Not surprisingly, lots of people I see with chronic pain feel like they’ve landed in a hole they can’t get out of. And one of the most positive things I think I can do is show people that change is possible.
Getting out of a hole is incredibly difficult all by yourself – but oh so necessary for life to move forward again.
Problem solving is a fundamental tool for many professions – not just occupational therapists who seem to have adopted it wholesale (see this article from November 2007!), but also engineers, mechanics – oh and psychologists! But occupational therapists have books (like this one by Jeanne E. Lewin and Colleen A. Reed, and this one (parts of which you can read online to get the drift) about the use of problem solving in mental health.
My main problem with ‘the problem solving process’ is the tendency to almost immediately focus on solving the problem rather than working to identify and manage contributing factors. So when I was trying to develop a problem solving process format for the people I work with who have chronic pain, I spent a bit of time trying to come up with something that would encourage them to go beyond the immediate. Here’s what I came up with.
At the top of the page:
- ‘the problem’ described briefly.
- Then a box below that with the label ‘factors contributing to the problem’
- Then a second box below that labelled ‘factors contributing to these factors’
- Then all around the outside I ask the participants to write possible solutions for each contributing factor with an arrow leading to the relevant factor.
This way, the tendency to prematurely close in on ‘The Solution’ is halted, and a range of options are generated. At the same time, there are two levels of problem solving – the immediate, and those that are underneath the immediate. (You could do this layering of contributing factors several times, but this gives you something not too complex to work with.)
To make it even more systematic, if you have a model to work with, you could use that to organise the layers of contributing factors…as in the ‘ishikawa’ fishtail model.
Or clinically, you might use a biopsychosocial model, or for cognitive behavioural pain management, you might use one of the Main & Spanswick models of disability to help yourself work your way through the relevant areas.
The astute amongst you might have noticed that the last two bear a striking resemblance to what can otherwise be called ‘case formulation’ – problem solving and case formulation are pretty much the same thing – well at least, they’re steps along the same track.
In each case you’re developing a set of hypotheses about what might be a factor relevant to the onset and maintenance of a problem.
The next step is, of course, to pick the hypothesis or possible solutions and DO IT! Clinically we would use evidence from the scientific literature to decide which approach to use first, based on which hypothesis appears to explain the majority of problems in the simplest way, with the fewest assumptions.
With clients, we would start with preferences, use logic, or work with available resources – especially if we’re trying to help the person develop self efficacy.