Healthcare Training Institute - Quality Education since 1979
CE for Psychologist, Social Worker, Counselor, & MFT!!
5 CBT Components of Problem Solving Continued
♦ Component #3 - Decision Making
At the initial session, she weighed 161 pounds; 30 pounds over her ideal weight. She reported that she felt trapped; she saw her weight as a major contributor to her depression. Yet when feeling depressed, she often used food to make herself "feel good." Often she engaged in nighttime eating episodes in which she consumed excessive amounts of calories. The following day she would not only feel depressed, but she would also feel guilty about her overeating.
Wendy's List of Alternatives to Deal with her Weight
--Quantity of thinking Exercise (Part 1): Here is an exercise based on Guilford's Brick Test. I told Wendy, "An employer has hired you to assist him in developing new uses for his products. Here's what I would like you to do. Spend the next few minutes thinking about this problem. After three minutes, I will ask you to tell me what you have come up with." After 3 minutes had elapsed, I asked Wendy to describe her ideas.
--Quantity of thinking Exercise (Part 2): For part two of the exercise, I instructed Wendy, "Now what I would like you to do is to use the next three minutes making a list of all the possible uses for bricks. This time, however, I would like you to take this piece of paper and make a written list, following two rules. First, you should generate as many responses as possible. Second, you should combine and improve responses to develop new possibilities."
When the quantity exercise is effective, patients typically are more productive using the "quantity-listing" instructions than the suggestion to "spend a few minutes." I have found that asking my clients to "spend the next few minutes thinking," typically results in five or fewer responses. Asking my clients to create a list increases their responses to 10-20. I have found that quantity training involves substantial practice. The use of impersonal examples facilitates practice in creativity and flexible thinking.
However, I have found it is also important to focus heavily on your client's real-life problems, so that this approach does not seem personally irrelevant. For personal situations, patients should be encouraged to produce as many ideas as possible for each identified goal or sub-goal. This often allows identification of a variety of effective solutions that can ultimately be implemented to attack the problem from a number of perspectives.
Moreover, a judgmental stance may cause the patient to be overly concerned about producing the right answers, thereby inhibiting productive and creative thinking. In applying this principle, you should instruct your client to suspend judgment and to avoid criticism when generating alternatives. I encouraged Wendy to be creative by letting go of her imagination.
I have found that getting depressed clients to delay self-criticism of their thinking is often a difficult task. It was not unusual during the generation-of-alternatives for Wendy to be unable to think of a single possibility. I told Wendy, "It is OK to make up an answer." The process of making up something is virtually identical to creatively generating a potential solution. A key distinction, however, rests in the extra degree of permission granted by the instruction, "Make up a response."
For many of my clients, instructing them to "make up a response" enables them to establish some distance from their responses. They are less inhibited in generating made-up responses because such responses are not expected to be perfect. In effect, the instruction to make up something gives the patient the freedom to generate alternatives without responsibility for coming up with good solutions.
She also developed a variety of specific, concrete actions or tactics to implement the strategy. Using the strategy-tactics principle, I encouraged Wendy to think of a wide range of possible solutions across a variety of strategies rather than to focus on one or two narrow tactics. For example, in completing the brick exercise, Wendy could think only in terms of one common strategy, namely, using a brick as a construction material. Often the potential solutions that my clients generate are simply multiple tactics representing one general strategy (for example, constructing a fireplace or patio, or building a wall or garage).
In such an instance, the individual may generate a quantity
of tactics, but overall problem-solving effectiveness is likely to be limited
by the use of only one strategy. I have found that a more effective approach to
generating alternatives includes several strategies along with multiple tactics
for implementing those strategies. For instance, alternative strategies for the
brick exercise might include their use as recreational objects like playground
blocks for children, artistic substances such as raw material for sculptures,
or athletic equipment such as a "brick shot put".
On first inspection, it would appear that Wendy had generated a quantity of reasonable solution ideas for dealing with the identified problem. In reviewing her list of alternatives, Wendy and I attempted to group her coping options into classes of strategies that reflected a common theme. We found that all her responses were related to dieting, and I was concerned that she had selected only one general strategy for coping with the problem. The strategies and tactics principle suggests that the greater the number of different approaches to the problem, the greater the chances of success.
In this case, the particular strategy that Wendy chose was one that was unlikely to be effective, simply because excessive dietary restraint is likely to prompt overeating and an eventual weight gain. After reviewing the strategy-tactics principle, Wendy and I attempted to generate a variety of strategies in addition to dieting. Furthermore, Wendy used the first two brainstorming techniques, the quantity and deferment-of-judgment principles, to generate several specific tactics for each new strategy that she devised.
Wendy's Revised List of Strategies
3 Guiding Principles of Brainstorming