Pages 39-42 from the Management of Mental Disorders, published by World Health Organization, Sydney. Editions in Australia, Canada, China, Italy, New Zealand and the United Kingdom.

There are rarely perfect or ideal solutions to problems, however, the structured problem solving approach aims to identify the most effective plan of action available at the time. The problem solving process includes

• Defining problems or goals in an everyday manner.
• Encouraging people to seek a wide range of ideas.
• Defining solutions in terms of current strengths.
• Careful consideration of the practical constraints that are involved in successfully applying a solution.

One of the main aims of teaching structured problem solving to individuals or families is to assist people to incorporate the principles of efficient problem solving and goal achievement into their everyday lives. The aim is NOT for the clinician to solve everyone's problems for them but to give people skills so that they can effectively overcome problems and achieve goals for themselves. Self-management is a key goal, with the clinician adopting the role of a teacher or guide.

When the structured problem solving method is first taught, try to avoid problems which are very difficult, emotional or long-standing. If individuals become too heated, or get too anxious, it will be difficult to follow the rules of each step if the rules are not well practised. Instead, deal with easier issues until the individual is very used to the method. Regular practice is important until the steps are well learned.

It is useful to encourage individuals to write down all problem solving exercises using the structured problem solving sheet provided in Section 1.3.5. Writing things down will often put problems and solutions into better perspective and ensure that a record of the decisions is always available.

Encourage individuals to use the structured problem solving method for each problem encountered or each major goal that they set. Because this structured approach is best suited for problems that are difficult, serious, or overwhelming, structured problem solving is best used at times specifically set aside for this purpose. For instance, problem solving should not be attempted while watching television or cooking the dinner. There should be no competing jobs or distractions.

The Six Step Method Of Structured Problem Solving

Step 1: Identifying problems
Gaining a clear definition of the problem or goal is a vital step in problem solving. Defining problems or goals helps to focus thinking on the issue at hand and minimises the possibility of getting side-tracked onto other issues. Also defining problems and goals makes it easier to know when the goal has been achieved or the problem solved.

At this stage of problem solving there are some `rules' that will help to suitably define goals or problems. Encourage individuals to:

• Only consider one problem at a time. If other problems arise in the course of the session they should be set aside for a problem solving session in the future.
• Avoid getting side-tracked into attempting to solve the problem at this stage.
• Apply the principles of goal planning (see Section 1.1.8).

Step 2: Generating solutions through brainstorming
Brainstorming is a method by which individuals come up with as many alternative solutions as possible. Rather than try to think of the best or ideal solution, the individual can list any ideas that come to mind, including those which may not be useful or may even be absurd. Encourage individuals to use their imagination! Even though a solution may at first seem ridiculous, the idea may help to generate better solutions than those that are more obvious. At this stage of problem solving there is no discussion of the solutions, they are just listed.

Step 3: Evaluating the solutions
This step involves a brief discussion of the advantages and disadvantages of each solution. There is no need for the individual to write these points down but just quickly run through the list of solutions, noting the strengths and weaknesses of each. No solution will be ideal since every good idea will have some faults, such as requiring time or money, or skills that individuals do not currently possess. However, most bad ideas will also have some advantages as well. For example, they may be easy to apply but may not really solve the problem in the long run.

Step 4: Choosing the optimal solution
In this step the aim is to choose the solution or combination of solutions which will solve the problem or achieve the goal. It is often helpful for the individual to choose a solution that can be readily applied and which is not too difficult to implement, even though this solution may not be the ideal solution. At least individuals can get started right away. Although the problem may not be solved immediately, the `solution' might have made a difference, and what is learned from this attempt might be useful the second time around. This approach is preferable to choosing a solution which is doomed to failure because someone has been overly ambitious.

Step 5: Planning
A detailed plan of action will increase the likelihood that the problem will be solved. Even if the agreed solution is excellent, the solution will not be of any use if it is not put into practice. The most common reason for failure is a lack of planning. Be sure that individuals spend some time on this planning stage. Cues, reminders or rewards may need to be incorporated into the plan

The following checklist (adapted from a checklist developed by Ian Falloon) applies to any problem and will be helpful in pinpointing any pitfalls or obstacles in the solution plan.

• Does the individual have the necessary resources (e.g., time, skills, equipment, money) or are you able to arrange the necessary resources, or personal or expert help? Expert help may include other members of your team (social work, occupational therapy, psychiatric or clinical psychology consultation).
• Does the individual have the agreement or co-operation of other people who might be involved in the plan?
• Does everyone involved in the problem solving exercise know exactly what they need to do and when they need to do it? Setting specified times or deadlines will minimise the risk of procrastination.
• Have all the steps been examined for possible difficulties?
• Has the individual planned any strategies for coping with likely difficulties?
• Has the individual planned any strategies for coping with any consequences that may arise? For example, if the individual applies for a job, what happens if he or she does not succeed? Or if they get the new job and have not considered what the demands of that job may entail.
• Have difficult parts of the plan been rehearsed? (e.g., a telephone call, conversation, or interview).
• How will the steps of the plan be monitored? If the plan involves a number of people it will be useful to nominate a co-ordinator to monitor progress and to prompt and remind people when they need to do the things they agreed upon. Include this monitoring as part of the plan so that everyone agrees and is prepared to be reminded.
• Has a time and place been set for a review of the overall progress of the plan?
  

When things do not go as planned:

• What went right?
• What went wrong?
• What alternative strategies could be used?
• Encourage the individual to acknowledge feelings of disappointment, but do not allow disappointment to turn into a catastrophe.
• Difficulties are usually due to a poorly planned strategy rather than personal inadequacy. Everyone does the best they can do.
• Label any attempt as partial success rather than failure.
• Consider partial success as practice and a useful learning experience.
• Encourage the individual to try again as soon as possible.

1. Goal: To feel secure at night.
2. Solutions
   1. Get my mother to stay
   2. Get others to keep me company in the evenings
   3. Get my husband to take a lower paying day job
   4. Make the house more secure
3. Assessment by patient
   `a' is OK but I'll lose my independence; `b' is not really practical unless I started some club and that's impossible; `c' is impossible, we need his money for the mortgage; `d' seems trivial but it might work.
4. Choose: Option `d'. It's simplest.
5. Plan
   1. I'll talk to someone at the hardware store and maybe they'll show me how to install locks.
   2. I'll save the money needed to buy the locks.
   3. I'll do it myself, but I've never done this sort of thing before.
6. Review

I do feel better at night; pleased to have done something constructive. I'm still lonely. Maybe I could implement solution `b' too, I saw a note in the supermarket that two women want to learn quilting. I could teach this. Now that I feel better, I can ask Mum to stay one night a week - we'll both enjoy that. Note: even part solutions are useful.

Edited by Gavin Andrews MD, UNSW, 2007
©2007 CRUfAD