family problem solving therapy

• Sign up and Get Listed

Outside of US & canada

Be found at the exact moment they are searching. Sign up and Get Listed

• For Professionals
• Worksheets/Resources

Find a Therapist

• Find a Treatment Center
• Find a Marriage Counselor
• Find a Child Counselor
• Find a Support Group
• Find a Psychologist
• If You Are in Crisis
• Self-Esteem
• Sex Addiction
• Relationships
• Child and Adolescent Issues
• Eating Disorders
• How to Find the Right Therapist
• Explore Therapy
• Issues Treated
• Modes of Therapy
• Types of Therapy
• Famous Psychologists
• Psychotropic Medication
• What Is Therapy?
• How to Help a Loved One
• How Much Does Therapy Cost?
• How to Become a Therapist
• Signs of Healthy Therapy
• Warning Signs in Therapy
• The GoodTherapy Blog
• PsychPedia A-Z
• Dear GoodTherapy
• Share Your Story
• Therapy News
• Marketing Your Therapy Website
• Private Practice Checklist
• Private Practice Business Plan
• Practice Management Software for Therapists
• Rules and Ethics of Online Therapy for Therapists
• CE Courses for Therapists
• HIPAA Basics for Therapists
• How to Send Appointment Reminders that Work
• More Professional Resources
• List Your Practice
• List a Treatment Center
• Earn CE Credit Hours
• Student Membership
• Online Continuing Education
• Marketing Webinars
• GoodTherapy’s Vision
• Partner or Advertise

• Learn About Therapy >
• Issues Treated in Therapy >

Family Problems

Common Concerns and Symptoms

Psychotherapy for family problems, case examples.

Ideally, our families are those whom we can always rely on for support, from whom we draw strength and feedback, for whom we feel love and concern, and with whom we feel close and comfortable, openly sharing thoughts and feelings. In reality, few families meet this expectation 100% of the time, and in some cases, a person’s family is far from ideal, associated instead with stress , misunderstanding, anger , disconnection, and unmet needs. From our family of origin, we develop our expectations of others, communication skills, outlook on life, ability to give and receive love, and coping skills, among myriad other traits, and chronic family problems can have lasting effects.

Family problems from mild to severe will challenge every family at some point. These can result from behavioral and mental health issues in the family or from specific stressful events. Common family problems include:

• Substance abuse
• Behavioral issues and academic concerns in children and adolescents
• Mental health concerns
• Separation, divorce , or blended family adjustments
• Chronic illness

Whatever the source, distressing family dynamics can greatly interfere with the functioning of every family member, including extended family, although those living in the same household are likely to be impacted more significantly than those who live apart. When family members do not get along, the tension can impact each family member’s mental and physical health, relationships, and even his or her capacity for routine tasks. Evidence of family problems can materialize through repeated family conflicts, dramatic behavioral shifts in children and adolescents , mood swings and depression .

Fortunately, resolving family issues require the cooperation of everyone in the family, and this provides a great opportunity to strengthen family ties and interactions.

Family therapy is designed to help families collaborate to address family problems. The course of treatment is often brief, and most family therapy models seek to address the communication (verbal and nonverbal) styles of the family, as well as any individual issues that may be interfering with the cohesiveness of the family system. Family problems do not have to be severe to warrant therapy. Working with a therapist , families can expect to learn to understand one another better, communicate more effectively, and work proactively to disrupt unhealthy patterns.

Ideally, family problems are addressed as they surface, but many times family problems are not handled in a timely fashion and sometimes not at all; instead, issues surrounding an event or family pattern may surface for family members later in life. Family-of-origin concerns are frequently addressed as part of individual therapy, whether the person enters therapy expressly for that purpose or for other concerns.

• Troubled teen: The Jay family brings their daughter, Amelia, 13, in for therapy due to her “anger problem.” In session with her parents, as the parents discuss Amelia’s poor behavior, Amelia is by turns withdrawn and sullen, then suddenly talkative, sarcastic, and silly. Alone with the therapist in the second session, she is quiet and sad, but more direct and focused. The therapist begins family sessions again, this time asking that Amelia’s younger brother attend as well and concentrating on communication patterns between the members of the family. Although the parents insist Amelia is the reason for their visit, with their young son in session Amelia is sweet and attends to him while the parent seem to have little to say to one another and barely make eye contact. The therapist is able to point this out to them privately, and soon begins couples therapy with them, seeing Amelia separately and not discussing her anger with her unless she brings it up, which she doesn’t. After two or three months, the family is getting along much better, and the parents have identified several areas of their marriage to work on in therapy.
• Adult sibling conflict: John, 47, seeks help to deal with his conflict with his adult siblings and parents. They seem to fight constantly whenever they are together, and his parents call him daily to “criticize” and “put me down.” The therapist takes a history and finds John’s family has always functioned somewhat like this, and informs John that there isn’t anything the therapist can do to change John’s family, but that she is willing to help John learn how better to deal with his family and the emotions John feels. John agrees to this, and the therapist works with him on communicating, self-care skills (such as eating right, relaxation meditation, and positive internal messages), and boundary-setting.

More Like This

• LGBT Coming-Out Considerations: How Siblings Factor In
• When Family Relationships Become Toxic: The Trauma of Enmeshment
• I Don’t Want to See My Family Anymore
• How Do I Trust a Therapist If I Can't Trust Anyone?
• Do I Have to Forgive My Dad for Leaving?
• How Do I Cope with Being the Least Favorite Child?

People Are Reading

• Dialectical Dilemmas and How ACT Models Can Help Guide Treatment
• How Emotionally Intelligent People Use Negative Emotions to Their Advantage
• Political Differences May Shorten Thanksgiving Visits
• Is ‘13 Reasons Why’ Part of the Problem or Part of the Solution?
• Time-Management Hacks to Be More Efficient and Procrastinate Less

Join GoodTherapy!

Mental health professionals who meet our membership requirements can take advantage of benefits such as:

• Client referrals
• Continuing education credits
• Publication and media opportunities
• Marketing resources and webinars
• Special discounts

Notice to users

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Indian J Psychiatry
• v.62(Suppl 2); 2020 Jan

Family Interventions: Basic Principles and Techniques

Mathew varghese.

Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India

Vivek Kirpekar

1 N.K.P. Salve Institute of Medical Sciences, Nagpur, Maharashtra, India

Santosh Loganathan

Introduction.

Mental health professionals in India have always involved families in therapy. However, formal involvement of families occurred about one to two decades after this therapeutic modality was started in the West by Ackerman.[ 1 ] In India, families form an important part of the social fabric and support system, and as a result, they are integral in being part of the treatment and therapeutic process involving an individual with mental illness. Mental illnesses afflict individuals and their families too. When an individual is affected, the stigma of being mentally ill is not restricted to the individual alone, but to family members/caregivers also. This type of stigma is known as “Courtesy Stigma” (Goffman). Families are generally unaware and lack information about mental illnesses and how to deal with them and in turn, may end up maintaining or perpetuating the illness too. Vidyasagar is credited to be the father of Family Therapy in India though he wrote sparingly of his work involving families at the Amritsar Mental Hospital.[ 2 ] This chapter provides salient features of broad principles for providing family interventions for the treating psychiatrist.

TYPES AND GRADES FOR FAMILY INTERVENTIONS

Working with families involves education, counseling, and coping skills with families of different psychiatric disorders. Various interventions exist for different disorders such as depression, psychoses, child, and adolescent related problems and alcohol use disorders. Such families require psychoeducation about the illness in question, and in addition, will require information about how to deal with the index person with the psychiatric illness. Psychoeducation involves giving basic information about the illness, its course, causes, treatment, and prognosis. These basic informative sessions can last from two to six sessions depending on the time available with clients and their families. Simple interventions may include dealing with parent-adolescent conflict at home, where brief counseling to both parties about the expectations of each other and facilitating direct and open communication is required.

Additional family interventions may cover specific aspects such as future plans, job prospects, medication supervision, marriage and pregnancy (in women), behavioral management, improving communication, and so on. These family interventions offering specific information may also last anywhere between 2 and 6 sessions depending on the client's time. For example, explaining the family about the marriage prospects of an individual with a psychiatric illness can be considered a part of psychoeducation too, but specific information about marriage and related concerns require separate handling. At any given time, families may require specific focus and feedback about issues such issues.

Family therapy is a structured form of psychotherapy that seeks to reduce distress and conflict by improving the systems of interactions between family members. It is an ideal counseling method for helping family members adjust to an immediate family member struggling with an addiction, medical issue, or mental health diagnosis. Specifically, family therapists are relational therapists: They are generally more interested in what goes on between the individuals rather than within one or more individuals. Depending on the conflicts at issue and the progress of therapy to date, a therapist may focus on analyzing specific previous instances of conflict, as by reviewing a past incident and suggesting alternative ways family members might have responded to one another during it, or instead proceed directly to addressing the sources of conflict at a more abstract level, as by pointing out patterns of interaction that the family might not have noticed.

Family therapists tend to be more interested in the maintenance and/or solving of problems rather than in trying to identify a single cause. Some families may perceive cause-effect analyses as attempts to allocate blame to one or more individuals, with the effect that for many families, a focus on causation is of little or no clinical utility. It is important to note that a circular way of problem evaluation is used, especially in systemic therapies, as opposed to a linear route. Using this method, families can be helped by finding patterns of behavior, what the causes are, and what can be done to better their situation. Family therapy offers families a way to develop or maintain a healthy and functional family. Patients and families with more difficult and intractable problems such as poor prognosis schizophrenia, conduct and personality disorder, chronic neurotic conditions require family interventions and therapy. The systemic framework approach offers advanced family therapy for such families. This type of advanced therapy requires training that very few centers, such as the Family Psychiatry Center at the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India offer to trainees and residents. These sessions may last anywhere from eight sessions up to 20 or more on occasions [ Table 1 ].

Types and grades of family interventions

Goals of family therapy

Usual goals of family therapy are improving the communication, solving family problems, understanding and handling special family situations, and creating a better functioning home environment. In addition, it also involves:

• Exploring the interactional dynamics of the family and its relationship to psychopathology
• Mobilizing the family's internal strength and functional resources
• Restructuring the maladaptive interactional family styles (including improving communication)
• Strengthening the family's problem-solving behavior.

Reasons for family interventions

The usual reasons for referral are mentioned below. However, it may be possible that sometimes the reasons identified initially may be just a pointer to many other lurking problems within the family that may get discovered eventually during later assessments.

• Marital problems
• Parent–child conflict
• Problems between siblings
• The effects of illness on the family
• Adjustment problems among family members
• Inconsistency parenting skills
• Psychoeducation for family members about an index patient's illness
• Handling expresses emotions.

CHALLENGES FACED BY THE NOVICE THERAPIST

Whether one is a young student, or a seasoned individual therapist, dealing with families can be intimidating at times but also very rewarding if one knows how to deal with them. We have outlined certain challenges that one faces while dealing with families, especially when one is beginning.

Being overeager to help

This can happen with beginner therapists as they are overeager and keen to help and offer suggestions straight away. If the therapist starts dominating the interaction by talking, advising, suggesting, commenting, questioning, and interpreting at the beginning itself, the family falls silent. It is advisable to probe with open-ended questions initially to understand the family.

Poor leadership

It is advisable for the therapist to have control over the sessions. Sometimes, there may be other individuals/family members who maybe authoritative and take control. Especially in crisis situations, when the family fails to function as a unit, the therapist should take control of the session and set certain conditions which in his professional judgment, maximize the chances for success.

Not immersing or engaging/fear or involving

A common problem for the beginning therapist is to become overly involved with the family. However, he may realize this and try to panic and withdraw when he can become distant and cold. Rather, one should gently try to join in with the family earning their true respect and trust before heading to build rapport.

Focusing only on index patient

Many families believe that their problem is because of the index patient, whereas it may seem a tactical error to focus on this person initially. In doing so, it may essentially agree to the family's hypothesis that their problem is arising out of this person. It is preferable, at the outset to inform the family that the problem may lie with the family (especially when referrals are made for family therapies involving multiple members), and not necessarily with any one individual.

Not including all members for sessions

Many therapeutic efforts fail because important family members are not included in the sessions. It is advisable to find out initially who are the key members involved and who should be attending the sessions. Sometimes, involving all members initially and then advising them to return to therapy as and when the need arises is recommended.

Not involving members during sessions

Even though one has involved all members of the family in the sessions, not all of them may be engaged during the sessions. Sometimes, the therapist's own transference may hold back a member of the family in the sessions. Rather, it is recommended that the therapist makes it clear that he/she is open to their presence and interactions, either verbally or nonverbally.

Taking sides with any member of the family

It may be easy to fall into the trap of taking one member's side during sessions leaving the other party doubting the fairness and judgment of the therapist. For example, after meeting one marital partner for a few sessions, the therapist, when entering the couple, discussions may be heavily biased in his views due to his/her prior interaction. Therapists should be aware of this effect and try to be neutral as possible yet take into confidence each member attending the sessions. Therapist's countertransference can easily influence him/her to take sides, especially in families that are overtly blaming from the start, or with one member who may be aggressive in the sessions, or very submissive during the sessions can influence the therapist's sides; and one needs to be aware of this early in the sessions.

Guarded families

Some families put on a guarded façade and refuse to challenge each other in the session. By being neutral and nonjudgmental, sometimes, the therapist can perpetuate this guarded façade put forth by families. Hence, therapists must be able to read this and try to challenge them, listen to microchallenges within the family, must be ready to move in and out from one family member to another, without fixing to one member.

Communicating with the therapist outside sessions

Many families attempt to reduce tension by communicating with therapist outside the session, and beginning therapist are particularly susceptible for such ploys. The family or a member/s may want to meet the therapist outside the sessions by trying to influence the therapist to their views and opinions. Therapists must refrain from such encounters and suggest discussing these issues openly during the sessions. Of course, rarely, there may be sensitive or very personal information that one may want to discuss in person that may be permissible.

Ignoring previous work done by other therapists

It is easy for family therapists to ignore previous therapists. The family therapist's ignorance of the effects of previous therapy can serious hamper the work. By discussing the previous therapist helps the new therapist to understand the problem easily and could save time also.

Getting sucked to the family's affective state/mood

If transference involves the therapist in family structure, the therapist's dependency can overinvolved him in the family's style and tone of interaction. A depressed family causes both: Therapist to relate seriously and sadly. A hostile family may cause the therapist to relate in an attacking manner. The most serious problem can occur when a family is in a state of anxiety, induces the therapist to become anxious and make his/her comments to seem accusatory and blaming. It is very difficult for the beginning therapist to “feel” where the family is affectively, to be empathic, yet to be able to relate at times on a different affective level-to respond according to situations. It is important to be aware of the affective state/mood of the family but slips in and out of that state [ Table 2 ].

Guidelines for conducting interventions with families

FUNCTIONS OF A FAMILY THERAPIST

• The family therapist establishes a useful rapport: Empathy and communication among the family members and between them and himself
• The therapist clarifies conflict by dissolving barriers, confusions, and misunderstandings
• Gradually, the therapist attempts to bring to the family to a mutual and more accurate understanding of what is wrong
• Counteracting inappropriate denials, conflicts
• Lifting hidden intrapersonal conflict to the level of interpersonal interaction.
• The therapist fulfills in part the role of true parent figure, a controller of danger, and a source of emotional support and satisfaction-supplying elements that the family needs but lacks. He introduces more appropriate attitudes, emotions, and images of family relations than the family has ever had
• The therapist works toward penetrating (entering into) and undermining resistances and reducing the intensity of shared currents of conflict, guilt, and fear. He accomplishes these aims mainly using confrontation and interpretation
• The therapist serves as a personal instrument of reality testing for the family.

In carrying out these functions, the family therapist plays a wide range of roles, as:

• An activator
• Interpreter
• Re-integrator

BASIC STEPS FOR FAMILY INTERVENTIONS

The initial phase of therapy, the referral intake.

• Family assessment
• Family formulation and treatment plan
• Formal contract.

Patients and their families are usually referred to as some family problem has been identified. The therapist may be accustomed to the usual one-on-one therapeutic situation involving a patient but may be puzzled in his approach by the presence of many family members and with a lot of information. A few guidelines are similar to the approaches followed while conducting individual therapy. The guidelines for conducting family interventions are given in Table 2 . At the time of the intake, the therapist reviews all the available information in the family from the case file and the referring clinicians. This intake session lasts for 20–30 min and is held with all the available family members. The aim of the intake session is to briefly understand the family's perception of their problem, their motivation and need to undergo family intervention and the therapist assessments of suitability for family therapy. Once this is determined the nature and modality of the therapy is explained to the family and an informal contract is made about modalities and roles of therapist and the family members. The do's and don’ts of the family interventions are laid down to the family at the outset of the process of the interventions.

The family assessment and hypothesis

The assessment of different aspects of family functioning and interactions must typically take about 3–5 sessions with the whole family, each session must last approximately 45 min to an hour. Different therapists may want to take assessments in different ways depending on their style. Mentioned below are a few tasks which are recommended for the therapist to perform. Usually, it is recommended that the naïve therapist starts with a three-generation genogram and then follows-up with the different life cycle stages and family functions as outlined below.

• The three-generation genogram is constructed diagrammatically listing out the index patient's generation and two more related generations, for example, patients and grandparents in an adolescent client or parents and children in a middle-aged client. The ages and composition of the members are recorded, and the transgenerational family patterns and interactions are looked at to understand the family from a longitudinal and epigenetic perspective. The therapist also familiarizes himself with any family dynamics prior to consultation. This gives a broad background to understand the situation the family is dealing with now
• The life cycle of the index family is explored next. The functions of the family and specific roles of different members are delineated in each of the stages of the family life cycle.[ 3 ] The index family is seen from a developmental perspective, and the therapist gets a longitudinal and temporal perspective of the family. Care is taken to see how the family has coped with problems and the process of transition from one stage to another. If children are also part of the family, their discipline and parenting styles are explored (e.g., whether there is inconsistent parenting)
• Problem Solving: Many therapists look at this aspect of the family to see how cohesive or adaptable the family has been. Usually, the family members are asked to describe some stress that the family has faced, i.e., some life events, environmental stressors, or illness in a family member. The therapist then proceeds to get a description of how the family coped with this problem. Here, “circular questions” are employed and therapist focuses on antecedent events. The crisis and the consequent events are examined closely to look for patterns that emerge. The family function (or dysfunction) is heightened when there is a crisis situation and the therapist look at patterns rather than the content described. Thus, the therapist gets an “as if I was there” view of the family. The same inquiry is possible using the technique of enactment[ 4 ]
• The Structural Map: Once the inquiry is over, the therapist draws the structural map, which is a diagrammatic representation of the family system, showing the different subsystems, its boundaries, power structure and relationships between people. Diagrammatic notions used in structural therapy or Bowenian therapy are used to denote relationships (normal, conflictual, or distant) and subsystem boundaries, in different triadic relationships. This can also be done on a timeline to show changes in relationships in different life cycle stages and influences from different life events
• What the client is trying to convey through his/her symptoms?
• What is the role of the family in maintaining these symptoms?
• Why has the family come now?

This circular hypothesis can be confirmed on further inquiry with the family to see how the “dysfunctional equilibrium” is maintained. At this stage, we suggest that a family formulation is generated, hypothesized and analyzed. This leads to a comprehensive systemic formulation involving three generations. This formulation will determine which family members we need to see in a therapy, what interventional techniques we should use and what changes in relationships we should effect. The team will also discuss the minimum, most effective treatment plan which emerges considering the most feasible changes the family can make

• Formal Contract: A brief understanding of the family homeostasis is presented to the family. Sometimes, the full hypothesis may be fed to the family in a noncritical and positive way (“Positive Connotation”), appreciating the way in which the system is functioning the therapist presents the treatment plat to the family and negotiates with the members the plan and action they would like to take up at the present time. The time frame and modality of therapy is contracted with the family, and the therapy is put into force. The frequency and intensity of sessions are determined by the degree of distress felt by the family and the geographical distance from the therapy center, i.e., families may be seen as inpatients at the center if they are in crisis or if they live far away.

The Family Psychiatry Center at The NIMHANS, Bengaluru, Karnataka, India, is one of the centers where formal training in therapy is regularly conducted. An outline of the Family Assessment Proforma[ 5 ] used at this center is given in Figure 1 . Several other structured family assessment instruments are available [ Figure 1 ].

Family assessment proforma (Obtained with permission from the Family Psychiatry Center, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India)

Middle phase of therapy

This phase of therapy forms the major work that is carried out with the family. Depending on the school of therapy, that is used, these sessions may number from a few (strategic) to many sessions lasting many months (psychodynamic). The techniques employed depend on the understanding of the family during the assessment as much as the family – therapist fit. For example, the degree of psychological sophistication of the clients will determine the use of psychodynamic and behavioral techniques. Similarly, a therapist who is comfortable with structural/strategic methods would put these therapies to maximum use. The nature of the disorder and the degree of pathology may also determine the choice of therapy, i.e., behavioral techniques may be used more in chronic psychotic conditions while the more difficult or resistant families may get brief strategic therapies. We will now describe some of the important techniques used with different kinds of problems.

Psychodynamic therapy

This school was one of the first to be described by people like Ackerman and Bowen.[ 1 , 6 ] This method has been made more contextual and briefer by therapists like Boszormenyi-Nasgy and Framo.[ 7 , 8 ] Essentially, the therapist understands the dynamics employed by different members of the family and the interrelationships of these members. These family ego defenses are interpreted to the members and the goal of therapy is to effects emotional insight and working through of new defense patterns. Family transferences may become evident and may need interpretation. Therapy usually lasts from 15 to 30 sessions and this method may be employed in persons who are psychologically sophisticated, and able to understand dynamics and interpretations. Sustained and high motivation is necessary for such a therapy. This method is found useful in couples with marital discord from upper middle-class backgrounds. Time required is a major constraint.

Behavioral methods

Behavioral techniques find use in many types of therapies and conditions. It has been extensively used in chronic psychotic illnesses by workers such as Fallon et al. , (1986) and Anderson et al. [ 9 , 10 ] Psychoeducation and skills training in communication and problem-solving are found very useful among families which do not have very serious dysfunction. Techniques such as modeling or role-plays are useful in improving communication styles and to teach parenting skills with disturbed children. Obviously, motivation for therapy is a major requisite and hence techniques such as contracting, homework assignments are used in couples with marital discord. Behavioral techniques used in sexual dysfunction are also possible when adapted according to clients’ needs.

Structural family therapy

Described by Minuchin; Fishman and Unbarger[ 4 , 11 , 12 ] has become quite popular over the past few years among therapists in India. This is possibly because of many reasons. Our families are available with their manifold subsystems of parents, children, grandparents and structure is easily discerned and changed. In addition, in recent years most clients present with conduct and personality disorders in adolescence and early adulthood. Hence, techniques like unbalancing, boundary-making are quite useful as the common problems involve adolescents who are wielding power with poor marital adjustments between parents. These techniques are useful for many of our clients.

Strategic technique

We have found that these brief techniques can be very powerfully used with families which are difficult and highly resistant to change. We usually employ them when other methods have failed, and we need to take a U-turn in therapy. Techniques employed by the Milan school[ 13 , 14 ] reframing, positive connotation, paradoxical (symptom) prescription have been used effectively. So also have techniques like prescription in brief methods advocated by Erikson, Watzlawick et al. ,[ 15 , 16 ] been useful. Familiarity and competence with these techniques is a must and therapy is usually brief and quickly terminated with prescriptions [ Table 3 ].

Summaries of the different schools of therapies

SES – Socioeconomic status

FAMILY INTERVENTIONS IN SPECIFIC DISORDERS

Techniques to promote family adaptation to illness.

• Heighten awareness of shifting family roles – pragmatic and emotional
• Facilitate major family lifestyle changes
• Increase communication within and outside the family regarding the illness
• Help family to accept what they cannot control, focus energies on what they can
• Find meaning in the illness. Help families move beyond “Why us?”
• Facilitate them grieving inevitable losses–of function, of dreams, of life
• Increase productive collaboration among patients, families, and the health-care team
• Trace prior family experience with the illness through constructing a genogram
• Set individual and family goals related to illness and to nonillness developmental events.

Schizophrenia

Family EE and communication deviance (or lack of clarity and structure in communication) are well-established risk factors for the onset of schizophrenia.

Psychoeducational interventions aim to increase family members’ understanding of the disorder and their ability to manage the positive and negative symptoms of psychosis.

Simple strategies would include reduction of adverse family atmosphere by reducing stress and burden on relatives, reduction of expressions of anger and guilt by the family, helping relatives to anticipate and solve problems, maintenance of reasonable expectations for patient performance, to set appropriate limits whilst maintaining some degree of separation when needed; and changing relatives’ behavior and belief systems.

Programs emphasize family resilience. Address families’ need for education, crisis intervention, skills training, and emotional support.

Bipolar mood disorder

To recognize the early signs and symptoms of bipolar disorder.

Develop strategies for intervening early with new episodes and assure consistency with medication regimens.

Manage moodiness and swings of the patient, anger management, feelings of frustration.

Family conflict and rejection, low family support, ineffective communication, poor expression of affect, abuse, and insecure attachment bonds are primary focus of family therapy associated with depression cognitive-behavioral and interpersonal interventions for depression.

Family-based treatment for anxiety combines family therapy with cognitive-behavioral interventions.

Targets the characteristics of the family environment that support anxiogenic beliefs and avoidant behaviors.

The goal is to disrupt the interactional patterns that reinforce the disorder.

To assist family members in using exposure, reward, relaxation, and response prevention techniques to reduce the patients’ anxieties.

Eating disorders

Target the dysfunctional family processes, namely, enmeshment and overprotectiveness.

To help parents build effective and developmentally appropriate strategies for promoting and monitoring their child's eating behaviors.

Childhood disorders

The primary focus is the development of effective parenting and contingency management strategies that will disrupt the problematic family interactions associated with ADHD and ODD.

Family-based interventions for autism spectrum disorder

Parents taught to use communication and social training tools that are adapted to the needs of their children and apply these techniques to their family interactions at home.

Substance misuse

Enhance the coping ability of family members and reduce the negative consequences of alcohol and drug abuse on concerned relatives; eliminate the family factors that constitute barriers to treatment; use family support to engage and retain the drug and/or alcohol user in therapy; change the characteristics of the family environment that contribute to relapse Al-Anon, AL-teen.

Termination phase

This last phase of therapy is finished in a couple of sessions. The initial goals of therapy are reviewed with the family. The family and the therapist review together the goals which were achieved, and the therapist reminds the family the new patterns/changes which have emerged. The need to continue these new patterns is emphasized. At the same time, the family is cautioned that these new patterns will occur when all members make a concerted effort to see this happen. Family members are reminded that it is easy to fall back to the old patterns of functioning which had produced the unstable equilibrium necessitating consultation.

At termination, the therapist usually negotiates new goals, new tasks or new interactions with the family that they will carry out for the next few months in the follow up period. The family is told that they need to review these new patterns after a couple of months so as to determine how things have gone and how conflicts have been addressed by the family. This way the family has a better chance of sustaining the change created. Sometimes booster sessions are also advised after 6–12 months especially for outstation families who cannot come regularly for follow-ups. These booster sessions will review the progress and negotiate further changes with the family over a couple of sessions. This follow-up period, after therapy is terminated is crucial for working through process and ensures that the client-therapist bond is not severed too quickly. It is easy to deal with the clients’ and therapist’ anxieties if this transition phase is smooth.

SPECIAL SOCIOCULTURAL ISSUES IN THERAPY SPECIFIC TO INDIA

Most Indian families are functionally joint families though they may have a nuclear family structure. Furthermore, unlike the Western world more than two generations readily come for therapy. Hence, it becomes necessary to deal with two to three generations in therapy and also with transgenerational issues. Our families also foster dependency and interdependency rather than autonomy. This issue must also be kept in mind when dealing with parent–child issues. Indians have a varied cultural and religious diversity depending on the region from which the family comes. The therapist has to be familiar with the regional customs, practices, beliefs, and rituals. The Indian family therapist has to also be wary of being too directive in therapy as our families may give the mantle of omnipotence to the therapist and it may be more difficult for us to adopt at one-down or nondirective approach. Hence, while systemic family therapy is eminently possible in India one must keep in mind these sociocultural factors so as to get a good “family-therapist fit.”

Constraint factors in therapy

The economic backwardness of most out families makes therapy feasible and affordable, in terms of time and money spent, only to the middle and upper classes of our society. The poorer families usually drop out of therapy as they have other more pressing priorities. The lack of tertiary social support and welfare or social security makes it less possible to network with other systems. We are also woefully inadequate in terms of trained family therapists to cater to our large population. In our country, distances seem rather daunting and modes of transport and communication are poor for families to readily seek out a therapist. We work with these constraint factors and so the “family-therapy” fit is an important factor for families that are seeking and staying in family therapy. 17

CONCLUSIONS

Over the last few years, a systemic model has evolved for service and for training. The model uses a predominantly systematic framework for understanding families and the techniques for therapy are drawn from different schools namely the structural, strategic, and behavioral psychodynamic therapies.

Appendix: Glossary of terms

The repetitive patterns of interaction that organize the way in which family members relate and interact with each other.

Boundaries are the rules defining who participates in the system and how, i.e., the degree of access outsiders have to the system.

It may comprise of a single person, or several persons joined together by common membership criteria, for example, age, gender, or shared purpose.

When alignments stand in opposition to another part of the system (i.e., when several family members are against another member/s.

The joining together of two or more members. It popularly designates appositive affinity between two units of a system.

Channels of communication are a mechanism that defines “who speaks to whom.” When channels of communication are blocked, needs cannot be fulfilled, problems cannot be solved, and goals cannot be achieved.

Enmeshed families

In which, there is extreme sensitivity among the individual members to each other and their primary subsystem.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

• Bipolar Disorder
• Therapy Center
• When To See a Therapist
• Types of Therapy
• Best Online Therapy
• Best Couples Therapy
• Best Family Therapy
• Managing Stress
• Sleep and Dreaming
• Understanding Emotions
• Self-Improvement
• Healthy Relationships
• Student Resources
• Personality Types
• Guided Meditations
• Verywell Mind Insights
• 2024 Verywell Mind 25
• Mental Health in the Classroom
• Editorial Process
• Meet Our Review Board
• Crisis Support

What Is Problem-Solving Therapy?

Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.

Verywell / Madelyn Goodnight

Problem-Solving Therapy Techniques

How effective is problem-solving therapy, things to consider, how to get started.

Problem-solving therapy is a brief intervention that provides people with the tools they need to identify and solve problems that arise from big and small life stressors. It aims to improve your overall quality of life and reduce the negative impact of psychological and physical illness.

Problem-solving therapy can be used to treat depression , among other conditions. It can be administered by a doctor or mental health professional and may be combined with other treatment approaches.

At a Glance

Problem-solving therapy is a short-term treatment used to help people who are experiencing depression, stress, PTSD, self-harm, suicidal ideation, and other mental health problems develop the tools they need to deal with challenges. This approach teaches people to identify problems, generate solutions, and implement those solutions. Let's take a closer look at how problem-solving therapy can help people be more resilient and adaptive in the face of stress.

Problem-solving therapy is based on a model that takes into account the importance of real-life problem-solving. In other words, the key to managing the impact of stressful life events is to know how to address issues as they arise. Problem-solving therapy is very practical in its approach and is only concerned with the present, rather than delving into your past.

This form of therapy can take place one-on-one or in a group format and may be offered in person or online via telehealth . Sessions can be anywhere from 30 minutes to two hours long. 

Key Components

There are two major components that make up the problem-solving therapy framework:

• Applying a positive problem-solving orientation to your life
• Using problem-solving skills

A positive problem-solving orientation means viewing things in an optimistic light, embracing self-efficacy , and accepting the idea that problems are a normal part of life. Problem-solving skills are behaviors that you can rely on to help you navigate conflict, even during times of stress. This includes skills like:

• Knowing how to identify a problem
• Defining the problem in a helpful way
• Trying to understand the problem more deeply
• Setting goals related to the problem
• Generating alternative, creative solutions to the problem
• Choosing the best course of action
• Implementing the choice you have made
• Evaluating the outcome to determine next steps

Problem-solving therapy is all about training you to become adaptive in your life so that you will start to see problems as challenges to be solved instead of insurmountable obstacles. It also means that you will recognize the action that is required to engage in effective problem-solving techniques.

Planful Problem-Solving

One problem-solving technique, called planful problem-solving, involves following a series of steps to fix issues in a healthy, constructive way:

• Problem definition and formulation : This step involves identifying the real-life problem that needs to be solved and formulating it in a way that allows you to generate potential solutions.
• Generation of alternative solutions : This stage involves coming up with various potential solutions to the problem at hand. The goal in this step is to brainstorm options to creatively address the life stressor in ways that you may not have previously considered.
• Decision-making strategies : This stage involves discussing different strategies for making decisions as well as identifying obstacles that may get in the way of solving the problem at hand.
• Solution implementation and verification : This stage involves implementing a chosen solution and then verifying whether it was effective in addressing the problem.

Other Techniques

Other techniques your therapist may go over include:

• Problem-solving multitasking , which helps you learn to think clearly and solve problems effectively even during times of stress
• Stop, slow down, think, and act (SSTA) , which is meant to encourage you to become more emotionally mindful when faced with conflict
• Healthy thinking and imagery , which teaches you how to embrace more positive self-talk while problem-solving

What Problem-Solving Therapy Can Help With

Problem-solving therapy addresses life stress issues and focuses on helping you find solutions to concrete issues. This approach can be applied to problems associated with various psychological and physiological symptoms.

Mental Health Issues

Problem-solving therapy may help address mental health issues, like:

• Chronic stress due to accumulating minor issues
• Complications associated with traumatic brain injury (TBI)
• Emotional distress
• Post-traumatic stress disorder (PTSD)
• Problems associated with a chronic disease like cancer, heart disease, or diabetes
• Self-harm and feelings of hopelessness
• Substance use
• Suicidal ideation

Specific Life Challenges

This form of therapy is also helpful for dealing with specific life problems, such as:

• Death of a loved one
• Dissatisfaction at work
• Everyday life stressors
• Family problems
• Financial difficulties
• Relationship conflicts

Your doctor or mental healthcare professional will be able to advise whether problem-solving therapy could be helpful for your particular issue. In general, if you are struggling with specific, concrete problems that you are having trouble finding solutions for, problem-solving therapy could be helpful for you.

Benefits of Problem-Solving Therapy

The skills learned in problem-solving therapy can be helpful for managing all areas of your life. These can include:

• Being able to identify which stressors trigger your negative emotions (e.g., sadness, anger)
• Confidence that you can handle problems that you face
• Having a systematic approach on how to deal with life's problems
• Having a toolbox of strategies to solve the issues you face
• Increased confidence to find creative solutions
• Knowing how to identify which barriers will impede your progress
• Knowing how to manage emotions when they arise
• Reduced avoidance and increased action-taking
• The ability to accept life problems that can't be solved
• The ability to make effective decisions
• The development of patience (realizing that not all problems have a "quick fix")

Problem-solving therapy can help people feel more empowered to deal with the problems they face in their lives. Rather than feeling overwhelmed when stressors begin to take a toll, this therapy introduces new coping skills that can boost self-efficacy and resilience .

Other Types of Therapy

Other similar types of therapy include cognitive-behavioral therapy (CBT) and solution-focused brief therapy (SFBT) . While these therapies work to change thinking and behaviors, they work a bit differently. Both CBT and SFBT are less structured than problem-solving therapy and may focus on broader issues. CBT focuses on identifying and changing maladaptive thoughts, and SFBT works to help people look for solutions and build self-efficacy based on strengths.

This form of therapy was initially developed to help people combat stress through effective problem-solving, and it was later adapted to address clinical depression specifically. Today, much of the research on problem-solving therapy deals with its effectiveness in treating depression.

Problem-solving therapy has been shown to help depression in: 

• Older adults
• People coping with serious illnesses like cancer

Problem-solving therapy also appears to be effective as a brief treatment for depression, offering benefits in as little as six to eight sessions with a therapist or another healthcare professional. This may make it a good option for someone unable to commit to a lengthier treatment for depression.

Problem-solving therapy is not a good fit for everyone. It may not be effective at addressing issues that don't have clear solutions, like seeking meaning or purpose in life. Problem-solving therapy is also intended to treat specific problems, not general habits or thought patterns .

In general, it's also important to remember that problem-solving therapy is not a primary treatment for mental disorders. If you are living with the symptoms of a serious mental illness such as bipolar disorder or schizophrenia , you may need additional treatment with evidence-based approaches for your particular concern.

Problem-solving therapy is best aimed at someone who has a mental or physical issue that is being treated separately, but who also has life issues that go along with that problem that has yet to be addressed.

For example, it could help if you can't clean your house or pay your bills because of your depression, or if a cancer diagnosis is interfering with your quality of life.

Your doctor may be able to recommend therapists in your area who utilize this approach, or they may offer it themselves as part of their practice. You can also search for a problem-solving therapist with help from the American Psychological Association’s (APA) Society of Clinical Psychology .

If receiving problem-solving therapy from a doctor or mental healthcare professional is not an option for you, you could also consider implementing it as a self-help strategy using a workbook designed to help you learn problem-solving skills on your own.

During your first session, your therapist may spend some time explaining their process and approach. They may ask you to identify the problem you’re currently facing, and they’ll likely discuss your goals for therapy .

Keep In Mind

Problem-solving therapy may be a short-term intervention that's focused on solving a specific issue in your life. If you need further help with something more pervasive, it can also become a longer-term treatment option.

Get Help Now

We've tried, tested, and written unbiased reviews of the best online therapy programs including Talkspace, BetterHelp, and ReGain. Find out which option is the best for you.

Shang P, Cao X, You S, Feng X, Li N, Jia Y. Problem-solving therapy for major depressive disorders in older adults: an updated systematic review and meta-analysis of randomized controlled trials .  Aging Clin Exp Res . 2021;33(6):1465-1475. doi:10.1007/s40520-020-01672-3

Cuijpers P, Wit L de, Kleiboer A, Karyotaki E, Ebert DD. Problem-solving therapy for adult depression: An updated meta-analysis . Eur Psychiatry . 2018;48(1):27-37. doi:10.1016/j.eurpsy.2017.11.006

Nezu AM, Nezu CM, D'Zurilla TJ. Problem-Solving Therapy: A Treatment Manual . New York; 2013. doi:10.1891/9780826109415.0001

Owens D, Wright-Hughes A, Graham L, et al. Problem-solving therapy rather than treatment as usual for adults after self-harm: a pragmatic, feasibility, randomised controlled trial (the MIDSHIPS trial) .  Pilot Feasibility Stud . 2020;6:119. doi:10.1186/s40814-020-00668-0

Sorsdahl K, Stein DJ, Corrigall J, et al. The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: A randomized controlled trial . Subst Abuse Treat Prev Policy . 2015;10(1):46. doi:doi.org/10.1186/s13011-015-0042-1

Margolis SA, Osborne P, Gonzalez JS. Problem solving . In: Gellman MD, ed. Encyclopedia of Behavioral Medicine . Springer International Publishing; 2020:1745-1747. doi:10.1007/978-3-030-39903-0_208

Kirkham JG, Choi N, Seitz DP. Meta-analysis of problem solving therapy for the treatment of major depressive disorder in older adults . Int J Geriatr Psychiatry . 2016;31(5):526-535. doi:10.1002/gps.4358

Garand L, Rinaldo DE, Alberth MM, et al. Effects of problem solving therapy on mental health outcomes in family caregivers of persons with a new diagnosis of mild cognitive impairment or early dementia: A randomized controlled trial . Am J Geriatr Psychiatry . 2014;22(8):771-781. doi:10.1016/j.jagp.2013.07.007

Noyes K, Zapf AL, Depner RM, et al. Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC pilot study .  Cancer Treat Res Commun . 2022;31:100552. doi:10.1016/j.ctarc.2022.100552

Albert SM, King J, Anderson S, et al. Depression agency-based collaborative: effect of problem-solving therapy on risk of common mental disorders in older adults with home care needs . The American Journal of Geriatric Psychiatry . 2019;27(6):619-624. doi:10.1016/j.jagp.2019.01.002

By Arlin Cuncic, MA Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

Problem-Solving Family Therapy

• Living reference work entry
• First Online: 11 November 2017
• Cite this living reference work entry

• David Hale 4 &
• Dale E. Bertram 5  

534 Accesses

Name of Model

Brief strategic ; Communication approach ; Interactional approach ; MRI

Prominent Associated Figures

Problem-solving family therapy began, most notably on the West Coast, as an evolution of the Gregory Bateson Team research project that spawned Communication/Interactional theory and present day family therapy. Jay Haley ( 1987 ) is often associated with this approach because he wrote a book with the title Problem-Solving Therapy . Yet, there are many more people associated with the creation of problem-solving therapy: Gregory Bateson, Don D. Jackson, Milton Erickson, John Weakland, Jay Haley, and William Fry. Don Jackson founded the Mental Research Institute (MRI), one of the first free-standing marriage and family therapy training institute in the United States where he and Richard Fisch, John Weakland, and Paul Watzlawick developed the Brief Therapy Center, as part of the MRI, in which problem-solving family therapy was practiced and...

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

Chubb, H. (1995). Outpatient clinic effectiveness with the MRI brief therapy model. In J. Weakland & W. Ray (Eds.), Propagations: Thirty years of influence from the Mental Research Institute (pp. 129–132). New York: The Haworth Press.

Google Scholar  

Hale, D., & Frusha, C. (2016). MRI brief therapy: A tried and true systemic approach. Journal of Systemic Therapies, 35 (2), 14–24.

Article   Google Scholar  

Haley, J. (1987). Problem-solving therapy . San Francisco: Josey-Bass, Inc.

Haley, J. (1993). Uncommon therapy: The psychiatric techniques of Milton H. Erickson, M.D . New York: W.W. Norton & Company.

Nardone, G., & Watzlawick, P. (2007). Brief strategic therapy . New York: Aronson.

Ray, W., Schlanger, K., & Sutton, J. (2009). One thing leads to another, redux: Contributions to brief therapy from John Weakland, Ch.E., Paul Watzlawick, Ph.D. and Richard Fisch, M.D. Journal of Brief, Strategic, and Systemic Therapies, 3 , 15–37.

Weakland, J., & Ray, W. (Eds.). (1995). Propagations: Thirty years of influence from the Mental Research Institute . New York: The Haworth Press.

Weakland, J., Fisch, R., Watzlawick, P., & Bodin, A. (1974). Brief therapy: Focused problem resolution. Family Process, 13 , 141–168.

Weakland, J., Watzlawick, P., & Riskin, J. (1995). Introduction: MRI – A little background music. In J. Weakland & W. Ray (Eds.), Propagations: Thirty years of influence from the Mental Research Institute (pp. 1–15). New York: The Haworth Press.

Download references

Author information

Authors and affiliations.

University of Louisiana, Monroe, LA, USA

Abilene Christian University, Abilene, TX, USA

Dale E. Bertram

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to David Hale .

Editor information

Editors and affiliations.

The Family Institute at Northwestern, Evanston, Illinois, USA

Anthony Chambers

Douglas C. Breunlin

Section Editor information

University of Louisville, Louisville, KY, USA

Eli Karam Ph.D., LMFT

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this entry

Cite this entry.

Hale, D., Bertram, D.E. (2018). Problem-Solving Family Therapy. In: Lebow, J., Chambers, A., Breunlin, D. (eds) Encyclopedia of Couple and Family Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-15877-8_332-1

Download citation

DOI : https://doi.org/10.1007/978-3-319-15877-8_332-1

Received : 06 June 2017

Accepted : 27 October 2017

Published : 11 November 2017

Publisher Name : Springer, Cham

Print ISBN : 978-3-319-15877-8

Online ISBN : 978-3-319-15877-8

eBook Packages : Springer Reference Behavioral Science and Psychology Reference Module Humanities and Social Sciences Reference Module Business, Economics and Social Sciences

• Publish with us

Policies and ethics

• Find a journal
• Track your research

Counseling and psychotherapy for individuals, couples and families in San Diego.

We all start this life with a family, whether that family is composed of blood relatives, adopted parents, a close-knit neighborhood, or a foster family. This family that we acquire when we are born influences every aspect of our lives, from our first moments to our last.

Our family affects who we are and who we become, for better and for worse. We learn our vocabulary, our habits, our customs and rituals, and how to view and observe the world around us.

We also learn how to love and how to interact with others from these first important relationships.

If we are born into a healthy family with healthy relationships, we are likely to learn how to maintain healthy relationships. If we are born into a dysfunctional family that struggles to connect, we may also struggle to connect with others.

While it is certainly unlucky to be born into the second kind of family, it’s not an unchangeable situation. Nearly all families deal with some sort of dysfunction at one time or another, yet most families retain or regain a sense of wholeness and happiness.

Family therapy offers families a way to do this—a way to develop or maintain a healthy, functional family.

What is Family Therapy / Family Counseling?

Family therapy or family counseling is a form of treatment that is designed to address specific issues affecting the health and functioning of a family. It can be used to help a family through a difficult period, a major transition, or mental or behavioral health problems in family members (“Family Therapy”, 2014).

As Dr. Michael Herkov explains, family therapy views individuals’ problems in the context of the larger unit: the family (2016). The assumption of this type of therapy is that problems cannot be successfully addressed or solved without understanding the dynamics of the group .

The way the family operates influences how the client’s problems formed and how they are encouraged or enabled by other members of their family.

Family therapy can employ techniques and exercises from cognitive therapy, behavior therapy, interpersonal therapy, or other types of individual therapy. Like with other types of treatment, the techniques employed will depend on the specific problems the client or clients present with.

Behavioral or emotional problems in children are common reasons to visit a family therapist. A child’s problems do not exist in a vacuum; they exist, and will likely need to be addressed, within the context of the family (Herkov, 2016).

It should be noted that in family therapy or counseling, the term “family” does not necessarily mean blood relatives. In this context, “family” is anyone who “plays a long-term supportive role in one’s life, which may not mean blood relations or family members in the same household” (King, 2017).

According to Licensed Clinical Social Worker Laney Cline King, these are the most common types of family therapy:

• Bowenian: this form of family therapy is best suited for situations in which individuals cannot or do not want to involve other family members in the treatment. Bowenian therapy is built on two core concepts: triangulation (the natural tendency to vent or distress by talking to a third party) and differentiation (learning to become less emotionally reactive in family relationships);
• Structural: Structural therapy focuses on adjusting and strengthening the family system to ensure that the parents are in control and that both children and adults set appropriate boundaries. In this form of therapy, the therapist “joins” the family in order to observe, learn, and enhance their ability to help the family strengthen their relationships;
• Systemic: The Systemic model refers to the type of therapy that focuses on the unconscious communications and  meanings behind family members’ behaviors. The therapist in this form of treatment is neutral and distant, allowing the family members to dive deeper into their issues and problems as a family;
• Strategic: This form of therapy is more brief and direct than the others, in which the therapist assigns homework to the family. This homework is intended to change the way family members interact by assessing and adjusting the way the family communicates and makes decisions. The therapist takes the position of power in this type of therapy, which allows other family members who may not usually hold as much power to communicate more effectively (King, 2017).

What is a Family Counselor Trained For?

As the different types of therapy described above show, a family therapist may be called upon to take on many different roles. These many roles require a family therapist to undergo a great deal of training, formal education, and testing to ensure that the therapist is up to the task.

“In this therapy, the therapist takes responsibility for the outcome of the therapy. This has nothing to do with good or bad, guilt or innocence, right or wrong. It is the simple acknowledgement that you make a difference.” – Eileen Bobrow

While therapists may have different methods and preferred treatment techniques, they must all have at least a minimum level of experience with the treatment of:

• Child and adolescent behavioral problems;
• Depression and anxiety;
• LGBTQ issues;
• Domestic violence;
• Infertility;
• Marital conflicts;
• Substance abuse (All Psychology Schools, 2017).

In order to treat these and other family issues, therapists must:

• Observe how people interact within units;
• Evaluate and resolve relationship problems;
• Diagnose and treat psychological disorders within a family context;
• Guide clients through transitional crises such as divorce or death;
• Highlight problematic relational or behavioral patterns;
• Help replace dysfunctional behaviors with healthy alternatives;
• Take a holistic ( mind-body ) approach to wellness (All Psychology Schools, 2017).

In order to gain the skills necessary to perform these functions, a family therapist usually obtains a bachelor’s degree in counseling, psychology, sociology, or social work, followed by a master’s degree in counseling or marriage and family therapy.

Next, the therapist will most likely need to complete two years of supervised work after graduation, for a total of 2,000 to 4,000 hours of clinical experience. When these requirements are met, the therapist will also likely need to pass a state-sanctioned exam, as well as complete annual continuing education courses.

This education trains therapists for guidance with a wide range of problems, including:

• Personal conflicts within couples or families;
• Unexpected illness, death, or unemployment;
• Developing or maintaining a healthy romantic relationship at any stage;
• Behavioral problems in children ;
• Divorce or separation;
• Substance abuse or addiction;
• Mental health problems like depression and anxiety .

This wide range of problems makes it clear that the answer to “What is a family therapist NOT trained to do?” may be shorter than the question of what they ARE trained to do!

To learn more about how marriage and family therapists are trained and how they practice their craft, the following websites are great resources:

• The American Association for Marriage and Family Therapy website ;
• The All Psychology Schools website ;
• The Careers in Psychology website ;
• The Marriage and Family Therapist Licensure website ;
• The Learn website .

What is the Goal of Family Therapy?

“To put the world right in order, we must first put the nation in order; to put the nation in order, we must first put the family in order; to put the family in order, we must first cultivate our personal life; we must first set our hearts right.” – Confucius

In a nutshell, the goal of family therapy is to work together to heal any mental, emotional, or psychological problems tearing your family apart (Lee, 2010). To guide a family towards a healthy life, family therapists aim to aid people in improving communication , solving family problems, understanding and handling family situations, and creating a better functioning home environment (Family Therapy, 2017A).

The goals of family therapy depend on the presenting problems of the clients. For example, goals may differ based on the following scenarios:

• A family member is suffering from schizophrenia or severe psychosis: The goal is to help other family members understand the disorder and adjust to the psychological changes that the patient may be undergoing;
• Problems arising from cross-generational boundaries, such as when parents share a home with grandparents, or children are being raised by grandparents: The goal is to improve communication and help the family members set healthy boundaries;
• Families deviating from social norms (unmarried parents, gay couples raising children, etc.): The goals here are not always to address any specific internal problems, but the family members may need help coping with external factors like societal attitudes;
• Family members who come from mixed racial, cultural, or religious backgrounds: The goal is to help family members further their understanding of one another and develop healthy relationships;
• One member is being scapegoated or having their treatment in individual therapy undermined: When one family member is struggling with feeling like the outcast or receives limited support from other family members, the goal is to facilitate increased empathy and understanding for the individual within their family and provide support for them to continue their treatment;
• The patient’s problems seem inextricably tied to problems with other family members: In cases where the problem or problems are deeply rooted in problems with other family members, the goal is to address each of the contributing issues and solve or mitigate the effects of this pattern of problems;
• A blended family (i.e., step-family): Blended families can suffer from problems unique to their situations. In blended families, the goal of family therapy is to enhance understanding and facilitate healthy interactions between family members (Family Therapy, 2017B).

Family Psychotherapy: Taking it One Step Further

We tend to think of therapy and psychotherapy as two different forms of treatment, but in fact, they are the same thing. This ambiguity is enhanced when we introduce the term “counseling” as well.

In truth, therapy is simply a shortened form of the word “psychotherapy” ( www.drpatrick.com ). However, counseling is sometimes called “talk therapy,” blurring the lines even further (Eder, “What is the Difference”).

Generally, counseling is applied in situations where an individual (or, in the case of family counseling, a family) engages the services of a counselor or other mental health professional to help with a specific problem or set of problems. Therapy, or psychotherapy, is a more in-depth and usually long-term form of treatment in which the client or clients discuss a wider range of issues and chronic patterns of problematic feelings, thoughts, and behaviors (Eder, “What is the Difference”).

A family who is struggling with a situation that brings added stress , such as the death of a family member, addiction, or dire financial straits, may benefit from counseling to help them through their struggles to emerge on the other side as a stronger and more cohesive unit.

If a family is struggling with more chronic mental or behavioral problems, such as a father dealing with schizophrenia, a mother fighting depression, or a child who has been abused, psychotherapy is likely the better choice.

This type of therapy is appropriate for families with problems such as these because a family therapist has a different perspective on treatment than an individual therapist. While the individual therapist works with one client on solving or curing a problem, the family therapist views problems in the context of the “system” of the family. To solve a problem in a system, you need to consider all parts of the system.

Fixing the alternator in a car will not fix the problem if it also has flat tires, a faulty transmission, and a plugged exhaust pipe.

Issues within a family are similar to the car with several problems. A parent struggling with alcoholism is not a problem in isolation; the parent’s struggle has likely affected their spouse and their children as well. A family therapist believes that problems must be addressed at the level of the whole family rather than on an individual level (Schwartz, 2009).

What are the Benefits of Family Therapy?

This more holistic approach to treating problems within a family has proven to be extremely effective in many cases. In family therapy, families can work on their problems with the guidance of a mental health professional in a safe and controlled environment.

The benefits of family therapy include:

• A better understanding of healthy boundaries and family patterns and dynamics;
• Enhanced communication;
• Improved problem solving;
• Deeper empathy;
• Reduced conflict and better anger management skills (10 Acre Ranch, 2017).

More specifically, family therapy can improve family relationships through:

• Bringing the family together after a crisis;
• Creating honesty between family members;
• Instilling trust in family members;
• Developing a supportive family environment;
• Reducing sources of tension and stress within the family;
• Helping family members forgive each other;
• Conflict resolution for family members;
• Bringing back family members who have been isolated (American Addiction Centers, 2017).

Family therapy enhances the skills required for healthy family functioning, including communication, conflict resolution, and problem-solving. Improving these skills also increases the potential for success in overcoming and addressing family problems.

In family therapy, the focus is on providing all family members with the tools they need to facilitate healing (Teen Treatment Center, 2014).

6 Examples and Exercises

If family therapy sounds like a treatment that would benefit you and your loved ones, the best course of action is to find a licensed professional with whom you can build a good working relationship and address the problems your family is facing.

However, if you’re not quite ready for this step, or there are obstacles between you and getting treatment, there are many exercises and suggestions that you may find to be good alternatives.

The exercises and techniques below are meant to be used within the context of a therapeutic working relationship, but some also have applications for those who wish to explore the possibilities of family therapy before committing to long-term treatment with a therapist. If you are a therapist or other mental health professional, you may find these exercises to be useful additions to your therapy toolbox.

The Miracle Question

This exercise can be used in individual, couples, or family therapy, and is intended to help the client(s) explore the type of future they would like to build. We all struggle at times, but sometimes the struggle is greater because we simply do not know what our goals actually are.

The Miracle Question is an excellent way to help the client or clients probe their own dreams and desires. When used in the context of couples or family therapy, it can aid clients in understanding what their significant other or family member needs in order to be happy with their relationship .

This Miracle Question is posed as follows:

“Suppose tonight, while you slept, a miracle occurred. When you awake tomorrow, what would be some of the things you would notice that would tell you life had suddenly gotten better?” (Howes, 2010)

While the client may give an answer that is an impossibility in their waking life, their answer can still be useful. If they do give an impossible answer, the therapist can dive deeper into the clients’ preferred miracle with this question: “How would that make a difference?”

This question aids both the client and the therapist—the client in envisioning a positive future in which their problems are addressed or mitigated, and the therapist in learning how they can best help their client in their sessions.

You can learn more about this exercise at this link .

Colored Candy Go Around

If you’re looking for a fun and creative icebreaker or introduction to family therapy, this exercise can be a great way to start.

To engage in this exercise with your family, you need a package of Skittles, M&Ms, or a similar colorful candy. Distribute seven pieces to each family member, and instruct them to sort their candy by color (and refraining from eating it just yet!).

Next, ask a family member to pick a color and share how many they have. For however many candies of this color they have, instruct them to give the same number of responses to the following prompts based on the color:

• Green – words to describe your family;
• Purple – ways your family has fun;
• Orange – things you would like to improve about your family;
• Red – things you worry about;
• Yellow – favorite memories with your family.

When the first family member has given their answers, tell them to choose the next family member to answer the same prompt based on the number of candies that person has.

Once the prompt has been answered, the candies can be eaten.

When all family members have responded to these prompts, initiate a discussion based on the answers provided by the family. The following questions can facilitate discussion:

• What did you learn?
• What was the most surprising thing you learned about someone else?
• How will you work towards making changes/improvements?

Given the high sugar content in this exercise, you can see that this is a great game to play with young children! If this sounds like a useful exercise that you would like to try with your family, you can find further information and instructions on page 3 of  this PDF  from therapist Liana Lowenstein.

Emotions Ball

This is a simple exercise, requiring only a ball and a pen or marker to write with. It is frequently used with children and teenagers in many contexts, as it takes the pressure off of talking about emotions for those who may be uncomfortable sharing their feelings.

A beach ball is a perfect ball for this activity—big enough to write several emotions on and easy to throw back and forth in a circle. Write several emotions on the ball, such as “joyful,” “lonely,” “silly,” or “sad.”

Gather your family into a circle and begin to toss the ball back and forth between family members. When a family member catches the ball, have them describe a time when they felt the emotion facing them. Alternatively, you could have the catcher act out an emotion, an activity specially suited for children.

The intent of this exercise is to discuss emotions with your family and practice listening to one another and expressing your feelings.

You can read more about this exercise here .

The Family Gift

This exercise can help a therapist to get to know a family better. If you are using it without the guidance of a therapist, it can help you to further your understanding of your own family and provoke thoughtful discussion.

To give this exercise a try, gather a variety of art supplies and a gift bag. Explain to the family that they are going to create a gift from the materials provided. This gift will be a gift for the whole family, that everyone in the family wants. They must decide together on this gift and how it can be used within their family.

They have 30 minutes to decide on this gift and craft it. Once they have created the gift, they must place it in the gift bag. Within the context of family therapy, this exercise provides the therapist with a look at the inner workings of the family, how they make decisions and complete tasks as a unit.

If you are engaging in this exercise as a family without the presence of a therapist, it can help you to start a meaningful conversation.

Use these questions or prompts to facilitate the discussion:

• Describe your gift.
• Tell how you each felt as you were creating your gift.
• Who made the decisions? For example, who decided what the gift should be?
• Were two or more people in your family able to work well together?
• Did anyone cause any difficulties or disagreements, and if so, how was this handled?
• Is there anything about the way you did the activity that reminds you of how things work in your family at home?
• How can the gift help your family? What else can help your family?

There is a wealth of information to be gained from observing these types of interactions or engaging in these kinds of discussion.

To read more about this exercise, see pages 3 and 4 of the PDF mentioned earlier.

Mirroring Activity

This fun exercise is a great way to help family members relate to each other and work together.

The activity can be explained to a family by the therapist with the following instructions:

“I want you to stand in front of me just right there (pointing to a spot about two feet in front of the practitioner). You are going to be my mirror. Everything I do you will try to copy, but the trick is to copy me at exactly the same time that I am doing it, so that you are my mirror. I will go slowly so you have a chance to think about where I will be moving and so that we can do it exactly at the same time. We can’t touch each other. I will lead first and then you will take a turn leading. Ready? Here we go!”

First, the therapist can model this exercise with one of the family members, then that person can take a turn leading another.

This is an especially useful exercise for children, but it can be used with family members of any age. It requires the family members to give each other their full attention, cooperate with one another, and communicate with both words and body language.

It also allows the family members to become more in tune with one another and can be applied with siblings, a parent, a child, or even couples in marriage counseling.

To see the instructions and read more about this exercise, see page 20 of  this booklet , also from Liana Lowenstein.

A genogram is a schematic or graphic representation of a client’s family tree. However, unlike the typical family tree, the genogram provides far more information on the relationships among members of the family.

It can be used to map out blood relations, medical conditions in the family, and, most often in the case of family therapy, emotional relationships.

Genograms contain two levels of information—that which is present on the traditional family tree and that which provides a much more comprehensive look at the family:

• Basic Information: name, gender, date of birth, date of death (if any);
• Additional Information: education, occupation, major life events, chronic illnesses, social behaviors, nature of family relationships, emotional relationships, social relationships, alcoholism, depression, diseases, alliances, and living situations (GenoPro, 2017).

By including this additional information, the therapist and client(s) can work together to identify patterns in the family history that may have influenced the client’s current emotions and behaviors. Sometimes the simple act of mapping out and observing this information can make clear things that were previously unnoticed.

The information on emotional relationships can include points of interest and any aspects of the relationship that may have impacted the client(s), such as whether the relationship is marked by abuse, whether a marriage is separated or intact, if a relationship is characterized by love or indifference, whether a relationship could be considered “normal” or dysfunctional, etc.

This exercise could be completed individually, but it is likely to be most effective when completed in conjunction with a qualified professional.

You can read more about the genogram here , and learn about how to use them in family therapy here .

Recommended Books

The Seven Principles for Making Marriage Work: A Practical Guide from the Country’s Foremost Relationship Expert by John M. Gottman

This is an excellent read for any non-professionals who wish to learn more about what family therapy can do for couples. Although this is intended for married couples, any individuals in a long-term relationship can benefit from this resource of practical wisdom.

Why Marriages Succeed or Fail: And How You Can Make Yours Last by John M. Gottman

Another entry from Dr. Gottman, this book provides an in-depth look at the inner workings of marriage and gives advice on how to ensure that your marriage is one of the successful ones.

Family Therapy: Concepts and Methods by Michael P. Nichols and Sean Davis

Those with only a casual interest in family therapy may not find much of interest in this book , but anyone who wishes to gain a deeper understanding of the theory and practice of family therapy will find this book invaluable. It gives the reader a solid foundation in the techniques, methods, and academic foundations of family therapy. If you are interested in becoming a family therapist, or simply learning more about the practice of therapy within the context of the family, this book is a perfect place to start.

Essential Skills in Family Therapy: From the First Termination by JoEllen Patterson, Lee Williams, Todd M. Edwards, Larry Chamow, Claudi Grauf-Grounds, and Douglas H. Sprenkle

This book is a fantastic resource for those with little or no experience in family therapy. The language is simple and accessible, and each chapter provides a guide for students and newly minted therapists who wish to prepare for their first sessions. Topics include intake and assessment, treatment planning, building and maintaining the therapeutic relationship , and problem-solving when treatment is not progressing.

The Family Therapy Treatment Planner by Frank M. Dattilio, Arthur E. Jongsma, Jr., and Sean D. Davis

This is another helpful resource for new therapists. The Family Therapy Treatment Planner will aid the therapist in planning treatment for clients, dealing with health insurance companies and health providers, and navigating the complex ocean of rules and regulations. In addition, this book includes many treatment plan options, a sample treatment plan, and guidelines on dealing with the most common presenting problems for family therapists.

A Take-Home Message

Family therapy is a way for you and your family to learn how to maintain healthy family relationships, communicate effectively with family members, and work cooperatively to solve family problems. This type of therapy is unique, in that problems are viewed through a broader lens and as part of the complex system of the family.

This perspective allows family therapists to help families get to the root of their problems and facilitates healing for all members of the family, whether the problem is related to substance abuse or addiction, abuse, mental health disorders, unexpected or dire circumstances, or just the ordinary everyday stress we all struggle with on occasion.

This piece described the benefits and goals of family therapy, introduced four of the most common types of therapy, contrasted family counseling with family psychotherapy, and provided examples of the exercises and techniques used in family therapy.

My hope is that you find this information useful whether you are interested in engaging with a family therapist, becoming a family therapist, or just learning more about family therapy.

If you have ever participated in family therapy or if you have practiced family therapy in your work as a mental health professional, we’d love to hear about your experiences in the comments. Did you find engaging in family therapy helpful?

Did you get to reap the benefits described here? If you have practiced family therapy, what are some of the most valuable things you have learned from your practice?

Thank you for reading!

Originally posted at Positive Psychology

References:

• 10 Acre Ranch. (2017, January 23). 10 Acre Ranch. Retrieved from https://www.10acreranch.org/blog/2017/01/23/5-benefits-family-therapy/
• American Addiction Centers. (2017). The benefits of family therapy. Forterus. Retrieved from http://forterustreatment.com/therapy/family-therapy/
• http://www.drpatrick.com/
• Eder, A. What is the difference between counseling & psychotherapy? Ashley EderCounseling & Psychotherapy. Retrieved from http://www.ashleyeder.com/counseling-psychotherapy/
• “Family Therapy”. (2014, January 14). Good Therapy. Retrieved from http://www.goodtherapy.org/learn-about-therapy/modes/family-therapy
• Family therapy. (2017A). In Encyclopedia of Children’s Health. Retrieved from http://libguides.dixie.edu/c.php?g=57887&p=371718
• Family therapy. (2017B). In Encyclopedia of Mental Disorders. Retrieved from http://www.minddisorders.com/Del-Fi/Family-therapy.html
• GenoPro. (2017). Introduction to the genogram. GenoPro. Retrieved from https://www.genopro.com/genogram/
• Herkov, M. (2016). About family therapy. Psych Central. Retrieved from https://psychcentral.com/lib/about-family-therapy/
• Howes, R. (2010, January 17). The ten coolest therapy interventions: Introduction. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/in-therapy/201001/the-ten-coolest-therapy-interventions-introduction
• Schwartz, A. (2009, March 31). Family therapy: A different approach to psychotherapy. Mental Help. Retrieved from https://www.mentalhelp.net/blogs/family-therapy-a-different-approach-to-psychotherapy/
• Teen Treatment Center. (2014, March 20). The benefits of family therapy. Teen Treatment Center. Retrieved from https://www.teentreatmentcenter.com/blog/the-benefits-of-family-therapy/

Keyword: What Is Family Therapy

Trauma-Informed CBT For Adults: What Is It & How It Helps

What to Expect From Therapy

Overcoming depression: How psychologists help with depressive disorders

Phone: 619-514-3320

Fax: 619-880-2587

Encomium Psychology

2801 B St #2134, San Diego,  CA 92102-2208

Encomium Psychology focuses on building possibilities and potential through in-person and online counseling for individuals, couples, and families in San Diego, CA. 

All Rights Reserved | Encomium Psychology

• CLASSIFIEDS
• Advanced search

American Board of Family Medicine

Advanced Search

The Effectiveness of Problem-Solving Therapy for Primary Care Patients' Depressive and/or Anxiety Disorders: A Systematic Review and Meta-Analysis

• Find this author on Google Scholar
• Find this author on PubMed
• Search for this author on this site
• Figures & Data
• Info & Metrics

Background: There is increasing demand for managing depressive and/or anxiety disorders among primary care patients. Problem-solving therapy (PST) is a brief evidence- and strength-based psychotherapy that has received increasing support for its effectiveness in managing depression and anxiety among primary care patients.

Methods: We conducted a systematic review and meta-analysis of clinical trials examining PST for patients with depression and/or anxiety in primary care as identified by searches for published literature across 6 databases and manual searching. A weighted average of treatment effect size estimates per study was used for meta-analysis and moderator analysis.

Results: From an initial pool of 153 primary studies, 11 studies (with 2072 participants) met inclusion criteria for synthesis. PST reported an overall significant treatment effect for primary care depression and/or anxiety ( d = 0.673; P < .001). Participants' age and sex moderated treatment effects. Physician-involved PST in primary care, despite a significantly smaller treatment effect size than mental health provider only PST, reported an overall statistically significant effect ( d = 0.35; P = .029).

Conclusions: Results from the study supported PST's effectiveness for primary care depression and/or anxiety. Our preliminary results also indicated that physician-involved PST offers meaningful improvements for primary care patients' depression and/or anxiety.

• Anxiety Disorders
• Depressive Disorder
• Mental Health
• Primary Health Care
• Problem Solving
• Psychotherapy

Depressive and anxiety disorders are the 2 leading global causes of all nonfatal burden of disease 1 and the most prevalent mental disorders in the US primary care system. 2 ⇓ – 4 The proportion of primary care patients with a probable depressive and/or anxiety disorder ranges from 33% to 80% 2 , 5 , 6 ; primary care patients also have alarmingly high levels of co-/multi-morbidity of depressive, anxiety, and physical disorders. 7 Depression and anxiety among primary care patients contribute to: poor compliance with medical advice and treatment 8 ; deficits in patient–provider communication 9 ; reduced patient engagement in healthy behaviors 10 ; and decreased physical wellbeing. 11 , 12 Given the high prevalence of primary care depression and anxiety, and their detrimental effects on the qualities of primary care treatments and patients' wellbeing, it is important to identify effective interventions suitable to address primary care depression and anxiety.

Primary care patients with depression and/or anxiety are often referred out to specialty mental health care. 13 , 14 However, outcomes from these referrals are usually poor due to patients' poor adherence and their resistance to mental health treatment 15 , 16 . Therefore, it is critical to identify effective mental health interventions that can be delivered in primary care for patients' depression and/or anxiety. 17 , 18 During the past decade, a plethora of clinical trials have investigated different mental health interventions for depression and anxiety delivered in primary care. One of the most promising interventions that has received increasing support for managing depression and anxiety in primary care is Problem-Solving Therapy (PST).

Holding that difficulties with problem solving make people more susceptible to depression, PST is a nonpharmacological, competence-based intervention that involves a step-by-step approach to constructive problem solving. 19 , 20 Developed from cognitive-behavioral-therapy, PST is a short-term psychotherapy approach delivered individually or in group settings. The generic PST manual 19 contains 14 training modules that guides PST providers working with patients from establishing a therapeutic relationship to identifying and understanding patient-prioritized problems; from building problem-solving skills to eventually solving the problems. Focused on patient problems in the here-and-now, a typical PST treatment course ranges from 7 to 14 sessions and can be delivered by various health care professionals such as physicians, clinical social workers or nurse practitioners. Because the generic PST manual outlines the treatment formula in detail, providers may deliver PST after receiving 1 month of training. For example, 1 feasibility study on training residents in PST found that residents can provide fidelious PST after 7 weeks' training and reach moderate to high competence after 3 years of practicing PST. 21 PST also has a self-help manual available to clients when needed.

PST is a well-established, evidence-based intervention for depression in specialty mental health care and is receiving greater recognition for its effectiveness in treating depression and anxiety in primary care. Systematic and meta-analytic reviews of PST for depression consistently reported moderate to large treatment effects, ranging from d = 0.4 to d = 1.15. 22 ⇓ – 24 Several clinical trials indicated PST's clinical effectiveness in alleviating anxiety as well. 25 , 26 Most importantly, PST has been adapted for primary care settings (PST-PC) and can be delivered by a variety of health care providers with fewer number of sessions and shorter session length. These unique features make PST(-PC) an ideal psychotherapy for depressive and/or anxiety disorders in primary care.

Previous reviews of PST focused on its effectiveness for depression care, but with little attention to PST's effect on anxiety or comorbid depression anxiety. In addition, to our knowledge, no previous reviews of PST have focused on managing depressive and/or anxiety disorders in primary care. Although research demonstrates that PST has a strong evidence base for treating depression and/or anxiety in specialty mental health care settings, more research is needed to determine whether PST remains effective for treating depressive and/or anxiety disorders when delivered in primary care. To address this gap, we conducted a systematic review and meta-analysis on the effectiveness of PST for treating depressive and/or anxiety disorders with primary care patients.

Search Strategies

This review included searches in 6 electronic databases (Academic Search Complete, CINAHL, Medline, PsychINFO, PUBMED, and the Cochrane Library/Database) and 3 professional Web sites (Academy of Cognitive Therapy, IMPACT, Anxiety and Depression Association of America) for primary care depression and anxiety studies published between January 1900 and September 2016. We also E-mailed major authors of PST studies for feedback and input. Search terms of title and/or abstract searches included: [“PST” or “Problem-Solving Therapy” or “Problem Solving Therapy” or “Problem Solving”] AND [“Depression” or “Depressive” or “Anxiety” or “Panic” or “Phobia”] AND [“primarycare” or “primary care” or “PCP” or “Family Medicine” or “Family Doctor”]. We supplemented the procedure described above with a manual search of study references.

Eligibility Criteria

For inclusion in analyses, a study needed to be 1) a randomized-controlled-trial of 2) PST for 3) primary care patients' 4) depressive and/or anxiety disorders. For studies that examined face-to-face, in-person PST, the intervention must be delivered in primary care for inclusion. If studies examined tele-PST (eg, telephone delivery, video conferencing, computer-based), the intervention must be connected to patients' primary care services for a study to be included. For example, when a primary care physician prescribed computer-based PST at home for their patients, the study met inclusion criteria (as it was still considered managing depression “in primary care” in the present review). However, studies would be excluded if a primary care physician referred patients to an external mental health intervention. Finally, studies must document and report sufficient statistical information for calculating effect size for inclusion in the final analysis.

Data Abstraction and Coding

Two authors (AZ and JES) reviewed an initial pool of 153 studies and agreed to remove 65 studies based on title and 68 studies based on abstract, resulting in 20 studies for full-text review. To develop the final list, we excluded 6 studies after closer review of full-text and consultation with a third reviewer who is an established PST researcher. Lastly, we excluded 2 studies due to 1) a study with a design that blurred the effect of PST with other treatments and 2) unsuccessful contact with a study author to request data needed for calculating effect size. We used a final sample of 11 studies for meta-analysis. The PRISMA chart is presented in Figure 1 .

• Download figure
• Open in new tab

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) chart of literature search for Problem-solving therapy (PST) studies for treating primary care patients' depression and/or anxiety.

Statistical Analysis

This study conducted meta-analysis with the following procedures: 1) calculated a weighted average of effect size estimates per study for depression and anxiety separately (to ensure independence) 27 ; 2) synthesized an overall treatment effect estimate using fixed- or random-effects model based on a heterogeneity statistic (Q-statistic) 28 ; and 3) performed univariate meta-regression with a mixed-effects model for moderator analysis. 29 Although other more advanced statistical approaches allow inclusion of multiple treatment effect size estimates per study for data synthesis, like the Generalized Least Squares method 30 or the Robust Variance Estimation method 31 , this study employed a typical approach because of the relatively small sample and absence of study information required to conduct more advanced methods. Following procedures outlined by Cooper and colleagues 32 , we conducted all analyses with R software. 33 We chose to conduct analyses in R, rather than software specific to meta-analysis (eg, RevMan), because R allowed for more flexibility in statistical modeling (eg, small sample size correction). 34 Sensitivity analysis using Robust Variance Estimation did not significantly alter results estimated with the typical approach. And so this study presents results from only the typical approach for purposes of parsimony and clarity.

Publication Bias, Risk of Bias and Quality of Studies

To detect publication bias, we used a funnel plot of effect size estimates graphed against their standard errors for visual investigation. To evaluate risk of bias, we used the Cochrane Collaboration's tool for assessing risk of bias in randomized trials 35 and the Quality Assessment of Controlled Intervention Studies to evaluate study quality. 36

Primary Studies

Eleven PST studies for primary care depression and/or anxiety reported a total sample size of 2072 participants. Participants' age averaged 50.1 and ranged from 24.5 to 71.8 years old. Ten studies reported participants' sex with an average of 35.6% male participants across all studies. Seven studies (63.6%) reported participants' racial background with most identified as non-Hispanic white (83.6%). Other racial/ethnic groups were poorly reported for meaningful summary. Five studies used active medication as a comparison, including 3 studies that used both active medication and placebo medication. The rest compared PST with treatment-as-usual while 2 studies used active control group (eg, video education material). Four studies involved physicians in some component of intervention delivery. PCPs provided PST in 2 studies; supervised and collaborated with depression care manager in 1 study, and collaborated with a primary care nurse in another. Ten studies reported an average of 6 PST sessions ( M = 6.1) ranging from 3 to 12 sessions. All but 1 study (n = 10) used individual PST and 2 studies used tele-health modalities to provide PST. All studies used standardized measures of depression and anxiety. Examples of the most common measures included: PHQ-9, CES-D, HAM-D, and BDI-II. Table 1 presents a detailed description of study characteristics.

• View inline

Study Characteristics for Problem-Solving Therapy as Intervention for Treating Depression and/or Anxiety Among Primary Care Patients ( n = 11)

Publication Bias, Risk of Bias, and Quality of Studies

The funnel plot ( Figure 2 ) did not indicate any clear sign of publication bias. Risk of bias ( Table 4 ) indicated an overall acceptable risk across studies included for review with blinding of participants and personnel, blinding of outcome assessment and incomplete outcome data most vulnerable to risk of bias. Quality of study assessment ( Table 5 ) indicated an overall satisfactory study quality with over half of studies (n = 6) achieving ratings of “Good” study quality.

Funnel Plot for Publication Bias in Problem-solving therapy (PST) Studies for Treating Primary Care Patients' Depression an/or Anxiety.

Meta-analysis and moderator analysis

Figure 3 presents a forest plot of treatment effects per study, including depression and anxiety measures. Table 3 presents subgroup analysis of overall treatment effect by moderator and Table 2 presents the results of meta-analysis and moderator analysis. Meta-analysis revealed an overall significant treatment effect of PST for primary care depression and/or anxiety ( d = 0.67; P < .001). Further investigation revealed no significant difference between the mean treatment effect of PST for depression versus anxiety in primary care ( d ( diff .) = −0.25; P = .317) while subgroup analysis revealed the overall treatment effect for anxiety was not significant ( d = 0.35; P = .226). Age was found to be a significant moderator (β 1 = 0.02; P = .012) for treatment outcomes, indicating that for each unit increase in participants' age, the overall treatment effect for primary are depression and/or anxiety are expected to increase by 0.02 (standard deviations). Neither participants' ethnic or racial backgrounds nor marital status significantly moderated the overall treatment outcome.

Forest Plot of PST Treatment Effect Size Estimates for Treating Primary Care Patients' Depression and/or Anxiety per Study.

PST for Treating Primary Care Patients' Depression and/or Anxiety; Results of Univariate Meta-regression

Results of Subgroup Analysis of Overall Treatment Effect (by Moderator) of PST for Treating Primary Care Patients' Depression and/or Anxiety

PST for Treating Primary Care Patients' Depression and/or Anxiety; Results of the Cochrane Collaboration's Tool for Assessing Risk of Bias *

Quality Assessment of Controlled PST Intervention Studies for Primary Care Patients' Depression and/or Anxiety ( n =11)

The overall treatment effect was not moderated by any treatment characteristics including: treatment modality (individual vs group PST), delivery methods (face-to-face vs tele-health PST), number of PST sessions and length of individual PST sessions. Subgroup analysis indicated an overall significant treatment effect of in-person PST ( d = 0.72; P < .001) but not of tele-PST ( d = 0.53; P = .097). However, the difference between the 2 was not statistically significant.

PST providers background and primary care physician's involvement significantly moderated the overall treatment effect size. Master's-level providers reported an overall treatment effect ( d = 1.57; P < .001) significantly higher than doctoral-level providers ( d = −1.33; P = .007). Both physician-involved and nonphysician involved PST reported significant overall treatment effect of PST for depression and/or anxiety in primary care ( d = 1.06; P < .001 and d = 0.35; P = .029, respectively). Moderator analysis further revealed that PST without physician involvement reported significantly greater treatment effects compared with physician-involved PST in primary care ( d = −0.71; P = .005). Results of subgroup and moderator analyses indicated that while the difference (in treatment effect) between physician and nonphysician involved PST in primary care were statistically significant, physician-involved PST was also statistically significant, thus practically meaningful.

Results of the study demonstrated a statistically significant overall treatment effect in outcomes of depression and/or anxiety for primary care patients receiving PST compared with patients in control groups. The outcome type—depression versus anxiety—failed to moderate treatment effect; only PST for depression reported a significant overall effect size. This could indicate that many studies primarily targeted depression and included anxiety measures as secondary outcomes. For this reason, we expect to find a greater treatment effect for primary care depression. It was unsurprising that treatment characteristics failed to moderate treatment effect size because most primary studies used PST-PC or its modified version; there was insufficient variation between studies (and moderators), yielding insignificant moderating coefficients.

Although delivery method did not moderate treatment effect reported in studies included in this review, significant effect was only reported by studies using face-to-face in-person PST but not by those with tele-PST modalities (n = 2). Although evidence for the effectiveness of tele-PST is established or increasing in a variety of settings 37 ⇓ – 39 most PST studies for primary care patients have used face-to-face, in-person PST. Our study further supported the use of face-to-face in-person PST for treating depression and anxiety among primary care patients. We recognize, however, that current and projected shortages in specialty mental health care provision, felt acutely in subspecialties such as geriatric mental health, necessitate more trials with PST tele-health modalities. 40

It is salient to note that, while nonphysician-involved PST studies reported significantly greater treatment effect than those involving physicians, PCP-involved studies also reported an overall significant effect size. Closer examination indicated that studies with physician-involved PST were either delivered by physicians or other nonmental health professionals (eg, registered nurses or depression care managers). Lack of sufficient PST training might explain the difference in treatment effect sizes being statistically significant. Yet, the fact that physician-involved PST studies reported an overall statistically significant effect size for primary care depression and/or anxiety suggested a meaningful treatment effect for clinical practice. When faced with a shortage of mental health professionals (eg, psychologists, clinical social workers, licensed professional counselors), our findings suggest physician-led or -supervised PST interventions could still improve primary care patients' depression and/or anxiety. Researchers are encouraged to further examine the treatment effect of PST delivered by mental health professionals in collaboration with primary care physicians.

This study has several weaknesses that are inherent to meta-analyses. There is no way to assure we included all studies despite adopting a comprehensive search and coding strategy (ie, file drawer problem). Second, while all studies in this meta-analysis seemed to have satisfactory methodological rigor, it is possible that internal biases within some studies may influence results. This study takes a quantitative meta-analysis approach which inherently neglects other study designs and methodologies that also provide valuable information about the effectiveness, feasibility, and acceptability of PST for treating primary care patients with depression. To ensure independence of data, this study used a weighted average of effect size estimates per study in synthesizing an overall treatment effect and conducting moderator analysis. While sensitivity analysis did not reveal significant differences from the reported results, we will not know for sure how our choice of statistical method might affect the results.

• Acknowledgments

The authors are grateful to Dr. Namkee Choi, Professor and the Louis and Ann Wolens Centennial Chair in Gerontology at the University of Texas at Austin Steve Hicks School of Social Work, for her mentorship and insightful comments during preparation of the manuscript.

This article was externally peer reviewed.

Funding: none.

Conflict of interest: none declared.

Ethics Review: This is a systematic review and meta-analysis based on de-identified aggregate study data. No human participants or animals were involved in this study. No ethics review was required.

To see this article online, please go to: http://jabfm.org/content/31/1/139.full .

• Received for publication July 5, 2017.
• Revision received September 14, 2017.
• Accepted for publication September 27, 2017.
• Whiteford HA ,
• Degenhardt L ,
• Kroenke K ,
• Spitzer RL ,
• Williams JB ,
• Monahan PO ,
• Verhaak PF ,
• Hilbink-Smolders M ,
• Mitchell AJ ,
• Sherbourne CD ,
• Mussell M ,
• Schellberg D ,
• Clarke DM ,
• Schenker Y ,
• Stewart A ,
• Vander Weg MW
• Salovey P ,
• Rothman AJ ,
• Detweiler JB ,
• Williams JW
• Hunkeler EM ,
• Pincus HA ,
• Thielke S ,
• Richards D ,
• Gilbody S ,
• Grimshaw J ,
• Maguth Nezu C ,
• D'Zurilla TJ
• D'Zurilla TJ ,
• Dietrich AJ ,
• Seville JL ,
• Cuijpers P ,
• van Straten A ,
• Warmerdam L
• Kirkham JG ,
• Kleiboer A ,
• Seekles W ,
• Higgins JP ,
• Thompson SG
• Raudenbush SW
• Hedges LV ,
• Valentine JC
• Gleser LJ ,
• Harris LV ,
• Valentine ,
• 33. ↵ R Development Core Team . R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria . Vienna, Austria : R Foundation for Statistical Computing 2015 .
• Pustejovsky JE
• Altman DG ,
• Gøtzsche PC ,
• 36. ↵ National Heart, Lung, and Blood Institute . Quality assessment of controlled intervention studies . Systematic evidence reviews and clinical practice guideline . Available from: https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/rct .
• Marinucci ML ,
• Sirrianni L ,
• Wilson NL ,
• Cartreine JA ,
• Buckey JC ,
• Sandoval L ,
• Yarborough BJ
• Barret JE ,
• Williams JW ,
• Chibanda D ,
• Shetty AK ,
• Tshimanga M ,
• Stranix-Chibanda L ,
• Rusakaniko S
• Von Korff M ,
• Tamburrino M ,
• McCusker J ,
• Mynors-Wallis LM ,
• Dietrich AJ
• Reynolds CF III . ,
• Thomas SB ,
• Schmaling KB ,
• Dimidjian S ,
• Williams JW Jr . ,
• Barrett J ,
• Sullivan M ,
• Cornell J ,

In this issue

• Table of Contents
• Table of Contents (PDF)
• Cover (PDF)
• Index by author

Thank you for your interest in spreading the word on American Board of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Citation Manager Formats

• EndNote (tagged)
• EndNote 8 (xml)
• RefWorks Tagged
• Ref Manager

• Tweet Widget
• Facebook Like
• Google Plus One

Jump to section

Related articles.

• No related articles found.
• Google Scholar

Cited By...

• Global health reciprocal innovation to address mental health and well-being: strategies used and lessons learnt
• Psychologic Treatment of Depression Compared With Pharmacotherapy and Combined Treatment in Primary Care: A Network Meta-Analysis
• Brief behaviour change strategies for distressed patients in primary care
• Interventions Must Be Realistic to Be Useful and Completed in Family Medicine

More in this TOC Section

• Perinatal Depression: A Guide to Detection and Management in Primary Care
• Denosumab versus Bisphosphonates for Reducing Fractures in Postmenopausal Women with Osteoporosis: A Meta-Analysis
• Practical Management of Lumps and Bumps of the Fingers, Hand, and Wrist

Similar Articles

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

Comparative effectiveness of family problem-solving therapy (F-PST) for adolescents after traumatic brain injury: Protocol for a randomized, multicenter, clinical trial

Affiliations.

• 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
• 2 Department of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
• 3 Case Western Reserve University and MetroHealth Medical Center, Cleveland Medical Center, Cleveland, OH, USA.
• 4 Biobehavioral Health Center, Nationwide Children's Hospital Research Institute, The Ohio State University, Columbus, OH, USA.
• 5 Case Western Reserve University, Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
• 6 Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
• 7 Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
• PMID: 30023445
• PMCID: PMC6046511
• DOI: 10.1016/j.conctc.2018.04.001

Introduction: The objective of this manuscript is to describe the methodology that will be used to test the comparative effectiveness, feasibility, and acceptability of three formats of family problem solving therapy (F-PST) for improving functional outcomes of complicated mild to severe adolescent TBI.

Methods: Three-arm comparative effectiveness, randomized clinical trial (RCT) design. We describe the protocol of a three-arm RCT comparing the effectiveness of three modalities of F-PST to reduce executive dysfunction and behavior problems following TBI in adolescence. The RCT will compare the relative effectiveness among face-to-face; online and self-directed; and therapist-supported online modes of treatment.

Ethics and dissemination: It is anticipated that findings from this work will inform future clinical care practices, with implications for treatment of other patient populations of youth with psychological symptoms arising from neurological conditions. Institutional review board approval will be obtained from all sites prior to commencement of the study.

Keywords: Behavior; Executive function; NCT:02368366; Pediatric traumatic brain injury; Problem solving; Telehealth.

PubMed Disclaimer

STUDY DESIGN. Study design is…

STUDY DESIGN. Study design is a randomized clinical trial (RCT) that examines the…

Similar articles

• Online Family Problem-Solving Therapy (F-PST) for Executive and Behavioral Dysfunction After Traumatic Brain Injury in Adolescents: A Randomized, Multicenter, Comparative Effectiveness Clinical Trial. Kurowski BG, Taylor HG, McNally KA, Kirkwood MW, Cassedy A, Horn PS, Stancin T, Wade SL. Kurowski BG, et al. J Head Trauma Rehabil. 2020 May/Jun;35(3):165-174. doi: 10.1097/HTR.0000000000000545. J Head Trauma Rehabil. 2020. PMID: 31834062 Free PMC article. Clinical Trial.
• A Randomized Comparative Effectiveness Trial of Family-Problem-Solving Treatment for Adolescent Brain Injury: Parent Outcomes From the Coping with Head Injury through Problem Solving (CHIPS) Study. Wade SL, Cassedy AE, McNally KA, Kurowski BG, Kirkwood MW, Stancin T, Taylor HG. Wade SL, et al. J Head Trauma Rehabil. 2019 Nov/Dec;34(6):E1-E9. doi: 10.1097/HTR.0000000000000487. J Head Trauma Rehabil. 2019. PMID: 31033747 Clinical Trial.
• The Relationship of Adolescent and Parent Preferences for Treatment Modality With Satisfaction, Attrition, Adherence, and Efficacy: The Coping With Head Injury Through Problem-Solving (CHIPS) Study. Wade SL, Cassedy AE, Sklut M, Taylor HG, McNally KA, Kirkwood MW, Stancin T, Kurowski BG. Wade SL, et al. J Pediatr Psychol. 2019 Apr 1;44(3):388-401. doi: 10.1093/jpepsy/jsy087. J Pediatr Psychol. 2019. PMID: 30452665 Clinical Trial.
• Psychological interventions for parents of children and adolescents with chronic illness. Eccleston C, Fisher E, Law E, Bartlett J, Palermo TM. Eccleston C, et al. Cochrane Database Syst Rev. 2015 Apr 15;4(4):CD009660. doi: 10.1002/14651858.CD009660.pub3. Cochrane Database Syst Rev. 2015. Update in: Cochrane Database Syst Rev. 2019 Mar 18;3:CD009660. doi: 10.1002/14651858.CD009660.pub4. PMID: 25874881 Free PMC article. Updated. Review.
• Psychological interventions for parents of children and adolescents with chronic illness. Eccleston C, Palermo TM, Fisher E, Law E. Eccleston C, et al. Cochrane Database Syst Rev. 2012 Aug 15;8(8):CD009660. doi: 10.1002/14651858.CD009660.pub2. Cochrane Database Syst Rev. 2012. Update in: Cochrane Database Syst Rev. 2015 Apr 15;(4):CD009660. doi: 10.1002/14651858.CD009660.pub3. PMID: 22895990 Free PMC article. Updated. Review.
• A Problem-Solving Intervention for Hospice Family Caregivers: A Randomized Clinical Trial. Demiris G, Oliver DP, Washington K, Pike K. Demiris G, et al. J Am Geriatr Soc. 2019 Jul;67(7):1345-1352. doi: 10.1111/jgs.15894. Epub 2019 Apr 4. J Am Geriatr Soc. 2019. PMID: 30946495 Free PMC article. Clinical Trial.
• Maas A.I., Stocchetti N., Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008;7(8):728–741. [published Online First: 2008/07/19] - PubMed
• Styrke J., Stalnacke B.M., Sojka P. Traumatic brain injuries in a well-defined population: epidemiological aspects and severity. J. Neurotrauma. 2007;24(9):1425–1436. [published Online First: 2007/09/26] - PubMed
• Tagliaferri F., Compagnone C., Korsic M. A systematic review of brain injury epidemiology in Europe. Acta Neurochir. 2006;148(3):255–268. discussion 68. [published Online First: 2005/11/29] - PubMed
• Langlois J., Rutland-Brown W., Thomas K. US Department of Health and Human Servicies, CDC; Atlanta, GA: 2004. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths.
• Faul M., Xu L., Wald M. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; Atlanta, GA: 2010. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002-2006.

Related information

Linkout - more resources, full text sources.

• Elsevier Science
• Europe PubMed Central
• PubMed Central

Other Literature Sources

• scite Smart Citations

• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

We will keep fighting for all libraries - stand with us!

Send me an email reminder

By submitting, you agree to receive donor-related emails from the Internet Archive. Your privacy is important to us. We do not sell or trade your information with anyone.

Internet Archive Audio

• This Just In
• Grateful Dead
• Old Time Radio
• 78 RPMs and Cylinder Recordings
• Audio Books & Poetry
• Computers, Technology and Science
• Music, Arts & Culture
• News & Public Affairs
• Spirituality & Religion
• Radio News Archive

• Flickr Commons
• Occupy Wall Street Flickr
• NASA Images
• Solar System Collection
• Ames Research Center

• All Software
• Old School Emulation
• MS-DOS Games
• Historical Software
• Classic PC Games
• Software Library
• Kodi Archive and Support File
• Vintage Software
• CD-ROM Software
• CD-ROM Software Library
• Software Sites
• Tucows Software Library
• Shareware CD-ROMs
• Software Capsules Compilation
• CD-ROM Images
• ZX Spectrum
• DOOM Level CD

• Smithsonian Libraries
• FEDLINK (US)
• Lincoln Collection
• American Libraries
• Canadian Libraries
• Universal Library
• Project Gutenberg
• Children's Library
• Biodiversity Heritage Library
• Books by Language
• Additional Collections

• Prelinger Archives
• Democracy Now!
• Occupy Wall Street
• TV NSA Clip Library
• Animation & Cartoons
• Arts & Music
• Computers & Technology
• Cultural & Academic Films
• Ephemeral Films
• Sports Videos
• Videogame Videos
• Youth Media

Search the history of over 866 billion web pages on the Internet.

Mobile Apps

• Wayback Machine (iOS)
• Wayback Machine (Android)

Browser Extensions

Archive-it subscription.

• Explore the Collections
• Build Collections

Save Page Now

Capture a web page as it appears now for use as a trusted citation in the future.

Please enter a valid web address

• Donate Donate icon An illustration of a heart shape

Problem-solving therapy : [new strategies for effective family therapy]

Bookreader item preview, share or embed this item, flag this item for.

• Graphic Violence
• Explicit Sexual Content
• Hate Speech
• Misinformation/Disinformation
• Marketing/Phishing/Advertising
• Misleading/Inaccurate/Missing Metadata

plus-circle Add Review comment Reviews

19 Favorites

Better World Books

DOWNLOAD OPTIONS

No suitable files to display here.

IN COLLECTIONS

Uploaded by Tracey.Gutierres on March 9, 2010

SIMILAR ITEMS (based on metadata)

10 Best Problem-Solving Therapy Worksheets & Activities

Cognitive science tells us that we regularly face not only well-defined problems but, importantly, many that are ill defined (Eysenck & Keane, 2015).

Sometimes, we find ourselves unable to overcome our daily problems or the inevitable (though hopefully infrequent) life traumas we face.

Problem-Solving Therapy aims to reduce the incidence and impact of mental health disorders and improve wellbeing by helping clients face life’s difficulties (Dobson, 2011).

This article introduces Problem-Solving Therapy and offers techniques, activities, and worksheets that mental health professionals can use with clients.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises 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:

What is problem-solving therapy, 14 steps for problem-solving therapy, 3 best interventions and techniques, 7 activities and worksheets for your session, fascinating books on the topic, resources from positivepsychology.com, a take-home message.

Problem-Solving Therapy assumes that mental disorders arise in response to ineffective or maladaptive coping. By adopting a more realistic and optimistic view of coping, individuals can understand the role of emotions and develop actions to reduce distress and maintain mental wellbeing (Nezu & Nezu, 2009).

“Problem-solving therapy (PST) is a psychosocial intervention, generally considered to be under a cognitive-behavioral umbrella” (Nezu, Nezu, & D’Zurilla, 2013, p. ix). It aims to encourage the client to cope better with day-to-day problems and traumatic events and reduce their impact on mental and physical wellbeing.

Clinical research, counseling, and health psychology have shown PST to be highly effective in clients of all ages, ranging from children to the elderly, across multiple clinical settings, including schizophrenia, stress, and anxiety disorders (Dobson, 2011).

Can it help with depression?

PST appears particularly helpful in treating clients with depression. A recent analysis of 30 studies found that PST was an effective treatment with a similar degree of success as other successful therapies targeting depression (Cuijpers, Wit, Kleiboer, Karyotaki, & Ebert, 2020).

Other studies confirm the value of PST and its effectiveness at treating depression in multiple age groups and its capacity to combine with other therapies, including drug treatments (Dobson, 2011).

The major concepts

Effective coping varies depending on the situation, and treatment typically focuses on improving the environment and reducing emotional distress (Dobson, 2011).

PST is based on two overlapping models:

Social problem-solving model

This model focuses on solving the problem “as it occurs in the natural social environment,” combined with a general coping strategy and a method of self-control (Dobson, 2011, p. 198).

The model includes three central concepts:

• Social problem-solving
• The problem
• The solution

The model is a “self-directed cognitive-behavioral process by which an individual, couple, or group attempts to identify or discover effective solutions for specific problems encountered in everyday living” (Dobson, 2011, p. 199).

Relational problem-solving model

The theory of PST is underpinned by a relational problem-solving model, whereby stress is viewed in terms of the relationships between three factors:

• Stressful life events
• Emotional distress and wellbeing
• Problem-solving coping

Therefore, when a significant adverse life event occurs, it may require “sweeping readjustments in a person’s life” (Dobson, 2011, p. 202).

• Enhance positive problem orientation
• Decrease negative orientation
• Foster ability to apply rational problem-solving skills
• Reduce the tendency to avoid problem-solving
• Minimize the tendency to be careless and impulsive

D’Zurilla’s and Nezu’s model includes (modified from Dobson, 2011):

• Initial structuring Establish a positive therapeutic relationship that encourages optimism and explains the PST approach.
• Assessment Formally and informally assess areas of stress in the client’s life and their problem-solving strengths and weaknesses.
• Obstacles to effective problem-solving Explore typically human challenges to problem-solving, such as multitasking and the negative impact of stress. Introduce tools that can help, such as making lists, visualization, and breaking complex problems down.
• Problem orientation – fostering self-efficacy Introduce the importance of a positive problem orientation, adopting tools, such as visualization, to promote self-efficacy.
• Problem orientation – recognizing problems Help clients recognize issues as they occur and use problem checklists to ‘normalize’ the experience.
• Problem orientation – seeing problems as challenges Encourage clients to break free of harmful and restricted ways of thinking while learning how to argue from another point of view.
• Problem orientation – use and control emotions Help clients understand the role of emotions in problem-solving, including using feelings to inform the process and managing disruptive emotions (such as cognitive reframing and relaxation exercises).
• Problem orientation – stop and think Teach clients how to reduce impulsive and avoidance tendencies (visualizing a stop sign or traffic light).
• Problem definition and formulation Encourage an understanding of the nature of problems and set realistic goals and objectives.
• Generation of alternatives Work with clients to help them recognize the wide range of potential solutions to each problem (for example, brainstorming).
• Decision-making Encourage better decision-making through an improved understanding of the consequences of decisions and the value and likelihood of different outcomes.
• Solution implementation and verification Foster the client’s ability to carry out a solution plan, monitor its outcome, evaluate its effectiveness, and use self-reinforcement to increase the chance of success.
• Guided practice Encourage the application of problem-solving skills across multiple domains and future stressful problems.
• Rapid problem-solving Teach clients how to apply problem-solving questions and guidelines quickly in any given situation.

Success in PST depends on the effectiveness of its implementation; using the right approach is crucial (Dobson, 2011).

Problem-solving therapy – Baycrest

The following interventions and techniques are helpful when implementing more effective problem-solving approaches in client’s lives.

First, it is essential to consider if PST is the best approach for the client, based on the problems they present.

Is PPT appropriate?

It is vital to consider whether PST is appropriate for the client’s situation. Therapists new to the approach may require additional guidance (Nezu et al., 2013).

Therapists should consider the following questions before beginning PST with a client (modified from Nezu et al., 2013):

• Has PST proven effective in the past for the problem? For example, research has shown success with depression, generalized anxiety, back pain, Alzheimer’s disease, cancer, and supporting caregivers (Nezu et al., 2013).
• Is PST acceptable to the client?
• Is the individual experiencing a significant mental or physical health problem?

All affirmative answers suggest that PST would be a helpful technique to apply in this instance.

Five problem-solving steps

The following five steps are valuable when working with clients to help them cope with and manage their environment (modified from Dobson, 2011).

Ask the client to consider the following points (forming the acronym ADAPT) when confronted by a problem:

• Attitude Aim to adopt a positive, optimistic attitude to the problem and problem-solving process.
• Define Obtain all required facts and details of potential obstacles to define the problem.
• Alternatives Identify various alternative solutions and actions to overcome the obstacle and achieve the problem-solving goal.
• Predict Predict each alternative’s positive and negative outcomes and choose the one most likely to achieve the goal and maximize the benefits.
• Try out Once selected, try out the solution and monitor its effectiveness while engaging in self-reinforcement.

If the client is not satisfied with their solution, they can return to step ‘A’ and find a more appropriate solution.

Download 3 Free Positive Psychology Exercises (PDF)

Enhance wellbeing with these free, science-based exercises that draw on the latest insights from positive psychology.

Download 3 Free Positive Psychology Tools Pack (PDF)

By filling out your name and email address below.

Positive self-statements

When dealing with clients facing negative self-beliefs, it can be helpful for them to use positive self-statements.

Use the following (or add new) self-statements to replace harmful, negative thinking (modified from Dobson, 2011):

• I can solve this problem; I’ve tackled similar ones before.
• I can cope with this.
• I just need to take a breath and relax.
• Once I start, it will be easier.
• It’s okay to look out for myself.
• I can get help if needed.
• Other people feel the same way I do.
• I’ll take one piece of the problem at a time.
• I can keep my fears in check.
• I don’t need to please everyone.

5 Worksheets and workbooks

Problem-solving self-monitoring form.

Answering the questions in the Problem-Solving Self-Monitoring Form provides the therapist with necessary information regarding the client’s overall and specific problem-solving approaches and reactions (Dobson, 2011).

Ask the client to complete the following:

• Describe the problem you are facing.
• What is your goal?
• What have you tried so far to solve the problem?
• What was the outcome?

Reactions to Stress

It can be helpful for the client to recognize their own experiences of stress. Do they react angrily, withdraw, or give up (Dobson, 2011)?

The Reactions to Stress worksheet can be given to the client as homework to capture stressful events and their reactions. By recording how they felt, behaved, and thought, they can recognize repeating patterns.

What Are Your Unique Triggers?

Helping clients capture triggers for their stressful reactions can encourage emotional regulation.

When clients can identify triggers that may lead to a negative response, they can stop the experience or slow down their emotional reaction (Dobson, 2011).

The What Are Your Unique Triggers ? worksheet helps the client identify their triggers (e.g., conflict, relationships, physical environment, etc.).

Problem-Solving worksheet

Imagining an existing or potential problem and working through how to resolve it can be a powerful exercise for the client.

Use the Problem-Solving worksheet to state a problem and goal and consider the obstacles in the way. Then explore options for achieving the goal, along with their pros and cons, to assess the best action plan.

Getting the Facts

Clients can become better equipped to tackle problems and choose the right course of action by recognizing facts versus assumptions and gathering all the necessary information (Dobson, 2011).

Use the Getting the Facts worksheet to answer the following questions clearly and unambiguously:

• Who is involved?
• What did or did not happen, and how did it bother you?
• Where did it happen?
• When did it happen?
• Why did it happen?
• How did you respond?

2 Helpful Group Activities

While therapists can use the worksheets above in group situations, the following two interventions work particularly well with more than one person.

Generating Alternative Solutions and Better Decision-Making

A group setting can provide an ideal opportunity to share a problem and identify potential solutions arising from multiple perspectives.

Use the Generating Alternative Solutions and Better Decision-Making worksheet and ask the client to explain the situation or problem to the group and the obstacles in the way.

Once the approaches are captured and reviewed, the individual can share their decision-making process with the group if they want further feedback.

Visualization

Visualization can be performed with individuals or in a group setting to help clients solve problems in multiple ways, including (Dobson, 2011):

• Clarifying the problem by looking at it from multiple perspectives
• Rehearsing a solution in the mind to improve and get more practice
• Visualizing a ‘safe place’ for relaxation, slowing down, and stress management

Guided imagery is particularly valuable for encouraging the group to take a ‘mental vacation’ and let go of stress.

Ask the group to begin with slow, deep breathing that fills the entire diaphragm. Then ask them to visualize a favorite scene (real or imagined) that makes them feel relaxed, perhaps beside a gently flowing river, a summer meadow, or at the beach.

The more the senses are engaged, the more real the experience. Ask the group to think about what they can hear, see, touch, smell, and even taste.

Encourage them to experience the situation as fully as possible, immersing themselves and enjoying their place of safety.

Such feelings of relaxation may be able to help clients fall asleep, relieve stress, and become more ready to solve problems.

We have included three of our favorite books on the subject of Problem-Solving Therapy below.

1. Problem-Solving Therapy: A Treatment Manual – Arthur Nezu, Christine Maguth Nezu, and Thomas D’Zurilla

This is an incredibly valuable book for anyone wishing to understand the principles and practice behind PST.

Written by the co-developers of PST, the manual provides powerful toolkits to overcome cognitive overload, emotional dysregulation, and the barriers to practical problem-solving.

Find the book on Amazon .

2. Emotion-Centered Problem-Solving Therapy: Treatment Guidelines – Arthur Nezu and Christine Maguth Nezu

Another, more recent, book from the creators of PST, this text includes important advances in neuroscience underpinning the role of emotion in behavioral treatment.

Along with clinical examples, the book also includes crucial toolkits that form part of a stepped model for the application of PST.

3. Handbook of Cognitive-Behavioral Therapies – Keith Dobson and David Dozois

This is the fourth edition of a hugely popular guide to Cognitive-Behavioral Therapies and includes a valuable and insightful section on Problem-Solving Therapy.

This is an important book for students and more experienced therapists wishing to form a high-level and in-depth understanding of the tools and techniques available to Cognitive-Behavioral Therapists.

For even more tools to help strengthen your clients’ problem-solving skills, check out the following free worksheets from our blog.

• Case Formulation Worksheet This worksheet presents a four-step framework to help therapists and their clients come to a shared understanding of the client’s presenting problem.
• Understanding Your Default Problem-Solving Approach This worksheet poses a series of questions helping clients reflect on their typical cognitive, emotional, and behavioral responses to problems.
• Social Problem Solving: Step by Step This worksheet presents a streamlined template to help clients define a problem, generate possible courses of action, and evaluate the effectiveness of an implemented solution.

If you’re looking for more science-based ways to help others enhance their wellbeing, check out this signature collection of 17 validated positive psychology tools for practitioners. Use them to help others flourish and thrive.

17 Top-Rated Positive Psychology Exercises for Practitioners

Expand your arsenal and impact with these 17 Positive Psychology Exercises [PDF] , scientifically designed to promote human flourishing, meaning, and wellbeing.

Created by Experts. 100% Science-based.

While we are born problem-solvers, facing an incredibly diverse set of challenges daily, we sometimes need support.

Problem-Solving Therapy aims to reduce stress and associated mental health disorders and improve wellbeing by improving our ability to cope. PST is valuable in diverse clinical settings, ranging from depression to schizophrenia, with research suggesting it as a highly effective treatment for teaching coping strategies and reducing emotional distress.

Many PST techniques are available to help improve clients’ positive outlook on obstacles while reducing avoidance of problem situations and the tendency to be careless and impulsive.

The PST model typically assesses the client’s strengths, weaknesses, and coping strategies when facing problems before encouraging a healthy experience of and relationship with problem-solving.

Why not use this article to explore the theory behind PST and try out some of our powerful tools and interventions with your clients to help them with their decision-making, coping, and problem-solving?

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

• Cuijpers, P., Wit, L., Kleiboer, A., Karyotaki, E., & Ebert, D. (2020). Problem-solving therapy for adult depression: An updated meta-analysis. European P sychiatry ,  48 (1), 27–37.
• Dobson, K. S. (2011). Handbook of cognitive-behavioral therapies (3rd ed.). Guilford Press.
• Dobson, K. S., & Dozois, D. J. A. (2021). Handbook of cognitive-behavioral therapies  (4th ed.). Guilford Press.
• Eysenck, M. W., & Keane, M. T. (2015). Cognitive psychology: A student’s handbook . Psychology Press.
• Nezu, A. M., & Nezu, C. M. (2009). Problem-solving therapy DVD . Retrieved September 13, 2021, from https://www.apa.org/pubs/videos/4310852
• Nezu, A. M., & Nezu, C. M. (2018). Emotion-centered problem-solving therapy: Treatment guidelines. Springer.
• Nezu, A. M., Nezu, C. M., & D’Zurilla, T. J. (2013). Problem-solving therapy: A treatment manual . Springer.

Share this article:

Article feedback

What our readers think.

Thanks for your information given, it was helpful for me something new I learned

Let us know your thoughts Cancel reply

Your email address will not be published.

Save my name, email, and website in this browser for the next time I comment.

Related articles

The Empty Chair Technique: How It Can Help Your Clients

Resolving ‘unfinished business’ is often an essential part of counseling. If left unresolved, it can contribute to depression, anxiety, and mental ill-health while damaging existing [...]

29 Best Group Therapy Activities for Supporting Adults

As humans, we are social creatures with personal histories based on the various groups that make up our lives. Childhood begins with a family of [...]

47 Free Therapy Resources to Help Kick-Start Your New Practice

Setting up a private practice in psychotherapy brings several challenges, including a considerable investment of time and money. You can reduce risks early on by [...]

Read other articles by their category

• Body & Brain (53)
• Coaching & Application (58)
• Compassion (25)
• Counseling (51)
• Emotional Intelligence (23)
• Gratitude (18)
• Grief & Bereavement (21)
• Happiness & SWB (40)
• Meaning & Values (26)
• Meditation (20)
• Mindfulness (44)
• Motivation & Goals (45)
• Optimism & Mindset (34)
• Positive CBT (30)
• Positive Communication (22)
• Positive Education (48)
• Positive Emotions (32)
• Positive Leadership (19)
• Positive Parenting (16)
• Positive Psychology (34)
• Positive Workplace (37)
• Productivity (18)
• Relationships (45)
• Resilience & Coping (39)
• Self Awareness (21)
• Self Esteem (38)
• Strengths & Virtues (32)
• Stress & Burnout Prevention (34)
• Theory & Books (46)
• Therapy Exercises (37)
• Types of Therapy (64)

Marriages, remarriages and complex extended family structures can make many ordinary situations difficult, filled with conflict and tension.

Here are some typical situations that a trained family oriented therapist can assist with:

• Your relationship with your siblings and/or parents has become strained
• Your new marriage/relationship hasn’t been accepted by your family and/or your partner’s family
• Your intimate dating relationships seem to end too soon
• You have frequent conflicts and arguments with friends, family members or people at work
• You are involved in a family business and tension has increased at home
• Other families seem to get along much better than yours does
• Family members seem unhappy or stressed when they are together
• Someone in the family is estranged, appears isolated, feels misunderstood
• The same issues and problems occur over and over and are never resolved
• Family members seem unable to comfort each other during a crisis
• One family member is verbally abusive or threatens others
• Parents tell children their adult problems
• You are a caregiver for an ill family member and feel exhausted
• You see your aging parents needing help and you don’t know what to do
• Your elderly parents require more than you can give and you feel guilty
• You have problems with intimacy
• You and your partner are considering getting married and want a “healthcheck”

You Can Feel Better Quicker Than You Think!

Problems just seem to happen at the worst times, and go on forever. but it doesn't have to be this way anymore..

• Have you stopped doing things that you used to enjoy?
• Do you feel easily fatigued and have problems concentrating?
• Do your intimate dating relationships seem to end too soon?

* No appointments are confirmed until you have spoken with Dr. Mazza.

The Center for Problem Solving 7112 Armat Drive Bethesda, MD 20817

E : [email protected]

P : 301-469-7200

COPYRIGHT © 2023 • DR. JUDITH MAZZA • THE CENTER FOR PROBLEM SOLVING

What is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness. Numerous research studies suggest that CBT leads to significant improvement in functioning and quality of life. In many studies, CBT has been demonstrated to be as effective as, or more effective than, other forms of psychological therapy or psychiatric medications.

It is important to emphasize that advances in CBT have been made on the basis of both research and clinical practice. Indeed, CBT is an approach for which there is ample scientific evidence that the methods that have been developed actually produce change. In this manner, CBT differs from many other forms of psychological treatment.

CBT is based on several core principles, including:

• Psychological problems are based, in part, on faulty or unhelpful ways of thinking.
• Psychological problems are based, in part, on learned patterns of unhelpful behavior.
• People suffering from psychological problems can learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives.

CBT treatment usually involves efforts to change thinking patterns. These strategies might include:

• Learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality.
• Gaining a better understanding of the behavior and motivation of others.
• Using problem-solving skills to cope with difficult situations.
• Learning to develop a greater sense of confidence in one’s own abilities.

CBT treatment also usually involves efforts to change behavioral patterns. These strategies might include:

• Facing one’s fears instead of avoiding them.
• Using role playing to prepare for potentially problematic interactions with others.
• Learning to calm one’s mind and relax one’s body.

Not all CBT will use all of these strategies. Rather, the psychologist and patient/client work together, in a collaborative fashion, to develop an understanding of the problem and to develop a treatment strategy.

CBT places an emphasis on helping individuals learn to be their own therapists. Through exercises in the session as well as “homework” exercises outside of sessions, patients/clients are helped to develop coping skills, whereby they can learn to change their own thinking, problematic emotions, and behavior.

CBT therapists emphasize what is going on in the person’s current life, rather than what has led up to their difficulties. A certain amount of information about one’s history is needed, but the focus is primarily on moving forward in time to develop more effective ways of coping with life.

Source: APA Div. 12 (Society of Clinical Psychology)

• Find It Fast

Funding Opportunities

• All Funding Opportunities
• What & Who We Fund
• PCORI’s Research Funding Process
• What You Need to Know to Apply
• Merit Review

Applicant and Awardee Resources

Research & related projects.

• Explore Our Portfolio
• About Our Research
• PCORI in the Literature
• Peer Review

Engagement in Research

• Foundational Expectations for Partnerships
• Foundational Expectations in Action
• Promotional Toolkit
• The Value of Engagement in Research
• Engagement Award Program
• Engagement Resources
• Engagement in Health Research Literature
• Influencing the Culture of Research
• Engage with Us

Implementation of Evidence

• Putting Evidence to Work
• Evidence Updates
• Evidence Synthesis Reports and Interactive Visualizations
• Emerging Topics: Reports and Horizon Scans
• PCORI Stories

Highlights of PCORI-Funded Research Results

Health topics.

• Cardiovascular Disease
• Intellectual and Developmental Disabilities
• Maternal Morbidity and Mortality
• Rare Diseases
• Women's Health
• View All Topics

News & Events

• PCORI News Hub
• View All Events
• Scholarships for Patients, Caregivers and PCORI Ambassadors
• Call for Poster Abstracts
• The PCORI Strategic Plan
• Our Programs
• Our Vision & Mission
• Financial Statements and Reports
• Board of Governors
• Methodology Committee
• Authorizing Law
• Planning Our Organizational Learning, Reporting Our Results
• Evaluating Key Aspects of Our Work
• PCORI Evaluation Group (PEG)
• Advisory Panel Openings
• Advisory Panels FAQs
• Application Review and Selection Process
• Procurement Opportunities
• Provide Input

Jump to Section

Comparing online and in-person family therapy for teens with traumatic brain injury and their parents, results summary, professional abstract.

• Download Summary
• Español (pdf)
• Audio Recording (mp3)

What was the research about?

Violent bumps or blows to the head can cause traumatic brain injury, or TBI. Teens may develop TBI from accidents or sports injuries. People with TBI often have headaches, nausea, dizziness, confusion, and mood changes. Some TBIs cause physical, emotional, and behavioral problems that may last a long time and that may be stressful for families. Family problem-solving therapy, or F-PST, teaches skills to help families communicate, manage anger, and adjust to changes in daily life.

In this study, the research team wanted to learn if online F-PST was similar to in-person F-PST in reducing the effects of TBI for teens and their parents. The team compared three ways of offering F-PST to teens and their parents:

• Online F-PST with a therapist: hour-long video calls with a therapist and online materials, including videos and ways to practice skills learned during the calls
• Online F-PST without a therapist: access to online materials that teens and parents could go through on their own; this group didn’t meet with a therapist
• In-person F-PST: hour-long meetings with a therapist at a hospital or clinic and printed materials

What were the results?

In this study, the online and in-person F-PST options had similar results for teens and their parents. Comparing the different ways of offering F-PST, the teens in the three groups didn’t differ in

• Behaviors, such as mood swings or outbursts of anger
• Ability to get things done
• Quality of life
• TBI symptoms

The study found no difference in parents’ depression or ability to deal with stress.

Who was in the study?

The study included 150 teens ages 14 to 19, treated at one of five TBI centers in Ohio and Colorado, and their parents. All teens had mild to severe TBI with lasting changes in behavior. Of these teens, 83 percent were white, 11 percent were African American, and 7 percent were another race or more than one race; 4 percent were Hispanic. The average age was 16, and 64 percent were teenage boys.

What did the research team do?

The research team assigned teens and their parents, by chance, to get F-PST in one of the three ways. In each approach, families could attend up to 10 sessions about staying positive, solving problems, and controlling emotions. The team offered up to four more sessions on topics such as how to handle a crisis.

Teens and their parents filled out surveys at the start of the study and again six and nine months later. Surveys asked about teens’ behaviors and ability to get things done. Surveys also included questions about quality of life, depression, and TBI symptoms.

Doctors, teens with TBI and their parents, and a web designer helped design and carry out the study.

What were the limits of the study?

After six months, 19 percent of teens and parents hadn’t completed treatment. The number of people who didn’t finish treatment was about the same in each group. On average, families completed only six sessions. Results might have been different if families attended more sessions. Problems with the website and with video calls may have kept teens and parents from viewing programs online or attending online therapy sessions.

Future research could test ways to help more people attend more sessions.

How can people use the results?

Doctors, teens with TBI, and their parents can use these results when considering different options for therapy.

To compare the effectiveness of online family problem-solving therapy (F-PST), either self-guided or therapist guided, versus traditional in-person F-PST for adolescents with traumatic brain injury (TBI) and their parents in improving adolescents’ behaviors and functioning

Study Design

This randomized controlled trial compared three approaches to providing F-PST to adolescents with TBI and their parents. F-PST for TBI aims to build skills to improve the family's ability to cope with stress after TBI.

The research team randomly assigned adolescents and their parents to one of three treatment groups:

• Therapist-guided online F-PST. Adolescents and parents attended hour-long videoconference sessions with a therapist and viewed modules online, including videos and exercises for families to practice skills learned during the sessions.
• Self-guided online F-PST. Adolescents and parents accessed the same modules provided to the other online group, but without a therapist. At baseline, adolescents and parents scheduled dates to complete modules. They received reminders if they did not complete modules by their goal dates.
• Therapist-guided in-person F-PST. Adolescents and parents discussed their concerns about TBI during hour-long meetings with a therapist at a hospital or outpatient clinic and received written modules.

In each study group, the research team offered participants 10 family sessions about staying positive, solving problems, communicating, and managing anger. Sessions were weekly for the first month and then biweekly for the next three months. The team offered participants four supplemental sessions to address other concerns, such as marital communication, help for siblings, and crisis management.

The study included 150 adolescents ages 14 to 19 with complicated mild to severe TBI and persistent behavioral symptoms, treated at one of five TBI centers in Ohio and Colorado, and their parents. Of these adolescents, 83% were white, 11% were African American, and 7% were another race or more than one race; 4% were Hispanic. The average age was 16, and 64% were male.

The research team collected assessments in person at baseline and again at six and nine months after the study started.

Clinicians, adolescents with TBI and their parents, and a web designer worked with the research team on the content and development of the interventions.

Overall, the three study groups did not differ significantly in adolescents’ executive function, behaviors, quality of life, depression, and TBI symptoms or in parental depression and distress.

Limitations

At six months, 19% of participants had not completed treatment; attrition did not differ significantly by group. Across treatment groups, the mean number of sessions attended was about six, which was below the intended number of 10 to 14 sessions. Technical difficulties with the website and videoconferencing may have interfered with participants’ abilities to view modules or attend therapy sessions online. Results might have differed with higher adherence or if participants had attended more sessions.

Conclusions and Relevance

This study found no difference among groups receiving F-PST online versus in person, suggesting that in-person therapist involvement may not be necessary for some adolescents with TBI and their families. However, the low adherence rate to F-PST across groups in this study makes this conclusion uncertain.

Future Research Needs

Future research could find ways to improve adherence to family therapy, whether online or in person, in all study groups.

Final Research Report

View this project's  final research report .

Implementation

Related pcori dissemination and implementation project.

Widespread Implementation of a Patient-Centered Online Therapy for Adolescent Traumatic Brain Injury

Journal Citations

Results of this project, online family problem-solving therapy (f-pst) for executive and behavioral dysfunction after traumatic brain injury in adolescents: a randomized, multicenter, comparative effectiveness clinical trial, related journal citations, professional stakeholders' perceptions of barriers to behavioral health care following pediatric traumatic brain injury, a randomized comparative effectiveness trial of family-problem-solving treatment for adolescent brain injury: parent outcomes from the coping with head injury through problem solving (chips) study, the relationship of adolescent and parent preferences for treatment modality with satisfaction, attrition, adherence, and efficacy: the coping with head injury through problem-solving (chips) study, behavioral clinical trials in moderate to severe pediatric traumatic brain injury: challenges, potential solutions, and lessons learned, peer-review summary.

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

• Reviewers questioned whether study participants received the same level of therapist involvement in the face-to-face and the therapist-guided online delivery of family problem solving treatment. The researchers confirmed that participants spent an equivalent amount of time in both delivery conditions with the therapist, reviewing content and developing plans to address their problems. The researchers revised the report to clarify this fact.
• Reviewers asked for additional substantiation for the criterion that attendance at 3 or more sessions out of 10-14 in the face-to-face condition constituted program participation. The researchers explained that three sessions were sufficient for the family to receive training in cognitive reframing and problem-solving skills, the focus of the treatment. As additional confirmation, the researchers ran their analysis model with sessions completed as a continuous variable and found no significant differences based on the number of sessions completed.
• Reviewers asked that the report better address how the researchers handled missing data in analyses. The researchers revised the analytical and statistical approaches portion of the methods section to explain that when they examined the utility of multiple imputation to account for missing data, they found minimal differences between the models with and without multiple imputation for the primary outcomes. Given that multiple imputation on repeated measures of outcomes fails to capture time-specific orderings also, the researchers used mixed models without imputation.  
• Reviewers asked how the researchers determined that the effect size of 0.5 indicated a minimally clinically important difference (MCID) for the primary outcomes. The researchers explained the 0.5 was equivalent to half a standard deviation change on the primary outcome measures, which is the MCID seen in many clinical studies.

Conflict of Interest Disclosures

Project information, study registration information.

• Has Results
• Completed; PCORI Public and Professional Abstracts, and Final Research Report Posted
• Mental/Behavioral Health
• Trauma/Injuries
• Head Injury
• Assessment of Prevention, Diagnosis, and Treatment Options
• Behavioral Interventions
• Other Clinical Interventions
• Technology Interventions
• Telemedicine
• Training and Education Interventions

What Is Strategic Family Therapy And How It Can Help You?

Family is the most important thing in life. They are the people who will always be there for you, no matter what. That is why it is so important to have a strong family unit. If your family is struggling, then you may want to consider strategic family therapy . This type of therapy can help resolve issues and improve communication within the family unit. In this blog post, we will discuss what strategic family therapy is and how it can help you!

• 1 What Is Strategic Family Therapy?
• 2 What Is An Example Of Strategic Family Therapy?
• 3 What Techniques Does It Involve?
• 4 What To Expect With Strategic Family Therapy Sessions?
• 5 What Are The Benefits Of It?
• 6 How Effective Is Strategic Family Therapy For Families?
• 7 How To Find The Family Therapist Near Me?
• 8 Conclusion

What Is Strategic Family Therapy?

It is a type of brief therapy, meaning that it is goal-oriented and typically done over a limited number of sessions. The therapist works to help families identify problems and then develop strategic approaches for resolving them. This includes developing communication and problem-solving skills. As well as helping family members understand one another’s perspectives.

What Is An Example Of Strategic Family Therapy?

An example of strategic family therapy is utilizing a problem-solving approach to assist families in finding solutions to the issues that they may be facing. This type of therapy focuses on the current problems and encourages the family members to resolve these issues through collaboration.

For example, during a strategic family therapy session a therapist would help the family identify their problem and brainstorm potential solutions. The family would then work together to make decisions on which solution they believe is best for them as a unit. Through this collaborative process, the family can learn how to better communicate with one another. And, eventually develop positive strategies for resolving conflicts in the future.

You should also be aware that this type of therapy is different from other family therapies. Because it is more directive and structured. The therapist serves as a mediator and teacher, rather than simply supporting the client’s process. Additionally, strategic family therapy often requires frequent sessions in order to provide an effective treatment intervention for the family.

What Techniques Does It Involve?

There are several techniques used in strategic family therapy, including:

• redirecting

Reframing involves redefining the problem within a larger context or in different terms so that it takes on new meaning for the family. Joining is a way to establish rapport and show understanding by demonstrating empathy and acceptance of each family member’s perspective. Redirecting is a way of pointing out how the family is stuck in negative patterns and suggesting solutions to break those patterns.

Other techniques may include:

• structural analysis
• brief therapies
• time-limited therapy
• intergenerational family therapy
• systematic problem solving

Structural analysis is a way of looking at how the family functions as a whole and identifying problematic dynamics between members. Brief therapies are short-term interventions meant to identify and address the root causes of problems.

Time-limited therapy is a form of intervention that focuses on specific goals in a brief amount of time, such as six weeks or fewer. Intergenerational family therapy works to resolve conflicts among different generations within the family. Systematic problem-solving involves working together to identify and address issues before they become uncontrollable.

What To Expect With Strategic Family Th erapy Sessions?

You can expect your Strategic Family Therapy sessions to be filled with open dialogue between all members of the family. The therapist will help each person in the family understand their role within the family system and how it affects other members.

For example, the first step of the Strategic Family Therapy process is to identify the family’s problem areas and establish clear goals that everyone agrees upon. The therapist will then work with each member of the family to help them understand how their individual behavior can influence the whole family system.

The therapist may also encourage certain types of communication, such as allowing each person to express their feelings and any needs they may have. In addition, the therapist will work to build trust and strengthen relationships between family members by helping them develop effective communication skills.

At the end of each session, the therapist will review with all family members what was discussed in the session. And then assign specific tasks that each person should complete in order to move closer to the family’s goals.

What Are The Benefits Of It?

The following are numerous benefits that people can have with strategic family therapy:

1. Increased understanding and communication – The therapist can help facilitate deeper conversations about topics that may be difficult for family members to discuss on their own. This increased understanding allows each member of the family to gain insights into how others think and feel. And that further leads to better communication within the family.

2. Improved relationships – It helps to identify and address underlying issues that can affect the dynamics between family members. It also helps to provide a safe place for family members to talk about difficult topics, allowing them to resolve conflicts and build better relationships with each other.

3. Increased problem-solving skills – The therapist will help the family learn new problem-solving skills that can be used in a variety of situations. Strategic family therapy also helps to develop greater empathy and understanding of each other, which can come in handy when trying to resolve disagreements in a healthy manner.

4. Improved emotional state – Through strategic family therapy, people are able to better regulate their emotions in stressful situations. This can help families to better cope with difficult circumstances and be more resilient when dealing with life’s challenges.

5. Support system – Finally, strategic family therapy provides an environment that is built on trust and understanding, which gives the members of the family support and security. This can give each individual within the family a sense of confidence and security, which can have a positive impact on their overall well-being.

By implementing strategic family therapy, families can be better equipped to handle difficult topics in healthy ways. And create strong relationships within the family unit. It is important to note that strategic family therapy should be used in combination with other therapeutic approaches. As it may not be suitable for all types of family dynamics .

How Effective Is Strategic Family Therapy For Families?

• communication problems
• relationship issues
• psychological issues

It can help to break cycles of negative behavior and improve the functioning of all members of a family. It is estimated that strategic family therapy can help 90% of families who seek it.

The focus of strategic family therapy is to identify the underlying causes of dysfunctional behavior within the family. Then develop strategies to address those issues. Through this process, all members of the family collaborate in developing solutions and learning communication and problem-solving skills.

How To Find The Family Therapist Near Me?

As strategic family therapy is becoming more widely accepted, it’s important to find a family therapist that is experienced and specialized in the particular issue or challenges you are facing. Here are some tips to help you find the best family therapist near you:

1. Ask for referrals from friends and family – It’s always a good idea to ask your close ones who have been in similar situations for recommendations. This can help narrow down your search and make sure you’re getting the best treatment possible.

2. Check professional organizations – Professional organizations have a comprehensive list of licensed therapists in your area. Along with detailed information on their qualifications and specialties.

3. Ask your healthcare provider – Your doctor might be able to refer you to a family therapist they’ve worked with in the past or make recommendations on where to look.

4. Look online – Many family therapists have their own websites or can be found on online therapist directories. Before booking an appointment, make sure to read through the reviews and do some research on their qualifications.

When you’ve found potential therapists in your area, schedule a consultation call. So you can get answers to any questions you might have and ensure they are the right fit for you and your family. Ultimately, it’s important to take time and find a professional that is experienced, compassionate, and understands your needs.

In conclusion, strategic family therapy is a highly effective and evidence-based intervention that can be used to help families with a wide variety of problems. It is designed to quickly identify underlying issues and create lasting change in the family system. Strategic family therapy is cost-effective, time efficient, and provides long-term benefits for families.

By using this approach, therapists can facilitate meaningful conversations between family members. And help them develop healthier relationships. Thus, do not forget the power of strategic family therapy and its ability to improve the quality of life.

For more information, please contact MantraCare. Parenting is a challenging yet rewarding experience that is crucial for the development and well-being of a child. If you have any queries regarding Online Parenting Counseling experienced therapists at MantraCare can help: Book a trial therapy session

Mantra Care aims at providing affordable, accessible, and professional health care treatment to people across the globe.

Online Therapy Physiotherapy Diabetes Hypertension Weight Loss / Gain Primary Care

Employers / Corporates Health plans Doctors / Providers Therapists

About Mantracare Careers Blog Contact Us

Download Our App

Privacy Policy | Terms of Use | Refund Policy | Our Locations

Try MantraCare Wellness Program free

" * " indicates required fields

How to Be Your Own Relationship Therapist: 7 Skills

Try looking at your problems and relationships through a different lens..

Updated June 2, 2024 | Reviewed by Kaja Perina

• What Does "Self Help" Mean?
• Find a therapist near me
• One of the advantages therapists have is seeing your problems through the lens of a neutral outsider.
• It's important to define problems concretely, look for patterns, and sort out problems of skill vs. emotions.
• By stepping back, finding the problems under the problem, you can discover what keeps you from solving it.

While you will probably never fake being a neurosurgeon , an airline pilot, or even a therapist, of the three, the therapist may be the easier. Yes, therapists go to graduate school for several years because there is much to learn, but at a basic level, part of what makes therapy effective is that the therapist, as the neutral outsider looking through a particular lens, can see things you can’t. But that being said, there are specific basic skills you can apply that may help you in your everyday life and relationships. Here’s my list of the top seven:

#1: Define your problems as clearly as possible

"I want us to be happy, communicate better, and have my kids behave." These are understandable problems but essentially unsolvable. To tackle a problem, you need to boil it down to an image or behavior: What does being happy, communicating better, or having your kids behave look like? By moving towards the concrete, you have something solid to strive for.

#2: Make language explicit

Just as making problems clear helps you know what to concretely strive for, making language clear helps draw out underlying emotions. This can be helpful for you, but it is especially useful if you’re helping a friend, child, or partner. When your friend says they’re “okay” and you ask what okay means, they emotionally drill down—they’re bored , mildly upset, better than yesterday. Explicit language is the gateway to more explicit emotions, and more explicit emotions are the gateway to defining the problem and solution.

#3: Think like an adult and ask hard questions

Just as your doctor compares your current physical state to those of other healthy adults, therapists, in their more objective, outsider stance, do the same, allowing them to ask the hard questions: If you’re complaining that you’re constantly arguing with your partner, why don’t you stop? If you hate your job, why don’t you quit and look for another? If you want to go to college or make pizzas, what stops you?

The key here is stepping back and taking problems at face value, wondering why, as an adult, you or the person you’re talking with can’t do what they want to do.

#4: Look for the problem under the problem

Usually, the answer is that there’s an underlying problem: You can’t stop arguing because you get triggered by a previous conflict or trauma ; you don’t quit your job because you fear that you can’t find another. What we often label as problems in ourselves—not paying your bills on time—and in others—your partner’s drinking—are usually bad solutions to other problems. Your partner is drinking because he is depressed or stressed about a current problem; you’re not paying your bills, which may be a symptom of AD/HD or anxiety about your credit card debt.

You always want to dig down and look for the obstacle under the problem that keeps you from moving forward to put the problem to rest.

#5: Sort skills vs. emotions

Most often, problems can be broken down into two types: those driven by a lack of skills and those by emotions: Your son isn’t doing math homework because his teacher is moving too fast; you feel underpaid but resist asking your supervisor for a raise. You want to drill down and find the culprit: Your son can't grasp the skills and needs outside help; you're afraid of asking for a raise because you fear conflict or your depression . Rather than beating yourself up for not doing anything, find out why you're not doing anything to move forward: Is it about skills or emotions or both?

#6: See control as anxiety

Sometimes, control is about raw power, ego, and dominating others—these are the power-hungry bullies of the world, but they are the minority. In most close relationships, the driver is anxiety—I’m worried, and if I can get you to do what I want you to do, I’ll feel better. What your partner or child hears is not anxiety but control. They feel micromanaged, which, in turn, stirs resentment and a power struggle.

If you’re the one feeling controlled, try seeing the other's control as anxiety. Rather than saying, “Leave me alone,” ask, “What are you worried about?” If you’re the controller, help others understand your worry.

#7: Look for patterns

Our close relationships are driven by how we’ve come to bounce off each other and form patterns. Some patterns are neutral or productive—how we work together when cooking—while some are destructive—how we argue. Thinking and looking for behavioral patterns are helpful in two ways: One is that it helps you separate that unusual event—the “perfect storm”—from a more regular pattern that needs to be addressed. You get into a stupid argument with your partner but realize later that it was atypical because you both were stressed and exhausted; you let it go. But if it happens on a regular basis, an ongoing pattern, maybe it’s time to take action.

Recognizing negative patterns in patterns is also the key to mending relationships. The therapeutic mantra here is that the pattern is always more powerful than the people. Rather than focusing on getting the other to change, focus instead on the pattern—the way you both get triggered and go on autopilot. Then, focus on changing your side of the behavioral equation—how you flare up or shut down. Change your behaviors, which, in turn, will help the other person change theirs as well.

There you have it, a possible foundation for looking at your problems and relationships in hopefully a different and more productive way. See where you have the most trouble, and experiment with tackling those problems one at a time. Keep in mind it’s not about doing it right; it’s about doing it differently.

Taibbi, R. (2022). Doing family therapy, 4th ed. New York: Guilford.

Bob Taibbi, L.C.S.W., has 49 years of clinical experience. He is the author of 13 books and over 300 articles and provides training nationally and internationally.

• Find a Therapist
• Find a Treatment Center
• Find a Psychiatrist
• Find a Support Group
• Find Online Therapy
• United States
• Brooklyn, NY
• Chicago, IL
• Houston, TX
• Los Angeles, CA
• New York, NY
• Portland, OR
• San Diego, CA
• San Francisco, CA
• Seattle, WA
• Washington, DC
• Asperger's
• Bipolar Disorder
• Chronic Pain
• Eating Disorders
• Passive Aggression
• Personality
• Goal Setting
• Positive Psychology
• Stopping Smoking
• Low Sexual Desire
• Relationships
• Child Development
• Self Tests NEW
• Therapy Center
• Diagnosis Dictionary
• Types of Therapy

At any moment, someone’s aggravating behavior or our own bad luck can set us off on an emotional spiral that threatens to derail our entire day. Here’s how we can face our triggers with less reactivity so that we can get on with our lives.

• Emotional Intelligence
• Gaslighting
• Affective Forecasting
• Neuroscience