Problem Solving Therapy in the Clinical Practice

Mehmet Eskin

• Publisher: Elsevier
• Year: 2012
• ISBN:
  9780123984685
• Topic: Psychology
• Subtopic: Cognitive Behavioral Therapy (CBT)
• Index: Psychology

Evidence based or empirically supported psychotherapies are becoming more and more important in the mental health fields as the users and financers of psychotherapies want to choose those methods whose effectiveness are empirically shown. Cognitive-behavioral psychotherapies are shown to have empirical support in the treatment of a wide range of psychological/psychiatric problems. As a cognitive-behavioral mode of action, Problem Solving Therapy has been shown to be an effective psychotherapy approach in the treatment and/or rehabilitation of persons with depression, anxiety, suicide, schizophrenia, personality disorders, marital problems, cancer, diabetes-mellitus etc.

Mental health problems cause personal suffering and constitue a burden to the national health systems. Scientific evidence show that effective problem solving skills are an important source of resiliency and individuals with psychological problems exhibit a deficiency in effective problem solving skills. Problem solving therapy approach to the treatment and/or rehabilitation of emotional problems assumes that teaching effective problem solving skills in a therapeutic relationship increases resiliency and alleviates psychological problems.The book, in the first chapters, gives information on problem solving and the role of problem-solving in the etiology and the treatment of different forms of mental health problems. In the later chapters, it concentrates on psychotherapy, assessment and procedures of problem solving therapy. At the end it provides a case study.

• Provides a comprehensive appreciation of problem solving therapy
• Contains empirical evidence and applied focus for problem solving therapy which provides a scientific base and best practices
• Highlights the problem solving difficulties of persons with specific disorders

1

Definition and Concepts

Introduction

Before we can consider using a therapy, we need to be sure that we understand the basic definitions and concepts so that we all interpret and apply the information in the same way. The definitions draw the boundaries around the terms and the concepts of any scientific topic and introduce its relationship to and difference from other topics. A scientific topic or a clinical therapy needs to be viewed within a theoretical and conceptual framework. In order to facilitate understanding and provide a guideline for application, this chapter introduces the fundamental definitions and concepts of problem-solving therapy (PST). It begins with a definition of PST and then proceeds to define the concept of a problem and of a solution. Once this has been established, we can consider problem solving and the difference between coming up with a solution to the problem and applying the solution. The clarification of these concepts is necessary for both research and application.

What Is PST?

PST is a treatment method that can be used when people have developed emotional problems through enduring the hardship caused by the daily problems that they face. The goal of PST is to teach people how to approach their problems as well as strategies and other means they can develop to solve these problems. Thus, PST aims to treat the emotional difficulties caused by these problems as well as to prevent the emergence of psychological difficulties.

In general, the problem-solving approach can be used in two ways. The first is the standard therapy method, wherein PST is used to treat psychological problems caused by exposure to problem situations. The second is a preventive approach. People can be taught how to effectively handle daily problems before those problems have produced any emotional difficulties. It is assumed that training healthy individuals how to solve or handle problems of daily living prevent the development of psychopathology. This way, problem solving mainly aims to increase the resiliency of the person.

The PST approach can also be defined as the clinical application of the information on problem solving and decision making collected through academic psychology. PST is a cognitive–behavioral psychotherapy approach. Psychotherapies are considered to be empirically supported if their efficiency is shown scientifically (Borkovec & Castonguay, 1998). As is known, cognitive–behavioral treatment approaches have come to occupy a very important place in the mental health field with good scientific evidence to support their use (Bandelow et al., 2007; Butler et al., 2006; DeRubeis et al., 2005; Hollon et al., 2005; Malhi et al., 2009; Steward & Chambless, 2009). Recent meta-analytic studies indicate that the efficacy of PST is shown empirically in the treatment of a wide range of health problems (Bell & D’Zurilla, 2009a; Cuijpers, van Straten, & Warmerdam, 2007; Malouff, Thorsteinsson, & Schutte, 2007).

So, where does PST take its place among cognitive–behavioral therapies? McGuire (2001) appraises cognitive and behavioral therapies on a scale that ranges from being “purely behavioral” to being “purely cognitive.” On the purely behavioral end of the scale, behavioral modification takes place, and on the purely cognitive end of the scale, schema-focused therapy takes place. On this scale, PST sits between self-instructional training and cognitive therapy.

PST is being used more and more for the treatment of emotional problems. Scientific research shows that the absence of problem-solving skills in people causes the emergence of psychopathology and its endurance. For this reason, the PST approach is important for eliminating the negative effects that people face in their lives as well as making it easier for them to cope with these problems.

What Is a Problem?

One of the most important definitions of PST is the definition of the problem. What is a problem? How does PST define a problem? How can a problem be defined in a formal way?

A problem can be defined in many ways. Creating a formal definition that allows everyone to meet on common ground is crucial. The Encyclopedia Britannica defines a problem as “a question raised for inquiry, consideration, or solution.” According to the extended definition offered by Webster’s Online Dictionary, “a problem is an obstacle which makes it difficult to achieve a desired goal, objective, or purpose. It refers to a situation, condition or issue that is yet unresolved. In a broad sense, a problem exists when an individual becomes aware of a significant difference between what actually is and what is desired. Every problem requires an answer or solution.”

These definitions consist of four aspects. The first aspect requires the problem to be inquired about and investigated. For example, a student who encounters a math problem should learn more about it. The student should collect and acquire more information about it and investigate what is required for solution. According to the second aspect, a problem is a situation that should be thought about and solved. The person who encounters the problem should think about it and find out what needs to be done. Third, a problem needs to be solved. One needs to solve the problem according to one’s own personal goals. Last, a person should know his or her goal or objective with regard to the problem. This way, he or she will know what to do and where to go.

Aside from the formal definitions, how PST defines the problem is also important. D’Zurilla, Nezu, and Maydeau-Olivares (2004) define a problem as “any life situation or task (present or anticipated) that demands a response for adaptive functioning but no effective response is immediately apparent or available to the person or people confronted with the situation because of the presence of one or more obstacles” (pp. 12–13). According to this definition, a solution to a problem requires a reaction from the individual who faces the problem. However, the individual may not be able to give a reaction due to certain obstacles. According to the authors, these obstacles can be environmental as well as personal. For D’Zurilla et al. (2004), objective qualities of the problem are referred to as the environmental obstacles, whereas the characteristics of the individual such as personal goals, needs, and commitment constitute the personal obstacles. The authors emphasize that the novelty, ambiguity, and unpredictability of the problem, conflicting stimulus necessities, lack of skills, and lack of resources can also be considered as obstacles.

What kind of problems do people encounter? What kinds of situations require a reaction from an individual? Literature on the issue shows that the problems that people face in their daily lives can be grouped into four main categories. These are personal, interpersonal, impersonal, and social problems.

Personal Problems

Personal problems can be described as health-related, behavioral, and emotional problems. No one is exempt from experiencing physical or mental health difficulties or problems. Therefore, personal problems can be identified as the most common problems that people go through. In order to overcome these problems and reduce their possible negative effects, the individual should know how to approach and handle them. The adaptive functioning of the individual increases based on the success of these efforts. If these efforts are unsuccessful or insufficient, both the effects and the intensity of the individual’s problems increase.

Interpersonal Problems

Most people find that what makes life beautiful is the time they share with loved ones. Yet, another thing that we learn in life is that those people who make our lives beautiful, livable, and meaningful can be the major source of our problems. Interpersonal relations can be the source of both happiness and unhappiness. Therefore, the most common problems that people have in life are likely to be caused by interpersonal relations. Interpersonal problems may have tremendous impact on people’s emotional well-being.

In order to search for the scientific basis of interpersonal problems, Horowitz (1979) studied the interpersonal problems of 28 psychiatry patients who had just begun receiving psychotherapy. Using a multidimensional scaling technique, the researcher found that interpersonal problems have three fundamental cognitive characteristics. The first characteristic is the psychological closeness between two people. As the psychological closeness between two individuals increases, the likelihood of facing problems in their relationship increases. The second characteristic is the nature of the interpersonal relationship, such as whether it is friendly or hostile. Friendly interpersonal relationships enhance psychological well-being, whereas hostile interpersonal relationships deteriorate it. The third characteristic concerns one party’s intention of effecting, controlling, or changing the other party. In a relationship between two people, problems are more likely to arise when one party realizes that the other party is trying to change or control him or her.

Impersonal Problems

The problems in this group are easier to solve because they are usually clearly defined—they are mundane problems that have mundane solutions (see Chapter 9) Examples include having your car break down or running out of groceries at home. These are well-defined problems and what is required from the individual is clear.

Social Problems

Everyone encounters social problems within the communities in which they live. The issues we face in our everyday lives such as heavy traffic, political problems, economic problems, and educational problems can be put in the social problems category. Even though these issues affect the individual both emotionally and socially, the discussion and the solution of social problems can take a long time. Naturally, the solutions for these problems are not personal. Individuals can contribute to the solution, but in order to solve the problem, different factions of society such as political, economical, social, and judicial should come together. Social problems can only be overcome by collective efforts and means. Different segments of the population should exert effort and make contributions in order to solve these problems.

What Is a Solution?

One of the concepts that should definitely be discussed within PST is the concept of a solution. What is a solution? How can we define it? What is considered an effective solution in PST? How can the therapist know that the problems of the client can be solved? According to what measures can it be said that a problem is resolved? Having answers to these questions is crucial for successful PST and the problem-solving therapist.

Webster’s Online Dictionary defines solution as “a statement that solves a problem or explains how to solve the problem; a method for solving a problem; the successful action of solving a problem and the act of solving, or the state of being solved; the disentanglement of any intricate problem or difficult question.” By solution, what is meant is the result of the attempts that one makes in order to solve a problem. The important point here is the quality of the result and its coherence with the aim. Is the result that is reached by the process consistent with one’s aim regarding the problem? People can make attempts to solve a problem, but the result that they get may not be the one that they were aiming to reach. It may be consistent with one’s aim, but it may not be satisfying in terms of its quality. In order to be named as a solution, one should have reached one’s aim and one should be satisfied with the quality of the solution.

In the context of PST, D’Zurilla et al. (2004) define the solution as “a situation-specific coping response or response pattern (cognitive or behavioral) that is the product or outcome of the problem-solving process when it is applied to a specific problematic situation” (p. 13). Based on this definition, the individual who encounters a problem starts a problem-solving process, which serves as a cognitive or behavioral way of coping with it. In order for this process to lead to a solution, the coping behavior should lead the individual to a positive outcome.

The crucial point here is to determine if the coping behavior that is produced by the problem-solving process is effective or not. D’Zurilla et al. (2004) define the effective solution as “one that achieves the problem-solving goal (i.e., changing the situation for the better or reducing the emotional distress that it produces), while at the same time maximizing other positive consequences and minimizing negative consequences” (p. 13). The problems that are discussed and sought to be solved in PST are mostly interpersonal. D’Zurilla et al. define the effective solution to interpersonal problems as “an effective solution is one that resolves the conflict or dispute by providing an outcome that is acceptable or satisfactory to all parties involved” (p. 13).

What Is Problem Solving?

What is problem solving? What does problem solving refer to? Heppner and Krauskopf (1987) define problem solving as “a goal-directed sequence of cognitive and affective operations as well as behavioral responses for the purpose of adapting to internal or external demands or challenges” (p. 375). The authors describe problem solving as the organization of cognitive, emotional, and behavioral reactions. Problem solving is understood as the individual’s adaptation to self-imposed demands and demands made by his or her environment.

Heppner and Krauskopf (1987) view problem solving as a coping process and as the interaction of three factors. Accordingly, problem solving is a result of an interaction of the characteristics of the problem, whether or not the individual applies problem-solving steps, and the individual’s personal characteristics. This is, in a sense, identical to Lewin’s (1939) B=ƒ(P,E) formula, the one he used to highlight the determinants of human behavior as a combination of the characteristics of the individual and the environment. In this formula, “P” represents the person and “E” represents the environment.

On the other hand, D’Zurilla et al. (2004) define problem solving as “the self-directed cognitive–behavioral process by which an individual, couple, or group attempts to identify or discover effective solutions for specific problems encountered in everyday living” (p. 12). The authors emphasize that the cognitive–behavioral problem-solving process has two important functions. Accordingly, the process first brings to light the effective possible solutions for a problem and secondly it increases the possibility of finding the most effective solution among these options. They view problem solving as a conscious, rational, and goal-directed activity that requires effort.

The Difference Between Finding a Solution and Applying It

In problem solving, there is an urgent need to distinguish between two processes and to follow the necessary strategies accordingly. The first thing for PST to determine is if the individual is having trouble with coming up with a solution to the problem or having trouble applying a solution. ...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Dedication
• Introduction
• 1. Definition and Concepts
• 2. Resilience, Coping, and Problem Solving
• 3. Components of Problem Solving
• 4. Theoretical Approaches to Problem Solving
• 5. Problem-Solving and Psychological Problems
• 6. Efficacy of Problem-Solving Therapy in Treating Mental Health Problems
• 7. The Practice of Problem-Solving Therapy and the Applied Patient Groups
• 8. Psychotherapy: Principles, Skills, Characteristics, Difficulties, and Change Processes
• 9. Assessment in Problem-Solving Therapy
• 10. Processes and Sessions of Problem-Solving Therapy
• 11. An Example of a PST Application
• References