TOPIC 7 - PROBLEM SOLVING THERAPY

PROBLEM SOLVING TECHNIQUES

1. INTRODUCTION
The problem-solving therapy (PST) was proposed by D'Zurilla and Goldfried (1971), later
revised and expanded to the present day (D'Zurilla and Nezu, 1982, 1990, 1999, 2007; D'Zurilla, Nezu and
Maydeu-Olivares, 2002; Maydeu-Olivares and D'Zurilla, 1995, 1996; Nezu, 2004; Nezu and D'Zurilla, 1989.
Since its emergence until today, the growth of its application has been enormous due to its usefulness. Furthermore, it has the
advantage of being useful alone in a treatment or as a treatment technique alongside others. This
recent has favored its use in multiple well-known treatments or treatment packages (for example,
it is used in Beck's cognitive therapy, in stress inoculation training, in different
training in social skills, etc.). The TSP emerged in the 1970s within cognitive techniques.
The events that favored its emergence were (D'Zurilla, 1986) the interest in creativity, the relevance of
social competence in psychopathology, the development of cognitive-behavioral techniques and the development of
la teoría transaccional del estrés de Lázaro La TSP es un proceso cognitivo, afectivo y conductual a través del
the individual tries to identify or discover solutions to the specific problems that arise in their
daily life. The aim of the TSP is to improve social competence and reduce psychological distress.
It was in 1982 when D'Zurilla and Nezu (1982) renamed the initially affected TSP to social TSP.
due to the problems that a person faces can be both personal and
interpersonal. Its goal has always been to produce positive consequences in the individual, along with reducing
to avoid the negative consequences. With the TSP we can learn a general room, the quality we
It can allow for a more positive, generalized, and lasting change in behavior (Chang, D'Zurilla, and Sanna, 2004).
The advantage of this treatment is that it takes place in the individual's natural real-world environment.
(D'Zurilla and Nezu, 1982). Therefore, today it can be assessed simultaneously as a learning process, a
general coping strategy and a self-control method (D'Zurilla and Nezu, 2007). At times, the
social problem solving represents a set of social skills that are important for the
social competence. Several training programs in social skills include the TSP as an essential part of
the same (for example, in Bedell and Lennox, 1997). The advantage of the TSP is that it is useful for addressing
any type of problem, whether interpersonal (for example, financial problems), personal and
intrapersonal (for example, marital conflicts, family disputes, depression, anxiety, etc.), or social or
community issues (for example, criminal behavior, discrimination, maltreatment, etc.). Perhaps the most significant change
Important in the historical evolution of TSP is its current emphasis on the need to focus on the principles.
of behavior change (whether behavioral, cognitive, or diplomatic) more exclusively in only the TSP (D'Zurilla and
Nezu, 2007). This is due to its usefulness, many versions as a complementary technique to others more than
as an exclusive treatment technique.

2. THEORETICAL BASES
2.1. The problem, the solution, and problem solving
The three main concepts of TSP are problems, solution, and problem-solving (Nezu, 2004;
D'Zurilla and Nezu, 2007). A problem, or problematic situation, is understood as any situation in life,
activity or task, present or anticipated by the individual, that demands a response for its functioning
adaptive but currently does not have any effective response. The person, couple, or group, in the face of
this situation, due to the obstacles that are present, whether they have recently survived (for example,
an illness), due to demands that cannot be met or because the individual is in a
chronic situation of loneliness, boredom, etc., has no solution for the problem. This can originate
within the individual (due to their emotions or thoughts), between individuals, or due to the environment. The
ambiguity, uncertainty, conflicting demands, resource capacity, or novelty are elements
that may be at the root of the problem. The solution is a coping response aimed at altering the
nature of the problem, the negative emotional reactions they produce, or both, effective solutions
they are coping responses that not only achieve specific goals, solving the problem,
but it also maximizes other positive consequences or benefits over time and minimizes others
negative consequences or costs. It takes into account the personal outcomes of the solution along with the
social, in the short and long term. Relevant consequences include personal and social outcomes, as well
like the results in the short and long term (Nezu, 2004).
The solution to social problems is the cognitive-behavioral process by which the individual attempts to identify
or to discover effective or adaptive solutions for their specific problem, usually detected by stress,
and for all the problems that arise in your daily life. It is a conscious, rational activity that involves
effort, and it is aimed at a fin. With this we intend to change the problematic situation to improve, reduce
the emotional male that produces, or both. This applies to an individual, a couple, or a group.

2.2. The role of emotions in problem-solving

It has always been recognized that emotions play an important role in problem-solving therapy (D'Zurilla and Nezu, 2007).
There would be three main sources of emotional activation in social problem solving:
a) The objective problematic situation.
b) Problem orientation.
c) The problem-solving style.
Emotional responses can be positive or negative. The former facilitate the problem-solving process.
problems, the negatives interfere with or inhibit them. Objective problematic situations are usually situations
aversive or displaceable, such as loss of reinforcers, conflict, frustration, uncontrollability,
ambiguity, complexity or untruth, or harmful or painful stimuli at the bodily level (for example, in a
(illness). These can generate anxiety, depression, anger, etc., in the individual. But in others they do not produce
negative emotions, as they are capable of facing and overcoming them. Other positive emotions, if they are
they counteract the negatives. The orientation towards the problem is a very important element to carry out
an appropriate problem-solving solution. If the person has a low tolerance for uncertainty or to the
frustration, or to whom they attribute the problem, then faced with the problem the person may have emotions
positive, negative, or both.
Positive emotions often arise when the individual sees the problem as a normal part of their life and
that can be resolved. Negative emotions, when one sees the problem as something overwhelming, that not
knows how to solve it or that it is unsolvable in the way he intends. The problem-solving style marks
a lot the problem-solving process. An adaptive style (rational problem-solving style)
allows solving the problem; a maladaptive style (impulsive avoidant problem-solving style)
difficult or impossible to solve it. One other style, and its results, directly impact emotions
facilitating or inhibiting the problem-solving process, in aspects such as recognition of
problema, motivación para resolverlo, metas, opciones de solución, anticipación de resultados, probabilidad de
that the same problems are repeated in the future and the efficiency of problem-solving implementation.
Sometimes, emotional responses interfere so much with the problem-solving process that it is necessary to
treat them with techniques such as cognitive restructuring, stress inoculation training, the
systematic desensitization or relaxation. Once these emotional responses are controlled, we would move on
then to apply the TSP.
2.3. Dimensions of problem-solving
A whole series of studies conducted with the Social Problem Solving Inventory.
Inventory-Revised, SPSI-R; D'Zurilla, Nezu, and Maydeu-Olivares, 2002) have allowed to delimit the
Dimensions related to an effective or ineffective problem-solving solution. As noted by D'Zurilla and
Nezu (2007), Nezu (2004), and Chang, D'Zurilla, and Sanna (2004) have found with the SPSI-R that the two
basic elements related to the outcome of problem-solving are:
a) The orientation towards the problem.
b) The problem-solving style.
The orientation towards the problem is a fundamental element for arriving at an appropriate solution to problems.
Considered as a stable group of cognitive-affective schemes, it serves the individual to face or not.
successfully the problems that arise in life. It would have two elements, that of self-efficacy of
generalized problem solving (or the belief that one is capable of solving problems and implementing solutions
effective solutions) and the result of generalized positive problem-solving (or general belief of
that the problem is solvable). There would be individuals with a problem-oriented positive approach and others
with an orientation towards the negative problem. Within the problem-solving styles, they have found
Three. The first is that of rational problem solving, or constructive problem solving style.
This includes four specific rational troubleshooting enablement: definition of the problem,
generation of alternative solutions, decision making and implementation and verification of the solution.
While the solution to rational problems is an adaptive type of problem-solving, there are others
two types of problem-solving approaches that are maladaptive. They are the impulsive problem-solving style and
careless and the avoidant style. The former is characterized by a generalized impulsive response
when facing problem-solving. The second, the avoidant, does not confront the solution to the problem.
delaying it, showing passivity toward it or a strong dependence on other people who are the ones that
they decide the solution to the problem. Therefore, it avoids problems, does not confront them, postpones them or loads them.
responsibility for their solution to others. Depending on the three styles of problem-solving (rational,
impulsive or avoidant), from the application of problem-solving training and experience
accumulated with the same, the specific objectives that are usually set when the TSP was carried out are
improve the positive orientation towards problems, decrease the negative orientation towards them, improve the
ability to solve rational problems, reduce impulsive/careful style and decrease the style
evasive.

TABLE 20.1
Summary table of the steps of problem-solving therapy
1. Underlying model of problem-solving therapy.
2. Creation of an appropriate therapeutic relationship
3. Behavioral assessment, case formulation, and problem-solving capacity evaluation.
4. Application of problem-solving training as a standalone treatment or as a technique
complementary to other treatments.
5. Pasos de la terapia de solución de problemas:
a. Problem-oriented.
b. Definition and formulation of the problem.
c. Generation of alternative solutions.
d. Decision making.
e. Implementation and verification of the solution.
 6. Homework and other problem-solving exercises.
7. Maintenance of results and prevention of relapse.
8. Most common problems and their solutions in the application of problem-solving therapy.

3.1. Underlying model of problem-solving therapy

The application of the TSP to anyone involves explaining to them what it will consist of, so they can see its usefulness and
that he/she must assume to work in a concrete way to face his/her problems. This implies that
We all have problems, or we have, but we can solve them. If the individual does not assume the model
Underlying the TSP, it is not possible to make progress in treatment. The problem-solving model
part of the psychopathological disorders that people suffer from, such as depression, anxiety, anger, problems
interpersonal, physical symptoms, etc., are a consequence of ineffective coping behaviors or
Maladaptive. Psychological stress is understood as a function of the reciprocal relationships in two types of
stressful life events (important negative life events and everyday problems), the states
negative emotions and problem-solving coping. All these elements interact with each other
yes, influencing some over others. If the person is able to solve the problems, this factor reduces or
minimize the weight of the previous factors. When problem-solving is ineffective, then the
emotional problems or psychological problems increase, potentially becoming a
clinical disorder. Therefore, based on this model, the entire therapeutic intervention aims to improve the
problem-solving skills.
It is important to indicate that research has shown that (D'Zurilla and Nezu, 1999, 2007; Nezu, 2004):
A. There is a clear association between various problem-solving deficits and negative affect (anxiety, ...
worry, depression
B. Problem-solving is a significant moderator of the relationship between stressful events and the
psychological macho later (that is, individuals who effectively solve their problems attenuate
better than those who do not face the negative effects of stressful situations or stress.
C. TSP is an effective clinical intervention for a wide range of disorders (for example, depression),
psychological problems (for example, relationship issues) and the associate teacher to different
chronic medical diseases (for example, hypertension). In figure 20.1 we present the model
what underlies the TSP.

THE PROBLEM-SOLVING PROCESS

3.2. Creation of an appropriate therapeutic relationship
In any type of cognitive-behavioral treatment, establishing a good therapeutic relationship is
essential (Farmer and Chapman, 2008). This is very important in all their therapies given that they require
they guide the action and the client who takes an active role in it. In problem-solving, this is still
more important, since the person must detect their problems and work to achieve the way to
to resolve them. For this reason, D'Zurilla and Nezu (2007) place great importance on what they call 'building a relationship
positive therapy", which will consist of being warm, empathetic, and genuine with our clients, being enthusiastic and
optimistic in front of any problem since in front of them we can see if it can be solved or not, face the
participation, both in treatment sessions and in the homework assigned to them. Given that the
TSP is carried out through teaching explanations, skill training activities, exercises.
the role and tasks for the house, maintaining an adequate relationship between the client and the therapist is essential in the whole
TSP.

3.3. Behavioral evaluation, case formulation, and problem-solving capacity assessment.

An important part of the behavioral assessment process is the functional analysis or case formulation.
Nezu, Nezu and Lombardo (2004) have designed a whole model based on problem-solving for the
formulation of the clinical case and for the design of the treatment. With it we can organize all the information
what we collect from each person and how we should proceed as therapists in the collection of the
information about the person and their problem(s) in order to be able to implement the best treatment.
example, when a person arrives at a treatment, being in the current state (for example, with depression),
while our goal and the client could have the desired state (to stop being depressed).
Detect the obstacles to solving the problem (for example, separating facts from assumptions, identifying
the factors that determine the problem situation, analyze whether the goals that are achieved will be feasible, if
they have the necessary skills, etc.) and put into practice the TSP and the techniques needed to achieve that
Improvement is what we do in treatment. It is very useful to refer to the Inventory in the application of TSP.
solution to social problems (D'Zurilla et al., 2002), of which there are several versions in Spanish (Calero et al.,
2001; Calvete and Cardeños, 2001; Maydeu-Olivares et al., 2000). With it, we can evaluate both the capabilities
of problem-solving of the person such as problem-solving styles (rational, impulsive and
(avoidant) and the changes that occur in a person's capabilities and styles as it is applied.
treatment, or once it has been completed.

3.4. Application of training in problem solving as a sole treatment or as a technique

complementary to other treatments
Today, TSP is a flexible procedure that can be applied alone or as part of a treatment. It allows to be
applied individually, with couples, in groups, in people with different types of disorders, in different
social contexts (for example, school, work, associations) and clinical ones (for example, primary care,
hospital, consultation). The new approach of the TSP, which is very well summarized by D'Zurilla and Nezu.
(2007) when they say that "we emphasize the notion of focusing on the processes of behavioral change more than
exclusively in problem-solving training" (p. 95), indicates the versatility of this
procedimiento terapéutico. Esto ha facilitado el que se ha convertido en un tratamiento muy útil tanto aplicado
only as part of a broader treatment. It has also been used as a strategy of
maintenance or as a preventive program (Malouff et al., 2007).

3.5. Steps of problem-solving therapy

As we have indicated, the TSP consists of five steps that follow sequentially one after the other. They are the following:
problem orientation, definition and formulation of the problem, generation of alternative solutions
decision making and implementation and verification of the solution (see table 20.2)

Components of the problem-solving process

3.5.1. Problem-oriented
Today we know that the problem orientation phase is fundamental. If it is not done properly, it fails.
the entire procedure. For this reason, it is often emphasized that not including it, due to the belief that it is unnecessary, can lead to
the failure of the entire treatment (Nezu, 2004). It is essential that the person, before trying to resolve their
problem, adopting a positive and optimistic attitude towards the problem and towards one's abilities to solve it. In
In this phase, we must encourage beliefs in self-efficacy, recognize problems, and see them as
challenges, using and controlling emotions in problem solving and learning to stop and think before acting.
In relation to fostering beliefs of self-efficacy, the first thing we need to achieve is the person of the sea.
able to assume that they can solve their problem. What we need to do is foster their beliefs.
of self-efficacy by identifying and recognizing the obstacles to a positive orientation towards the problem,
how can it be their low security, negative thoughts, negative emotional reactions, etc. Another aspect
is to detect and see how to overcome negative emotions if they are present. In this process we must achieve
that the person is able to recognize and identify problems, differentiate negative problems (or
maladaptive) of the positive (or adaptive) ones and have a positive sense towards problems and their possibility
to be resolved. In this phase we will need to improve the individual's abilities to be able to
detect the problem when this happens. This requires focusing on its relevant aspects, not letting the
emotions blind them. It can be very helpful to include a list of possible problematic situations here. Another
the aspect is that the person must see the problem as a replica or as an opportunity to solve it, to
improving your skills in front of him, such as personal growth, as a funding that you can have, in
contradiction to the negative payment on it, which is often at the root of not finding a solution.
In all of this, the use and control of emotions in problem-solving is a relevant aspect.
We need to clarify the relevance of negative emotions in maintaining the problem or in avoiding seeking a solution.
appropriate solution. We also have to consider whether positive emotions are present more
likely that the problem can be solved, given that positive emotions and a positive way of thinking
they facilitate the problem-solving process. In those cases where it is necessary, use the ABC method here.
of constructive thinking (A-activating event, B-belief or self-talk, C-consequence)
emotional). With him, one could explain and make the connection between events, their beliefs, and their emotions.
He/She will also be trained in strategies for stress management (for example, relaxation, distraction, exercise)
or emotional activation if necessary. The last aspect of this first phase is the series in which it is separated
and think before acting. You can't react automatically. Probably until now is how it has
acted, and this has proven ineffective. Normally, people with impulsive or avoidant styles fail in
solves specific problems their problems. The goal will be to use, learn to apply, a style of
solution to rational problems. The training strategies used throughout the different
phases of the TSP are the teaching methods, training, modeling, shaping, behavioral rehearsal,
comments on execution and positive reinforcement.

General suggestions for the first TSP sessions

3.5.2. Definition and formulation of the problem

Once the individual assumes that there are problems and that we can find appropriate solutions, the phase
The definition and formulation of the problem is of utmost importance. If we manage to define and formulate the
Problem, we already have half of it solved. In this phase what we will do is: gather relevant information.
about the fact-based problem, clarify its nature, establish a realistic solution goal and
re-evaluate the meaning of the problem for the personal and social well-being of the individual. To better understand the
We need to gather relevant information about it again or make the information aware to him.
regarding what we overlook, we do not want to see or recognize. This information must be based on facts, not on
assumptions or beliefs, and be described in concrete, specific, relevant terms. It is useful to differentiate
facts of assumptions. D'Zurilla and Nezu (2007) can use the imaginary role-playing technique.
very useful at this stage. The clarification of the nature of the problem will focus on correcting any distortion
the misconception that may interfere with an adequate definition of identification because of that situation
Dad is a problem. Analyze the cognitive distortions proposed by Beck (arbitrary inference,
selective abstraction, overgeneralization, erroneous attributions) can be useful in this phase.
Sometimes the problem lies in the discrepancy between what is and what should be. If the person is capable of
realizing this, then he/she will be able to begin the process towards effectively solving problems. The problem
it is based on different obstacles that prevent its solution, such as skill deficits, emotional problems,
complexity, etc. Another important aspect is to set a realistic goal for problem solving. A few
Some problems are solvable, others are not. Some problems are solved simply, others are complex or there are
that decomposing them into subproblems. All of this must be carried out by the individual to reevaluate the meaning
from the problem so that I can better know, define, and understand that it can lead to solutions narlo. A
cost-benefit analysis exercise, a short term and a long term, can be very useful (see table 20.4).

3.5.3. Generation of alternative solutions

The objective of the alternative solutions generation phase is to achieve the availability of as many solutions.
alternatives as possible. With this, we hope to maximize the probability that the best solution is
possible among them. Usually the obstacles that prevent the development of alternative solutions
creativity is habit and convention. Habits are good if they lead us to effective solutions.
the problems. But they are negative if the individual responds automatically to a problematic situation of
a way that does not lead him to his solution. We know that the first solutions that come to mind do not
They are always the best.

Therefore, in this phase, three principles derived from Guildford's divergent production are used.
Osborn's brainstorming: the principle of quantity, the principle of postponing judgment, and the principle
of the variety. The principle of quantity refers to how more alternative solutions are produced in the face of a
problem, more quality of the available ideas and with a higher probability we can reach the best solution. The
The principle of deferring judgment refers to a person who generates better solutions if they do not have to
evaluate them at that moment. In addition, the judgment used to inhibit imagination if used at the same time.
The principle of variety states that the greater the range or variety of solution ideas, the more ideas of
good quality will be discovered. If the client emphasizes difficult-to-generate solutions, the therapist may
to suggest unrealistic or clearly inadequate solutions. This usually serves to have the client provide
more alternatives and that need to be more realistic. Likewise, the therapist must encourage the client to
opt for certain solutions that are relevant and specific, as opposed to those that are less relevant,
general, nonspecific or unrealistic (table 20.5).
In this process, emotional blocking, anxiety, depression, and always arriving at the same point interfere.
solution, the lack of information, etc. This leads to a way of avoiding the appropriate alternative solutions, if
this is the case, it would be necessary to resort to other techniques, such as cognitive restructuring, the
autoinstructions or training in relaxation. They are also useful procedures to enhance
quantity and quality of generating alternatives, using combinations, modifications or alterations of
the ones that come to mind. Finally, we need to achieve relevant solutions to the problem,
specific, in order to later implement a strategy that specifically leads to the solution and
the tactic to achieve it.
Examples of solutions that are little or not realistic at all

3.5.4. Decision Making

The objective of the decision-making phase is to evaluate (compare and judge) the partnership alternatives.
available and select the best one (to improve) to apply in the problematic situation. This is
based on two theoretical decision models:
a) The expected utility theory, according to which the qualification of behavior is based on a rational analysis
cost / benefit.
b) The theory of perspective, which takes into account the effects of perceptual and subjective factors on
the chosen behavior.

In this phase, for each alternative solution, indicate the costs and benefits, in the short and long term, and judge the
expected result or the usefulness of each alternative, compare alternatives and select the solution or
combinations of solutions with the best expected utility. The judgment of expected utility is based
mainly on four cost/benefit criteria:
a. Resolution of the problem (probability of achieving the goal of solving the problem).
b. Emotional well-being (quality of the expected emotional outcome).
c. Time / effort (amount of time and effort that you estimate it requires)
d. Personal and social well-being together (cost/total expected benefit rationing).

Even using the previous criteria, the person making the decision may vary in their evaluations of the
results of the solution due to differences in norms, values, and personal commitments. It is useful for each
decision the person rates their level of satisfaction with the expected outcome for each solution. Thus, it establishes
la utilidad esperada de cada solución alternativa. Esto puede hacerlo con hojas de decisión (tabla 20.6), en la
that the person rates on a scale of 1 to 10, or on another type of scale, different consequences (personal,
interpersonal, social, etc.) or advantages and disadvantages of each alternative solution. In the end, a
scoring that allows for a more objective selection of the best alternative.
Also in this phase of the process, we can use various procedures to facilitate knowledge of
alternative problem-solving structures, as well as the beliefs, values, and emotions that can
influence their preference for alternative solutions. Among them are vague or ambiguous solutions, which are
whether to move them to concrete conditional terms, behavioral testing or undercover testing; see the problem
from another perspective and generate alternative problem formulations, propose as many solutions as possible
possible and consider alternative solution concepts and all possible solution outcomes
anticipating the gains and losses that each of them may suffer.
Based on the estimated results of the available solution alternatives, the person must respond to
these three issues:
a) Is the problem solvable?
b) Do I need more information before I can select and implement a solution?
c) What solution or combination of solutions can you choose to put into practice?

If the answer to the first question is affirmative, the answer to the second is negative, and we can answer the third,
So we have a solution to the problem. If that is not the case, we have to go back to the previous phases.
from the problem-solving process so that with its change or reform we can achieve a
satisfactory solution. The solution plan you prepare should be characterized by having the best probability of
maximize expected utility.
The plan can be simple or complex. A simple one would involve a single course of action; a complex one consists of
combine combinations of alternative solutions. With this we can choose the inadequate solutions and
to focus on the relevant ones. However, at times it is difficult to assess the consequences of different
solutions. In such a case, the imaginary essay and the behavioral essay proved useful, especially in the face of problems.
interpersonal.

Example of a decision-making sheet

3.5.5. Implementation and verification of the solution

In the implementation and verification phase of the solution, the result of the solution is evaluated and verified.
solution of the chosen solution strategy in the real-life problem situation. This is done first
symbolically before doing it in the real-life situation. D’Zurilla (1986) uses as a conceptual framework
in this phase, the theory or cybernetics of control and the cognitive-behavioral conception of self-control. This
constant of four components: execution, self-observation, self-evaluation, and self-reinforcement.
The execution refers to the implementation of the solution. It is important to keep in mind that the execution of
a chosen solution in real life can be influenced by other factors aside from the ability to solve
problems. For example, having a deficit in another skill (academic ability), a deficit in the expulsion skill
(social skills), emotional inhibition, and motivational deficits (reinforcement). If necessary, in this
At some point, it will be necessary to train or teach the individual concrete strategies that they lack, such as skills.
social skills, stress management, removing obstacles, etc.
Self-observation consists of observing one's own behavior in carrying out the solution and its
results. This should evaluate the objective mode (for example, frequency, intensity, duration).
In the self-assessment, the result of the observed solution is compared with the predicted or expected result.
for the solution, based on the decision-making process. If the solution has been effective, then only
the last step of self-reinforcement remains, in which one reinforces oneself for a 'job well done'. This
reinforcement can be either a positive self-affirmation or a more tangible reinforcement like buying an object or
carry out an activity. But there is no doubt that the resolution of the problem itself is an important
reinforcer. This step of reinforcement is very important in the problem-solving process, as it does not
it not only reinforces the execution of effective problem-solving but also strengthens control
perceived and self-efficacy expectations, which are very important for problem-solving efforts
futures.
If there are discrepancies between the observed solution result and the expected result, the source must be sought.
of that discrepancy, especially if it is in the process of troubleshooting in the execution of the
solution (for example, skills deficit, emotional inhibition). If after carrying out all the
evaluations and all corrections specifically solve the problem, the process will be completed; If
there is no solution to the problem and strategies cannot be successfully applied, seek help for
concluding the problem is unsolvable and focusing on other types of techniques. Perfectionism in the solution of
problems and the inability to accept that some are irreparable as they are formulated are some
sometimes characteristics of some people that lead them time and again to not resolve their problems.

3.6. Homework and other problem-solving exercises

An important element of the TSP is the homework assignments. These will consist of completing the exercises that you
they have practiced in the consultation, but not only the achievements at the cognitive or imaginary level, but also the behaviors
of putting into practice the solution alternatives that are being arrived at little by little throughout all the
treatment process. Also, on many occasions, it is necessary to encourage the person in specific techniques,
as part of the TSP itself, if there are strategies or necessary capabilities to solve its problem (by
example, training in relaxation, cognitive restructuring, training in social skills, etc.). In
in that case we must train him in the techniques and have him practice them in his daily life through tasks
for home that we love. You can put these into practice in imaginary or real situations, applying them in your
daily life everything you will learn in the consultation and outside of it (see table 20.7).

3.7. Maintenance of results and prevention of relapse

As we have discussed previously, specific training in problem-solving is a
basic part of an intervention when applying this technique, but one must not forget about the previous phase of
evaluation and subsequent maintenance and generalization. For these greatly helpful alternatives, the
different tasks that the client has achieved in a session of therapy and in the tasks for the home. Another
A way to enhance generalization is to provide the client with different material in the sessions that they can later use.
continue to use once the treatment is finished. In table 20.8, a manual for the client is presented, what
it is provided in the early treatment sessions, as supporting material, so that you always have it
clear the training phases, or the end of it so that I can attend it to maintain the process of
problem-solving always active (see table 20.8).
Hypothetical examples of problems whose resolution helps to become familiar with training in problem-solving
problems

Customer Manual
3.8. Most common problems and their solutions in the application of problem-solving therapy
There are several problems that arise in the application of the TSP (Bedell and Lennox, 1997; D'Zurilla and Nezu,
2007), such as the therapist's inexperience applying the TSP mechanically, being unable to do
relevant the TSP for an individual or group, do not include homework as part of the treatment, focus on
mechanically in its application and not in the client, in the treatment or in the problem for which they have come, not
focused on the problem that the individual has, but on others that are less relevant, not taking into account the
emotional experiences of the individual that require a preferential approach, not differentiating coping
centered on the problem of solution-focused coping, believing that with training in solution
of problems and solutions everything, without resorting to other techniques that are essential at times to
to achieve such change or, not having a clear understanding of the strengths and weaknesses of the TSP parents. When it happens
the above, the mode of solution is for the therapist to follow the evaluation and treatment process as Nezu et
al. (2004) within a conceptual framework of problem society. Following it, the therapist will achieve that
centered on their client, on the problem for having sought treatment, and, with all of that, they will have a
open, pragmatic, problem-centered therapeutic approach that focuses on how the client can solve it.

3.9. Example of application in the generation of alternative solutions

As an example of the application of one of the phases of the TSP, indicate how solutions are transformed.
alternatives. In this case, we refer to the following problem that a couple has: "discussions due to my
"the partner (the child) never helps me with the household chores." Once the process has been followed, as...
It was indicated earlier for this phase, they generated the following alternative solutions:
Make a calendar with the days that each person is assigned to clean.
Clean in shifts according to available time, especially the kitchen and bathroom.
Don't let anyone clean.
Divide the house cleaning tasks.
Call my mother (of the woman) to do the house cleaning.
Always eat out so you don't have to limit.
That one always cleans up after distributing all the household chores.
Hire someone to clean the house.
Ask a family member for help in cleaning the house.
Dedicate one day a week to clean together.

They must keep three of them, following the steps to select the best. They will demonstrate that
select the one they consider best and then put it into practice to verify if it resolves or not
problem.

4. VARIATIONS OF THE TECHNIQUE

Although a few decades ago, alongside D'Zurilla and Goldfried's TSP (1971), we had procedures
similar, as was the solution to interpersonal cognitive problems by Spivack and Shure and science
Mahoney's staff (see Becoña, 1993), in recent years there have been barely any applications with them, being
the TSP of D'Zurilla and Nezu the TSP that has been almost exclusive and has a large number of applications and
experimental studies.

5. AREAS OF APPLICATION
We currently have a large number of studies that have been conducted with social TSPs, well treated.
alone, well as a technique of a treatment palette. Its most relevant applications have been the ones referred to
to the treatment of depression (for example, Areán, 2000; Nezu et al., 1989, 2007), but there are many others (table
20.9).
We have several meta-analyses that evaluate the effectiveness of the TSP. The one by Malouff et al. (2007) analyzed
different physical and mental health problems. We included 31 studies in it, with almost 3,000 patients. The
Results indicate that TSP is more effective than no treatment, and than the usual treatment received by others.
groups, that the placebo attention control groups, although not more effective than other treatments
experimental ones that were compared. Specifically for depression, we have the meta-analysis by Cuijpers
et al. (2007) Included 13 studies. There is a great variety of results among them, although most
with favorable results for the application of TSP. The average effect size is 0.34, with the
fixed effects model, and 0.83, with the random effects model. The group intervention of the best
results that the individual; in studies of people who suffer only from depression, the results are lower; and
the strongest effects appear when comparing the TSP with a waiting list control group. With
primary care patients with depression, the results have not shown that CBT is effective compared
with the control conditions.

Examples of application of problem-solving therapy

6. EXAMPLE OF APPLICATION TO A CASE

Eduardo is a 39-year-old person, a businessman by profession, who is undergoing treatment for dependence on the
cocaine. Married for the second time, he has a 5-year-old son and two daughters from his first marriage, aged 10 and 18.
years. He has been using cocaine since he was 22, and he has undergone two previous treatments, which he abandoned at
I started them a little time ago. The last one I did was 9 months ago in a public drug dependence center.
He only attended four treatment sessions. The first treatment was done 5 years ago, attending only to
six treatment sessions, a private psychologist. In both cases, he left the treatment because he felt under the
encouragement although I had managed to reduce cocaine consumption in both cases. The current reason for wanting to quit
the consumption of cocaine is that he is spending a lot of money, he has problems with his current wife because of his consumption
and begins to suffer from paranoia and frequent tachycardia and has low self-esteem.
When it comes to treatment, using snorted cocaine, usually four times a week,
around one gram each time. Spends between 1,000 and 1,500 euros monthly on cocaine. Smokes 20 cigarettes.
diaries, baby drinks wine at lunch and dinner and occasionally a mixed drink. Sometimes, when the party sale with
his friends can reach the embassy. He also smokes joints, especially when he consumes cocaine, to
reduce its stimulating effect. Usually smokes three joints a day, which can reach ten when consuming a lot.
cocaine. He currently has problems with his wife, with the daughters from his first marriage, and with his ex-wife.
(monetary noncompliance, visitation issues, reproaches, etc.). She left him because of his cocaine use and for the
couple problems that had been left behind due to their disordered life caused by their consumption. His current wife
He found out about his cocaine problem years ago. This forced him to seek treatment, but he did not consent.
quit the consumption. Currently, he has problems with her due to the consumption. He fears that she will leave him if he doesn't quit.
cocaine. The main problems they have when seeking treatment are: dependence on the
cocaine, cannabis, relationship problems, and fears of failing in treatment. The objectives of the treatment
and the techniques used for each of them are indicated in table 20.10. They are usually the usual ones for
many of the people with cocaine dependence, focused on motivational aspects,
psychological rehabilitation and relapse prevention. As can be seen, an important aspect throughout
Different treatment objectives have been TSP.
This has been important for the recognition of the problem, for the abandonment of consumption (desensitization)
psychological), in order to consider other alternatives different from consumption, for managing their mood state
and for relapse prevention. It has also been the central component for managing their problems.
with his current wife (since she has not wanted to go to treatment with him) and for the management of the
problems he had with the daughters of his first marriage. Finally, the TSP has been a component
important in the final part of the treatment, referred to seeking alternative solutions for a change towards a
healthy lifestyle. Please refer to the client manual (table 20.8) regarding household tasks.
in the problem-solving exercises. The treatment was carried out over 4 months (12 sessions).
He stopped using cocaine in the third session, had several relapses throughout the treatment, and the main ones
goals, except for the one to stop cannabis consumption. The reinforcers and incompatible activities with the
The most important factors for cocaine consumption in this case were his work (expanding the business), his wife (improvement of
the relationship and obtaining greater gratification and a more family-oriented life), their children (spending more time with them) and going out to
dinner with his wife and other friends and not without her like he used to. The abstinence from cocaine was confirmed.
with urinalysis. In the 6-month follow-up, he maintained abstinence and treatment gains. There was
a period of two specific relapses during that time because they had offered him cocaine
people we met. We saw another person and they had improved so much on both a physical and psychological level.