During
the last track, we discussed how to use problem orientation to let clients know
that having a rational, realistic, and positive attitude towards problems was
both healthy and normal. In this track we will discuss the next step in the problem-solving
process with depressed clients.
5
CBT Components of Problem Solving (Continued)
Component #4 - Problem
Definition and Formulation Tasks
Sometimes I feel like an investigative
reporter who is aware of the necessary components for a well-covered story. I
need to have a list of information regarding my client's problem situation. Essential
features include answering the "Five W's and an H" questions which are
"Who," "What," "When," "Where," "Why,"
and "How."
Providing this information enables my dysthymic child or
adult to objectively view the various contexts and viewpoints in the situation
they are defining as a problem. More importantly, Problem Definition and Formulation
Tasks help my client to understand what has actually happened. As you know, conclusions
that are based only on partial information may be extremely misleading to the
client.
To assist Wendy in this process of problem definition and formulation to tasks,
I suggested, "Take the role of an extremely ethical reporter who gathers
all the facts and uses only the most reliable sources. Additionally, particularly
where personal evaluations and interpersonal relationships are concerned, a reporter
nearly always seeks validation among sources of information."
Six CBT Steps to Define and Formulate the Problem
a. Seek all available facts and information concerning when she overeats.
b. Try to locate the source of her overeating.
c. Describe the facts in clear and unambiguous terms.
d. Identify the
factors that actually make the situation a problem.
e. Differentiate relevant from irrelevant information and objective facts from unverified inferences,
assumption, and interpretations.
f. Set realistic problem-solving
goals.
As
Elsa stated, "But when I saw you write down aging, I didn't even want to
think about it - yet I do think about it all the time. I guess I really believe
that even with the antidepressant medication, I still think about things very
negatively."
On
a side note regarding Elsa and Wendy concerning medication, as you know according
to the Journal of the American Medical Association, antidepressants often work
as well as placebos. Also as you are aware, according to the National Institute
of Health, antidepressants do not work for a large percentage of the depressed
population.
Take a second to reflect on your experience with your Elsa and your
Wendy regarding antidepressants. What has been you experience? Do you feel antidepressants
work well for most of you clients? What do you define as an antidepressant working
or not working? Under what circumstances do you suggested the use of antidepressants
to a client?
If
you recall Elsa, age 67, initially she had not yet begun to admit to herself her
aging was a problem for her. Although she later admitted she had a problem with
aging, Elsa was not initially ready to be self-honest enough to share her feelings
and thoughts in a treatment session. As you saw, Elsa's problem with aging carried
itself to other parts of her life. This problem-definition step helped both Elsa
and Wendy realize that they needed to face the problem and set goals to solve
it.
Peer-Reviewed Journal Article References:
Brinegar, M. G., Salvi, L. M., Stiles, W. B., & Greenberg, L. S. (2006). Building a meaning bridge: Therapeutic progress from problem formulation to understanding. Journal of Counseling Psychology, 53(2), 165–180.
Cummings, J. A., Ballantyne, E. C., & Scallion, L. M. (2015). Essential processes for cognitive behavioral clinical supervision: Agenda setting, problem-solving, and formative feedback. Psychotherapy, 52(2), 158–163.
Geschwind, N., Bosgraaf, E., Bannink, F., & Peeters, F. (2020). Positivity pays off: Clients’ perspectives on positive compared with traditional cognitive behavioral therapy for depression. Psychotherapy, 57(3), 366–378.
Klein, D. N., Leon, A. C., Li, C., D'Zurilla, T. J., Black, S. R., Vivian, D., Dowling, F., Arnow, B. A., Manber, R., Markowitz, J. C., & Kocsis, J. H. (2011). Social problem solving and depressive symptoms over time: A randomized clinical trial of cognitive-behavioral analysis system of psychotherapy, brief supportive psychotherapy, and pharmacotherapy. Journal of Consulting and Clinical Psychology, 79(3), 342–352.
Online Continuing Education QUESTION 14
What are the
"Five W's and an H" questions? To select and enter your answer go to .
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