SISTEMAS DE CONTROL DISTRIBUIDO

Tasks for Topic 6

• Introducing the basic steps of problemsolving • Practicing problemsolving skills within the session

Session Goals

Key Interventions

Introduce the

Basic Steps

problem may make one anxious, effective problemsolving takes time and concentration, and the impulsive first solution is not necessarily the best. Therapists should review the basic steps in problemsolving summarized be- low.*

• Recognize the problem (“Is there a problem?”).

Recognition of problems may come from several clues, including worry, anger, and depression; having problems pointed out by oth ers; being preoccupied; and always feeling like one is in crisis.

• Identify and specify the problem (“What is the problem?”).

It is easier to solve problems that are concrete and well-defined than those that are global or vague. For large problems that seem over whelming, it is important to try to break them down into smaller, more manageable steps.

• Consider various approaches to solving the problem (“What can I do to solve the problem?”).

An effective way to approach this is to brainstorm, that is, generate as many solutions as possible without considering, at first, which are good or bad ideas. It is more important to try for quantity, rather than quality, in the beginning. Writing these ideas down is very helpful in cases where patients may want to return to the list in the future. It is also important to recognize that not doing anything immediately is an option.

• Select the most promising approach (“What will happen if . . . ?”).

This step involves thinking ahead. Review each approach, consider ing both the positive and negative consequences of all solutions. This step may also involve collecting more information and assessing whether some solutions are feasible (e.g., “Can I borrow Tom’s car to take the driving test?”).

• Assess the effectiveness of the selected approach (“What did happen when I . . . ?”).

Therapists may need to point out that while some problems are easy to solve, others are more difficult. It may be necessary to repeat steps one through five several times before a complex problem is solved.

and the selected approach so that the steps are not forgotten when it is time to implement them.

Therapists should ask patients to identify two recent problems, one that is closely related to cocaine abuse and one that is less so, and work with them through the problemsolving steps for both. Therapists may have to help pa- tients slow down, because some will have difficulty recognizing current prob- lems. Others will quickly select a solution since they lack practice with brain- storming and considering alternatives.

Therapists ask patients to practice problemsolving skills outside of the ses- sions using a reminder sheet for problemsolving (exhibit 10). Remind patients that treatment will end soon, and they will be using these skills on their own.

Practice

Problemsolving

Skills

Identify the problem:

Exhibit 10: Reminder Sheet For Problemsolving

These, in brief, are the steps of the problemsolving process.

• “Is there a problem?” Recognize that a problem exists. We get clues from our bodies, our thoughts and feelings, our behavior, our reactions to other people, and the ways that other people react to us.

• “What is the problem?” Identify the problem. Describe the problem as accurately as you can. Break it down into manageable parts.

• “What can I do?” Consider various approaches to solving the problem. Brainstorm to think of as many solutions as you can. Consider acting to change the situation and/or changing the way you think about the situation.

• “What will happen if . . .?” Select the most promising approach. Consider all the positive and negative aspects of each possible approach and select the one likely to solve the prob lem.

• “How did it work?” Assess the effectiveness of the selected approach. After you have given the approach a fair trial, does it seem to be working out? If not, consider what you can do to beef up the plan, or give it up and try one of the other possible approaches.

Select a problem that does not have an obvious solution. Describe it accurately. Brainstorm a list of possible solutions. Evaluate the possibilities, and number them in the order of your preference.

Most patients will present for treatment with a range of concurrent psycho- social problems in addition to cocaine abuse. Some problems are best as- sessed and addressed after patients have achieved a period of stable absti- nence, while other problems, if unaddressed, are likely to present barriers to treatment and undermine the patients’ efforts to become abstinent. Thus, to deal with these issues, therapists may engage in modified “case manage- ment.”

In this approach, therapists do not serve as advocates for patients outside of sessions. Rather, therapists use problemsolving strategies within treatment to help patients contact and make use of the social service system. The intent is to build patients’ self-efficacy in recognizing and coping with concurrent problems and in successfully using the network of available social service agencies.

To be effective, therapists should be knowledgeable about the community’s service system, with current information on the type of services provided by each organization, the types of patients served by the organization, eligibil- ity requirements, sources for alternative serv-ices, and reasonable timeframes for various types of service delivery. Therapists should help patients trans- form their goals into a service plan and help them articulate the steps needed to attain these goals.

The goals of this topic are to -

• Review and apply problemsolving skills to psychosocial problems that present a barrier to treatment.