Problem-solving therapy (PST) is an intervention with cognitive and behavioral influences used to assist individuals to better manage life problems. PST is used in a variety of settings to address a wide range of issues including depression, anxiety, and more. This action-oriented approach tends to be brief, often taking up to one to three months with clients typically attending 60-minute sessions weekly.1
What Is Problem-Solving Therapy?
Problem-solving therapy is based on a model which holds that the body, mind, and environment all interact with each other, and that life stress can interact with a person’s predisposition for developing a mental condition.2 Within this context, PST contends that mental, emotional, and behavioral struggles stem from an ongoing inability to solve life’s problems or deal with everyday stressors. Therefore, the key to preventing health consequences and improving a quality of life is to become a better problem-solver.3,4
The problem-solving model has undergone several revisions, but continues to uphold the same value of teaching people to become better problem-solvers. Overall, the goal of PST is to provide individuals with a set of rational problem-solving tools to reduce the impact of stress on their well-being.
PST has two main components:3,4
- Problem-solving orientation focuses on helping individuals adopt an optimistic outlook, seeing problems as opportunities to gain from, believing that problems can be solved and that all of us possess the ability to do so.
- Problem-solving style aims to provide people with constructive problem-solving tools that they can use in coping with different life stressors by identifying the problem, generating/brainstorming solution ideas, choosing a specific option, and implementing and reviewing it.
Here are some of the benefits you can gain from problem-solving therapy:
- Gain a sense of control over your life
- Move toward action-oriented behaviors instead of avoiding your problems
- Gain self-confidence as you improve the ability to make better decisions
- Develop patience by learning that successful problem-solving is a process that requires time and effort
- Feel a sense of empowerment as you solve your problems independently
- Increase your ability to recognize and manage stressful emotions and situations
- Learn to focus on the problems that have a solution and let go of the ones that don’t
- Identify barriers that may hinder your progress
PST is versatile, treating a wide range of problems and conditions, and it can be effectively delivered to various populations and in different forms and settings—self-help manuals, individual or group therapy, online materials, home-based or primary care settings, as well as inpatient or outpatient treatment.
Techniques Used in Problem Solving Therapy
PST’s emphasis is on the client, and techniques used are merely conduits that facilitate the problem-solving learning process. Generally, the problem-solving work is mostly led by the individual in collaboration and support from the clinician. Thus, a strong therapeutic alliance sets the foundation for encouraging clients to apply these outside of therapy sessions.4
Here are some of the most relevant guidelines and techniques used in problem-solving therapy:
Creating Collaboration
As with any other psychotherapy, creating a collaborative environment and a strong therapist-client relationship is essential in PST. The role of a therapist is to cultivate this bond by conveying a genuine sense of commitment to the client; while also displaying kindness, using active listening skills, and providing support. The purpose is to build a meaningful balance between being an active and directive clinician while delivering a feeling of optimism to encourage the client’s participation.
Assessment
This tool is used in all psychotherapies and is just as important in the practice of PST. It seeks to gather facts and information about current problems, contributing stressors and evaluates a client’s appropriateness for PST. The problem-solving therapy assessment also examines a person’s immediate issues, problem-solving attitudes, and abilities, including their strengths and limitations. This sets the groundwork for developing an individualized problem-solving plan.
Psychoeducation
This is an integral component of problem-solving therapy and used throughout treatment. The purpose of psychoeducation is to provide a client with the rationale for problem-solving therapy, including an explanation for each step involved in the treatment plan. Moreover, the individual is educated about mental health symptoms, and taught solution-oriented strategies and communication skills.
Coaching
This technique involves verbal prompting like asking leading questions, giving suggestions, and providing guidance. For example, the therapist may prompt a client to brainstorm or consider alternatives, or they may ask about times when a certain skill was used to solve a problem during a difficult situation. Coaching can be particularly useful when clients are having difficulty with eliciting solutions on their own.
Shaping
This intervention refers to teaching a new skill and building on it as the person gradually improves the quality of each skill. Shaping works by reinforcing the desired problem-solving behavior and adding perspective as the individual gets closer to their intended goal.
Modeling
This is a method in which a person learns by observing. It can include written/verbal problem-solving illustrations or demonstrations performed by the clinician to be used in hypothetical or real-life situations. Through modeling, a client can learn effective problem-solving skills via role-play exercises, live demonstrations, or short-film presentations. This allows individuals to imitate observed problem-solving skills in their own life and apply it to specific problems.
Rehearsal & Practice
These techniques provide clients with the opportunity to practice problem-solving exercises and engage in homework assignments. This may involve role-playing during therapy sessions, practicing with real-life issues, or imaginary rehearsal where individuals visualize themselves carrying out a solution. Furthermore, homework exercises are an important aspect when learning a new skill. Ongoing practice is strongly encouraged throughout treatment so a client can effectively use these techniques when faced with a problem.
Positive Reinforcement & Feedback
The therapist’s task in this intervention is to provide support and encouragement for efforts made in attempting to apply various problem-solving skills. The goal here is for the client to continue using more adaptive behaviors even if they do not get it right at first. Then, the therapist provides feedback so the client can explore barriers encountered and generate alternate solutions by weighing the pros and cons to continue working toward a specific goal.
Use of Analogies & Metaphors
When appropriate, the use of analogies and metaphors can be useful as a method that provides the client with a clearer vision or a better understanding about specific concepts. For example, the therapist may use diverse skills or points of reference (E.g., cooking, driving, sports) to explain the process of problem-solving and finding solutions, as well as to convey that time and practice are required before mastering a particular skill.
What Can Problem Solving Therapy Help With?
Although PST was initially developed to treat depression among primary care patients, it has expanded to address or rehabilitate other psychological problems, including anxiety, post-traumatic stress disorder, personality disorders, and more.
PST theory asserts that vulnerable populations can benefit from receiving constructive problem-solving tools in a therapeutic relationship to increase resiliency and prevent emotional setbacks or behaviors with destructive results like suicide. It is worth noting that in severe psychiatric cases, PST can be effectively used when integrated with other mental health interventions.3,4
PST is most effective and frequently used for people that have psychological/physical issues that are being treated separately and need assistance in addressing daily stressors and emotional distress related to their health condition.3,4
PST can help individuals who are challenged with specific issues and have difficulty finding solutions or ways to cope. These issues can involve a wide range of incidents such as the death of a loved one, divorce, stress related to a chronic medical diagnosis, or a series of minor ongoing issues like financial stress, marital difficulties, or tension at work.
Through the problem-solving approach, mental and emotional distress can be reduced by helping individuals break down problems into smaller pieces that are easier to manage and cope with. However, this can only occur as long the person being treated is open to learning and able to value the therapeutic process.3,4
Lastly, a large body of evidence has indicated that PST can have a positive impact on mental health, quality of life, and problem-solving skills with older adults. PST is an approach that can be implemented by different types of practitioners and settings (in-home care services, telemedicine, etc.), making mental health treatment accessible to the elderly population who often face age-related barriers and comorbid health issues.1,5,6
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Problem Solving Therapy Examples
Due to PST’s versatility it can be used in different forms, settings, and formats. Following are some examples where the problem-solving therapeutic approach can be used effectively.4
Depression
People who suffer from depression often evade or even attempt to ignore their problems because of their state of mind and symptoms. PST incorporates techniques that encourage individuals to adopt a positive outlook to problems and motivate individuals to tap into their own coping resources and apply healthy problem-solving skills. Through psychoeducation, individuals can learn to identify and understand their emotions in relationship to their problems. Employing rehearsal exercises, someone can practice adaptive responses to problematic situations. Once the depressed person begins to solve problems, symptoms are reduced, and mood is improved.
Veterans
PST is presently being employed across the United States in numerous medical centers from the Veterans Health Administration as a preventive approach. This program is geared to assist veterans healthily adjust to civilian life by teaching them how to apply different problem-solving strategies to difficult situations. The ultimate objective is that such individuals are at a lower risk of experiencing major mental health issues and consequently need less medical and/or psychiatric care.
Psychiatric Patients
PST is considered highly effective and strongly recommended for individuals with psychiatric conditions. These individuals often struggle with problems of daily living and stressors that they feel unable to overcome. These unsolved problems are both the triggering and sustaining reasons for their mental health related problems. Therefore, a problem-solving approach can be vital for the treatment of people with psychological issues.
Adherence to Other Treatments
PST can also be applied to clients undergoing another mental or physical health treatment. In such cases, PST strategies can be used to motivate individuals to stay committed to their treatment plan by discussing the benefits of doing so. PST interventions can also be utilized to assist patients in overcoming emotional distress and other barriers that can interfere with successful compliance and treatment participation.
How to Find a Therapist Who Practices Problem-Solving Therapy
Finding a therapist who is skilled in problem-solving therapy is not any different from finding any qualified mental health professional. This is because many clinicians often have knowledge in cognitive-behavioral interventions which hold similar concepts as PST.
As a general recommendation, it is best to check your health insurance provider lists, use an online directory where you can filter for PST, or ask trusted friends or family if they can recommend someone. Then contact any of these providers and ask questions to determine who is more compatible with what you are looking for.3,4
Are There Special Certifications to Provide PST?
Specific certification is not required to provide PST, however there are some organizations that can provide special training. Problem-solving therapy can be delivered by a variety of health care professionals such as psychologists, psychiatrists, physicians, mental health counselors, social workers, and nurses.
Most of these clinicians have naturally acquired valuable problem-solving abilities throughout their career and continuing education. Thus, all that may be required is fine-tuning their skills and familiarity with the current and relevant PST literature. A reasonable amount of understanding and planning will transmit a level of competence and help clients gain insight into the causes that led them to their current situation.3,4
Key Questions to Ask a Therapist When Considering Problem-Solving Therapy
Psychotherapy is most successful when you feel comfortable and have a good collaborative relationship with your therapist. Asking specific questions can simplify the process of choosing a clinician that is the right fight for you. Consider making a list of questions to help you with this task.
Here are some key questions to ask before starting PST:
- Is problem-solving therapy suitable for the struggles I am dealing with?
- Can you tell me about your professional experience including providing problem-solving therapy?
- Have you dealt with other clients who present with similar issues as mine?
- If cultural consideration is important to you, ask: Have you worked with individuals with similar cultural backgrounds as me?
- How do you structure your PST sessions and treatment timeline?
- How long do PST sessions last?
- How many sessions will I need?
- What expectations should I have in working with you from a problem-solving therapeutic stance?
- What expectations are required from me throughout treatment?
- Does my insurance cover PST, if not what are your fees?
- What is your cancellation policy?
How Much Does PST Cost?
The cost of problem-solving therapy can range from $25 to $150 depending on the number of sessions required, severity of symptoms, the type of practice, geographic location, and provider’s experience level. However, if your insurance provider covers behavioral health, the out-of-pocket costs per session may be much lower. PST is also supported by Medicare for use by professionally-trained general health practitioners.1
What to Expect at Your First PST Session
During the first session, the therapist will strive to build a connection and become familiar with you. You will be assessed through a clinical interview and/or a series of questionnaires. During this process, the therapist will gather your background information, inquire about how you approach life problems, how you typically resolve them, and if problem-solving therapy is a suitable treatment for you.3,4
Additionally, you will be provided psychoeducation relating to your symptoms, the problem-solving method and its effectiveness, and your treatment goals. The clinician will likely guide you through generating a list of the current problems you are experiencing, selecting one to focus on, and identifying concrete steps necessary for effective problem-solving. Lastly, you will be informed about the content, duration, costs, and number of the therapy sessions the therapist suggests.3,4
Is Problem-Solving Therapy Effective?
Extensive research and studies have shown the efficacy of problem-solving therapy. PST is considered effective in its practice and in that significant improvements can be visible within a short amount of time. PST is also a useful approach in addressing numerous problems and psychological issues. Lastly, PST has shown its efficacy with different populations and age groups.
Below are the major conclusions of these studies:
Meta-Analysis of Problem-Solving Therapy for Depression
A meta-analysis of 21 independent samples utilizing PST for depression concluded that problem-solving therapy was as efficient for reducing symptoms of depression as other types of psychotherapies and antidepressant medication. Furthermore, PST was also shown to be significantly more effective than not receiving any type of treatment. And, lastly, it was determined that when all the training components of PST were included it led to a person having self-confidence in solving future problems.7
More recent meta-analyses were conducted with older adults diagnosed with Major depressive disorder. One meta-analysis published in the International Journal of Geriatric Psychiatry concluded that problem-solving therapy is as efficient in improving symptoms of depression as other types of mental health treatments. However, more investigation may be necessary in relation to PST’s long-term efficacy in comparison to other treatments.6
Another meta-analysis published by Cambridge University Press also aligns with previous large meta-analyses’ findings and showed PST to be as effective as other types of therapy treatments for adult depression.5
General Shortcomings of Problem-Solving Therapy
- The need to have more trained practitioners
- In general, is not as effective as sole intervention for severe chronic psychiatric populations, but instead works best as an approach to be integrated into their overall treatment plan
- More research is necessary to determine efficacy in underrepresented populations
How Is PST Different From CBT & SFT?
Problem-solving therapy, cognitive-behavioral therapy, and solution-focused therapy all belong to the cognitive-behavioral framework, sharing a common goal to modify certain thoughts, aptitudes, and behaviors to improve mental health and quality of life.
Problem-Solving Therapy vs. Cognitive-Behavioral Therapy
Cognitive behavioral therapy (CBT) is a short-term, psychosocial treatment developed under the premise that the way we think affects the way we feel and behave. CBT addresses problems arising from maladaptive thought patterns and seeks to challenge and modify these to improve behavioral responses and overall well-being. CBT is the most researched approach and preferred line of treatment in psychotherapy due to its effectiveness in addressing a wide variety of problems like anxiety, sleep disorders, substance abuse and more.
Like CBT, PST addresses mental/emotional and behavioral issues; however, PST is considered to have a better balance between the cognitive and behavioral elements.
Another difference between these two approaches is that PST is mostly concerned with faulty thoughts in relation to problem-solving orientation and the modification of maladaptive behaviors that specifically interfere with effective problem-solving. Usually, PST is mostly seen in CBT as an integrated approach and applied as one of several other interventions in CBT psychotherapy sessions.
Problem-Solving Therapy vs Solution-Focused Therapy
Solution-focused therapy (SFT), like PST, is a goal-directed, evidence-based brief therapeutic approach that encourages optimism, options, and self- efficacy. Similarly, it is also grounded on cognitive behavioral principles. However, it differs from problem-solving therapy in that SFT is a semi-structured approach that does not follow a step-by-step sequential format.8
SFT mainly focuses on solution building rather than problem-solving specifically looking at a person’s strengths and previous successes. SFT helps people recognize how their life would differ without their problems by exploring coping skills they already possess. This approach is increasingly being used within community mental health, inpatient settings, and educational environments due to its demonstrated efficacy.8
History of Problem-Solving Therapy
Originally, problem-solving therapy began with a cognitive‐behavioral framework that can be traced to an influential article published in 1971 by the American Psychological Association. Psychologists Thomas D’Zurilla and Marvin Goldfried discussed a training model that involved teaching individuals cognitive and behavioral strategies to improve their problem-solving skills and enhance their overall health.3,4
Subsequently, Art Nezu, a clinical psychology graduate, mentored by D’Zurilla, further investigated the clinical applications of the problem-solving model. Based on this research, D’Zurilla and Nezu collaborated on the development of the relational/problem-solving model of stress which provided a framework for applying PST across a wide range of problems and populations. Since then, Nezu and many other clinical researchers have adapted the earlier approach to encompass a wider range of problems and populations.3,4
Over the past decades the problem-solving model has undergone numerous makeovers. Nonetheless, while holding to the essential principles, PST has evolved into a new model called emotion‐centered problem‐solving therapy (EC‐PST). This updated version integrates emotions as an important aspect of healing and solving life’s problems. Looking ahead, PST will likely continue to conduct studies and research into areas that need further empirical validation in order to broaden clinical treatment applications.9
Additional Resources for Problem Solving Therapy
To learn more about problem-solving therapy, check out these resources:
- Advancing Integrated Mental Health Solutions (AIMS) Center: Encourages organizations and clinicians to pursue certification in Problem Solving Treatment.
- American Psychiatric Association: Offers psychotherapy training videos on problem-solving therapy intended to be used as an educational tool for mental health professionals.
- Moving Forward: Offers a free online course developed specifically for veterans which teaches effective skills to overcome stressful problems.
