1. CHANGE strategies:
PROBLEM SOLVING A (analyse problem) & B
(choose solution-solution analysis)
• A UNDERSTAND AND ACCEPT the problem
at hand (behaviour analysis techniques,
insight techniques)
• B generate, evaluate and implement
ALTERNATIVE SOLUTIONS (solution
analysis techniques & get commitment to act)
2. Before and during PROBLEM SOLVING:
orient the client
• orient client to DBT and to HER ROLE in
therapy
• Use list of TARGET BEHAVIOURS
• EXPLAIN problem-solving strategies
• REHEARSE with client exactly what she is to do
in trying to respond to the problem
3. PROBLEM SOLVING A (analyse problem)
•1 Define the behaviour: choose
focus, formulate, describe
•2 Chain Analyse target
behaviours
4. PROBLEM SOLVING A (analyse problem)
• 3 Formulate the problem: in terms of client’s
or therapist’s behaviour
• 4 Provide insight highlight, observe and
describe patterns, comment on implications of
behaviour, assess difficulties in
accepting/rejecting hypotheses
• 5 Be didactic provide information, reading,
family sessions
5. PROBLEM SOLVING A (analyse problem)
• 1 Define the behaviour:
•
• choose focus: Use the target hierarchy
• Describe: the problem specifically
• Validate: the client’s distress
6. Problem-solving
• 2 CHAIN ANALYSE TARGET BEHAVIOUR
• Choose specific instance
• Links: where to start? Filling in the links
• Where to stop?
• Analyse in-session behaviours
• Watch out for therapist and client avoidance!!
7.
8. PROBLEM SOLVING A (analyse
problem)
• 3 Formulate what?
• Target behaviours and their precursors
• Observable events
• Current events
9. PROBLEM SOLVING A (analyse problem)
3 Formulate how?
1 Generate hypotheses about factors
controlling behaviour ABC
• Use theory to guide analysis
• Look for unbearable emotion as antecedent
• Look for negative reinforcement (escape)
10. PROBLEM SOLVING A (analyse problem)
• 4 provide insight: how?
• Highlight: patterns of behaviour
• Observe and describe: recurrent patterns
• Comment on implications
• assess difficulties in accepting/rejecting
hypotheses
11. PROBLEM SOLVING A (analyse problem)
• 4 provide insight: how?
• Be non-judgmental
• observe the effects of formulation and
react
• surround insight with validation
12. PROBLEM SOLVING A (analyse problem)
• 4 provide insight: how?
• Base explanations on bio-social theory, rules
governing client’s behaviour
• use DBT assumptions (client is trying her best
etc)
• Use non-pejorative language
13. PROBLEM SOLVING A (analyse problem)
• 5 be didactic
• Give reading, websites,videos, DVDs
• Give info to family/friends/carers
14. PROBLEM SOLVING B (solution analysis)
•
• 1 INDENTIFY WANTS, NEEDS and GOALS
(life-goals)
• 2 GENERATE SOLUTIONS
• 3 EVALUATE solutions generated
• 4 choose a solution
• 5 TROUBLESHOOT review ways in which
attempts to solve problem can go wrong.
15. PROBLEM SOLVING B (solution analysis)
• 2 GENERATE SOLUTIONS
• Brainstorm every possibility
• Suspend judgment
• Be irreverent if appropriate
16. PROBLEM SOLVING B (solution analysis)
• 3 EVALUATE solutions generated
• Pros & cons
• Give points
• Reject immoral/impractical
• Do not accept ‘I can’t’
17. PROBLEM SOLVING B (solution analysis)
• 4 choose a solution
• Select most effective remaining option
• Use mindfulness & commitment strategies to
address ‘I can’t’ and ‘I won’t’
• Obtain promise to implement solution
18. PROBLEM SOLVING B (solution analysis)
• TROUBLESHOOT potential pitfalls/obstacles
• Anticipate what might go wrong
• Make plans to cover these eventualities
• Obtain commitment to implement these plans
• Reinforce all desired behaviour in solution
analysis session
19. Consult group
• Use problem analysis and solution analysis in
consult group meetings
