Tuesday, September 1, 2020

Structured problem solving is a simple CBT tool that GPs can implement in their practice

Structured problem solving is a simple Cognitive Behavioral Therapy (CBT) tool that all GPs can implement in their practices in my opinion. I was taught this as a Registrar trainee and used it ever since. 

The key problem for many folks is that when they are faced with a difficult problem, and there are no good/perfect solutions, they get stuck in procrastination.  Being stuck in limbo can be worse than bad news.  Our job then is to get them unstuck.  Acknowledgement of how difficult it is for our patient at this point is a good start.

So how can we get our patients to get unstuck through structured problem solving?

There are a number of steps to this. It can occur over a number of sessions depending on the complexity of the problem and the patient’s pace.

1 Through supportive counseling and reflection, we help our patient find clarity and define the problem accurately.  It is a very important part of the process because, if we define the problem incorrectly, wrong problem definition=wrong solution. 

2 Next step is to help our patient explore ALL possible options including the “bad ones”.  We get our patient to write them all down. 

(Reinforce to patient that our primary aim is to find the best option, and acknowledge that the best option can be still bad but at least it is the BEST.)

3 Next step is to narrow it down like narrowing down a differential diagnosis list. First, we ask patient to cross out the options that are a definite “no” for them. These are the more “obvious ones”. 

Hopefully at this stage, we have narrowed it down to 2-3 options. 

4 Next step is to instruct our patient to write down a detailed list of pros and cons for each of these options.  Explore those with our patient and facilitate a decision towards what is their best option, ie one with the most pros and the least cons. Validation and acknowledgement of how difficult it is for the patient during this whole process is very important.  Be patient and allow them time to come up with the answers. 

5 Then take committed action towards the “best option”.  Helpful questions at this phase may look like these. What do you think you can commit to doing before we see you next week?  From 0-10, how confident are you in being able to do that this week? (Aim for at least 7/10). If patient is not confident, we can simply break down the task to smaller and achievable chunks.  

6 Review, check progress, with plenty of support and validation. 

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