Clinical Prompt
Step 1. State the Problem
- The Problem Checklist
- visualization
- identify problem category
- select one situation
- Problem Analysis Form
Step 2. Outline Goals
- set goals
- weigh WANTs
Step 3. List Alternatives
- brainstorm
Step 4. View the Consequences
- select the most promising strategy.
- evaluating Consequences Form
- ask the child:
- ‘How would putting that strategy into action affect what you feel, need, or want?’
- ‘How would it affect the people in your life?’
- ‘How would it change their reaction to you?’
- ‘How would it affect your life right now, next month, or next year?’
- take some time to get both positive and negative consequences for each possible strategy
- rank the consequences
- select the strategy
- develop tactical steps [repeat brainstorming, if necessary]
Step 5. Implement & Evaluate
- satisfaction
- dissatisfaction
- return to Alternative Strategies list
- select strategies previously passed over
- redo the strategies list
Special Considerations:
Follow the full procedure
Forms & Charts
Problem Checklist CBM#13-001
Problem Analysis Form CBM#13-002
Preparing for upload:
- Developing Objectives Form CBM#13-003
- Alternative Strategies form CBM#13-004
- Evaluating Consequences Form CBM#13-005
Download Available | CBMT 13 Supplemental Docs
Introduction
Problems that elude solution result in chronic emotional pain. When the usual coping strategies fail, a growing sense of helplessness makes the search for novel solutions more difficult. The possibility of relief seems to recede, the problem begins to appear insoluble, and anxiety or despair can increase to crippling levels.
In 1971, Thomas D’Zurilla and Marvin Goldfried devised a five-step problem-solving strategy for generating novel solutions to any kind of problem. They defined a problem as “failure to find an effective response.” For example, the fact that a person can’t find one of his shoes in the morning is not in itself a problem. It becomes a problem only if he neglects to look under the bed where the shoe is most likely to be found. If he looks in the sink, the medicine cabinet, and the garbage disposal, he is beginning to create a problem – his response is not effective in finding the missing shoe and, therefore, the situation becomes “problematic.”
A convenient acronym for the five steps of problem management is SOLVE, which stands for:
State the problem.
Outline your goals.
List your alternatives.
View the consequences.
Evaluate your results.
Symptom Effectiveness
Problem management is effective for reducing anxiety associated with procrastination and the inability to make decisions. It is useful for relieving the feelings of powerlessness or anger associated with chronic problems for which no alternative solution has been found. Problem management is focused on dealing with chronic problems and is not recommended for interpersonal in vivo problem solving. See Interpersonal Cognitive Problem Solving to address these kinds of problems.
Time for Mastery
Problem-solving techniques can be put into effect the same day they are learned. After several weeks of practice, applying the steps becomes largely automatic.
Instructions
Step 1: State the Problem
The first step in problem management is to help the child to identify the problem situations in his/her life. People normally experience problems in areas such as finances, work, social relationships, and family life. The Problem Checklist Chart CBT#13-001] will help the child identify the area in which s/he operates least effectively and has the most problems. This is the area you and the child will concentrate on as you teach him/her to develop problem solving skills.
After each situation listed, the child can check the box that best describes how much of a problem it is. If s/he has trouble determining whether a situation is a significant problem, have him/her imagine him/herself in that situation. Have the child include lots of sights and sounds and actions to make it seem real.
Ask the child ‘In that situation, do you feel angry? depressed? anxious? confused?’ These are “red flag” emotions. When a person experiences anger, depression, anxiety, or confusion, s/he is probably in a situation that is a problem for him/her – something about the way s/he is responding to the situation isn’t working.
On the Problem Checklist, have the child mark the appropriate cell or box:
No interference – This doesn’t apply to me or doesn’t bother me.
Interferes a little – This mildly affects my life and is a small drain on my energy.
Interferes moderately – This has a significant impact on my life.
Interferes a great deal – This greatly disrupts my day-to-day existence and strongly affects my sense of well-being.
Using the Problem Checklist just completed, help the child determine the general category that causes the most interference in his/her life. From that area, pick one of the situations that s/he has ranked as interfering moderately or a great deal.
Using the situation chosen, have the child fill out the Problem Analysis Form [CBT#13-002]. Have the child try to put at least one word in each blank. When a blank isn’t large enough, use a separate sheet of paper.
By describing the situation in terms of who, what, where, when, how, and why, the child will get the problem clearer in his/her mind. S/he will also uncover many more details than are usually available for consideration. Have the child take his/her time. The details of the behavior, feelings, and wants are also important because they will provide clues for generating solutions later.
Step 2: Outline Goals
Having completed the Problem Analysis Form, we may find that we have identified the goals that are being frustrated. You will need to have the child examine his/her response to the problem – what s/he does, how s/he feels, and what s/he wants. These statements are particularly helpful for developing specific goals. Clarify the fundamental purpose of the actions taken to achieve the goal. Generally, we will find that a goal statement will contain opportunities to develop objectives of smaller steps that one will take in pursuit of the goal.
Using the Defining Objectives Form CBT#13-003 the child can being to list the goals and objectives. Once these are in place, the child can classify the objectives into MUSTS and WANTS. Help the child look for those objectives which are mandatory for a successful outcome.
Not every situation will have MUST objectives, but most decisions have objectives that, while not essential, are nevertheless desirable. These are the WANT objectives, and they usually vary in their degree of importance. Therefore, you may want to additionally classify the WANT objectives.
Listing all of the WANTS and weigh the relative importance on a scale from 10 to 1. The other WANT objectives are assessed relative to that benchmark. The rating is the client’s, not yours. Once having developed and classified the objectives, it is helpful to step back and review them. The objectives should be stated so that the MUSTS are measurable and the WANTS are well defined.
It’s time to set one or more goals for change. Have the child examine his/her response to the problem – what s/he does, how s/he feels, and what s/he wants. These statements are particularly helpful for developing specific goals.
Step 3: List the Alternatives
In this phase of problem management, you will need to “brainstorm” with the client to create strategies that will help to achieve the newly formulated goals. The brainstorming technique set forth by Osborn in 1963 has four basic rules:
- Criticism is ruled out. This means that you and the child write down any new idea or possible solution without judging it as good or bad. Evaluation is deferred to a later decision-making phase.
- Freewheeling is welcomed. The crazier and wilder the idea is, the better. Following this rule can help lift you and the child out of a mental rut. The child may suddenly break free of old, limited views of the problem and see it in an entirely different light.
- Quantity is best. The more ideas generated, the better the chances are of having a few good ones. Just have the child write them down, one after another, without thinking a lot about each idea. Don’t stop until you and the child have a good, long list.
- Combination and improvement are sought. Go back over the list to see how some ideas might be combined or improved. Sometimes two pretty good ideas can be joined into an even better idea.
Brainstorming during this phase should be limited to general strategies for achievement of goals. Leave the nuts and bolts of specific actions for later. The child will need a good overall strategy first. Particular behavioral steps come in the next phase.
Use the Alternative Strategies Form [CBT#13-004] to list at least ten alternative strategies for accomplishing each of your goals. It is important not to give up the search for alternative strategies too quickly. Your tenth idea may be the best one.
Step 4: View the Consequences
By now the child should have several goals, each with at least ten strategies for its accomplishment. The next step is to select the most promising strategies and view the consequences of putting them into action. For some people this process of figuring and weighing consequences happens automatically as soon as they think of a possible strategy for getting what they want. Others are likely to ponder the consequences more slowly. Whichever category better describes your client, it will be helpful to do this step thoroughly and conscientiously.
Pick the goal that is for the child, most attractive. Help the child go over its strategies and cross out any obviously bad ideas. Whenever possible, s/he should combine several strategies into one. Try to reduce the list to three strategies representing the best ideas. It is important that these be the child’s ideas and not yours. While you can suggest and even recommend, the child must choose.
Have the child list these three strategies in the spaces provided on the following Evaluating Consequences Form [CBT#13-005]. Under each strategy, have the child list any negative and positive consequences s/he can think of.
Ask the child:
- ‘How would putting that strategy into action affect what you feel, need, or want?’
- ‘How would it affect the people in your life?’
- ‘How would it change their reaction to you?’
- ‘How would it affect your life right now, next month, or next year?’
Take some time to get both positive and negative consequences for each possible strategy.
When you have the major consequences listed, have the child go over each one and ask him/herself how likely it is to come about. If the consequence is very unlikely, have the child cross it out – s/he is simply telling him/herself horror stories or being falsely optimistic.
Then score the remaining consequences as follows:
- If the consequence is predominantly personal, give it two points.
- If the consequence predominantly affects others, give it one point.
- If the consequence is predominantly long range, give it two points.
- If the consequence is predominantly short range, give it one point.
Note that consequences can be both personal and long range at the same time (total score of 4), affect others long range (total score of 3), and so on.
Add up the scores for each strategy to see whether the positive consequences outweigh the negative. Then select the strategy whose positive consequences most greatly outweigh the negative consequences.
Now you need to encourage the child to decide on the steps s/he will have to take to put the strategy into action.
The child may have trouble thinking of concrete tactical or behavioral steps. If so, return to brainstorming to have the child develop a list of alternative tactics. Then have him/her explore the likely consequences of the steps using the same technique learned for selecting the overall strategy.
Step 5: Implement & Evaluate the Results
The last step will be the hardest one for the child, since s/he will now have to act. You’ve helped him/her to select some new and different responses to an old situation. It is time to put those decisions into effect.
Once the child has tried the new response, s/he must observe the consequences. Are things happening as s/he predicted? Is s/he satisfied with the outcome? Being satisfied means that the new response is helping you reach your goals in a positive way that the old “solution” was not.
If the child is still not reaching his/her goals, have him/her return to the alternative strategies list. You can help him/her either generate more ideas at this point or select one or more strategies that was passed over before. You may have the child repeat Steps 3, 4, and 5 of the problem-solving procedures.
Special Considerations
Some people feel a little overwhelmed by the complex steps involved in problem management. Their response is, “Do I really have to do all that?” The answer is yes – the first time. The child has been stuck for a while in a problematic situation. Old, habitual solutions haven’t worked. You need to encourage the child to follow each step of the technique to identify and then achieve his/her goals. Later, s/he can tailor the procedures to fit his/her particular style, and much of it will have become automatic.