Problem Solving Therapy (PST)

Some people have expressed surprise when I say my social work training and education experience was just as useful to my present day practice as my psychology training.

During that social work training, I learned about Problem Solving (PS) strategies. I learned about their limitations when I got into actual practice.

Most of my training in the 1960’s was pre-occupied with analytic models with a focus on the individual and their internal experience. Such perspectives paid little attention to the power imbalances and social inequalities engrained in our communities. Those analytic models too often looked to the past assuming early years problems might be rooted out and years of experience could be re-balanced. Too often this did not happen; indeed, it could not happen.

Some of my training recognized that socio-economic factors oppressed many – not all – clients.  Information from PS helped shape more realistic models of social work practice. It fostered some compassion when assessing the challenges imposed on clients.  This attitude helped with strategies such as reinforcement of a client’s support structure or making connections with others to resolve problems – in relation to housing, employment and income.

It was one thing to appreciate the socio-economic factors contributing to a client’s problems but the social worker’s approach could be more direct. There were some options open to the individual. What was required was a sense of proportion and and a realistic assessment of what the individual might acheive. In particular, it needed an attitude that did not hold that individual accountable for each and every complication in their life.

So, devising small, safe and achievable change was helped by Problem Solving Therapy (PST). It was an approach with its roots in the behaviour modification strategies that emerged  in the mid-20th century.

One such strategy of PST is to keep focus on the present; to address today’s problems for individuals and families in difficult personal circumstances.  For that reason, the ‘middle box’ in my inverted tree illustration is central to the design of small, safe experiments.

In the 1970’s this PST model was ‘translated’ into social work by William Reid and Laura Epstein. They worked in Chicago developing task-centred social work practice and giving attention to do-able solutions to specific problems. It was an active, direct and measurable approach; either something happened, or it did not.

Of course, both models had limitations and one of them went back to those structural inequalities mentioned above. Too often the ‘professional’ had too much influence over what the client was ‘supposed’ to do. It was rather too easy to impose sanctions on non-compliant clients.  OK, that option was not written in to the text-books, but it was an actuality. Some would argue it is a a necessary actuality in situations were a some-one’s safety is compromised.

The tendency still applies in its more modern manifestations of these therapies, e,g. where ‘homework’ is used in cognitive behavioural models in psychological services. Continuing availablity of service can depend on client compliance. Today the pressures on clients from health and social services systems are subtle and sanitised, but scratch them enough and you will find it.

Despite all this, you can use this task-centred framework to design your small, safe experiments. The framework offered is:

Identify your Target Problem(s)

Set Goals in negotiation with important people in your family and community

Create and execute an Action Plan

Evaluate the results and re-assess outstanding needs.

Redesign goals and re-create another Action Plan ….. forever, if necessary!

This process is not a million miles away from the Problem Solving Therapy approach i will summarise as:

Addressing problem orientation: Each person in the world has a unique approach to problems and it is helpful to normalise the existence of ‘problems’. Often, they are normal responses to abnormal situations. It may help to know you are not alone when seeking to know what is really troubling. What’s your experience here?

Clearly defining problems: it can be difficult to identify what the problem actually is. That’s why professionals can help – as long as you know they can hinder as well.

Brainstorming and evaluating solutions: The PS approach discourages us from taking the first problem we find and the using the first ‘answer’ that comes our way. Too often it is not clear what is happening, and what can be done about it.  There is a need to evaluate problems and solutions thoroughly, to avoid cul-de-sacs or blind alleys. Instead, look for multiple solutions – even zany ones, in the first place.

Taking action: If a problem can be broken down into steps, then the problem solving process can be far more achievable. Too often a problem-solving process is stopped by an indigestible course of action.  Yes, there have to be limitations to the ‘smallness’ of a step, but often – in general terms – there cannot be a step that is too small.  As you plan your actions, look for the Just Noticeable Difference (JND) and go for it. Later on, actions might be larger and you may take them with greater confidence. However, the prospect of small defeats increases when the size of any step is enlarged.  One such defeat worth highlighting is procrastination – putting off today, what you think you can leave until tomorrow. You ever done that?!

Notice, if you would, the connection here with the Change models I have touched on elsewhere.

Verify: it’s important to consider whether you chose the best alternative when you first evaluated your options. How are you going to test that? Not possible without some information  – some record of your ‘results’.  From those results, you may notice the balance of small defeats and small victories you have obtained from taking action.

In many ways, I am re-hashing the design of small safe experiments, as described elsewhere.  I wanted to do this to demonstrate that there are many ways approach therapy. Indeed, there is little that is new in therapy. So much that is available is re-packaging of what has gone before.

Therefore, in addition to fostering curiosity and creativity, as I have done several times, please consider a tea-spoon of scepticism. Beware of lavish claims. change is hard-won in my experience and, in general terms, it is not a process that comes easy to human beings.

 

Return to:

Welcome

What is a nudge

A light-hearted history of therapy

Designing safe experiments

More on designing experiments.