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- CBT, Hypnotherapy, Problem-Solving
Imagination, Suggestion, and Problem-Solving
Copyright (c) Donald Robertson, 2010. All rights reserved.
Problem-Solving Therapy (PST) originated in the 1970s as a sub-genre of cognitive-behavioural therapy (CBT) that focused on helping individuals to improve their confidence and skill when it comes to solving their own problems in general. PST draws on psychological research on problem-solving abilities in experimental settings. It's a relatively brief, simple, action-oriented and pragmatic approach to therapy. It's been used for a very wide variety of client groups and issues and seems to hold promise as quite a general-purpose therapeutic strategy. However, most of the research in this area has focused on the finding that depression tends to be associated with problem-solving deficits and a substantial body of clinical outcome research now demonstrates that problem-solving therapy is effective in the treatment of clinical depression.
Brief Description of Problem-Solving Therapy (PST)
Modern Problem-Solving Therapy derives from a seminal journal article describing the technique, written by Goldfried and D'Zurilla in 1971. The method attempts to train clients to improve in two main areas,
Problem Orientation. Developing a positive problem-orientation or problem-solving attitude involves seeing problems as challenges or opportunities rather than threatening or overwhelming, being confident in one's ability (self-efficacy) to solve problems, and being motivated to tackle problems in a timely manner, without rushing.
Problem-Solving Proper. The actual skills involved in effective problem-solving can be divided into four generic components, which occur in sequence,
- Problem Definition & Formulation. Defining one's problems and goals accurately, concisely, and objectively, without reference to too many assumptions or using emotive language, i.e., “sticking to the facts.” Problem definitions should aim to capture the heart or essence of a problem as clearly as possible and goals should be SMART, i.e., Specific, Measurable, Achievable, Relevant, and Time-limited. Vague definitions of problems or unrealistic goals are common reasons for failed problem-solving.
- Brainstorming Alternatives. An attempt is made to think creatively and exhaustively about the range of possible solutions or options available and to “brainstorm” or draw up a list. Osborn's principles of brainstorming suggest that quantity, variety, and suspension of judgement contribute to finding the best solution. A wide range of varied solutions is helpful but it's particularly important to list solutions before becoming sidetracked by evaluating them. People who fail at problem-solving often identify one or two possible solutions and become distracted by analysis or evaluation of them before identifying the full range of options available to them.
- Decision-Making. Each potential solution should normally be evaluated, perhaps after “screening out” obviously unsuitable ideas. There are different ways of evaluating proposed solutions but they usually involve cost-benefit analysis, i.e., consideration of the short and long-term consequences (pros and cons) of each option, and perhaps consideration both of the personal and social consequences. Failure to predict the consequences of different options or to evaluate them adequately is a common error in problem-solving.
- Solution Implementation & Verification. The final stage involves developing an action plan, broken down into logical steps, putting it into practice, and properly evaluating its effectiveness and reflecting on the outcome. This may start another cycle of problem-solving, if a plan isn't completely successful. People who procrastinate often find it difficult to complete this stage but no matter how good your plans are on paper you'll only really learn by testing them out in practice. You may have to develop a “contingency plan” (Plan B) to cope with possible setbacks but that should be part of your preparation where necessary.
There is some reason to believe that problem-solving orientation, adopting the right mind-set, may be about as important as the individual skills. However, there may be be a reciprocal interaction between one's attitudes toward problem-solving and practical attempts to develop and utilise the specific skills above. There's also some overlap between conventional cognitive therapy and the correction of negative problem-orientation as this may involve correcting over-estimates of threat and under-estimates of one's strengths resources using standard cognitive restructuring techniques.
By maintaining the right mind-set (orientation) and repeatedly applying these skills to specific problems, the overarching goal of problem-solving therapy is achieved, which is not just the solution of individual problems but long-standing improvement in one's underlying problem-solving confidence and ability in general. In other words, the goal of problem-solving therapy isn't just to solve individual problems but to make you a better problem-solver in general.
The main clinical manual describing Problem-Solving Therapy is,
Problem-solving Therapy: A Positive Approach to Clinical Interventionby D'Zurilla & Nezu
There's also an accompanying self-help book,
Solving Life's Problems: A 5-Step Guide to Enhancing Well-Being by Nezu, Nezu & D'Zurilla
Hypnotherapy has not been explicitly combined with problem-solving therapy but doing so may be justified by the following considerations,
- Both hypnotherapy and PST are brief interventions, typically delivered over about 5-6 sessions.
- PST appears to be a relatively generic approach applicable to a wide range of presenting problems of the kind dealt with by hypnotherapists.
- PST is a simple technique, requiring minimal training, and therefore suitable for delivery by “lay” hypnotherapists.
- PST employs concepts, such as SMART goal-setting, which are familiar to many hypnotherapists from fields such as NLP, life coaching, and self-help literature.
Hypnotherapy techniques can be used in combination with problem-solving therapy in the following ways,
- Hypnotherapy can be used to help problem definition and formulation by having clients imagine themselves in a problem situation, while describing in detail their thoughts, actions, and feelings – a form of “evocative imagery” not unlike regression hypnotherapy.
- Hypnotherapy can be used to help SMART goal definition by having clients mentally rehearse their desired outcomes and elaborate in detail upon their thoughts, actions, feelings, etc.
- Rehearsing goal imagery is already used in PST to increase motivation and this technique can easily be replicated and perhaps enhanced in hypnosis.
- Hypnotherapy may facilitate the adoption of alternative perspectives and encourage creative thinking, which can facilitate the generation of alternative solutions.
- Hypnotherapy may facilitate the use of mental rehearsal techniques, which allow clients to explore the consequences of proposed solutions using mental imagery, rehearse skills and develop confidence, in preparation for implementing their chosen solution and action plan.
- Hypnotherapy is well-suited to the development of cognitive sets (mind-sets) by means of direct suggestion, especially in the form of self-hypnosis recordings, which could be used between sessions to enhance problem-solving orientation and confidence.
In modern cognitive therapy clients are often be helped to develop “scripts”, which may tell a story about certain situations or responses. For example, clients may write cognitive therapy scripts in the form of stories describing how they would think, act, and feel if they were coping better with a problem or acting “as if” their core beliefs about themselves had improved. It's likewise possible to collaboratively develop problem-solving self-hypnosis scripts with clients, i.e., asking them to write a story about how they would think, act, and feel if they were confident about solving their problems in general and turning this into a self-hypnosis recording. There's considerable overlap between positive problem-orientation and the traditional approach to “ego-strengthening” by suggestion in hypnotherapy.
In addition, there are many ways in which mental imagery can be used in hypnosis to facilitate problem-solving, particularly in terms of defining a problem, generating alternative solutions and rehearsing proposed action plans. Hypnosis tends to facilitate the adoption of different imaginary roles and perspectives, as in hypnotic regression or age progression techniques. In hypnosis a client can be asked to assume the role of a courageous person, a creative person, wise person, etc., to help identify alternative solutions. Likewise, a client can be asked to project themselves to a time in the future when the problem has been solved and looking back to observe changes in their perspective and to elaborate how they think they're most likely to have solved the problem, and the consequences of doing so. Mental rehearsal of proposed solutions or action plans serves a double purpose of both elaborating upon the skills required and consequences of putting a certain solution into practice but also reducing anxiety and increasing self-confidence. Rehearsing action plans in the imagination during hypnosis overlaps considerably with established methods such as desensitisation, coping imagery, imaginal exposure, etc.
Overall, there appears to be considerable potential for combining these two brief therapy techniques. Moreover, PST already has a compelling evidence-base, which is continually growing and hypnotherapists arguably have an obligation to assimilate other evidence-based approaches into their practice where possible. It's much easier to learn PST than it is to learn full-blown CBT, and doing so may also provide an avenue through which hypnotherapists can assimilate more cognitive-behavioural components into their practice over time, i.e., acting as a first step on the ladder of integration between hypnosis and CBT in general.