Seven Steps

Problem solving therapy (PST) is a brief psychological intervention, or "talking therapy". PST is usually provided over a series of between four and eight sessions. During these sessions the clinician and client collaborate to identify what problems are occurring in the client's life, and then focus on one or more of these while the therapist/clinician teaches the client a structured approach to solving these problems, as well as focusing on improving the client's general approach to problems.

Clinicians can choose to use PST as a complete format or structure for therapy sessions with their client, or may choose to add PST to other approaches that they use. The aim of our training programme is to provide clinicians working with clients at risk of self harm with new skills and knowledge that they can add to their current therapeutic "toolkit".

PST consists of a series of seven steps. For an overview of each of the steps please click on the links on the left.

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Problem orientation can be understood as a client's attitude to solving problems, as distinct from the actual problem solving skills they possess. Problem orientation is made up of a client's thoughts and feelings about problems in general, and thoughts and feelings about their own ability to solve problems. Together these two elements determine how a client will respond when faced with a stressful problem. This makes it a really important part of problem solving therapy.

Positive problem orientation is linked with a rational, and effective, problem solving style. By contrast, negative problem orientation is linked with either an impulsive/careless problem solving style, or an avoidant problem solving style. An impulsive/careless style means clients are likely to make sudden decisions that are not well thought out and are not necessarily relevant to the actual problem. An avoidant style means clients are likely to ignore the problem in the hope that it might go away or in the hope that someone else might solve it.

Problem Orientation is referred to often throughout the therapy sessions. One of the primary aims of PST is to assist the client to develop a more positive orientation, and this is done by education, helping the client to recognise when their attitude toward problems is negative, teaching the client to challenge their more negative attitudes and encouraging them to increase their belief in their ability to solve problems through positive experiences.

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The aim of this step is to teach the client how to recognise when a problem exists so they can correctly identify it and begin to solve it. This may sound obvious but is not always straightforward to achieve. When someone is used to either avoiding problems or responding impulsively, their ability to first recognise a problem exists and then correctly identify what that problem is may be under developed.

There are three parts to this step:

The outcome is twofold. In therapy, it results in generating a list of problem areas with the client which will form the basis of your work together. More importantly, it provides the client with the skills necessary for the ongoing real life task of problem recognition and identification.

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The third step in problem solving therapy is to assist the client to select one clear problem to work on and then define it. Defining a problem clearly is particularly important because the more clearly a problem is defined, the easier it is to find possible solutions. A woolly problem is likely to result in fuzzy solutions. Clear definition is achieved by gathering all the available facts and writing them clearly and objectively.

Selecting & defining a problem worksheet

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After selecting and defining a problem to work on, the fourth step in problem solving therapy is to identify possible solutions, and brainstorming is how we accomplish this. Brainstorming is a method of generating as many possibilities and alternative solutions to the problem at hand without evaluating their potential usefulness. The reason for thinking of a lot of ideas is to increase the likelihood of coming up with an effective solution. It involves asking the client to come up with all the ideas they can think of that could contribute to solving the problem. The main criteria are that each idea should be relevant to the problem and have a chance of solving the problem or contributing to solving it.

Brain storming worksheet 1
Brain storming worksheet 2

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Once the client has identified a number of potential solutions, the fifth step is decision making. In this step the client looks in more depth at the solutions generated during the brainstorm, and by weighing up the advantages and disadvantages of potential solutions makes a decision about which one to implement. The aim is to find a solution that will be effective.

Some clients find the decision making stage difficult, with potential solutions going round and round in their minds. It can certainly be difficult to know where to start when you have a large number of options before you. The clinician's role is to teach the client a systematic way to sort through the alternative solutions by using decision-making guidelines. This is achieved by first considering whether there are any solutions we can immediately discard (initial selection). Then similar solutions are grouped together to gain a sense of the range of options available (grouping solutions). Finally, the client chooses two or three solutions they would like to try out and evaluates them in more depth (weighing the advantages and disadvantages).

Decision making worksheet

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This step requires the client to create and then implement, or carry out, an action plan. The action plan should outline the step by step process the client will follow to transform their chosen solution/s into concrete action. Don't be afraid of asking the client to go into an exacting level of detail. It is important to break the plan down into small, achievable steps. This detail is especially important in the early stages of using problem solving therapy, or when the solution is complex or difficult. Be sure to include a time target for each step, and a review date, in any action plan.

Action plan worksheet

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The final step in problem solving therapy is to review the client's progress with carrying out their action plan. The purpose is to evaluate:

  • if they are underway with their plan
  • whether the plan is having the desired impact on resolving the problem
  • whether any more needs to be done in relation to the problem
  • any areas of the client's problem solving skills that need to be fine tuned

Summary form