Problem-Solving Therapy

According to D'Zurilla and Nezu, problem solving consists of five skills. The first is problem orientation, which is concerned with how one views his or her ability to cope with a problem. The second is problem definition, which is concerned with the specific and concrete definition of the problem, and setting achievable and definable goals. The third skill, generation of alternative solutions, involves creating various methods for solving problems and meeting one's goals while withholding judgment on their effectiveness. The fourth skill, decision making, involves a systematic process to select the best solution for a problem from the list generated. The fifth and final skill, solution implementation and evaluation, involves planning and initiation of solutions, and subsequently evaluating the success of the solution. The intervention is delivered over ten to twelve sessions. The first session covers education about depression and explication of the model. It is important to educate older people about what depression is and how this therapy works because so many older adults hold inaccurate ideas about depression and are afraid of psychotherapy. After this introduction, the next five sessions focus on teaching each of the skills. It is important that these skills be taught sequentially, rather than all at once. Older people generally need a longer period to process new information, and allowing more time for discussion of each step facilitates learning. After each skill is taught and practiced, the remaining sessions are spent using the model to solve the patient's problems. Guided practice is particularly important in teaching new psychosocial skills. The more opportunities older people have to practice new behavior, the more likely they are to retain the skills and use them in the future.