Problem-solving therapy

Domain II · Behavioural & cognitive · D'Zurilla, Goldfried, Nezu · 1971

What it is

Problem-solving therapy is a brief, skills-based cognitive-behavioural intervention. It teaches people to cope with stressful problems, large and small, using a set way of thinking and acting. D'Zurilla & Goldfried (1971) first set it out as a five-stage training model. D'Zurilla & Nezu later…

Format

• Format. Individual or group; face to face, by telephone or by video (the 2019 guidelines cover telehealth and community collaborative-care delivery). Length depends on the version: (a) contemporary PST and EC-PST are organised as "stepped care", so the number of toolkits and sessions is tailored…
• Phases (contemporary PST / EC-PST)

Who practises it, and how they are trained or regulated

• Tailoring rule. Profile the client's problem-solving style. A strong negative orientation, hopelessness or high emotional reactivity calls for more time on motivation, Stop and Slow Down, and healthy thinking. Deficits in planful skills call for more time on planful problem solving. A client whose main issue is an impulsive or avoidant style needs SSTA plus graded planful practice. A client who already…
• PEARLS (Program to Encourage Active, Rewarding Lives for Seniors): for adults aged 60 and over with minor depression or dysthymia who receive home-based social services. Eight 50-minute sessions are held in the client's home over 19 weeks, delivered by a trained social-service counsellor. Components: problem-solving treatment (recognising depressive symptoms, defining the problems that feed them, and devising steps…
• What it is. Problem-solving therapy is a brief, skills-based cognitive-behavioural intervention. It teaches people to cope with stressful problems, large and small, using a set way of thinking and acting. D'Zurilla & Goldfried (1971) first set it out as a five-stage training model. D'Zurilla & Nezu later developed it into the "social problem-solving" model, and the Nezus have since built it into an emotion-centred,…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Tasks that are too large or vague. It is working when the completion rate rises.
• The client relying on the therapist to finish the steps. It is working when solo homework attempts show all the steps.
• Picking the hardest piece first. It is working when goals are specific enough that you can tell next week whether they were done.
• Clients with literacy or visual limits (use voice notes or drawings). It is working when the client starts writing things down unprompted.
• Activities that are too ambitious, or that cost money or mobility the client lacks. It is working when the client completes them and mood ratings rise.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.