Cognitive · 1971
Problem-Solving Therapy (PST)
Competence increases when diffuse problems become defined goals, varied alternatives, reasoned decisions and actions submitted to verification.
Problem-Solving Therapy is a cognitive behavioural intervention focused on strengthening the capacity to face the real problems of life autonomously. It conceives social problem solving as a cognitive, affective and behavioural process through which the person recognises a discrepancy between their current situation and a desired one, defines precisely the obstacles preventing them from reaching the goal, generates alternatives, anticipates their consequences, selects and plans a response, carries it out and verifies its results. Suffering is understood largely as the outcome of problematic person–environment transactions, of a negative orientation towards problems, of impulsive or avoidant styles, of deficits in specific skills or of emotional interference that prevents the use of available capacities. The intervention combines explicit teaching, Socratic dialogue, modelling, rehearsal, self-monitoring, between-session assignments, feedback and the gradual withdrawal of therapeutic help so that the person can act as their own agent of change; it may be used as a principal treatment, a component of broader programmes, a maintenance strategy, prevention or stress management, and it adapts to personal, interpersonal, family, occupational and health problems, provided that a clear distinction is kept between the process of discovering a solution and the skills needed to put it into practice.
Theory of change
A person changes by acquiring a more positive orientation and a transferable method for defining, deciding, acting and learning from the consequences of real problems.
Core ideas
-
Competence is measured by how problems are faced, not by their absence
Everyday life produces unavoidable difficulties, and therapeutic success does not consist in eliminating their appearance but in increasing the capacity to recognise, formulate, act and learn without generating additional chains of stress and deterioration. This perspective shifts the criterion from mere symptom reduction towards social competence and autonomy in the face of new demands. (D'Zurilla, 1986, Problem-Solving Therapy: A Social Competence Approach to Clinical Intervention).
-
Problem solving is a cognitive, affective and behavioural process
Solving a problem involves processing information, appraising control and consequences, experiencing and regulating emotions, producing and choosing responses and carrying them out in the environment. Any purely intellectual formulation remains incomplete, because a symbolically correct solution may fail because of arousal, motivation, skills or the contingencies of the real situation. (D'Zurilla & Nezu, 1982, Social Problem Solving in Adults; D'Zurilla, 1986, Problem-Solving Therapy).
-
A problem is a transactional discrepancy, not a fixed property of the person
A situation becomes problematic when there is a relevant distance between the actual and the desired state and an effective response is not immediately available. The discrepancy depends on demands, resources, goals, information, emotions and obstacles, so it may change by modifying the environment, widening capacities, reformulating the goal or transforming one's reaction to the unchangeable. (D'Zurilla & Goldfried, 1971, Problem Solving and Behavior Modification; Nezu, Nezu & D'Zurilla, 2007, Solving Life's Problems).
-
Orientation determines whether skills are actually used
Recognising the problem, attributing it to specific and modifiable factors, appraising it as a challenge, perceiving realistic control and committing effort create the conditions in which the rational skills can work. Threat, self-disparagement, pessimism and low tolerance of frustration can block a technically capable person and must be assessed as targets in their own right. (D'Zurilla, 1986, Problem-Solving Therapy; D'Zurilla, Nezu & Maydeu-Olivares, 2002, SPSI-R Manual).
-
Defining the problem well is a central intervention
Gathering facts, separating data from inferences, identifying obstacles and formulating a concrete goal reduce ambiguity and prevent work on secondary symptoms or false problems. The definition can by itself change the appraisal of threat and determines which alternatives are relevant and what consequences count as success. (D'Zurilla, 1986, Problem-Solving Therapy: A Social Competence Approach to Clinical Intervention).
-
Generating and evaluating are distinct operations
Creativity is protected by separating a divergent phase, guided by quantity, deferment of judgement and variety, from a convergent phase of comparison and selection. Evaluating while generating narrows the repertoire, whereas producing alternatives without a subsequent decision leaves the process incomplete; both operations are necessary and serve different functions. (D'Zurilla & Goldfried, 1971, Problem Solving and Behavior Modification; D'Zurilla, 1986, Problem-Solving Therapy).
-
The best solution maximises a broad balance of consequences
An effective response is defined not only by reaching an immediate goal but by its emotional, temporal, personal, interpersonal and long-term effects. Systematic evaluation prevents quick relief, a single advantage or the pressure of the moment from concealing foreseeable harm, a lack of feasibility or the displacement of the problem into other areas. (D'Zurilla & Goldfried, 1971, Problem Solving and Behavior Modification; Nezu, Nezu & D'Zurilla, 2007, Solving Life's Problems).
-
Discovering a solution and executing it are different competences
A person may choose a response correctly and yet not carry it out because of anxiety, lack of motivation, insufficient resources or a skill deficit. The therapy must locate the breaking point and incorporate regulation, modelling, rehearsal, environmental support or behavioural training, maintaining the distinction so as not to attribute every difficulty to a cognitive or motivational failure. (D'Zurilla & Goldfried, 1971, Problem Solving and Behavior Modification; D'Zurilla, 1986, Problem-Solving Therapy).
-
Emotions are information and can also interfere
Emotion helps to detect that a problem exists, indicates the importance of goals, mobilises effort, anticipates consequences and makes it possible to evaluate the result. When arousal is excessive or organised through appraisals of threat, it reduces attention and flexibility; it is therefore regulated as far as necessary to restore the capacity to solve problems, while its functional information is preserved. (D'Zurilla, 1986, Problem-Solving Therapy: A Social Competence Approach to Clinical Intervention).
-
Action and verification turn a hypothesis into learning
The selected alternative remains a prediction until it is implemented and its actual consequences are compared with those expected. Self-monitoring, self-evaluation and recycling make it possible to correct the model of the problem, improve the capacity to anticipate and consolidate mastery experiences, so that a partial result can still produce clinically valuable learning. (D'Zurilla, 1986, Problem-Solving Therapy; Nezu, Nezu & D'Zurilla, 2007, Solving Life's Problems).
Influences
- Behaviour modification
- Social learning
- Cognitive behavioural therapy
- Self-control
- The transactional theory of stress and coping
- Social competence
- Divergent thinking and creativity
- Brainstorming
- Decision theory
- Self-efficacy
Key references
- D’Zurilla, T. J., & Goldfried, M. R. (1971). Problem solving and behavior modification. Journal of Abnormal Psychology, 78(1), 107–126. https://doi.org/10.1037/h0031360
- D’Zurilla, T. J. (1986). Problem-Solving Therapy: A Social Competence Approach to Clinical Intervention. Springer Publishing Company. ISBN 0-8261-5680-0.
- D’Zurilla, T. J., & Nezu, A. M. (1982). Social problem solving in adults. In P. C. Kendall (Ed.), Advances in Cognitive-Behavioral Research and Therapy (Vol. 1, pp. 202–274). Academic Press.
- D’Zurilla, T. J., & Nezu, A. M. (1990). Development and preliminary evaluation of the Social Problem-Solving Inventory. Psychological Assessment, 2(2), 156–163.
- D’Zurilla, T. J., Nezu, A. M., & Maydeu-Olivares, A. (2002). Manual for the Social Problem-Solving Inventory-Revised (SPSI-R). Multi-Health Systems.
- Nezu, A. M. (2004). Problem solving and behavior therapy revisited. Behavior Therapy, 35(1), 1–33.
- Nezu, A. M., Nezu, C. M., & D’Zurilla, T. J. (2007). Solving Life’s Problems: A 5-Step Guide to Enhanced Well-Being. Springer Publishing Company. ISBN 0-8261-1489-X.