
fear to live, fear of dying

Contact
Behavioral disturbances, compulsions, social phobias,
social withdrawal, emotional dependence

wanting to have anxiety anymore,” are turned aspects—profession and the ability to work,
into positively formulated realistic goals. other capabilities, housework, relevant com-
• The balance model is also used by therapists pulsive symptoms, difficulties at the work-
to describe their countertransference: what place, date when hired or when the job was
they think and feel about the patient, specific lost, or financial burdens such as housing
experiences of interaction with the counter- construction.
part, and the therapist’s fantasies can be put – Relationships/Contacts: Here, we find a brief
into the balance model and used to understand overview of relationships and social resources,
the material gathered during the sessions. which include problems, dealings, friend-
• We can record symptoms, conflict reactions, ships, data on the social environment, associa-
and resources into the balance model during tions, etc.
the therapy session. Eventually, the patient – Future/Purpose: She has concerns about the
will thereby attain an understanding of his/her philosophy of life, about that which gives sup-
life situation and of the effects of his/her port in life, about anxieties, dreams, beliefs,
disorder. religion, politics, goals, desires and creative
activities, the goals in life, and of therapy.

Case Example and Application Besides symptoms and disorders, patients suf-
fer a lot with regard to their influence on daily
Here is an example of a 45-year-old female life. In addition to the report of the patient, the
patient during the first session (see Fig. 8.6): following questions can be asked about the effect
of the complaints and disorder in the four areas:
– Body/Health: The patient’s current and previ-
ous illnesses and complaints, in addition to • What are the effects of your complaints on
her physical resources, are documented. Goal- your physical constitution?
oriented questions in the first interview con- • How have your sleep, sexuality, eating or
cerning nutrition, sports, sexuality, relaxation, pleasure changed during this time?
and sleep complete the spontaneously pro- • How do your complaints affect your ability to
vided data. work and your present job?
– Work/Achievement: We enter spontaneously- • How does your partner (your family) react to
given and elicited data about the following your complaints?
8 Life Balance with Positive Psychotherapy 97

Fig. 8.6 Symptoms of a Body

patient in the four areas Migraine, exhaustion, kidney trouble, sleep disturbances
of the Balance Model no desire for sex, generally feels healthy
no sports, healthy nutrition

Future/Purpose Achievement
Concern about her husband’s work, Work as a salesperson makes her satisfied,
family gives meaning and support, always goes to work, customers like
concern for her own parents her, works at home, more than before

Contact
Satisfied with the development of her daughters (16 and 14 years),
married for 20 years, good relations with her parents and siblings

• How have your relationships in the family or at the next session(s). For example, “How do you
with friends changed because of your see your own balance among these four areas?”
complaints? with reference to distribution of energy by using
• Who shows an understanding attitude toward Fig. 8.4. Working with the balance model leads to
your suffering? further stages of therapy. Often in these discus-
• Who acts differently toward you than before? sions, not only the contents of conflicts but also
• Which contacts have been most badly affected typical conflict reactions, basic concepts, mottos,
by your complaints? and model dimensions become clear.
• How do you see your future and that of your
family being influenced by your illness?
• What gives you support and what makes you Questions for the Area of Body/
anxious? Health
• What goals or desires do you have now that
you did not have before? • How do you judge your appearance?
• Do you view your body as friend or foe?
In the case of this patient, the balance model • Which of your organs reacts to anger, anxiety
was presented in its function of describing the or fear?
effects of the symptoms. Through this half- • How do you sleep?
structured approach with questions, unexpected • Are you satisfied with your sex life?
ideas, conflict reactions, experiences, and • Do you do some sport? What kind of sport?
resources come to the surface in the four areas, How intensively?
particularly in the second stage of therapy. The
comparison of the patient’s balance model with
that of his/her partner provides the means through Questions for the Area of Work/
which to differentiate the social resources, con- Achievement
flict reactions, and conflicted areas.
• Are you satisfied with your present job and
your learned profession?
Questions for the Assessment • What profession or job would you like to
of Life Balance practice?
• Which professional activities are giving you a
There are questions used to effectively assess the hard time?
balance of the patient. These questions [7, 8] can • How do you feel when you have nothing to
be given to the patient as homework and reviewed do? Can you do “nothing”?
98 H. Peseschkian and A. Remmers

• Would you still continue working, if you had Peseschkian calls the “energy of life” is approxi-
enough money? mately equivalent to “libido” or a general energy,
• What role does money play in your life? as described by Carl Jung or Alfred Adler. Jung
• How do you react when a supervisor or a col- also presents as the goal of therapy and the way
league criticizes you? of life a balance among the four areas of “func-
• Which of your parents put more emphasis on tion types”: thinking, feeling, perception, and
achievement? intuition. When all four of these functions have
been brought to the conscious level, the entire
crisis can stand in the spotlight; thus, we can
Questions for the Area speak of a “rounded” person ([3], p. 21; [11]).
of Relationships/Contact The operationalized psychodynamic diagno-
sis (OPD-2) includes four observable basic
• How do you feel when you are in a gathering capacities of the personality structure, which are
of many people? similar to the “four means of the capacity to
• Do you like to invite guests (family, friends, know” ([9]), as described by Remmers [10]:
colleagues)?
• How often do you go to the movies, theatre, – The “means of the senses” is comparable with the
concerts or other events? With whom? structural capacity to perceive oneself and others,
• Are you a member of an association? Do you as described in the OPD-2. In the foreground,
participate actively? there stands the body—the self—the feeling.
• Are traditions (family, religious, cultural, – The “means of reason” serves in Peseschkian’s
political) important to you? balance model as the reality check through
• Which of your parents was more sociable and which problems can be resolved systematically,
liked contact? and it directs our activities. It is related in
• In your childhood, to whom could you turn OPD-2 to the structural capacities that direct
when you had a problem? our inner and outer impulses.
– The “means of tradition” serves as the capac-
ity to take up relationships and to flee from
Questions for the Area of Meaning/ them. In OPD-2, the analogy to this is the
Future emotional communication with oneself (inter-
nal dialogue) and with others as the structural
• Do you consider yourself an optimist or a capacity for empathy, and the anticipation of
pessimist? relating to and thinking about others.
• Do you sometimes think about the future? – The “means of intuition” is described by
About your future, that of your family, your Nossrat Peseschkian as the fourth area, that of
country, the world? meaning, future, and fantasy. He defines it as
• Do you believe in life after death? the capacity to imagine something in one’s
• What gives you support in your life? thoughts. It can allow for the sudden appear-
• What is the purpose of your life? ance of the vision of a painful separation from
a partner. Intuition and imagination can go
beyond immediate reality and take in what-
A Brief Comparison of the Balance ever we can depict as the meaning of an action,
Model with Similar Concepts the meaning of life, desires, pictures of the
future or utopia. In the OPD-2, the fourth
A comparison of the balance model with the capacity of the personality structure is the
models presented by other authors shows simi- “capacity to form attachments” [5]. Included
larities between this anthropological approach in this is the imagination of objects that pro-
and other therapeutic orientations. What Nossrat vide support, the connection to an ideal and
8 Life Balance with Positive Psychotherapy 99

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Munich: Ernst Reinhardt; 2013.
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present a forerunner of the structural models as therapist. Berlin, Heidelberg: Springer; 1986. (first
in OPD-2 (English translation, [5]). German edition in 1980, latest English edition in 2016
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1987. (first German edition in 1977).
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