Problem-solving

Miriam Sequeira
Intervention Coordinator
Prevention of Depression in Late Life (DIL) project
Sangath, Goa
Overview
• What is Problem-solving therapy (PST)
• Key principles of PST
• 7 steps of PST
• Role-plays
Focus areas of the intervention
Healthy Brain

Good adaptation
leading to good
stress
management
Proactive
Problem Right amount
of activity
Solving
 Style of the counsellor

Choice and Learning Encourage Action

Collaborative
Flexibility together progress focused

Meet person Counsellor’s

Teach skills and Practice and
where he or she skills + person’s Present focus
reasons for it revise
is experience

Driven by Rapport for Manageable

Basic skills Build skill
person’s choice motivation parts or steps
 Phases of the Intervention
3 phases:
1. Engaging (session1-2)
2. Problem-solving (session 2-4)
3. Ending well (session 4- 6)
 Moving through the phases
• Each phase has a set of goals and tasks.
• Move to the next phase only after completing goals
and tasks of the previous phase.
• Each session 30- 40 min.
• Preferably 1 session a week but be flexible
Psycho-education
about stress related
disorders
 Right amount of activity

Feel Bad

Do Less
The relationship between low mood and
reduced happy activities.
The Stress Cycle
Downward Spiral
Mood rating scale

1
2
3
4
5
 Proactive problem-solving

Good
Reduced
Problem
Symptoms
Solving
Problems
Not-so-good
Increased
Problem
Symptoms
Solving

The relationship between problem-solving

skills & stress symptoms.
Upward Spiral
Exercise
 h
rtn
d
icth
7
o
teh
c
(ew
o
6
fn
ap
rn
co
• Itru esa
5
difp to
eo cfr
4
nn o
rse
3 tsm ra
iecli
p
2 fld h
s
b
yalt
tn seis
h)o o
c
1
eslla
u
c
u
o
ptlth
i
The 7 steps of PST: INSPIRE
riu
oto e
n
v
Step 1. Identify the problem
• Clear
• Specific
• Small, manageable parts
• Begin with a more practical and not
emotionally sensitive problem
• Make a problem list

‘Look before you leap’

16
 Step1: Identify and clarify the problem

1. What makes this a problem?

2. When does the problem occur?
3. Where does the problem occur?
4. Who is involved in the problem?
5. How often does the problem occur?
6. What have you already tried to solve the problem?
7. Do you truly have control over this problem?
Exercise
Step 2: Note down a realistic achievable goal

• What does the person want to change

about the problem?
“If the problem didn’t exist anymore, what
would be different?”

• Factors to be considered:
T- Time
I- Involvement of others
M- Money
19
 Exercise
“I will lose 5kgs in 1 month”

versus

“I will find ways to decrease my fat consumption”

“I will increase my activity level”
 Step 3: Search for possible solutions
• ‘Brainstorming’
• Person may be stuck on one unrealistic
solution, e.g. winning the lottery
• Brick technique (Nezu, Nezu & Perri, 1989)
• Number of solutions generated is important
• No idea is silly (humour)
• “How would someone else deal with a
problem like this?”
Brainstorming
Exercise
Step 4: Probe through the pros and cons of
each solution
• Initiate by asking “How do you think this
option will help you?”
• Talk about pros first
• 3 important factors to consider:
1. Does it directly affect the goal?
2. How does it affect time, involvement of
others, money, effort (TIME)?
3. Impact of the solution on loved ones
 Important points to remember
• Remind the person if they miss out on any
important advantage or disadvantage
• Use open-ended questions
• Make a note of all the pros and cons
mentioned

25
Exercise
Step 5: Identify the preferred solution(s)
• “Which of these solutions do you think are most likely
to help you reach your goal?”
• “How many of these solutions would you like to put
into action?”

3 main tasks of step 5:

1. Review the pros and cons listed out in the
previous step.
2. Assist the person in choosing a preferred solution.
3. Ask the person about the reasons why that particular
solution was chosen.
Step 5: Identify the preferred solution
Important points to remember at step 5:
• The easiest option is not always the best
solution
• Measure the amount of conflict it will create on
others and address it
• Remind the person that more than 1 option can
be chosen at the same time
• In case the person chooses a clearly
inappropriate option then we need to remind
her/him about the disadvantages of it
Exercise
 Step 6: Run with it (action plan)
• Actions required to implement the preferred
solutions
• Date, time, materials required, assistance
needed, etc.
• Take time to plan every detail
• Write down the specifics in the session
record/workbook
• Address barriers that might arise
 Helpful questions at this stage:
• “What needs to be done?”
• “When can this be done?”
• “Where can you do this?”
• “How do you think you can do this?”
• “Would you need to ask someone to help you do
this or can you do it on your own?”
Step 6: Run with it (Action plan)
Exercise
 Step 7: Evaluate the outcome
• Done in the next session
Questions we should ask if the person ran the
action plan:
“What did you do?”
“How did it help you?”
“How did you feel after doing the action plan?”
“Is there anything new you learnt from doing
this which you can use with other problems?”
35
Important points to remember at step 7:
• Use the mood rating scale to review the
person’s mood after having done the action
plan
• Strengthen the mind-body relationship
concept

36
Questions to be asked if the action plan was
not done
“What happened? What went wrong?”
“What prevented you from working on it?”
“What do you think should have been different?”

Apply PST to the problem identified

Person tried the action plan but failed?
• Find out what went wrong
• Reassure the elder of our genuine belief that
he/she has the potential to solve problems
• Encourage persistence reminding the person
that this is a slow process
• Consider the factors that were not taken into
account earlier and repeat PST
 PSA summary

Action

Solutions
Problem 39