Chapter 9

Problem Solving—Finding a Better Way

My hope is that you’re becoming more aware of your own thoughts. Did you try looking for evidence for one of your hot thoughts? Did you try writing out the evidence for and against a client’s hot thought? What did you learn from the homework?

If you did not try any of the homework from the last chapter, take a moment to think of a difficult situation from last week. Identify your hot thought, and now look for the evidence.

Set the Agenda

In this chapter I am going to cover problem solving. We’ll also see how a problem-solving approach can help Raoul and Suzanne address the various issues they bring up in therapy.

Work the Agenda

One of the strengths of CBT is the universality of the approaches. All people encounter problems, and everyone can benefit from a step-by-step approach to solving them.

Agenda Item #1: What Is Problem Solving?

Problem-solving therapy was originally developed by D’Zurilla and Goldfried (1971), and although it has been revised over the years (D’Zurilla & Nezu, 2006), the core process and principles have remained essentially the same.

Overview of the Problem-Solving Process

Problem solving involves both an attitude that problems can be solved or at least improved, and a process based on a specific set of skills. The process of problem solving has four distinct steps. For many clients, you will want to go through the whole problem-solving process step by step; however, for some clients, you may use only parts of the process. Below are the four steps.

  1. Identify the problem and set realistic goals.
  2. Generate new solutions. This is often called brainstorming.
  3. Evaluate the different solutions and decide which one to try.
  4. Try one of the solutions: evaluate the consequences and decide whether the problem is solved or whether you need to continue to problem solve.

You can find the Problem-Solving Worksheet at http://www.newharbinger.com/38501. The worksheet summarizes the steps and includes helpful questions for each section. You can use the worksheet as a guide for therapy as well as a handout to give your clients.

The Theory Behind Problem Solving

The theory underlying problem solving is that clients’ emotional distress is due to poor problemsolving skills which lead to dysfunctional ways of coping. Poor problem solving leads to more problems, which in turn are poorly solved. Clients quickly find themselves dealing with multiple problems and it becomes a vicious negative cycle. Problem solving stops the vicious cycle and helps clients find better ways to cope (D’Zurilla & Nezu, 2010).

When you help your client find solutions to his problems, you are also saying, “You matter, I care about your welfare, and together we can figure out how to address your problems.” These are very powerful messages. For many clients the whole problem-solving process feels new and empowering.

Is Problem Solving Effective?

Let’s look at the research. Good problem-solving skills are consistently associated with better overall emotional adjustment, and poor problem-solving skills are associated with more distress and poorer adjustment (D’Zurilla & Nezu, 2010). For example, poor problem-solving skills are related to drug and alcohol addiction, criminal behavior, and psychological distress. The good news is that individuals with good problem-solving skills are less likely to become depressed after a stressful event (Nezu, Nezu, Saraydarian, Kalmar, & Ronan, 1986).

Over the past three decades, a large number of studies have demonstrated that problem solving is an effective treatment for depression (Bell & D’Zurilla, 2009), anxiety, and a variety of other mental health problems (D’Zurilla & Nezu, 2010; Malouff, Thorsteinsson, & Schutte, 2007). Problem solving has also helped people learn to cope with serious physical illnesses such as diabetes (Glasgow, Toobert, Barrera, & Stryker, 2004) and cancer (Nezu, Nezu, Felgoise, McClure, & Houts, 2003). Interventions that focus on developing a positive problem-solving attitude as well as teaching problem-solving skills seem to be the most effective (Bell & D’Zurilla, 2009).

Agenda Item #2: Develop a Positive Problem Orientation

A positive problem orientation is a core element of good problem solving. The table below compares the beliefs of individuals with positive and negative problem orientations (Nezu, Nezu, & D’Zurilla, 2013).

Characteristics of a Positive and Negative Problem Orientation
Positive Problem Orientation Negative Problem Orientation

Problems are a challenge. It is possible to improve most situations.

One has the ability to successfully solve problems or make the situation better.

Successful problem solving takes time, effort, and persistence. Initial failure is part of finding a solution.

Problems are unsolvable and frightening. It is useless to try to improve most situations.

One does not have the ability to successfully solve problems or make the situation better.

Initial failure means the problem cannot be solved.

Individuals with a positive problem orientation see difficulties as normal life challenges and try to find solutions to their problems. Individuals with a negative problem orientation tend to either avoid their problems or approach them with an impulsive or careless problem-solving style. Clearly, a positive orientation is better, but how do you help your clients develop one?

Modeling optimism and having faith in your client’s ability to problem solve is one of the most effective ways to help your client develop a positive problem orientation. Here are some phrases I use to encourage a positive problem-solving orientation:

Such relatively simple interventions communicate that you believe in your client’s ability to find a better solution, and that together you will be able to improve his life. You will also find that as your client uses the problem-solving process successfully, his problem orientation will start to automatically become more positive.

Let’s see how Raoul’s therapist helps him develop a more positive problem orientation. Raoul was telling his therapist about his poor relationship with his boss, who gave him a poor work evaluation.

Raoul: I feel so depressed when I think of going to work. I used to like going to work, but I feel so awkward and anxious with my boss since I received the poor work evaluation. I think we have a terrible relationship. It just seems hopeless to do anything about it.

Therapist: I hear you’re thinking that it is hopeless to try and change your relationship with your boss, is that right?

His therapist has identified a negative problem orientation: It is hopeless to try and change the relationship with his boss.

Raoul: Definitely, what can I do?

Therapist: I am wondering if you would be willing to put aside the thought that it is hopeless to do anything and see if we could find some better ways to cope with the situation, to help you feel better.

Raoul: What do you mean?

Therapist: Well, when you tell yourself that it’s hopeless, how does that affect your behavior?

Raoul: I just avoid him, and keep doing the same old thing.

Therapist: And does avoiding help?

Raoul: No, in fact, it is getting worse. I just feel more and more awkward.

Therapist: I am wondering if you would be willing to work with me to see if we could problem solve some different ways of coping with your boss that might improve the situation.

Raoul: I would be willing, but I don’t think we will find any.

Therapist: You may be right, but I want to see if we put our heads together if we could find a better way for you to cope.

Notice how the therapist acknowledges that Raoul might be right but asks him to try problem solving. The therapist is modeling a calm, thoughtful approach to the problem.

Agenda Item #3: Identify Your Client’s Problems

Before your client can solve his problems, he needs to identify them. Defining the problem and setting realistic goals are the first components of a problem-solving skill set. Problems can be a one-time event, such as a divorce or a serious health problem. They can be situations that happen fairly regularly, such as disciplining a child who refuses to do chores, fighting over finances with a partner, or dealing with constant daily difficulties such as a long commute to work, chronic pain, or loneliness.

Sometimes it is very clear that a client needs help problem solving. A client may start therapy saying, “I don’t know what to do about X,” or one of your client’s thoughts may be, What else can I do? or I don’t know how to handle this. In other cases, it can be more difficult to identify your client’s need to problem solve. Clients with a negative problem orientation often avoid their problems but feel anxious. It is helpful to teach a client who tends to avoid that if he is anxious, he should ask himself whether there is a problem he is not looking at.

Problem Definition

The more specific and concrete the problem, the easier it will be to think of helpful solutions. For example, “I don’t communicate well with my partner” is a very vague problem and hard to start solving, whereas, “My partner and I don’t agree on how to discipline our children” is much clearer and an easier problem to address.

Raoul had started his therapy session by saying in a low voice, “I feel so depressed when I think of going to work. I used to like work, but I feel so awkward and anxious with my boss since I received the poor work evaluation. I think we have a terrible relationship. It just seems hopeless to do anything about it.”

At this point, Raoul’s problem is not very specific. His therapist uses the questions under “Questions to Help Define the Problem” in the Problem-Solving Worksheet to help Raoul become more specific and concrete. Sometimes you may want to use all of the questions, and sometimes only a few may be relevant. You can find Raoul’s answers in the table below.

Raoul Defines His Problem
Questions to Help Define the Problem Raoul’s Answers

What happened or did not happen that bothers your client?

Raoul’s boss handed him his poor work evaluation, but his boss has never talked to him about it.

Tension between Raoul and his boss

Presently, almost no casual contact with his boss

Boss never asks for his opinion, never chat together, boss often ignores him

Who is involved? Where does the problem happen? When does the problem happen?

The problem involves Raoul and his boss; it happens at work during the day.

Why is this problem difficult for your client?

Raoul feels ashamed about the poor work evaluation.

Raoul feels judged, hates work, has trouble concentrating, and thinks everyone knows about his problems with his boss.

Raoul does not know what to do about the poor evaluation.

What does your client currently do to handle the problem? Is your client avoiding or acting in an impulsive manner?

Raoul tries to avoid interacting with his boss. In the past, Raoul used to drop by his boss’s office in the morning for a five-minute chat; he used to ask his boss for his opinion on a project. Now Raoul goes straight to his desk.

What does your client hope will happen as a consequence of his/her behavior?

Raoul hopes “things will go back to normal.”

Setting Goals

Both Raoul and his therapist now have a much better sense of his problems. The next step is setting goals. Goals need to be specific and concrete, realistic, and possible to accomplish. You also want to articulate both short-term and long-term goals. For example, a short-term goal might be becoming more assertive with your boss and asking for an extra two weeks of holiday time during the Christmas season, but that might conflict with the long-term goal of being seen as a team player and getting a promotion.

Often after your client answers the questions to help define the problem on the Problem-Solving Worksheet, his goals are clear. If your client’s goals are not clear, the following questions may be helpful.

When Raoul’s therapist asked how he would like the situation to change, Raoul responded that he wanted “everything to go back to normal.” This is not a very specific goal. His therapist then asked how he would like his boss to change and if there were ways that he would like to change. Raoul explained that generally he wanted to have a good relationship with his boss again. He wanted his boss to joke with him and talk to him easily. He also wanted to be comfortable asking his boss for his opinion about projects. As Raoul articulated his goals, he realized that he also wanted to understand his negative work evaluation better. When a client slows down and examines his problems and goals, he often realizes aspects of the problem that are important to him that he had not focused on before.

You can also identify goals by paying attention to what your client hopes will happen as a consequence of his current behavior. As ineffective as their behavior may be, most people act in a way that they hope will make their situation better. In Raoul’s case his therapist could have asked, “What are you hoping will happen when you avoid your boss?”

Once you have identified your client’s goals and explored what he hopes will happen as a consequence of his behavior, it is important to examine the actual consequences of his behavior. Unless your client understands that his behavior is ineffective, he will not be motivated to problem solve. In Raoul’s case, he hoped that by avoiding his boss everything would “go back to normal.” When his therapist asked Raoul what were the consequences of avoiding, Raoul quietly acknowledged that it was not helping, and was in fact making things worse.

Explain Problem Solving to Your Client

Once you have established that what your client is currently doing is not working, it is a good time to explain problem solving. You want to give your client an overview of the process and instill hope that problem solving can help. Here is how I explain problem solving (you can find a copy of this script at http://www.newharbinger.com/38501):

We have been talking about your problem and how hopeless you feel. Sometimes people get into negative cycles and don’t see alternative possibilities. I am wondering if you would be willing to see if we could find some other ways of coping with your problem. I want to explain a process called problem solving. We start with identifying a specific problem and then we brainstorm to try to think of different possible solutions. We are looking for as many solutions as we can find, without judging them. Once we have thought of some alternative ways of handling your problem, I want to spend some time evaluating the different solutions to see if there is one that makes more sense. Would you be willing to try?

Your Turn! Practice in Your Imagination: Explain Problem Solving

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I would like you to imagine explaining problem solving to a client. Before you start, rate from 1 to 10 how comfortable you feel explaining problem solving. At the end of the exercise, rate your level of comfort again to see if it changed. Now, let’s try this exercise.

Choose a specific client who you think would benefit from a problem-solving approach. Imagine that your client has identified a problem and you want to explain problem solving. Try to get a picture of him or her in your mind. Imagine yourself in your office with your client. See your office; notice the sounds and smells in the room. Read over how I suggest explaining problem solving while imagining yourself saying the words. You can also use your own phrases. Really hear and feel yourself explaining problem solving. Imagine explaining problem solving two more times with the same client. Each time, imagine that your client responds positively.

Agenda Item #4: Brainstorm Solutions

The next phase involves helping your client find new solutions for his problem. Finding new solutions to problems is difficult—if clients knew of better ways to manage their lives, they would already be doing things differently. Problem solving involves asking your client to step outside of his usual mind-set. You want to engage in a process called brainstorming, which means coming up with as many varied solutions as you can. When brainstorming, it is helpful to follow these three principles:

Include a few far-fetched and seemingly impossible solutions; they can help your client think outside the box. Sometimes combining a far-fetched solution with another solution can lead to a good solution.

Finding New Solutions

It can be very hard not to jump in and solve your client’s problems. Ideally, brainstorming new solutions is a collaboration between therapist and client. The more your client can discover his own solutions, the more empowering the process will be. I start with asking my client for his suggestions. Often, all I need to say is, “I wonder if there are some other ways of handling this situation.” If I think of a specific strategy that my client did not mention, I usually say, “I have an idea that might help. Let’s see if you like it.” If my client likes the suggestion, I encourage him to apply the strategy to his specific problem.

For many of your clients, the process of stopping and consciously looking at their problems will naturally lead to thinking of new, effective solutions. However, some clients find it hard to think of alternative ways of handling their problems. Try the “Questions to Help Find New Solutions” list on the Problem-Solving Worksheet. Below are the questions.

Let’s see how Raoul’s therapist helps him brainstorm. Initially Raoul has some difficulty finding alternative solutions. However, his therapist maintains an optimistic attitude and sticks to problem solving.

Therapist: Right now you are avoiding your boss, and you were saying that it doesn’t seem to be improving the situation. Let’s see if we can think of some other things you could do. I want us to write down everything we think of. In this early stage, we’re looking for quantity and variety of solutions. Every idea is a good idea. Later we’ll figure out which one we want to use.

Notice how his therapist explains the principles of quantity, variety, and deferred judgment.

Raoul: Anything I can think of just seems impossible.

Therapist: You may be right, but let’s see if we can think of what you could do to improve your relationship with your boss.

Notice that Raoul’s therapist acknowledges that he might be right but maintains an optimistic attitude.

Raoul: I think that the best solution may be to get out of the department and ask for a transfer.

Therapist: So one option is to ask for a transfer. Any other options you can think of?

Raoul: I could just keep doing what I am doing; it is not going so badly. I’ve also thought of asking a friend who works in another department if he had any ideas.

Therapist: We have a couple of solutions; let’s write them down. First, ask for a transfer; second, keep doing what you are doing; and third, ask a friend for advice. I’m going to ask you some questions to see if they help you come up with any other solutions. I’m wondering…if a colleague had this problem, what would you suggest to him?

Notice how Raoul’s therapist starts with a summary statement to indicate she heard Raoul, and then follows up with a question from the “Questions to Help Find New Solutions” list.

Raoul: That’s easy, but I don’t think it would work for me.

Therapist: You might be right, but let’s look at what you would suggest in any case.

Raoul: Well, the first thing I would suggest is that my colleague stop avoiding his boss and behave in a friendly manner.

Your Turn! Help Raoul Find New Solutions

Raoul’s suggestion that he stop avoiding his boss and behave in a friendly manner is a good overall strategy, but it is not very concrete.

Look at the three possible responses below and pick the one that will help Raoul be more specific and concrete.

  1. Great suggestion. I wonder if you started generally participating more in meetings whether that would be helpful.
  2. When you think of being friendlier, what are your thoughts?
  3. If your colleague wanted to stop avoiding his boss and be friendlier, what are some things he could do?

    Response #3 is the most likely to help Raoul develop specific and concrete solutions. In response #1, the therapist is solving the problem for Raoul. Response #2 would be a good question if we had a specific, concrete solution, but it is too soon in the problem-solving process.

  4. Therapist: If your colleague wanted to generally stop avoiding his boss and be friendlier, what are some things he could do?
  5. Raoul: (laughing slightly) Well, I guess I would suggest saying hello to his boss before meetings, speaking up at meetings, and probably letting his boss know how some of his projects are going.
  6. Therapist: Could we put these down as possible solutions for you? (Raoul nods and smiles.) You’ve come up with quite a long list.

Look at the three possible responses below and pick the one that will help Raoul continue to find alternative solutions.

  1. I’m wondering whether we could find more solutions. What would someone who knew you well suggest as a solution?
  2. What are the obstacles to starting to speak up at meetings?
  3. Let’s make a plan for when you could start speaking up more at meetings.

    Response #1 is the most likely to help Raoul continue to find solutions. Responses #2 and #3 would be good responses if Raoul had already picked speaking up at meetings as a solution; however, he has not yet finished listing all of his possible solutions.

  4. Therapist: I’m wondering whether we could find more solutions. What would someone who knew you well suggest as a solution?
  5. Raoul: Honestly? I think my wife would suggest that I wait until the next evaluation, which is in six months, before I do anything. My daughter would suggest that I make an appointment with my boss to talk about the poor work evaluation. But that’s totally impossible for me to do. I would just be too anxious.

Often when clients think of an assertive response, they immediately back away. It just feels too hard. That’s what happened when Raoul thought of talking to his boss about his poor work evaluation. It is worthwhile spending some time exploring what exactly your client could say. Often when clients have a concrete scenario, the assertive response feels more doable.

Here is Raoul’s list of possible solutions:

  • • Keep doing what I am doing
  • • Ask for a transfer to another department
  • • Ask a friend for advice
  • • Talk to my boss before meetings, participate in meetings, and tell my boss how my projects are going
  • • Wait for next evaluation
  • • Arrange a meeting with my boss to discuss my evaluation

Agenda Item #5: Choose a Solution

For many clients, calmly evaluating different solutions is a new and empowering experience. You want your client to evaluate the likelihood that the different solutions will either resolve or improve the problem. I teach my clients to ask themselves the following questions from the Problem-Solving Worksheet so that they can make an informed choice.

If my client finds the concept of benefits and drawbacks too abstract, I ask, “If you use this solution, what are some of the good things that might happen and what are some of the bad things that might happen?” We make a chart and write down the answers; clients can then take the chart home and spend more time thinking about the decision. Below are some of the questions that I ask to encourage clients to think about the short-term and long-term consequences of each solution.

Raoul has a large number of solutions; it’s hard to evaluate all of them. His therapist asked him to pick three solutions to evaluate. Below is how Raoul completed his evaluation. You can download the worksheet Benefits and Drawbacks of My Solutions at http://www.newharbinger.com/38501.

Benefits and Drawbacks of My Solutions
Solution Short-Term Benefit Short-Term Drawback Long-Term Benefit Long-Term Drawback

Ask for a transfer

Will get me out of the office

A change might be good

I have to tell my boss, and until I leave it will be worse

Applying for a transfer is difficult, hard to get a good reference, can take a long time

It might lead to a better situation

I lose some of my seniority if I change departments

Next job might be worse

Talk more with boss; discuss projects, etc.

Relationship might improve

Fairly easy to do

Does not address the poor work evaluation

Relationship might improve

Still do not understand poor work evaluation

Meet with boss to discuss poor work evaluation

Might resolve the issue

Might make it worse; could find out boss very critical of my work

High anxiety

Ideally will help with relationship and work performance

Might make it impossible to stay in job

Once Raoul and his therapist had evaluated the three solutions, his therapist asked him to summarize the benefits and drawbacks of each solution.

Asking for a transfer: It might make me feel good initially, but it will be a lot of work and may not lead to a better solution. Plus, I lose my seniority.
Talk more with the boss: It might help with the relationship. There is no real risk. Only problem is that it does not address the poor work evaluation.
Meet with boss to discuss poor work evaluation: The most high risk and the hardest. Might be the best solution, but might make it hard to stay.

When Raoul evaluated the different solutions, it was clear that asking for a transfer was not a good idea. He decided he wanted to start with dropping by his boss’s office to chat and also try talking to his boss about different projects he was working on. He wanted to see what happened when he started talking more to his boss before deciding whether he wanted to discuss his poor work evaluation with him.

Make a Plan

Next, your client needs to develop a plan for implementing the solution he chose. Make sure that the plan is specific and concrete. It is helpful to write out what your client will actually do. Next, specify a first step to the plan and a time and date when your client will try the first step to the solution. You also want to check if there are any obstacles to the plan, and try to address them.

Raoul decided he wanted to try dropping by his boss’s office the next day. He had meetings on Monday, Wednesday, and Friday, and he would make a point of getting there early to chat with his boss before the meeting.

Prepare for the Worst

Sometimes your client wants to try a solution where there is a realistic possibility of a negative outcome. For example, my client Julia decided to disclose to her partner that she had been sexually abused as a child, even though she knew there was a realistic possibility her partner would blame her for the abuse. Other clients have raised various difficult issues with their bosses, partners, and friends, hoping to improve the relationship, but instead the discussion resulted in increased tension. You want to be sure your client understands the realistic risk of a negative reaction and is prepared for that should it occur.

Use Imagery to Practice

Rehearsing using imagery is an opportunity to practice the new solution and to check if there are any obstacles. I ask my client to imagine doing the new solution in his mind. I encourage my client to close his eyes, and I describe him carrying out the new solution. I ask him to see and feel himself in the situation, and if the solution involves talking, to hear himself and the other people. After he has imagined doing the solution once, I ask him to open his eyes and I ask if there were any obstacles, or if he would like to change anything. We address the obstacles. I then ask him to imagine doing the new solution two more times and incorporate any changes he wanted. I ask my client to rate how doable the solution is before and after practicing in his mind.

When Raoul imagined dropping by his boss’s office to chat, he realized it would be easier if he had a specific question about a file that he wanted to ask. His therapist incorporated that into the next two imaginal rehearsals.

Your Client Tries His New Solution

Think of your client’s new solution as an experiment that will provide additional data, rather than the one right way to proceed. Often clients prematurely dismiss a solution because the outcome wasn’t perfect. Results need to be evaluated on a continuum rather than a “perfect or else failure” yardstick. It is helpful to decide ahead of time how your client will evaluate whether his new solution is successful. If the solution did not work out, or if aspects of the problem remain, you need to continue to problem solve. It may also be helpful to reevaluate what aspects of the problem can and cannot be changed. The reality is that many of life’s difficulties take time and effort to address, and often there is no perfect solution.

It is also important to teach your client to give himself a pat on the back for trying his new solution. Even if the new solution did not work out, trying indicates a willingness to attempt to solve the problem rather than staying stuck. I model a positive problem orientation. Depending on what happened, some of the statements I use are, “That went well,” “Trying is an important first step,” and “Even though it wasn’t perfect, it is a step in the right direction.”

Suzanne Problem Solves

If you remember, in the last chapter we helped Suzanne manage her anxiety about going to the barbecue by looking at her hot thought and developing a more balanced thought. Her worry had decreased sufficiently that she decided to go to the barbecue. However, she still worried that she would not know what to say and that the other teachers would not talk to her.

Her therapist thought it would be helpful to problem solve what Suzanne could do to make the barbecue easier for her. They came up with a number of strategies, including offering to help with any food preparation and the cooking; thinking of some questions she could ask that might start a conversation, such as how long the other teachers had been at the school and whether they had children; approaching the other teachers, introducing herself, and standing there as part of the group; focusing her attention on what the other teachers were saying; and spending some time playing with the principal’s young children.

When Suzanne evaluated the different solutions, she picked offering to help with the cooking, thinking of some questions she could ask to start a conversation, and then approaching one of the teachers at the party and starting to talk. She felt a lot better once she had a plan.

Agenda Item #6: Develop Coping Thoughts

Once your client has decided how he wants to handle the problem, and has a plan, it can be useful to develop coping thoughts that help him focus on the task and manage any negative feelings. Highly critical thoughts about ourselves or others not only make us feel bad, but also distract us from the present moment, making it harder to handle a stressful situation. In a coping thought model, you and your client actively develop thoughts that help your client execute his plan and manage his negative emotions. Coping thoughts tend to be short and provide directions as to what to do in a specific situation.

Here is the general process that I use to develop coping thoughts:

  1. Identify the behavior your client wants to accomplish and his plan.
  2. Check if your client’s current thoughts are interfering with or sabotaging his plan.
  3. Develop coping thoughts.
  4. Use imagery to practice your client’s coping thoughts.

Identify the Behavior Your Client Wants to Accomplish

In addition to being part of a problem-solving plan, coping thoughts can be used for any specific behavior your client wants to accomplish. For example, I have used coping thoughts to help my client Elyse stop procrastinating, sit down, and complete her tax return; I have also used coping thoughts to help clients drink only one glass of wine a night, start an exercise program, use relaxation for pain control, and raise an awkward topic with a friend or family member. You can also use coping thoughts to help clients manage their feelings of anxiety or of being overwhelmed. You want to be sure the behavior is specific and doable. If Elyse does not know how to complete her tax return, all the coping statements in the world will not help her.

Identify Current Thoughts That Are Interfering with the Plan

Sometimes when clients think of a solution to their problem, they are optimistic; however, often negative, sabotaging thoughts interfere with their ability to implement their plan. I usually ask my client what might interfere with his plan, and specifically whether there is anything he is likely to say to himself that would sabotage the plan. I want to make sure my client understands the impact of his thoughts on his ability to complete his plan. Let’s see if Suzanne has any thoughts that will sabotage her plans for how to handle the barbecue.

Therapist: Suzanne, I am wondering, when you think of helping with the food at the barbecue, or starting to talk to one of the other teachers, what thoughts go through your mind?

Suzanne: Helping with the food at the barbecue is easy, a really great idea. When I think of going up to the other teacher and starting a conversation, I get pretty anxious.

Suzanne has identified a feeling, but we are looking for sabotaging thoughts. We know from our four-factor model that thoughts lead to feelings.

Therapist: What are some of your thoughts that go with your anxious feeling?

Suzanne: I guess I think that no one will find my questions interesting, and that it was probably a mistake to go to the party.

Suzanne’s therapist wants her to see how these thoughts might sabotage her plan.

Therapist: When you have these thoughts, how does it affect your plan to start talking to the other teachers?

Suzanne: It makes it really hard and makes me not want to go or just stand there quietly, instead of trying to talk.

I sometimes draw a diagram to help my client see how his thoughts are sabotaging his plan. Many clients find it helpful to visualize the process. This can be especially helpful if a client wants to accomplish his plan but then doesn’t carry out the plan and doesn’t understand what got in the way. Figure 9.1 shows what Raoul’s therapist drew for Raoul to help him understand the impact of his thoughts on his procrastinating around writing a report.

Figure 9.1. Raoul avoids a project.

Once you have identified your client’s negative sabotaging thoughts, you use a coping thought model to ask him to put aside these thoughts. Unfortunately, if you tell your client to stop a thought, it just bounces back stronger. However, your client can learn to ignore his interfering thoughts, especially if he has developed coping thoughts. You can’t think of coping thoughts and interfering thoughts at the same time.

Help Your Client Develop Coping Thoughts

The next step is to develop thoughts that help your client cope with the situation and manage his disruptive feelings. Below are questions to help your client develop coping thoughts. You can download a Questions to Develop Coping Thoughts handout at http://www.newharbinger.com/38501.

Once you have a list of coping thoughts, write them down. Coping thoughts generally fall into three categories: placing the situation in a realistic perspective, focusing on the task at hand, and managing anxious or overwhelming feelings. Different types of thoughts will be helpful in different situations. Let’s look at some examples of thoughts in each category. You can download a copy of Examples of Coping Thoughts at http://www.newharbinger.com/38501.

Examples of Coping Thoughts
Place the Situation in a Realistic Perspective Focus on the Task Manage Anxiety

Try not to take this too seriously.

This is just one situation.

If this situation doesn’t work out, there will be others.

Don’t blow this up out of proportion.

You have a plan.

Do the first step of your plan.

Focus on the task.

It does not have to be perfect.

One step at a time

Even if I’m upset, I can do my plan.

Anxiety is not dangerous.

It doesn’t matter if my heart is pounding.

I can take some deep breaths.

It will pass.

Anxiety is normal.

Remember your rational thoughts.

You don’t have to listen to worry thoughts.

Suzanne, together with her therapist, identified a number of thoughts she could use as coping thoughts to help her start talking to one of the other teachers. They included Stick to your plan, Just ask a question, There are only three other teachers, and Don’t listen to anxiety.

Use imagery to practice. Once your client has developed coping thoughts, you take him through his plan again in his imagination, this time adding coping thoughts. After we have practiced once, I ask if there is anything he would like to change and if any of the coping thoughts were particularly helpful or not that helpful. I make any changes and then we practice two more times in his imagination.

When Suzanne rehearsed her plan and coping thoughts in her imagination, she particularly liked the thoughts Just ask a question and Don’t listen to anxiety.

YOUR TURN! Help Raoul Develop Coping Thoughts

Raoul decided that he wanted to call one of his colleagues whom he had been avoiding and suggest that they have lunch together. He was fairly anxious about calling, and rated his anxiety at a 6 out of 10. His thoughts were I haven’t had lunch with him in a long time; he will think it weird that I phone him. How could you help Raoul develop coping thoughts that would help him call his colleague?

Look at the three possible responses below and pick the one that will help Raoul develop coping thoughts.

  1. How could you contact your colleague to ask him out for lunch?
  2. I think it is important that you tell yourself to stop thinking these thoughts; they are clearly stopping you from calling your colleague.
  3. I am wondering if you could try to put these thoughts aside and see if we could come up with some thoughts that will help you call your colleague.

    Response #3 is the next step in developing coping thoughts. Response #1 will help Raoul develop a specific plan of what he will do, but it will not help develop coping thoughts. In response #2, the therapist is telling Raoul to try to stop his thoughts. This will backfire—when we try to stop thinking a thought, we just think about it more.

  4. Therapist: I am wondering if you could try to put these thoughts aside and see if we could come up with some thoughts that will help you call your colleague.
  5. Raoul: What do you mean?

Look at the three possible responses below and pick the one that will help Raoul develop coping thoughts.

  1. If a friend were anxious about inviting a colleague for lunch, what would you suggest that he tell himself?
  2. Your problem is that you are not positive enough.
  3. Just say to yourself—be positive!

    Response #1 is the best answer. It uses the question “What advice could you give a friend in terms of helpful coping thoughts?” and applies it to Raoul’s situation. In responses #2 and #3, the therapist is trying to use positive thinking. The problem is that positive thinking doesn’t work because it is too general and doesn’t address the specific behavior the client wants to do.

Homework: Practice CBT

Before continuing with the next chapter, take some time to try the homework.

Apply What You Learned to a Clinical Example

Complete the following exercises.

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Apply What You Learned to Your Own Life

For the following homework assignment, you can use the guided audio file to help you go through each step; I think it is more effective than reading the exercise.

Homework Assignment #1 Practice Using the Problem-Solving Steps

Accompanying audio file: Solve Your Own Problems

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Think of a problem that is currently troubling you. Don’t choose something huge, as it may be too challenging for an initial attempt at problem solving. Choose a problem that is sufficiently large that you care about it, but sufficiently small that there is a chance you could solve it. Go through the four problem-solving steps in order using the Problem-Solving Worksheet as a guide.

  • Problem-Solving Steps:
  • Identify the problem and set realistic goals. Remember to ask yourself what you hope will be the consequences of your current behavior.
  • Generate new solutions. Try to think of at least three. Don’t evaluate them until you have completed your list.
  • Evaluate the different solutions and decide which one to try. Remember to look at both the short-term and long-term benefits and drawbacks.
  • Try one of the solutions: evaluate the consequences and decide whether the problem is solved or if you need to continue to problem solve.

Apply What You Learned to Your Therapy Practice

This coming week I would like you to try to apply the problem-solving process with a client.

Homework Assignment #2 Help a Client Problem Solve

Start by asking your client to identify the problem that is causing his or her distress. See if you can engage your client in a problem-solving process. Remember, all you have to do is the following: identify the problem and how your client is currently coping, identify his goal, brainstorm alternative solutions, choose a solution to try, and make a specific and concrete plan. You may also want to try asking your client to rehearse his new plan in his imagination. Fill in the form below so you can monitor how you are doing.

Client Identify the Problem and Set Goals Brainstorm New Solutions Evaluate and Choose a Solution Make a Plan

Let’s Review

Answer the questions under the agenda items.

Agenda Item #1: What is problem solving?
Agenda Item #2: Develop a positive problem orientation.
Agenda Item #3: Identify your client’s problems.
Agenda Item #4: Brainstorm solutions.
Agenda Item #5: Choose a solution.
Agenda Item #6: Develop coping thoughts.