A pivotal skill that has been quite extensively researched within psychologi- cal therapy for both adults and children is that of problem solving. It is the psychotherapeutic equivalent of the old adage: give a man to fi sh and you feed him for a day; teach him to fi sh and you feed him for the rest of his life. Within the cognitive–behavioral therapy (CBT) tradition, the concept was originally introduced by D’Zurilla and Goldfried (1971). However, it has been most vig- orously championed and developed in recent years by Arthur Nezu. He and his colleagues and students have extensively evaluated its application in both health psychology contexts (coping with diabetes or cancer, for example) and mental health areas (depression and anxiety) (Nezu, Nezu, & D’Zurilla, 2007). Th ey call it “problem-solving therapy ” for the reasons discussed at the begin- ning of this book—our fi eld likes to think of discrete treatments rather than principles of change. Nevertheless, the essence of the approach is to provide the client with a set of generalizable, meta-cognitive, pivotal skills—how to go about solving problems—and only the solutions that emerge are likely to be specifi c to a particular kind of syndrome, personal distress, or emotional challenge.
It is not really possible to do justice to the approach within a few paragraphs. Yet the basics are actually quite simple and straightforward. Nezu divides prob- lem solving into (1) social problem solving and (2) a relational/problem-solving
model of stress. Th e former essentially refers to the challenges and vicissitudes of everyday life and how we resolve them; these may be major events, such as job loss, or relatively minor events, such as forgetting an appointment. Th e latter division is somewhat more closely tied to Lazarus and Folkman’s (1984) hugely infl uential ideas about stress and coping, where the problems are specifi cally likely to overwhelm the individual emotionally. Usually, eff ective coping in such situations is “problem-focused” coping, hence the close connection between problem-solving therapy and models of coping. However, Nezu explains that “emotion-focused” coping in which clients are taught to reduce or modify nega- tive feelings can be just as useful in some contexts. Stressful life events need to be thought of as “problems to be solved” rather than overwhelming disasters. Note that when trying to manage major problem situations, daily challenges and hassles can derail constructive solution generation, so problem-solving skills need to be applied at many diff erent levels of signifi cance.
Th e actual components of problem solving are fairly standard. First, this “therapy” really resembles teaching in which the strategies are explained, modeled, and rehearsed, feedback is provided, and fi nally practice is extended and implemented. Many of the components are almost identical to elements emphasized in Acceptance and Commitment Th erapy (ACT): seeing emotions as not undesirable in themselves but signaling that a problem exists; using metaphors such as a red traffi c light to encourage the client to “stop and think”; and normalizing problems as part of the rich panoply of living. Clients are taught not 12 but fi ve problem-solving steps, mnemonically represented by the word ADAPT: have an attitude that is positive, defi ne the problem, alterna- tive solutions need to be generated, predict the outcomes of each one, and try the best one out.
Sometimes good problem-solving strategies are known to clients but are just not being implemented; clients complain that if they could sit down and think rationally and calmly about their problem, they would, but they feel too over- whelmed to do so. Nezu’s partial answer to this is to assess by questionnaire what the client’s current (probably dysfunctional) problem-solving style and barriers are (such as being impulsive or avoidant), thus allowing the teaching of the skills to be tailored to individual needs. Also, the underlying mechanism of change might be more than acquiring new strategies. Th e exercises provide a structure allowing the causes of clients’ distress to be isolated from the cognitive and emotional experiences that have, in a sense, become the problem. Anxiety and depression are not the problem; they are the result of wrestling—unsuccess- fully—with the problem. It is in this way that giving clients a way of distancing themselves from the struggle of the problem is not dissimilar to the principles of ACT. What I fi nd so benefi cial about this whole approach is that it recognizes that so much of the emotional distress we label as psychiatric symptoms can be traced to stressful life events, both daily crises and more major calamities, including chronic and life-threatening illnesses (Read, Mosher, & Bentall, 2005).
People can be taught general problem-solving skills as alternatives that are incompatible with ineff ectual worry, avoidance, or giving up.
P r o b l e m S o l v i n g a s a P i v o t a l S k i l l f o r C h i l d r e n
Like all skill development described in the previous chapter, problem solving requires dividing the task requirements into components. Th e early work on interpersonal problem solving for very young children by Shure and Spivack (1982), which became immensely popular, required a fairly rigid formula to be followed: generate possible solutions (without censoring any of them), think- ing through the pros and cons of each one, and then selecting the strategy with the greatest likelihood of success. Children’s ability to think through the pos- sible consequences of diff erent actions was assessed by a What Happens Next Game in which hypothetical actions were described to children and they had to predict the most likely events that would happen next. In Shure and Spivack’s well-conducted randomized controlled trial of their “I Can Problem Solve” proto- col with preschool children, the results of the training showed not only improve- ment in the cognitive components being taught but also in improved behavior. A longitudinal evaluation showed benefi ts into the fourth grade.
Some of my own doctoral students conducted a number of studies on high- risk children in our region at the time (e.g., Mdaka, 1994). Our general conclu- sion was that children of all ages could indeed learn the formal processes that they were taught: brainstorming solutions, predicting the consequences of their actions, and understanding cause–eff ect relationships in interpersonal situa- tions. However actually using these strategies in the heat of real life situations was another matter entirely. Like so many other topics in changing behavior, we have come to recognize that both context and individual diff erences con- tribute greatly to successful use of problem-solving skills. Take the example of self-managing behavior in the context of a chronic illness such as diabetes. In addition to requiring general problem-solving skills, to be successful the child needs specifi c knowledge about the disease, the ability to transfer past experi- ences, and attitudes or self-effi cacy beliefs regarding the potential of problem- solving strategies (Hill-Briggs, 2003).