Topic 6: problem solving
Tasks for Topic 6
- Introducing the basic steps of problem solving
- Practicing problem solving skills within the session
Over time, many patients' repertoires of coping and problem solving skills have narrowed such that cocaine or other substance abuse has become their single, overgeneralized means of coping with problems. Many patients are unaware of problems when they arise and ignore them until they become crises. Many others, particularly those who have impulsive cognitive styles or who are unaccustomed to thinking through alternative behaviors and consequences, find this topic particularly useful. Others think they have good problem solving skills but, when confronted with a problem, are likely to act impulsively, making practice of this skill within sessions particularly important.
This session (This section is adapted closely from Monti et al. 1989 as well as Kadden et al. 1992 and D'Zurilla and Goldfried 1971.) provides a basic strategy that can be applied to a range of problems related to cocaine abuse as well as the variety of problems that will invariably arise after patients leave treatment. Despite many patients' fantasies that life will be easier and problem free after stopping cocaine use, often they become aware of problems they have neglected or ignored only after becoming abstinent.
The goals of this session are to -
- Introduce or review the basic steps of problem solving.
- Practice problem solving skills within the session.
Introduce the Basic Steps
Therapists should convey that everyone has problems from time to time and that most can be effectively handled. Also, although having a problem may make one anxious, effective problem solving takes time and concentration, and the impulsive first solution is not necessarily the best.
Therapists should review the basic steps in problem solving summarized below.(Adapted from D'Zurilla and Goldfried 1971 and Monti et al. 1989.)
- Recognize the problem ("Is there a problem?").
Recognition of problems may come from several clues, including worry, anger, and depression; having problems pointed out by others; being preoccupied; and always feeling like one is in crisis.
- Identify and specify the problem ("What is the problem?").
It is easier to solve problems that are concrete and well-defined than those that are global or vague. For large problems that seem overwhelming, it is important to try to break them down into smaller, more manageable steps.
- Consider various approaches to solving the problem ("What can I do to solve the problem?").
An effective way to approach this is to brainstorm, that is, generate as many solutions as possible without considering, at first, which are good or bad ideas. It is more important to try for quantity, rather than quality, in the beginning. Writing these ideas down is very helpful in cases where patients may want to return to the list in the future. It is also important to recognize that not doing anything immediately is an option.
- Select the most promising approach ("What will happen if . . . ?").
This step involves thinking ahead. Review each approach, considering both the positive and negative consequences of all solutions. This step may also involve collecting more information and assessing whether some solutions are feasible (e.g., "Can I borrow Tom's car to take the driving test?").
- Assess the effectiveness of the selected approach ("What did happen when I . . . ?").
Therapists may need to point out that while some problems are easy to solve, others are more difficult. It may be necessary to repeat steps one through five several times before a complex problem is solved.
For impulsive patients, it is important to write down the problem and the selected approach so that the steps are not forgotten when it is time to implement them.
Practice problem solving Skills
Therapists should ask patients to identify two recent problems, one that is closely related to cocaine abuse and one that is less so, and work with them through the problem solving steps for both. Therapists may have to help patients slow down, because some will have difficulty recognizing current problems. Others will quickly select a solution since they lack practice with brainstorming and considering alternatives.
Therapists ask patients to practice problem solving skills outside of the sessions using a reminder sheet for problem solving (exhibit 10). Remind patients that treatment will end soon, and they will be using these skills on their own.