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Problem-Solving Therapy: How It Works & What to Expect

Author: Lydia Antonatos, LMHC

Lydia Angelica Antonatos LMHC

Lydia has over 16 years of experience and specializes in mood disorders, anxiety, and more. She offers personalized, solution-focused therapy to empower clients on their journey to well-being.

Problem-solving therapy (PST) is an intervention with cognitive and behavioral influences used to assist individuals in managing life problems. Therapists help clients learn effective skills to address their issues directly and make positive changes. PST is used in various settings to address mental health concerns such as depression, anxiety, and more.

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What Is Problem-Solving Therapy?

Problem-solving therapy (PST) is based on a model 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 problems or deal with everyday stressors. Therefore, the key to preventing health consequences and improving quality of life is to become a better problem-solver. 3 , 4

The problem-solving model has undergone several revisions but upholds the 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.

The two main components of problem-solving therapy include: 3 , 4

• Problem-solving orientation: This focuses on helping individuals adopt an optimistic outlook and see problems as opportunities to learn from, allowing them to believe they can solve problems.
• Problem-solving style: This component aims to provide people with constructive problem-solving tools to deal with different life stressors by identifying the problem, generating/brainstorming solution ideas, choosing a specific option, and implementing and reviewing it.

Techniques Used in Problem-Solving Therapy

PST emphasizes the client, and the techniques used are merely conduits that facilitate the problem-solving learning process. Generally, the individual, in collaboration and support from the clinician, leads the problem-solving work. Thus, a strong therapeutic alliance sets the foundation for encouraging clients to apply these skills outside therapy sessions. 4

Here are some of the most relevant guidelines and techniques used in problem-solving therapy:

Creating Collaboration

As with other psychotherapies, creating a collaborative environment and a healthy 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 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.

This tool is used in all psychotherapies and is just as essential in PST. Assessment seeks to gather facts and information about current problems and 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

Psychoeducation is an integral component of problem-solving therapy and is 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.

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 beneficial when clients struggle with eliciting solutions on their own.

Shaping intervention refers to teaching new skills and building on them 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.

In problem-solving therapy, modeling is a method in which a person learns by observing. It can include written/verbal problem-solving illustrations or demonstrations performed by the clinician in hypothetical or real-life situations. 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 lives and apply them to specific problems.

Rehearsal & Practice

These techniques provide opportunities 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 to apply various problem-solving skills. The goal is for the client to continue using more adaptive behaviors, even if they do not get it right the first time. 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, analogies and metaphors can be useful in providing the client with a clearer vision or a better understanding of specific concepts. For example, the therapist may use diverse skills or points of reference (e.g., cooking, driving, sports) to explain the problem-solving process and find solutions to convey that time and practice are required before mastering a particular skill.

What Can Problem-Solving Therapy Help With?

Although problem-solving therapy was initially developed to treat depression among primary care patients, PST 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 can help individuals challenged with specific issues who 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, 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 positively impact mental health, quality of life, and problem-solving skills in 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 the versatility of problem-solving therapy, PST can be used in different forms, settings, and formats. Following are some examples where the problem-solving therapeutic approach can be used effectively. 4

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 on issues and motivate individuals to tap into their coping resources and apply healthy problem-solving skills. Through psychoeducation, individuals can learn to identify and understand their emotions influence 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.

The Veterans Health Administration presently employs problem-solving therapy as a preventive approach in numerous medical centers across the United States. These programs aim to help veterans 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 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 they feel unable to overcome. These unsolved problems are both the triggering and sustaining reasons for their mental health-related troubles. Therefore, a problem-solving approach can be vital for the treatment of people with psychological issues.

Adherence to Other Treatments

Problem-solving therapy 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.

Benefits of Problem-Solving Therapy

PST is versatile, treating a wide range of problems and conditions, and can be effectively delivered to various populations 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.

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

How to Find a Therapist Who Practices Problem-Solving Therapy

Finding a therapist 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 that hold similar concepts as PST.

As a general recommendation, check your health insurance provider lists, use an online therapist directory , or ask trusted friends and family if they can recommend a provider. Contact any of these providers and ask questions to determine who is more compatible with your needs. 3 , 4

Are There Special Certifications to Provide PST?

Therapists do not need special certifications to practice problem-solving therapy, but some organizations can provide special training. Problem-solving therapy can be delivered by various healthcare 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 competence and help clients gain insight into the causes that led them to their current situation. 3 , 4

Questions to Ask a Therapist When Considering Problem-Solving Therapy

Psychotherapy is most successful when you feel comfortable and have a collaborative relationship with your therapist. Asking specific questions can simplify choosing a clinician who is right 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 with providing problem-solving therapy?
• Have you dealt with other clients who present with similar issues as mine?
• Have you worked with individuals of 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 Problem-Solving Therapy Cost?

The cost of problem-solving therapy can range from $25 to $150 depending on the number of sessions required, severity of symptoms, 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. Medicare supports PST through 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 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 therapy sessions the therapist suggests. 3 , 4

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Is Problem-Solving Therapy Effective?

Extensive research and studies have shown the efficacy of problem-solving therapy. PST can yield significant improvements within a short amount of time. PST is also useful for addressing numerous problems and psychological issues. Lastly, PST has shown its efficacy with different populations and age groups.

One meta-analysis of 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 significantly more effective than not receiving any treatment. 7 However, more investigation may be necessary about PST’s long-term efficacy in comparison to other treatments. 5,6

How Is PST Different From CBT & SFT?

Problem-solving, cognitive-behavioral, and solution-focused therapy belong to the cognitive-behavioral framework, sharing a common goal to modify 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 how we think affects how 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 treatment in psychotherapy due to its effectiveness in addressing various problems like anxiety, sleep disorders, substance abuse, and more.

Like CBT, PST addresses mental, emotional, and behavioral issues. However, PST may provide a better balance of cognitive and behavioral elements.

Another difference between these two approaches is that PST mostly focuses on faulty thoughts about problem-solving orientation and modifying maladaptive behaviors that specifically interfere with effective problem-solving. Usually, PST is used 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 because 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 lives would differ without problems by exploring their current coping skills. Community mental health, inpatient settings, and educational environments are increasing the use of SFT due to its demonstrated efficacy. 8

Final Thoughts

Problem-solving therapy can be an effective treatment for various mental health concerns. If you are considering treatment, ask your doctor for recommendations or conduct your own research to learn more about this approach and other options available.

Additional Resources

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For Further Reading

• 12 Strategies to Stop Using Unhealthy Coping Mechanisms
• Depression Therapy: 4 Effective Options to Consider
• CBT for Depression: How It Works, Examples, & Effectiveness

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Online psychiatry, sometimes called telepsychiatry, platforms offer medication management by phone, video, or secure messaging for a variety of mental health conditions. In some cases, online psychiatry may be more affordable than seeing an in-person provider. Mental health treatment has expanded to include many online psychiatry and therapy services. With so many choices, it can feel overwhelming to find the one that is right for you.

Problem-Solving Therapy Infographics

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Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy .

Beaudreau, S. A., Gould, C. E., Sakai, E., & Terri Huh, J. W. (2017). Problem-Solving Therapy. In N. A. Pachana (Ed.), Encyclopedia of geropsychology : with 148 figures and 100 tables . Singapore: Springer.

Broerman, R. (2018). Diathesis-Stress Model. In T. Shackleford & V. Zeigler-Hill (Eds.), Encyclopedia of Personality and Individual Differences (Living Edition, pp. 1–3). Springer, Cham. https://doi.org/10.1007/978-3-319-28099-8_891-1

Mehmet Eskin. (2013). Problem solving therapy in the clinical practice . Elsevier.

Nezu, A. M., Nezu, C. M., & D’Zurilla, T. J. (2013). Problem-Solving Therapy A Treatment Manual . Springer Publishing Company.

Cuijpers, P., et al. (2018). Problem-solving therapy for adult depression: An updated meta-analysis. European Psychiatry   48 , 27–37. https://doi.org/10.1016/j.eurpsy.2017.11.006

Kirkham, J. G., Choi, N., & Seitz, D. P. (2015). Meta-analysis of problem-solving therapy for the treatment of major depressive disorder in older adults. International Journal of Geriatric Psychiatry , 31 (5), 526–535. https://doi.org/10.1002/gps.4358

Bell, A. C., & D’Zurilla, T. J. (2009). Problem-solving therapy for depression: A meta-analysis. Clinical Psychology Review , 29 (4), 348–353. https://doi.org/10.1016/j.cpr.2009.02.003

Proudlock, S. (2017). The Solution Focused Way Incorporating Solution Focused Therapy Tools and Techniques into Your Everyday Work . Routledge.

Nezu, A. M., Nezu, C. M., & Gerber, H. R. (2019). (Emotion‐centered) problem‐solving therapy: An update. Australian Psychologist , 54 (5), 361–371. https://doi.org/10.1111/ap.12418

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Can Problem-Solving Therapy Help With Managing Life’s Challenges?

Problem-solving therapy is rooted in CBT (cognitive behavioral therapy) and focuses on the present issue at hand more than in the past. It’s often a brief intervention, working to solve the most pressing problem. It aims to improve overall quality of life and reduce mental health symptoms by equipping people with the tools they need to tackle issues themselves, fostering resilience and self-reliance.

What is problem-solving therapy?

Problem-solving therapy (PST) takes a results-oriented approach to managing issues. PST is rooted in cognitive behavioral therapy (CBT) and can also be referred to as problem-solving brief therapy (PSBT).

It’s growing in popularity thanks to evidence showing it can effectively treat a variety of health and mental health problems , such as anxiety, depression, and chronic disease management. With PST, the goal is to tackle the most pressing problem and help people learn how to manage difficulties on their own.

Each person is viewed as a unique whole, not a label or diagnosis. There isn’t a belief that there is something wrong with a person that needs 'fixing.' Instead, it takes a very personalized and solution-oriented approach to help manage each person’s unique challenges.

What makes problem-solving therapy so different?

Unlike other therapy models, PST doesn’t open every door to every problem or painful memory a person has in an attempt to find a root problem. The goal is to resolve the most pressing issue as effectively as possible — which is what can make it brief.

Strategies are based on current behaviors and interactions. Effective implementation of specific problem-solving behaviors is a major treatment goal.

Another important note about PST is that it can be helpful for relationship difficulties between couples or families. While many therapists ask to see both people in a couple or the entire family, PST therapists work to disrupt patterns through just one member.

How does problem-solving therapy work?

With PST, you and your therapist will work together to:

• Clearly define the most pressing issue.
• Learn what behavior is maintaining the problem.
• Set small, manageable action goals that break the pattern .

Change can come more quickly when we focus on trying something new. Of course, intervention strategies all depend on the issue at hand and what would work best for each individual.

Is problem-solving therapy really effective?

Several meta-analyses show that PST is effective for varying conditions, with many studies focused on depression in particular. It’s also been shown to work for anxiety and different health conditions, such as cancer .

Within 6–8 sessions, you may notice a difference in the problem presented. For someone who can’t commit to lengthier treatment with a professional, PST can be a good option.

For people with more serious mental illnesses, such as bipolar disorder or schizophrenia, additional treatment may be helpful. In general, the best method of therapy can vary per person and depends on your particular concerns.

What conditions work best with PST?

PST can help with various mental disorders and daily struggles, such as:

• Chronic stress
• Eating disorders
• Daily life stressors
• Relationship difficulties
• Post-traumatic stress disorder
• Self-harm or suicide ideation
• Emotional distress
• Chronic disease

It can also work for managing life’s difficulties, such as divorce, job loss, financial problems, and weight management. With a focus on goal-setting and stress management techniques, you can learn how to develop healthier habits to better manage future difficulties as well.

Finding the right therapist

If you’re wondering how this therapy can work for you, look for a PST or PSBT therapist online or in person. For example, you can look for therapists who hold a problem-solving brief therapy diploma. The cost could be anywhere from $100–250, depending on your location and the therapists' experience. Check with your insurance provider to find a PST therapist, as it may be covered.

Above all, feeling comfortable with your therapist and as though you have a connection is essential. You’ll work together to clearly define the issue and what a measure of progress would look like.

In general, if you’re not seeing progress with your current psychologist and you’re feeling frustrated, it might be time to break up with your therapist. You can experiment with different methods and people to see who you feel most comfortable with. Within a few sessions, you should feel as though you’re on the path toward progress.

Common myths about PST

If you’re wondering about how PST compares to other therapeutic methods, here are the myth-busting responses:

PST doesn’t work for complex issues

PST breaks down complex psychological issues and works on them in manageable parts. It focuses on the behavioral side to manage current problems or symptoms. Even people who have struggled for years with the same issue can benefit.

PST provides instant solutions to complex problems

PST offers manageable strategies that begin measurable progress on the most pressing issue at hand. Keep in mind that no matter the therapy, you have to put in the work. It’s not about instant solutions but tools to address issues more effectively and efficiently.

PST is less effective than medication for mental health issues

PST and medication serve different roles in the management of mental health symptoms and issues. For some, PST might be enough on its own, while others may benefit from a combination. It all depends on the individual situation — everyone is unique.

PST is the same as giving advice

PST is not merely giving advice. It’s a collaborative process where the therapist and client work together to identify the problem and potential solutions. Therapists foster independence and self-efficacy so that they’re not needed for the long term.

Only psychologists can provide PST

Several different types of trained mental health professionals can offer PST. This includes social workers, counselors, mediators, and coaches.

PST is not suitable for children or the elderly

This therapy model is adapted to each individual and the system they live within. This includes children and the elderly, with modifications to suit their cognitive and emotional development levels and needs.

PST ignores past traumas

Rarely does any therapy method completely avoid past traumas. PST acknowledges whatever is brought to therapy and works through it with the client. It balances the fine line between letting out the past and knowing when it’s time to help the client start working on moving forward. This helps avoid over-analyzing or letting the client stay stuck ruminating without progress.

PST compared to other methods

Below is a comparative table outlining the differences between problem solving therapy and other therapeutic methods, providing a clear overview to help you understand their unique approaches and benefits.

In the end, PST can offer a practical approach to managing life's challenges and work for a wide range of issues and age groups. By focusing on the present and empowering people to develop their own solutions, PST can lead to meaningful and long-lasting change . Whether you're facing relationship difficulties, mental health conditions, or daily stressors, PST provides tools to navigate life's obstacles — both in the present and the future.

Problem-solving therapy (PST) or problem-solving brief therapy (PSBT) is a practical, strategic approach to managing life’s stressors or mental health issues . It’s results-oriented and designed to help see measurable progress faster than other methods.

What can problem-solving therapy help with?

This method can work for a broad range of mental health issues. For example, anxiety disorders, depressive disorders, eating disorders, panic disorders, PTSD, relationship difficulties, chronic disease, stress, and more.

How much does problem-solving therapy cost?

The cost depends on a variety of factors , including location, experience, and qualifications. In the U.S., it can range from $100–250 or more. The caveat is that fewer sessions may be needed when compared to other therapists. You can also search for international therapists who work online for cost savings.

• PST focuses on tackling the most pressing problem with actional goals for noticeable improvements.
• This method aims to teach people problem-solving techniques they can use on their own, making it helpful for people who can’t commit to lengthy therapy.
• Research shows PST to be effective for various mental health issues and daily challenges. This includes anxiety, depression, health conditions, or managing life stressors.
• Australian Family Physician. Problem solving therapy - use and effectiveness in general practice.
• Clinical Psychology Review. Problem-solving therapy for depression: a meta-analysis.
• International Journal of Geriatric Psychiatry. Meta-analysis of problem solving therapy for the treatment of major depressive disorder in older adults.
• European Psychiatry. Problem-solving therapy for adult depression: an updated meta-analysis.
• Journal of the American Board of Family Medicine. The effectiveness of problem-solving therapy for primary care patients' depressive and/or anxiety disorders: a systematic review and meta-analysis.
• The American Journal of Geriatric Psychiatry. Depression agency-based collaborative: effect of problem-solving therapy on risk of common mental disorders in older adults with home care needs.
• Cancer Treatment and Research Communications. Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC pilot study.

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7 Solution-Focused Therapy Techniques and Worksheets (+PDF)

It has analyzed a person’s problems from where they started and how those problems have an effect on that person’s life.

Out of years of observation of family therapy sessions, the theory and applications of solution-focused therapy developed.

Let’s explore the therapy, along with techniques and applications of the approach.

Before you read on, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises will explore fundamental aspects of positive psychology including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.

This Article Contains:

5 solution-focused therapy techniques, handy sft worksheets (pdf), solution-focused therapy interventions, 5 sft questions to ask clients, solution-focused brief therapy (sfbt techniques), 4 activities & exercises, best sft books, a take-home message.

Solution-focused therapy is a type of treatment that highlights a client’s ability to solve problems, rather than why or how the problem was created. It was developed over some time after observations of therapists in a mental health facility in Wisconsin by Steve de Shazer and Insoo Kim Berg and their colleagues.

Like positive psychology, Solution Focused Therapy (SFT) practitioners focus on goal-oriented questioning to assist a client in moving into a future-oriented direction.

Solution-focused therapy has been successfully applied to a wide variety of client concerns due to its broad application. It has been utilized in a wide variety of client groups as well. The approach presupposes that clients have some knowledge of what will improve their lives.

The following areas have utilized SFT with varying success:

• relationship difficulties
• drug and alcohol abuse
• eating disorders
• anger management
• communication difficulties
• crisis intervention
• incarceration recidivism reduction

Goal clarification is an important technique in SFT. A therapist will need to guide a client to envision a future without the problem with which they presented. With coaching and positive questioning, this vision becomes much more clarified.

With any presenting client concern, the main technique in SFT is illuminating the exception. The therapist will guide the client to an area of their life where there is an exception to the problem. The exception is where things worked well, despite the problem. Within the exception, an approach for a solution may be forged.

The ‘miracle question’ is another technique frequently used in SFT. It is a powerful tool that helps clients to move into a solution orientation. This question allows clients to begin small steps toward finding solutions to presenting problems (Santa Rita Jr., 1998). It is asked in a specific way and is outlined later in this article.

Experiment invitation is another way that therapists guide clients into solution orientation. By inviting clients to build on what is already working, clients automatically focus on the positive. In positive psychology, we know that this allows the client’s mind to broaden and build from that orientation.

Utilizing what has been working experimentally allows the client to find what does and doesn’t work in solving the issue at hand. During the second half of a consultation with a client, many SFT therapists take a break to reflect on what they’ve learned during the beginning of the session.

Consultation breaks and invitations for more information from clients allow for both the therapist and client to brainstorm on what might have been missed during the initial conversations. After this break, clients are complemented and given a therapeutic message about the presenting issue. The message is typically stated in the positive so that clients leave with a positive orientation toward their goals.

Here are four handy worksheets for use with solution-focused therapy.

• Miracle worksheet
• Exceptions to the Problem Worksheet
• Scaling Questions Worksheet
• SMART+ Goals Worksheet

Download 3 Free Positive Psychology Exercises (PDF)

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Compliments are frequently used in SFT, to help the client begin to focus on what is working, rather than what is not. Acknowledging that a client has an impact on the movement toward a goal allows hope to become present. Once hope and perspective shift occurs, a client can decide what daily actions they would like to take in attaining a goal.

Higher levels of hope and optimism can predict the following desirable outcomes (Peterson & Seligman, 2004):

• achievement in all sorts of areas
• freedom from anxiety and depression
• improved social relationships
• improved physical well being

Mind mapping is an effective intervention also used to increase hope and optimism. This intervention is often used in life coaching practices. A research study done on solution-focused life coaching (Green, Oades, & Grant, 2006) showed that this type of intervention increases goal striving and hope, in addition to overall well-being.

Though life coaching is not the same as therapy, this study shows the effectiveness of improving positive behavior through solution-focused questioning.

Mind mapping is a visual thinking tool that helps structure information. It helps clients to better analyze, comprehend, and generate new ideas in areas they might not have been automatically self-generated. Having it on paper gives them a reference point for future goal setting as well.

Empathy is vital in the administration of SFBT. A client needs to feel heard and held by the practitioner for any forward movement to occur. Intentionally leaning in to ensure that a client knows that the practitioner is engaged in listening is recommended.

Speaking to strengths and aligning those strengths with goal setting are important interventions in SFT. Recognizing and acknowledging what is already working for the client validates strengths. Self-recognition of these strengths increases self-esteem and in turn, improves forward movement.

The questions asked in Solution-Focused Therapy are positively directed and in a goal-oriented stance. The intention is to allow a perspective shift by guiding clients in the direction of hope and optimism to lead them to a path of positive change. Results and progress come from focusing on the changes that need to be made for goal attainment and increased well being.

1. Miracle Question

Here is a clear example of how to administer the miracle question. It should be delivered deliberately. When done so, it allows the client to imagine the miracle occurring.

“ Now, I want to ask you a strange question. Suppose that while you are sleeping tonight and the entire house is quiet, a miracle happens. The miracle is that the problem which brought you here is solved. However, because you are sleeping, you don’t know that the miracle has happened. So, when you wake up tomorrow morning, what will be different that will tell you that a miracle has happened and the problem which brought you here is solved? ” (de Shazer, 1988)

2. Presupposing change questions

A practitioner of solution-focused therapy asks questions in an approach derived way.

Here are a few examples of presupposing change questions:

“What stopped complete disaster from occurring?” “How did you avoid falling apart.” “What kept you from unraveling?”

3. Exception Questions

Examples of exception questions include:

1. Tell me about times when you don’t get angry. 2. Tell me about times you felt the happiest. 3. When was the last time that you feel you had a better day? 4. Was there ever a time when you felt happy in your relationship? 5. What was it about that day that made it a better day? 6. Can you think of a time when the problem was not present in your life?

4. Scaling Questions

These are questions that allow a client to rate their experience. They also allow for a client to evaluate their motivation to change their experience. Scaling questions allow for a practitioner to add a follow-up question that is in the positive as well.

An example of a scaling question: “On a scale of 1-10, with 10 representing the best it can be and one the worst, where would you say you are today?”

A follow-up question: “ Why a four and not a five?”

Questions like these allow the client to explore the positive, as well as their commitment to the changes that need to occur.

5. Coping Questions

These types of questions open clients up to their resiliency. Clients are experts in their life experience. Helping them see what works, allows them to grow from a place of strength.

“How have you managed so far?” “What have you done to stay afloat?” “What is working?”

3 Scaling questions from Solution Focused Therapy – Uncommon Practitioners

The main idea behind SFBT is that the techniques are positively and solution-focused to allow a brief amount of time for the client to be in therapy. Overall, improving the quality of life for each client, with them at the center and in the driver’s seat of their growth. SFBT typically has an average of 5-8 sessions.

During the sessions, goals are set. Specific experimental actions are explored and deployed into the client’s daily life. By keeping track of what works and where adjustments need to be made, a client is better able to track his or her progress.

A method has developed from the Miracle Question entitled, The Miracle Method . The steps follow below (Miller & Berg, 1996). It was designed for combatting problematic drinking but is useful in all areas of change.

• State your desire for something in your life to be different.
• Envision a miracle happening, and your life IS different.
• Make sure the miracle is important to you.
• Keep the miracle small.
• Define the change with language that is positive, specific, and behavioral.
• State how you will start your journey, rather than how you will end it.
• Be clear about who, where, and when, but not the why.

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A short selection of exercises which can be used

1. Solution-focused art therapy/ letter writing

A powerful in-session task is to request a client to draw or write about one of the following, as part of art therapy :

• a picture of their miracle
• something the client does well
• a day when everything went well. What was different about that day?
• a special person in their life

2. Strengths Finders

Have a client focus on a time when they felt their strongest. Ask them to highlight what strengths were present when things were going well. This can be an illuminating activity that helps clients focus on the strengths they already have inside of them.

A variation of this task is to have a client ask people who are important in their lives to tell them how they view the client’s strengths. Collecting strengths from another’s perspective can be very illuminating and helpful in bringing a client into a strength perspective.

3. Solution Mind Mapping

A creative way to guide a client into a brainstorm of solutions is by mind mapping. Have the miracle at the center of the mind map. From the center, have a client create branches of solutions to make that miracle happen. By exploring solution options, a client will self-generate and be more connected to the outcome.

4. Experiment Journals

Encourage clients to do experiments in real-life settings concerning the presenting problem. Have the client keep track of what works from an approach perspective. Reassure the client that a variety of experiments is a helpful approach.

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These books are recommended reads for solution-focused therapy.

1. The Miracle Method: A Radically New Approach to Problem Drinking – Insoo Kim Berg and Scott D. Miller Ph.D.

The Miracle Method by Scott D. Miller and Insoo Kim Berg is a book that has helped many clients overcome problematic drinking since the 1990s.

By utilizing the miracle question in the book, those with problematic drinking behaviors are given the ability to envision a future without the problem.

Concrete, obtainable steps in reaching the envisioned future are laid out in this supportive read.

Available on Amazon .

2. Solution Focused Brief Therapy: 100 Key Points and Techniques – Harvey Ratney, Evan George and Chris Iveson

Solution Focused Brief Therapy: 100 Key Points and Techniques is a well-received book on solution-focused therapy. Authors Ratner, George, and Iveson provide a concisely written and easily understandable guide to the approach.

Its accessibility allows for quick and effective change in people’s lives.

The book covers the approach’s history, philosophical underpinnings, techniques, and applications. It can be utilized in organizations, coaching, leadership, school-based work, and even in families.

The work is useful for any practitioner seeking to learn the approach and bring it into practice.

3. Handbook of Solution-Focused Brief Therapy (Jossey-Bass Psychology) – Scott D. Miller, Mark Hubble and Barry L. Duncan

It includes work from 28 of the lead practitioners in the field and how they have integrated the solution-focused approach with the problem-focused approach.

It utilizes research across treatment modalities to better equip new practitioners with as many tools as possible.

4. More Than Miracles: The State of the Art of Solution -Focused Therapy  (Routledge Mental Health Classic Editions) – Steve de Shazer and Yvonne Dolan

It allows the reader to peek into hundreds of hours of observation of psychotherapy.

It highlights what questions work and provides a thoughtful overview of applications to complex problems.

Solution-Focused Therapy is an approach that empowers clients to own their abilities in solving life’s problems. Rather than traditional psychotherapy that focuses on how a problem was derived, SFT allows for a goal-oriented focus to problem-solving. This approach allows for future-oriented, rather than past-oriented discussions to move a client forward toward the resolutions of their present problem.

This approach is used in many different areas, including education, family therapy , and even in office settings. Creating cooperative and collaborative opportunities to problem solve allows mind-broadening capabilities. Illuminating a path of choice is a compelling way to enable people to explore how exactly they want to show up in this world.

Thanks for reading!

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

• de Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York, NY: W.W. Norton and Co. https://www.amazon.com/dp/0393700542/
• Green, L. S., Oades, L. G., & Grant, A. M. (2006). Cognitive-behavioral, solution-focused life coaching: Enhancing goal striving, well-being, and hope. The Journal of Positive Psychology, 1 (3), 142-149. https://doi.org/10.1080/17439760600619849
• Miller, S. D., & Berg, I. K. (1996). The miracle method: A radically new approach to problem drinking. New York, NY: W.W. Norton and Co. https://www.amazon.com/dp/0393315339/
• Peterson, C., & Seligman, M. E. P., (2004).  Character strengths and virtues: A handbook and classification (Vol. 1). New York, NY: Oxford University Press. https://www.amazon.com/dp/0195167015/
• Santa Rita Jr, E. (1998). What do you do after asking the miracle question in solution-focused therapy. Family Therapy, 25( 3), 189-195.

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5 Problem-Solving Therapy: Theory and Practice

• Published: May 2017
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Problem-solving therapy (PST) is a psychosocial intervention that teaches clients to cope with the stress of “here-and-now” problems in order to reduce negative health and mental health outcomes. In this chapter, the six stages of PST—problem orientation, problem definition, solution generation, decision-making, solution implementation, and outcome evaluation—are explained and exemplified via vignettes. Areas for which problem-solving therapy has been found useful are summarized, including depression, anxiety, relationship difficulties, and distress related to medical problems such as cancer and diabetes. The chapter describes contexts for practice, including primary care and home care, as well as adaptations for the use of PST with older adults. Finally, a case example of a problem-solving intervention with an unemployed depressed older man is presented to illustrate this approach.

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Problem-Solving Therapy

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In Problem-Solving Therapy , Drs. Arthur Nezu and Christine Maguth Nezu demonstrate their positive, goal-oriented approach to treatment. Problem-solving therapy is a cognitive–behavioral intervention geared to improve an individual's ability to cope with stressful life experiences. The underlying assumption of this approach is that symptoms of psychopathology can often be understood as the negative consequences of ineffective or maladaptive coping.

Problem-solving therapy aims to help individuals adopt a realistically optimistic view of coping, understand the role of emotions more effectively, and creatively develop an action plan geared to reduce psychological distress and enhance well-being. Interventions include psychoeducation, interactive problem-solving exercises, and motivational homework assignments.

In this session, Christine Maguth Nezu works with a woman in her 50s who is depressed and deeply concerned about her son's drug addiction. Dr. Nezu first assesses her strengths and weaknesses and then helps her to clarify the problem she is facing so she can begin to move toward a solution.

The overarching goal of problem-solving therapy (PST) is to enhance the individual's ability to cope with stressful life experiences and to foster general behavioral competence. The major assumption underlying this approach, which emanates from a cognitive–behavioral tradition, is that much of what is viewed as "psychopathology" can be understood as consequences of ineffective or maladaptive coping behaviors. In other words, failure to adequately resolve stressful problems in living can engender significant emotional and behavioral problems.

Such problems in living include major negative events (e.g., undergoing a divorce, dealing with the death of a spouse, getting fired from a job, experiencing a major medical illness), as well as recurrent daily problems (e.g., continued arguments with a coworker, limited financial resources, diminished social support). How people resolve or cope with such situations can, in part, determine the degree to which they will likely experience long-lasting psychopathology and behavioral problems (e.g., clinical depression, generalized anxiety, pain, anger, relationship difficulties).

For example, successfully dealing with stressful problems will likely lead to a reduction of immediate emotional distress and prevent long-term psychological problems from occurring. Alternatively, maladaptive or unsuccessful problem resolution, either due to the overwhelming nature of events (e.g., severe trauma) or as a function of ineffective coping attempts, will likely increase the probability that long-term negative affective states and behavioral difficulties will emerge.

Social Problem Solving and Psychopathology

According to this therapy approach, social problem solving (SPS) is considered a key set of coping abilities and skills. SPS is defined as the cognitive–behavioral process by which individuals attempt to identify or discover effective solutions for stressful problems in living. In doing so, they direct their problem-solving efforts at altering the stressful nature of a given situation, their reactions to such situations, or both. SPS refers more to the metaprocess of understanding, appraising, and adapting to stressful life events, rather than representing a single coping strategy or activity.

Problem-solving outcomes in the real world have been found to be determined by two general but partially independent processes—problem orientation and problem-solving style.

Problem orientation refers to the set of generalized thoughts and feelings a person has concerning problems in living, as well as his or her ability to successfully resolve them. It can either be positive (e.g., viewing problems as opportunities to benefit in some way, perceiving oneself as able to solve problems effectively), which serves to enhance subsequent problem-solving efforts, or negative (e.g.,viewing problems as a major threat to one's well-being, overreacting emotionally when problems occur), which functions to inhibit attempts to solve problems.

Problem-solving style refers to specific cognitive–behavioral activities aimed at coping with stressful problems. Such styles are either adaptive, leading to successful problem resolution, or dysfunctional, leading to ineffective coping, which then can generate myriad negative consequences, including emotional distress and behavioral problems. Rational problem solving is the constructive style geared to identify an effective solution to the problem and involves the systematic and planful application of specific problem-solving tasks. Dysfunctional problem-solving styles include (a) impulsivity/carelessness (i.e., impulsive, hurried, and incomplete attempts to solve a problem), and (b) avoidance (i.e.,avoiding problems, procrastinating, and depending on others to solve one's problems).

Important differences have been identified between individuals characterized as "effective" versus "ineffective" problem solvers. In general, when compared to effective problem solvers, persons characterized by ineffective problem solving report a greater number of life problems, more health and physical symptoms, more anxiety, more depression, and more psychological maladjustment. In addition, a negative problem orientation has been found to be associated with negative moods under both routine and stressful conditions, as well as pessimism, negative emotional experiences, and clinical depression. Further, persons with negative orientations tend to worry and complain more about their health.

Problem-Solving Therapy Goals

PST teaches individuals to apply adaptive coping skills to both prevent and cope with stressful life difficulties. Specific PST therapy objectives include

• enhancing a person's positive orientation
• fostering his or her application of specific rational problem-solving tasks (i.e., accurately identifying why a situation is a problem, generating solution alternatives, conducting a cost-benefit analysis in order to decide which ideas to choose to include as part of an overall solution plan, implementing the solution, monitoring its effects, and evaluating the outcome)
• reducing his or her negative orientation
• minimizing one's tendency to engage in dysfunctional problem-solving style activities (i.e., impulsively attempting to solve the problem or avoiding the problem)

PST interventions involve psychoeducation, interactive problem-solving training exercises, practice opportunities, and homework assignments intended to motivate patients to apply the problem-solving principles outside of the therapy sessions.

PST has been shown to be effective regarding a wide range of clinical populations, psychological problems, and the distress associated with chronic medical disorders. Scientific evaluations have focused on unipolar depression, geriatric depression, distressed primary-care patients, social phobia, agoraphobia, obesity, coronary heart disease, adult cancer patients, adults with schizophrenia, mentally retarded adults with concomitant psychiatric problems, HIV-risk behaviors, drug abuse, suicide, childhood aggression, and conduct disorder.

Moreover, PST is flexible with regard to treatment goals and methods of implementation. For example, it can be conducted in a group format, on an individual and couples basis, as part of a larger cognitive–behavioral treatment package, over the phone, as well as on the Internet. It can also be applied as a means of helping patients to overcome barriers associated with successful adherence to other medical or psychosocial treatment protocols (e.g., adhering to weight-loss programs, diabetes regulation).

Arthur M. Nezu, PhD, ABPP, is currently professor of psychology, medicine, and community health and prevention at Drexel University in Philadelphia. He is one of the codevelopers of a cognitive–behavioral approach to teaching social problem-solving skills and has conducted multiple RCTs testing its efficacy across a variety of populations. These populations include clinically depressed adults, depressed geriatric patients, adults with mental retardation and concomitant psychopathology, distressed cancer patients and their spousal caregivers, individuals in weight-loss programs, breast cancer patients, and adult sexual offenders.

Dr. Nezu has contributed to more than 175 professional and scientific publications, including the books Solving Life's Problems: A 5-Step Guide to Enhanced Well-Being , Helping Cancer Patients Cope: A Problem-Solving Approach , and Problem-Solving Therapy: A Positive Approach to Clinical Intervention . He also codeveloped the self-report measure Social Problem-Solving Inventory—Revised . Dr. Nezu is on numerous editorial boards of scientific and professional journals and a member of the Interventions Research Review Committee of the National Institute of Mental Health.

An award-winning psychologist, he was previously president of the Association for Advancement of Behavior Therapy, the Behavioral Psychology Specialty Council, the World Congress of Behavioral and Cognitive Therapies, and the American Board of Cognitive and Behavioral Psychology. He is a fellow of the American Psychological Association, the Association for Psychological Science, the Society for Behavior Medicine, the Academy of Cognitive Therapy, and the Academy of Cognitive and Behavioral Psychology. Dr. Nezu was awarded the diplomate in Cognitive and Behavioral Psychology from the American Board of Professional Psychology and currently serves as a trustee of that board.

He has been in private practice for over 25 years, and is currently conducting outcome studies to evaluate the efficacy of problem-solving therapy to treat depression among adults with heart disease.

Christine Maguth Nezu, PhD, ABPP, is currently professor of psychology, associate professor of medicine, and director of the masters programs in psychology at Drexel University in Philadelphia. She previously served as director of the APA-accredited Internship/Residency in Clinical Psychology, as well as the Cognitive–Behavioral Postdoctoral Fellowship Program, at the Medical College of Pennsylvania/Hahnemann University.

She is the coauthor or editor of more than 100 scholarly publications, including 15 books. Her publications cover a wide range of topics in mental health and behavioral medicine, many of which have been translated into a variety of foreign languages.

Dr. Maguth Nezu is currently the president-elect of the American Board of Professional Psychology, on the board of directors for the American Board of Cognitive and Behavioral Psychology, and on the board of directors for the American Academy of Cognitive and Behavioral Psychology. She is the recipient of numerous grant awards supporting her research and program development, particularly in the area of clinical interventions. She serves as an accreditation site visitor for APA for clinical training programs and is on the editorial boards of several leading psychology and health journals.

Dr. Maguth Nezu has conducted workshops on clinical interventions and case formulation both nationally and internationally. She is currently the North American representative to the World Congress of Cognitive and Behavioral Therapies. She holds a diplomate in Cognitive and Behavioral Psychology from the American Board of Professional Psychology and has been active in private practice for more than 20 years.

Her current areas of interest include the treatment of depression in medical patients, the integration of cognitive and behavioral therapies with patients' spiritual beliefs and practices, interventions directed toward stress, coping, and health, and cognitive behavior therapy and problem-solving therapy for individuals with personality disorders.

• D'Zurilla, T. J., & Nezu, A. M. (2007). Problem-solving therapy: A positive approach to clinical intervention (3rd ed.). New York: Springer Publishing Co.
• D'Zurilla, T. J., Nezu, A. M., & Maydeu-Olivares, A. (2002). Social Problem-Solving Inventory—Revised (SPSI-R): Technical manual . North Tonawanda, NY: Multi-Health Systems.
• Nezu, A. M. (2004). Problem solving and behavior therapy revisited. Behavior Therapy, 35 , 1–33.
• Nezu, A. M., & Nezu, C. M. (in press). Problem-solving therapy. In S. Richards & M. G. Perri (Eds.), Relapse prevention for depression . Washington, DC: American Psychological Association.
• Nezu, A. M., Nezu, C. M., & Clark, M. (in press). Problem solving as a risk factor for depression. In K. S. Dobson & D. Dozois (Eds.), Risk factors for depression . New York: Elsevier Science.
• Nezu, A. M., Nezu, C. M., & Perri, M. G. (2006). Problem solving to promote treatment adherence. In W. T. O'Donohue & E. Livens (Eds.), Promoting treatment adherence: A practical handbook for health care providers (pp. 135–148). New York: Sage Publications.
• Nezu, A. M., Nezu, C. M., & D'Zurilla, T. J. (2007). Solving life's problems: A 5-step guide to enhanced well-being . New York: Springer Publishing Co.
• Nezu, A. M., Nezu, C. M., Friedman, S. H., Faddis, S., & Houts, P. S. (1998). Helping cancer patients cope: A problem-solving approach . Washington, DC: American Psychological Association.
• Nezu, C. M., D'Zurilla, T. J., & Nezu, A. M. (2005). Problem-solving therapy: Theory, practice, and application to sex offenders. In M. McMurran & J. McGuire (Eds.), Social problem solving and offenders: Evidence, evaluation and evolution (pp. 103–123). Chichester, UK: Wiley.
• Nezu, C. M., Palmatier, A., & Nezu, A. M. (2004). Social problem-solving training for caregivers. In E. C. Chang, T. J. D'Zurilla, & L. J. Sanna (Eds.), Social problem solving: Theory, research, and training (pp. 223–238). Washington, DC: American Psychological Association.
• Cognitive–Behavioral Relapse Prevention for Addictions G. Alan Marlatt
• Cognitive–Behavioral Therapy With Donald Meichenbaum Donald Meichenbaum
• Depression With Older Adults Peter A. Lichtenberg
• Depression Michael D. Yapko
• Emotion-Focused Therapy for Depression Leslie S. Greenberg
• Relapse Prevention Over Time G. Alan Marlatt
• Behavioral Interventions in Cognitive Behavior Therapy: Practical Guidance for Putting Theory Into Action, Second Edition Richard F. Farmer and Alexander L. Chapman
• Experiences of Depression: Theoretical, Clinical, and Research Perspectives Sidney J. Blatt
• Preventing Youth Substance Abuse: Science-Based Programs for Children and Adolescents Edited by Patrick Tolan, José Szapocznik, and Soledad Sambrano

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What Is Cognitive Behavioral Therapy (CBT)?

Michela Buttignol for Verywell Mind / Stocksy

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Cognitive behavioral therapy (CBT) is a type of psychotherapeutic treatment that helps people learn how to identify and change the destructive or disturbing thought patterns that have a negative influence on their behavior and emotions.

Cognitive behavioral therapy combines cognitive therapy with behavior therapy by identifying maladaptive patterns of thinking, emotional responses, or behaviors and replacing them with more desirable patterns.

Cognitive behavioral therapy focuses on changing the automatic negative thoughts that can contribute to and worsen our emotional difficulties, depression , and anxiety . These spontaneous negative thoughts also have a detrimental influence on our mood.

Through CBT, faulty thoughts are identified, challenged, and replaced with more objective, realistic thoughts.

Everything You Need to Know About CBT

This video has been medically reviewed by Steven Gans, MD .

Types of Cognitive Behavioral Therapy

CBT encompasses a range of techniques and approaches that address our thoughts, emotions, and behaviors. These can range from structured psychotherapies to self-help practices. Some of the specific types of therapeutic approaches that involve cognitive behavioral therapy include:

• Cognitive therapy centers on identifying and changing inaccurate or distorted thought patterns, emotional responses, and behaviors.
• Dialectical behavior therapy (DBT)  addresses destructive or disturbing thoughts and behaviors while incorporating treatment strategies such as emotional regulation and mindfulness.
• Multimodal therapy suggests that psychological issues must be treated by addressing seven different but interconnected modalities: behavior, affect, sensation, imagery, cognition, interpersonal factors, and drug/biological considerations.
• Rational emotive behavior therapy (REBT) involves identifying irrational beliefs, actively challenging these beliefs, and finally learning to recognize and change these thought patterns.

While each type of cognitive behavioral therapy takes a different approach, all work to address the underlying thought patterns that contribute to psychological distress.

Cognitive Behavioral Therapy Techniques

CBT is about more than identifying thought patterns. It uses a wide range of strategies to help people overcome these patterns. Here are just a few examples of techniques used in cognitive behavioral therapy. 

Identifying Negative Thoughts

It is important to learn what thoughts, feelings, and situations are contributing to maladaptive behaviors. This process can be difficult, however, especially for people who struggle with introspection . But taking the time to identify these thoughts can also lead to self-discovery and provide insights that are essential to the treatment process.

Practicing New Skills

In cognitive behavioral therapy, people are often taught new skills that can be used in real-world situations. For example, someone with a substance use disorder might practice new coping skills and rehearse ways to avoid or deal with social situations that could potentially trigger a relapse.

Goal-Setting

Goal setting can be an important step in recovery from mental illness, helping you to make changes to improve your health and life. During cognitive behavioral therapy, a therapist can help you build and strengthen your goal-setting skills .

This might involve teaching you how to identify your goal or how to distinguish between short- and long-term goals. It may also include helping you set SMART goals (specific, measurable, attainable, relevant, and time-based), with a focus on the process as much as the end outcome.

Problem-Solving

Learning problem-solving skills during cognitive behavioral therapy can help you learn how to identify and solve problems that may arise from life stressors, both big and small. It can also help reduce the negative impact of psychological and physical illness.

Problem-solving in CBT often involves five steps:

• Identify the problem
• Generate a list of potential solutions
• Evaluate the strengths and weaknesses of each potential solution
• Choose a solution to implement
• Implement the solution

Self-Monitoring

Also known as diary work, self-monitoring is an important cognitive behavioral therapy technique. It involves tracking behaviors, symptoms, or experiences over time and sharing them with your therapist.

Self-monitoring can provide your therapist with the information they need to provide the best treatment. For example, for people with eating disorders, self-monitoring may involve keeping track of eating habits, as well as any thoughts or feelings that went along with consuming a meal or snack.

Additional cognitive behavioral therapy techniques may include journaling , role-playing , engaging in relaxation strategies , and using mental distractions .

What Cognitive Behavioral Therapy Can Help With

Cognitive behavioral therapy can be used as a short-term treatment to help individuals learn to focus on present thoughts and beliefs.

CBT is used to treat a wide range of conditions, including:

• Anger issues
• Bipolar disorder
• Eating disorders
• Panic attacks
• Personality disorders

In addition to mental health conditions, cognitive behavioral therapy has also been found to help people cope with:

• Chronic pain or serious illnesses
• Divorce or break-ups
• Grief or loss
• Low self-esteem
• Relationship problems
• Stress management

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Benefits of Cognitive Behavioral Therapy

The underlying concept behind CBT is that thoughts and feelings play a fundamental role in behavior. For example, a person who spends a lot of time thinking about plane crashes, runway accidents, and other air disasters may avoid air travel as a result.

The goal of cognitive behavioral therapy is to teach people that while they cannot control every aspect of the world around them, they can take control of how they interpret and deal with things in their environment.

CBT is known for providing the following key benefits:

• It helps you develop healthier thought patterns by becoming aware of the negative and often unrealistic thoughts that dampen your feelings and moods.
• It is an effective short-term treatment option as improvements can often be seen in five to 20 sessions.
• It is effective for a wide variety of maladaptive behaviors.
• It is often more affordable than some other types of therapy .
• It is effective whether therapy occurs online or face-to-face.
• It can be used for those who don't require psychotropic medication .

One of the greatest benefits of cognitive behavioral therapy is that it helps clients develop coping skills that can be useful both now and in the future.

Effectiveness of Cognitive Behavioral Therapy

CBT emerged during the 1960s and originated in the work of psychiatrist Aaron Beck , who noted that certain types of thinking contributed to emotional problems. Beck labeled these "automatic negative thoughts" and developed the process of cognitive therapy. 

Where earlier behavior therapies had focused almost exclusively on associations, reinforcements , and punishments to modify behavior, the cognitive approach addresses how thoughts and feelings affect behaviors.

Today, cognitive behavioral therapy is one of the most well-studied forms of treatment. It has been shown to be effective in the treatment of a range of mental conditions, including anxiety, depression, eating disorders, insomnia, obsessive-compulsive disorder , panic disorder, post-traumatic stress disorder , and substance use disorder.

• Research indicates that cognitive behavioral therapy is the leading evidence-based treatment for eating disorders .
• CBT has been proven helpful in those with insomnia, as well as those who have a medical condition that interferes with sleep, including those with pain or mood disorders such as depression.
• Cognitive behavioral therapy has been scientifically proven to be effective in treating symptoms of depression and anxiety in children and adolescents.
• A 2018 meta-analysis of 41 studies found that CBT helped improve symptoms in people with anxiety and anxiety-related disorders, including obsessive-compulsive disorder and post-traumatic stress disorder.
• Cognitive behavioral therapy has a high level of empirical support for the treatment of substance use disorders, helping people with these disorders improve self-control , avoid triggers, and develop coping mechanisms for daily stressors.

CBT is one of the most researched types of therapy, in part, because treatment is focused on very specific goals and results can be measured relatively easily.

Verywell Mind's Cost of Therapy Survey , which sought to learn more about how Americans deal with the financial burdens associated with therapy, found that Americans overwhelmingly feel the benefits of therapy:

• 80% say therapy is a good investment
• 91% are satisfied with the quality of therapy they receive
• 84% are satisfied with their progress toward mental health goals

Things to Consider With Cognitive Behavioral Therapy

There are several challenges that people may face when engaging in cognitive behavioral therapy. Here are a few to consider.

Change Can Be Difficult

Initially, some patients suggest that while they recognize that certain thoughts are not rational or healthy, simply becoming aware of these thoughts does not make it easy to alter them.

CBT Is Very Structured

Cognitive behavioral therapy doesn't focus on underlying, unconscious resistance to change as much as other approaches such as  psychoanalytic psychotherapy . Instead, it tends to be more structured, so it may not be suitable for people who may find structure difficult.

You Must Be Willing to Change

For cognitive behavioral therapy to be effective, you must be ready and willing to spend time and effort analyzing your thoughts and feelings. This self-analysis can be difficult, but it is a great way to learn more about how our internal states impact our outward behavior.

Progress Is Often Gradual

In most cases, CBT is a gradual process that helps you take incremental steps toward behavior change . For example, someone with social anxiety might start by simply imagining anxiety-provoking social situations. Next, they may practice conversations with friends, family, and acquaintances. By progressively working toward a larger goal, the process seems less daunting and the goals easier to achieve.

How to Get Started With Cognitive Behavioral Therapy

Cognitive behavioral therapy can be an effective treatment choice for a range of psychological issues. If you or someone you love might benefit from this form of therapy, consider the following steps:

• Consult with your physician and/or check out the directory of certified therapists offered by the National Association of Cognitive-Behavioral Therapists to locate a licensed professional in your area. You can also do a search for "cognitive behavioral therapy near me" to find local therapists who specialize in this type of therapy.
• Consider your personal preferences , including whether face-to-face or online therapy will work best for you.
• Contact your health insurance to see if it covers cognitive behavioral therapy and, if so, how many sessions are covered per year.
• Make an appointment with the therapist you've chosen, noting it on your calendar so you don't forget it or accidentally schedule something else during that time.
• Show up to your first session with an open mind and positive attitude. Be ready to begin to identify the thoughts and behaviors that may be holding you back, and commit to learning the strategies that can propel you forward instead.

What to Expect With Cognitive Behavioral Therapy

If you're new to cognitive behavioral therapy, you may have uncertainties or fears of what to expect. In many ways, the first session begins much like your first appointment with any new healthcare provider.

During the first session, you'll likely spend some time filling out paperwork such as HIPAA forms (privacy forms), insurance information, medical history, current medications, and a therapist-patient service agreement. If you're participating in online therapy, you'll likely fill out these forms online.

Also be prepared to answer questions about what brought you to therapy, your symptoms , and your history—including your childhood, education, career, relationships (family, romantic, friends), and current living situation.

Once the therapist has a better idea of who you are, the challenges you face, and your goals for cognitive behavioral therapy, they can help you increase your awareness of the thoughts and beliefs you have that are unhelpful or unrealistic. Next, strategies are implemented to help you develop healthier thoughts and behavior patterns.

During later sessions, you will discuss how your strategies are working and change the ones that aren't. Your therapist may also suggest cognitive behavioral therapy techniques you can do yourself between sessions, such as journaling to identify negative thoughts or practicing new skills to overcome your anxiety .

If you are having suicidal thoughts, contact the  National Suicide Prevention Lifeline  at  988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our  National Helpline Database .

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Trauer JM, Qian MY, Doyle JS, Rajaratnam SMW, Cunnington D. Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis .  Ann Intern Med . 2015;163(3):191. doi:10.7326/M14-2841

Agras WS, Fitzsimmons-craft EE, Wilfley DE.  Evolution of cognitive-behavioral therapy for eating disorders .  Behav Res Ther . 2017;88:26-36. doi:10.1016/j.brat.2016.09.004

Oud M, De winter L, Vermeulen-smit E, et al.  Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis . Eur Psychiatry . 2019;57:33-45. doi:10.1016/j.eurpsy.2018.12.008

Carpenter J, Andrews L, Witcraft S, Powers M, Smits J, Hofmann S. Cognitive behavioral therapy for anxiety and related disorders: A meta‐analysis of randomized placebo‐controlled trials .  Depress Anxiety . 2018;35(6):502–14. doi:10.1002/da.22728

National Institute on Drug Abuse (NIDA).  Cognitive-behavioral therapy (alcohol, marijuana, cocaine, methamphetamine, nicotine) .

Gaudiano BA. Cognitive-behavioural therapies: Achievements and challenges . Evid Based Ment Health . 2008;11(1):5-7. doi:10.1136/ebmh.11.1.5

Beck JS. Cognitive Behavior Therapy: Basics and Beyond .

Coull G, Morris PG. The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: A systematic review . Psycholog Med . 2011;41(11):2239-2252. doi:10.1017/S0033291711000900

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

• Seven Steps

Problem solving therapy (PST) is a brief psychological intervention, or "talking therapy". PST is usually provided over a series of between four and eight sessions. During these sessions the clinician and client collaborate to identify what problems are occurring in the client's life, and then focus on one or more of these while the therapist/clinician teaches the client a structured approach to solving these problems, as well as focusing on improving the client's general approach to problems.

Clinicians can choose to use PST as a complete format or structure for therapy sessions with their client, or may choose to add PST to other approaches that they use. The aim of our training programme is to provide clinicians working with clients at risk of self harm with new skills and knowledge that they can add to their current therapeutic "toolkit".

PST consists of a series of seven steps. For an overview of each of the steps please click on the links on the left.

Step 1 - Problem Orientation

Problem orientation can be understood as a client's attitude to solving problems, as distinct from the actual problem solving skills they possess. Problem orientation is made up of a client's thoughts and feelings about problems in general, and thoughts and feelings about their own ability to solve problems. Together these two elements determine how a client will respond when faced with a stressful problem. This makes it a really important part of problem solving therapy.

Positive problem orientation is linked with a rational, and effective, problem solving style. By contrast, negative problem orientation is linked with either an impulsive/careless problem solving style, or an avoidant problem solving style. An impulsive/careless style means clients are likely to make sudden decisions that are not well thought out and are not necessarily relevant to the actual problem. An avoidant style means clients are likely to ignore the problem in the hope that it might go away or in the hope that someone else might solve it.

Problem Orientation is referred to often throughout the therapy sessions. One of the primary aims of PST is to assist the client to develop a more positive orientation, and this is done by education, helping the client to recognise when their attitude toward problems is negative, teaching the client to challenge their more negative attitudes and encouraging them to increase their belief in their ability to solve problems through positive experiences.

Step 2 - Recognising And Identifying Problems

The aim of this step is to teach the client how to recognise when a problem exists so they can correctly identify it and begin to solve it. This may sound obvious but is not always straightforward to achieve. When someone is used to either avoiding problems or responding impulsively, their ability to first recognise a problem exists and then correctly identify what that problem is may be under developed.

There are three parts to this step:

• inviting a client to spontaneously report current problems
• learning how to track problem indicators
• using a checklist

The outcome is twofold. In therapy, it results in generating a list of problem areas with the client which will form the basis of your work together. More importantly, it provides the client with the skills necessary for the ongoing real life task of problem recognition and identification.

Step 3 - Selecting And Defining A Clear Problem

The third step in problem solving therapy is to assist the client to select one clear problem to work on and then define it. Defining a problem clearly is particularly important because the more clearly a problem is defined, the easier it is to find possible solutions. A woolly problem is likely to result in fuzzy solutions. Clear definition is achieved by gathering all the available facts and writing them clearly and objectively.

Selecting & defining a problem worksheet

Step 4 - Generating Solutions

After selecting and defining a problem to work on, the fourth step in problem solving therapy is to identify possible solutions, and brainstorming is how we accomplish this. Brainstorming is a method of generating as many possibilities and alternative solutions to the problem at hand without evaluating their potential usefulness. The reason for thinking of a lot of ideas is to increase the likelihood of coming up with an effective solution. It involves asking the client to come up with all the ideas they can think of that could contribute to solving the problem. The main criteria are that each idea should be relevant to the problem and have a chance of solving the problem or contributing to solving it.

Brain storming worksheet 1 Brain storming worksheet 2

Step 5 - Decision Making

Once the client has identified a number of potential solutions, the fifth step is decision making. In this step the client looks in more depth at the solutions generated during the brainstorm, and by weighing up the advantages and disadvantages of potential solutions makes a decision about which one to implement. The aim is to find a solution that will be effective.

Some clients find the decision making stage difficult, with potential solutions going round and round in their minds. It can certainly be difficult to know where to start when you have a large number of options before you. The clinician's role is to teach the client a systematic way to sort through the alternative solutions by using decision-making guidelines. This is achieved by first considering whether there are any solutions we can immediately discard (initial selection). Then similar solutions are grouped together to gain a sense of the range of options available (grouping solutions). Finally, the client chooses two or three solutions they would like to try out and evaluates them in more depth (weighing the advantages and disadvantages).

Decision making worksheet

Step 6 - SMART Action Plan

This step requires the client to create and then implement, or carry out, an action plan. The action plan should outline the step by step process the client will follow to transform their chosen solution/s into concrete action. Don't be afraid of asking the client to go into an exacting level of detail. It is important to break the plan down into small, achievable steps. This detail is especially important in the early stages of using problem solving therapy, or when the solution is complex or difficult. Be sure to include a time target for each step, and a review date, in any action plan.

Action plan worksheet

Step 7 - Reviewing Progress

The final step in problem solving therapy is to review the client's progress with carrying out their action plan. The purpose is to evaluate:

• if they are underway with their plan
• whether the plan is having the desired impact on resolving the problem
• whether any more needs to be done in relation to the problem
• any areas of the client's problem solving skills that need to be fine tuned

Summary form

• PST Training
• Case Studies
• Acknowledgments

“One thing is sure. We have to do something. We have to do the best we know how at the moment… If it doesn’t turn out right, we can modify it as we go along.” –  Franklin D.Roosevelt

P roblems in life can take on a variety of forms, but many of them share common characteristics that serve as cues, alerting us to the presence of a bonafide problem. The attitude that we choose to take toward the problem can serve as a powerful determinant of our ability to reduce distress and use emotional information in helpful ways. Many of the problems or chaos that we invite , create, or have thrust upon us become less intimidating and paralyzing when we take a proactive stance toward solving them. A mindfully open and alert stance can serve as a stable foundation as you begin the process of confronting the problem and moving toward a solution.

Part of the wisdom inherent in effective problem solving is discerning between solvable and unsolvable problems … and being willing to radically accept and let go of those problems which are truly out of your control. For all of the problems that you have the power to solve, remember that quite often a puzzling or painful problem is actually just a very difficult decision that is waiting to be made. It is possible that the looming “problem” in your life has taken on its imposing or frightening form due to a conscious or unconscious un willingness on your part to make a tough decision.

Brief Mindfulness Exercise:

Before you begin the following five steps of problem solving from your base of mindfulness, allow yourself a few moments to slow down and take a some slow deep breaths. Bring your full awareness to this  moment. Allow your thoughts, emotions, and sensations to naturally emerge; notice them just as they are, accept their presence, and release them with each breath that leaves your lungs. If confusing or unsettling thoughts enter into awareness, observe them with an open heart and nonjudgmental mind. Allow yourself to become disentangled from those thoughts as you notice that they are just thoughts … not “facts” or absolute truth.

Notice your emotions as they arise naturally from within. Perhaps you sense a deep-seated fear as you approach this problem. Observe this experience and direct compassion toward your fear, anxiety , or doubt. Embrace your suffering , rather than push it away. Notice what useful information is embedded within those painful disavowed experiences. Observe any physical sensations that emerge at this time, reconnecting with your body . Direct your full awareness in a nonjudgmental, accepting, and curious way toward those sensations. Perhaps there is a tightness in your throat or chest, shaking in your hands, a racing heart, or queasiness at your core.

Be kind toward yourself and notice the delicate way that your thoughts, emotions, and sensations are all coming together in a nuanced dance as you approach solving this problem. Allow wise mind to guide you, bringing together reason with emotion, as you begin to become open, reflective, and alert to the problem. When you are ready, direct your mindful awareness and focus  completely to the problem you are facing. Remember that part of being mindful involves directing your full presence toward one thing at a time , so give yourself the gift of slowing down as you go through this five step process of problem solving.

Mindful Problem Solving

R ead through the following five steps of problem solving and write down your authentic responses at each step along the way. Let go of the notion of “right” or “wrong” responses and trust yourself . As you go through these steps, make a commitment to yourself to follow through with your plan. When you take the time to move through solving a difficult problem with an open heart and awakened mind, you may begin to see that the right path out of the woods was there all along… just waiting for you to notice it and summon the courage to make the journey.

(1) State your problem

Problems cannot be solved and decisions cannot be made effectively before you have clearly and accurately identified the problem. If this step is easy for you, simply write down in simple and concise terms exactly what problem you are facing. If it seems challenging to identify the problem, try writing down some characteristics of the problem or common themes. For example, “health issues: illness, sleep, diet, mental health” or “relationship issues: conflict, loneliness, dissatisfaction.”

Once you have clearly identified and stated your current problem, take the time to engage in a bit of “ problem analysis ” to help you understand the various dimensions of the problem with greater clarity:

• What is the problem?
• Who is involved?
• What happens? What bothers you?
• Where does the problem occur?
• When does it occur?
• How does it happen? (Is there a pattern ?)
• Why do you think it happens?
• What else is important in this situation?
• How do you respond to the situation? (List your behaviors .)
• How does it make you feel?
• What outcome do you want to see?

(2) Outline your solutions

Once you have sufficiently identified the problem from various perspectives, you are ready to start identifying the best solutions available. Maintain a mindfully open attitude as you approach potential solutions from a place of creativity. Even if your “ideal” solution may not be realistic at this present moment, stay open to making the most out of the tools you do  have to work with at this point in time. Notice if any potential solutions come to you as you reflect on your responses to the last three questions from step one, regarding what you do , what you feel , and what you truly want .

Try coming up with and writing down three possible solutions based on those responses. For example, possible solutions may be worded in some of the following ways: “Figure out better ways to respond when I feel confused or frozen by the problem,” or  “Learn how to manage intense emotions more effectively when the problem occurs,” or  “Deliver painful news or express authentic feelings , no matter how scary it may feel.”

As you begin to set goals that will move you closer to your desired solution , remember to describe what you do want  to happen, as opposed to what you don’t want  to happen. For example, instead of “I don’t want to feel sad and confused,” rephrase that as, “I do want to feel happiness and a sense of clarity.” It is easier to move toward desired goals when they are stated in positive terms. If your goals feel general or vague (e.g., “I want to feel happier”), simply notice this for now – you will develop specific strategies intended to help you realize your goals in the next step.

Remember to state your intended goal from your own point of view, taking responsibility and ownership… this is what you  want to do. For example, instead of “I don’t want my friend to get angry with me so easily,” rephrase it as, “I want to learn how to develop a better relationship with my friend.” When goals are stated in these terms, you can become empowered by realizing the amount of control you have in reaching your goal, instead of depending on or wondering about the thoughts or behaviors of others.

(3) List your strategies

Maintain the creative mindful attitude that you took while generating possible solutions, as you allow your heart and mind to fully open to the process of recognizing strategies that will move you closer toward your goals. As you begin the process of coming up with ideas that may or may not help you reach your goal(s), remember: (1) don’t criticize/judge your ideas, (2) allow yourself to generate lots  of ideas/possibilities, (3) think creatively – allow yourself to be free of censorship, and (4) integrate and improve on ideas if needed – perhaps a few of your strategies have the potential to integrate into one amazing idea.

As you begin to create a brainstorm list of potential strategies, reflect back on your three possible solutions from the previous step. This exercise in brainstorming possible strategies involves the following steps:

• Write down the clearly stated/defined problem
• List your three possible solutions
• Underneath each solution, write at least 10 possible strategies

Part of engaging in this process of brainstorming from a centered place of mindfulness involves giving yourself permission to take your time, slow down your mind , and allow creative and productive strategies to emerge naturally into conscious awareness. Creative, effective, and mindful problem solving allows for strategies/ideas to be borne out of your authentic self … from your innermost sense of values , intuition, and alert wisdom.

(4) View the consequences of your strategies

At this step in the problem solving process, you have clearly stated the problem, come up with three possible solutions (think of them as solutions A, B, & C), and at least 10 possible strategies for each. Now that you are equipped with at least 30 problem-solving strategies, you are prepared to narrow down that list as you evaluate the potential (realistic) consequences of putting them into action.

• Look at the three lists of strategies you created for solutions A, B, and C. Notice which solution has generated the most strategies that appear to have the greatest chances of actually  succeeding.
• After you mindfully evaluate which of the three lists contains strategies that seem most effective (likely to bring about the desired outcome), choose the solution that you believe has the greatest chance of bringing success.
• Using the solution you chose (A, B, or C), begin to narrow down the strategies to three. These three strategies should be the best strategies for that particular solution; bear in mind you can always combine a few strategies into an even more powerful one. During the process of narrowing down your list, cross out any ideas that strike you as exceedingly unrealistic or not aligned with your true values or authentic self.
• In order to evaluate the consequences of each strategy, reflect on how each may positively and negative impact yourself, others, and your short-term/long-term goals.
• Write down each of your three narrowed down strategies in specific terms and list the positive and negative consequences in two columns underneath each strategy.
• If the best strategy does not become readily apparent to you at this point, try rating the positive and negative consequences for each of the three strategies on a scale of 1 to 4 (1 = not too important or significant, 4 = very important or significant).
• You can now go through all three strategies and add up those scores. The idea is that the most effective strategy is the one with the highest positive/lowest negative consequence score.
• If you feel at peace and content with the strategy that yielded the greatest positive consequences for yourself/others and your short-term/long-term goals, carry this knowledge and confidence with you to the final step of this problem-solving process.

(5) Evaluate your results

Now that you have selected the best strategy as a result of your deliberate, focused, and mindful process of problem solving, the time has come to put that strategy into action . It is time to take your carefully selected strategy and break it down into simple, specific, realistic steps that you will commit to enacting. Remember to insert different/specific words into the following example that allow you to connect this final step to the personal problem you are currently facing. A specific example of breaking down your chosen strategy into concrete steps can be found at step five of the following example.

General example of final outcome – “Five steps of effective and mindful problem solving” :

(1) Problem : “I’m at a major crossroads in my life and don’t know what to do.”

(2) Best solution – based on which of the three primary solutions generated the most effective list of strategies: “Figure out better ways to respond when I feel confused or frozen by the problem.”

(3) Best strategy – based on greatest/realistic chances of success and mindful weighing of potential consequences: “Practice mindfulness meditation , emotion regulation exercises , & interpersonal assertiveness .”

(4) Awareness of consequences  – accurate recognition of short-term/long-term consequences to yourself/others based on enacting the best strategy: “ Positive : feel more centered/relaxed/in touch with my authentic experience, increased ability to effectively identify/respond to emotions in myself and others, & increased confidence in ability to take a stand and speak my true feelings with healthy assertiveness ; Negative : fears of becoming lost within the process of meditation, temporary discomfort with allowing and responding to uncomfortable emotions authentically, & potential that expressing authentic thoughts/feelings may cause short-term/long-term hurt to others.”

(5)   Evaluate & break down strategy into manageable steps  – consider desired actions based on chosen strategy and commit to specific steps you will take toward putting that strategy into action: “Read about simple mindfulness exercise s and set aside 20 minutes each morning/evening to practice, write out specific emotion regulation coping skills onto flashcards and practice using them when feeling calm/centered as well as during times of emotional distress, & learn about interpersonal effectiveness and assertiveness skills – actively practice clearly stating thoughts, feelings, and needs on a daily basis.”

P roblem solving becomes significantly easier and less intimidating when you take a proactive approach toward solving the problem and become mindfully attuned with your authentic inner experience (focusing less on what others may think, want, or do as you determine what you  are feeling). Give yourself the opportunity go through this type of deliberate, thoughtful, and wise process of reaching healthy resolutions to your problems.

Remember that even when taking a mindful approach, problems aren’t always solved in the first, second, or even third attempts. This is because there are so many unknowns inherent within life’s mysteries and the only person’s behaviors you can ultimately control are your own. If your initial attempts at problem solving go awry, choose to reframe that perceived failure as a learning opportunity and a valuable chance to do things differently next time. The sooner you start taking active steps toward solving problems and recognize what works and what doesn’t work… the sooner you can shed the heavy robes of indecision and emotional paralysis and begin to live your most authentic life.

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Wood, J.C. (2010). The cognitive behavioral therapy workbook for personality disorders.  Oakland, CA: New Harbinger Publications, Inc.

Featured image: For What It’s Worth by Adam Swank / CC BY-SA 2.0

About Laura K. Schenck, Ph.D., LPC

I am a Licensed Professional Counselor (LPC) with a Ph.D. in Counseling Psychology from the University of Northern Colorado. Some of my academic interests include: Dialectical Behavior Therapy, mindfulness, stress reduction, work/life balance, mood disorders, identity development, supervision & training, and self-care.

Extremely helpful, Laura. Thank you so much.

I would so enjoy seeing more about problem-solving and decision-making.

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Today's Therapist

What Is Problem Solving Therapy and Who Can It Help

February 1, 2017 By TodaysTherapist

Stressful events are part of everyday life. For some, coping with the negative effects of these events can be difficult, whether stressors are considered large (such as the death of a loved one) or small (like making a mistake at work). Stressors can create or exacerbate psychological and physical health problems. Problem solving therapy can help individuals develop effective coping methods for dealing with stressors in their lives by providing structured goals and coaching adaptation skills for decision-making situations. While this article provides some facts on problem solving therapy, it is strongly advised that individuals considering problem solving therapy receive care from licensed professionals.

What Is Problem Solving Therapy?

Problem Solving Therapy (PST), or structured problem solving, is psychological treatment used to help clients manage stressful life events. Therapists employ behavioral and cognitive intervention techniques to assist clients in establishing and actualizing goals and creating effective problem-solving, stress management techniques. Clients are encouraged and guided in how to be more proactive in their daily lives and make decisions that help them achieve goals. Core components of PST are addressing problem orientation, explicitly defining problems the client faces, coming up with and evaluating solutions, and breaking problems down into achievable, reasonable, and ultimately less stressful steps.

Solving Problems Outcomes

PST involves finding ways for individuals to change the stressful nature of situations and how they respond to stressors. Generally, problem-solving outcomes are based upon problem-solving style and problem orientation . Problem orientation is the feelings and thoughts a person has about their problems and perceived ability to resolve them. A positive problem orientation generally leads the person to enhance problem-solving efforts while a negative problem orientation tends to lead to the person being inhibited in solving their problems. Problem-solving style is behavioral and cognitive activities targeted at coping with stressors. Those with ineffective styles tend to report having more stressors and negative life events.

Problem solving therapy is essentially a series of training sessions in learning how to utilize adaptive problem solving skills that help clients better deal with and/or resolve problems that arise in their daily lives. Clients learn how to make more effective decisions for themselves, come up with their own creative ways to solve problems, and identify barriers or obstacles that surface when trying to reach their goals and how best to negate these hurdles. The overall intended outcome is that a client will feel more confident in their decision-making and problem-solving techniques and will be able to carry on their solutions as independently as possible.

Medical Conditions and Problem Solving Therapy

PST can be used by General Practitioners (GPs) to help treat difficult medical conditions, such as chronic pain management. As with a therapist, GPs have clients identify problems they want solved, set up goals, have clients come up with solutions for how they would like to solve the problem, weigh pros and cons of each solution in order to select the best one, and implement the solution. Together, a GP and client can review how well the selected solution is working and make any necessary changes. Again, this article is to provide helpful information in learning about PST; it is, therefore, highly recommended that one seeks help from a licensed, well-reputed professional who can help implement and analyze PST goals.

Developing and Achieving Problem Solving Therapy Goals

Therapists and GPs tend to use PST with clients who seem to be having difficulties coping with stressful life situations that can become confusing and overwhelming. The goals of PST revolve around meeting four key therapy objectives:

• Improving the client’s positive orientation;
• Reducing the client’s negative orientation;
• Enhancing the client’s ability to identify what is causing a problem, coming up with a few potential solutions, conducting cost-benefit analysis to determine the best solution, implementing the solution, then analyzing the outcome;
• Reducing impulsive and ultimately ineffective methods for attempting to solve problems.

Since every client is a different person and has diverse needs, therapists and doctors try to allow as much creative and analytic processing by the client as possible, although PST relies on the four basic components mentioned in the list above.

Therapists and clients alike should be aware of several obstacles that can occur during the PST process, including the client experiencing cognitive overload, difficulties with emotional regulation, usage of ineffective or maladaptive problem solving styles, feelings of hopelessness leading to decreased motivation to follow through on goals, and difficulties removing oneself from negative moods or thought patterns.

Who Can Benefit from Problem Solving Therapy?

Problem solving therapy can be beneficial for many different people. Since there is flexibility in regard to treatment goals and methods for achieving them, PST can be used in a group setting or one-on-one with an individual client. Since negative stressors are scientifically linked to mental and physical health problems, problem solving therapy can be beneficial to almost anyone, so long as they are open to the idea of pursuing treatment and engaging in the process.

PST has been found to be an effective therapeutic method for clients who are dealing with a vast array of mental, physical and emotional conditions. These conditions include some personality disorders, major depressive disorder, suicidal ideation, generalized anxiety disorder, relationship issues, emotional duress, and medically-based issues that result in emotional and physical pain (such as fibromyalgia, Hashimoto’s and hypothyroidism, diabetes, and cancer).

Problem solving therapy is a widely-acknowledged tool used by therapists and general medical practitioners alike to help clients find proactive and reasonable ways to deal with the stressful events that occur in their lives. Overall, PST can help people find meaningful, creative, and adjustable ways of reaching their problem-resolution goals and ultimately lead to a better quality of living for those dealing with major physical and mental health concerns. Anyone considering PST should contact a trained medical or counseling professional to inquire about how this type of therapy could potentially suit their needs.

Image from depositphotos.com.

How to Solve a Problem in Seven Easy Steps

By Dovid Spinka , LMSW

Unwanted situations are an inevitable part of life. Fully embracing and radically accepting that fact is a firm basis to managing difficult emotions. Acceptance is especially important when there is nothing we can do, such as when the weather is too cold, hot, or rainy, or when roommates continue to be loud after repeated requests to keep the noise down.

But in many situations, we can solve or at least minimize the problems at hand. Here are seven steps to problem solving, taken from the principles and practices of Dialectical Behaviour Therapy (DBT) .

Step 1 – Describe the problem

Take the time to describe the situation you’re facing. Be specific and detailed, and include the consequences that you’re concerned about. For example, “I keep failing my exams despite the fact that I study a lot before taking them, which leaves me feeling anxious and fearful that I may not graduate.”

Step 2 – Check the facts ( all the facts)

Be mindful of extreme thinking and make sure that your description is correct. For example, did you really fail the exam? Or did you not get as high a grade as you had hoped for? How many exams have you failed? How much study and prep time did you actually put in beforehand? Is this a general exam issue or limited to a particular subject? Sometimes after checking the facts we realize that our description of the problem needs to be revised. If the facts are incorrect, go back to Step 1. If they’re correct, move on to Step 3.

Step 3 – Identify your primary goal

Take the time to clarify what needs to happen or change for you to feel ok. Keep it simple and be realistic – choose something that can actually happen. For example, “I want to improve the effectiveness of my studying, so I don’t fail any more exams”.

Step 4 – Brainstorm

Take the time to identify lots of solutions to achieve your goal. Think about as many solutions as possible, and don’t throw anything out because it seems strange or unrealistic. It is crucial not to judge brainstorming or evaluate ideas for feasibility at this stage. Have fun being a creative thinker. For example, could you… Study with your classmate Daniel who does well in exams? Ask to meet with your professor to get feedback and advice about the exams? Learn mindfulness and relaxation techniques to help improve your concentration during study time? Drop a few courses and take online classes for beginners, then try again next semester? Quit school and become a professional ballet dancer??

Step 5 – Choose a solution

Pick one of your brainstormed ideas that fits the goal and is most likely to work. Don’t aim for perfection – just pick the best answer. If necessary, do a pros and cons to decide between two or more good options.

Step 6 – Put the solution into Action

The entire enterprise of problem solving is aimed at this step: Putting effective solutions into action. However, people often get stuck with anxiety at this point. If thoughts such as “this is too hard” or “this isn’t going to work” arise in your mind, accept them and mindfully refocus on action. Stay focused and stay the course! For example if you selected studying with Daniel, call him up, explain the situation, and book a time to get together to study.

Step 7 – Evaluate the outcome

Take the time to think about how things went. Did your solution help you to achieve the goal? If the answer is yes, take even more time out to congratulate yourself and celebrate! And if not, don’t be disheartened – sometimes the best solutions come after several tries. Just go back to brainstorming (step 4) and try again until you succeed. Additionally, when solutions are carried out as planned, there are often secondary benefits that we can enjoy, so reap the benefit of those even if your planned outcome did not work out.

In sum, effective problem solving is a skill that needs to be learned, practiced, and honed over time. Therefore, we can be methodical, planned and deliberate about the process.

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This One Thing Can Make or Break Your Therapy

Here's the truth about therapy that most people don't know..

Updated September 4, 2024 | Reviewed by Davia Sills

• What Is Therapy?
• Take our Do I Need Therapy?
• Find a therapist near me
• Therapists' personal traits, such as interpersonal skills and emotional intelligence, affect therapy results.
• Many patients drop out of therapy or realize later that another therapist would have been a better choice.
• Most people prefer an engaged and responsive therapist who provides feedback. 
• Therapists who stick to one approach or are distant often limit their effectiveness and can seem artificial.

A therapist’s personality , mind, and psychology are all interwoven with their approach and the therapy relationship that ensues. Therefore, it is no surprise that these personal variables can help explain why some therapists get better results, rather than their credentials alone or the type of therapy they use, referred to as orientation or modality.

Approximately 20 percent of patients drop out of therapy (Leichsenring, Sarrar, & Steinert, 2019), and some people stay and realize later that another therapist would have been a better choice.

Common complaints include therapists being “just OK,” distant or passive, not providing enough feedback or guidance, and, ultimately, a lack of progress.

Sorting through the maze of therapists and therapies is complicated by the number of therapy approaches, the ambiguity in how therapists practice them, and the personal qualities of the therapist that are all part of the picture.

Some people choose a therapist randomly, based on practical considerations, but many seek a particular therapy modality that they have heard is effective or is popular in the public eye. Cognitive behavioral therapy (CBT), for example, is promoted by insurance companies and marketed as uniquely “evidence-based.” Interestingly, however, there is no evidence that one therapy modality is superior to another (Wampold & Imel, 2017).

Another problem with selecting a therapist based on therapy modality alone is that without an excerpt or direct experience, no one knows how a therapist comes across in sessions, let alone whether the label they use to describe their orientation has shared meaning and practical translation. In fact, there is a lack of consensus between the approaches therapists say they are using and how trained observers classify them (Hill & Knox).

Part of the confusion is that different therapy approaches overlap in practice. More importantly, therapy unfolds within the landscape of an interpersonal relationship. Although two therapists may use the same modality, the way they apply it and the approach to therapy are filtered through the lens, personality, and voice of the therapist.

Co-Mingling of Orientation and Personality

The type of therapy a patient receives matters in that it should be a good fit for their personality and preferences and, of course, lend itself to treating their issues.

Effective therapists are experienced in a variety of approaches and flexible in how they practice. Their knowledge and expertise inform their perspective but do not override their ability to be uniquely responsive to the person in front of them. They are able to be present in the here and now, adapting their approach to best address a particular patient’s needs, preferences, symptoms, and personality—as well as the climate of a particular interaction (Castonguay & Hill, 2017).

Still, some therapists stick to just one approach. However, the rote application of a protocol or framework can be problematic because it limits what therapists notice and can lead to interventions that patients experience as artificial, forced, or not relatable. Further, an approach that works with one patient, or at a particular point in time, may not be suited to another.

Interestingly, a therapist’s training, intellect, cognitive style, defenses, and personality not only play a role in how they conduct therapy generally but may also influence the modality they are drawn to and find personally compatible, particularly if they adhere to one approach (Ogunfowora et al., 2008; Topolinski et al., 2007).

For example, certain orientations lend themselves to a more formulaic and structured and less interpersonally dynamic climate, potentially attracting some therapists who are more linear versus creative thinkers. Other orientations may be conducive to a passive style, potentially attracting some therapists who are comfortable being more distant interpersonally.

Passive or Distant Therapists

Staying emotionally distant in therapy interactions may not be an issue when it comes to certain more one-dimensional, circumscribed problems (for example, some phobias) or for certain types of patients. But even then, it’s hard for a therapist to be inspiring from an aloof position.

In general, people find emotionally distant therapists, passive therapists, or those using manualized approaches to be unhelpful (Delboy & Michaels, 2021). No one wants to feel like they are being treated as a generic “patient,” specimen, or diagnosis rather than cared about as a person in their full humanity. It’s reasonable to expect active participation, warmth, and help from your therapist.

Therapy isn’t just talking about your problems and having a sounding board. Most people prefer an engaged and responsive therapist who provides feedback (Delboy & Michaels, 2021). Effective therapists use a multidimensional approach in which the therapeutic relationship itself is healing but also functions as a secure base for learning and moving forward in their lives. Helpful therapists genuinely connect with their patients and get involved. They roll up their sleeves to be fully with each person and co-create positive solutions.

Why Do Personal Qualities Matter?

A therapist’s character, capacities, and style directly and indirectly affect the quality of the therapy relationship, which is the foundation of treatment, the medium through which the therapy is delivered, and a direct agent of change. Further, the interpersonal dynamics that develop and how they are managed shape the therapeutic relationship and either facilitate, disrupt, or impede the therapeutic process.

Qualities of Effective Therapists

Successful outcomes in therapy are associated with the therapist’s warmth, attunement, ability to manage their own emotions, interpersonal skills, emotional intelligence , self-awareness, and the capacity to notice and interpret their own and others’ internal experience, referred to as “mentalizing” or reflection (Abargil & Tishby, 2021; Allen et al., 2008; Castonguay & Hill, 2017; Nyklíček et al., 2015; Norcross & Lambert, 2019).

Mentalizing involves knowing how to interpret both heart and mind and understanding the complex interplay of thoughts, feelings, intentions, and behavior (Allen et al., 2008). Since therapy is about healing the heart and mind, it makes sense that therapists be skilled at tuning in to and understanding their patient’s inner and interpersonal worlds, as well as their own.

This capacity allows therapists to create stronger therapeutic alliances by facilitating a deeper empathic connection and a better grasp of the underlying issues contributing to the patient’s problem. In addition, therapists who can reflect and mentalize are more likely to have other qualities associated with successful outcomes, such as the ability to regulate their emotions, accurately perceive, interpret, and adapt to cues from the patient, as well as hold the patient’s perspective in mind alongside their own (Cologon et al., 2017)

Further, when therapists have this ability, their patients are more likely to develop it and heal their problematic attachment styles. This is an important advantage since mentalizing is not only associated with developing healthier attachment styles, but when parents have this skill, they are able to protect their children from the negative effects of their own problematic attachment styles (Cologon et al., 2017; Allen et al.,2008). In general, being able to interpret oneself and others accurately helps people get along better in relationships, manage conflict, have perspective, and solve problems.

How to Tell if It’s a Good Match

First, a therapist must have training, experience, and success in treating your primary issues.

Second, since it takes two to make a relationship, a good match also involves “chemistry.” Chemistry involves subtleties such as intuitive “feel” and gut impression. Does this person strike you as someone you like? Would you want to talk to and confide in them?

Listening to a therapist’s outgoing voicemail message—the melody of their voice, tone, and use of language—can provide a quick initial sense of whether a therapist feels warm and relatable to you. This can be an efficient means to screen out therapists who are not the right fit.

The bottom line is that patients have very different experiences and outcomes with different therapists. Therefore, if you’re new to therapy or have not had a productive experience, consult with more than one therapist and have a conversation.

Abargil, M., & Tishby, O. (2021). How therapists' emotion recognition relates to therapy process and outcome. Clinical Psychology & Psychotherapy , 29(3), 1001-1019. https://doi.org/10.1002/cpp.2680

Allen, J. G., Fonagy, P., & Bateman, A. W. (2008). Mentalizing in clinical practice . American Psychiatric Publishing, Inc..

Castonguay, L. G., & Hill, C. E. (Eds.). (2017). How and why are some therapists better than others?: Understanding therapist effects. American Psychological Association. https://doi.org/10.1037/0000034-000

Cologon, J., Schweitzer, R. D., King, R., & Nolte, T. (2017). Therapist reflective functioning, therapist attachment style, and therapist effectiveness . Administration and Policy in Mental Health and Mental Health Services Research, 44(5), 614-625. https://doi.org/10.1007/s10488-017-0790-5

Delboy, S., & Michaels, L. (2021). Going Beneath the Surface: What People Want from Therapy. Psychoanalytic Inquiry, 41(8), 603–623. https://doi.org/10.1080/07351690.2021.1992232

Hill, C. E., & Knox, S. (2019). Therapist technique and orientation: Are they distinguishable in practice? Journal of Counseling Psychology, 66 (2), 217-228. https://doi.org/10.1037/cou0000321

Leichsenring, F., Sarrar, L., & Steinert, C. (2019). Drop-outs in psychotherapy: A change of perspective. World Psychiatry, 18(1), 32-33. https://doi.org/10.1002/wps.20588

Norcross, J. C., & Lambert, M. J. (2019). Evidence-Based Psychotherapy Relationship: The Third Task Force. Psychotherapy Relationships That Work , 1–23. https://doi.org/10.1093/med-psych/9780190843953.003.0001

Nyklíček, I., Schalken, P., & Meertens, S. (2015). The role of emotional intelligence in symptom reduction after psychotherapy in a heterogeneous psychiatric sample . Comprehensive Psychiatry , 57, 65-72. https://doi.org/10.1016/j.comppsych.2014.11.022

Ogunfowora, B., & Drapeau, M. (2008) . A study of the relationship between personality traits and theoretical orientation preferences. Counseling and Psychotherapy Research , 8, 151-159. https://doi.org/10.1080/14733140802193218

Topolinski, S., & Hertel, G. (2007). The role of personality in psychotherapists’ careers: Relationships between personality traits, therapeutic schools, and job satisfaction. Psychotherapy Research, 17, 365 - 375. https://doi.org/10.1080/10503300600830736 .

Wampold, B. E., & Imel, Z. E. (2017). The efficacy of different psychotherapeutic approaches: A meta-analysis of comparative outcome studies. Clinical Psychology Review, 52, 1-11. https://doi.org/10.1016/j.cpr.2017.11.001

Lynn Margolies, Ph.D., is a clinical psychologist and former Harvard Medical School faculty and fellow. She has helped many different types of people and families overcome obstacles and improve their lives.

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