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Chapter 2

The Problem-Solving Model: A Framework for Integrating the Science and Art of Practice

Kristin W. Bolton and Peter Lehmann

LEARNING OBJECTIVES

•Understand the role of problem-solving in social work practice

•Understand the historical development of the problem-solving model

•Understand the different phases of a problem-solving model

INTRODUCTION

The term “problem-solving” has a slightly different meaning depending on which discipline it refers to. A cursory look suggests that there are several professions that use the term as part of their nomenclature. Curiously, a reference to social work is absent and there is no mention of it in the discussion of psychology. In spite of this, the term problem-solving has been and, in many respects, continues to be part of the social work practice literature even though as Shier (2017, p. 397) noted, “problem-solving has been little explored in relation to therapeutic intervention.” Despite this, and ever since Perlman (1957) promoted a problem-solving process for social casework (i.e., direct social work practice), we believe that the problem-solving model can continue to develop into an important feature of social work practice. As summarized by McMahon (1996, p. 35), the problem-solving model has been called the general method of social work because it “may be utilized with individuals, groups, families, or communities” (McMahon, 1996, p. 35).

In this chapter, we begin by (a) making an argument via the practice of social work for the use of a problem-solving approach; (b) reviewing the early development of the problem-solving model for social work practice; (c) summarizing the recent shift in the problem-solving model including a summary of the evidence base for the use of this approach in social work practice, which we liken to an interdisciplinary social science process that will be helpful to social workers (Shier, 2017); and finally (d) discussing the phases of a problem-solving model (i.e., engagement; data collection and assessment; planning, contracting, and intervention; and evaluation and termination).

An Argument for the Use of Problem-Solving

It should go without saying that modern contemporary social work continues to have as its core values respect for the client and allowing the client to determine their own course of life. Thus, problem-solving may also be included as promoting a similar trajectory with clients. Thus, we offer a brief number of arguments for the continued attention for social work practice.

First, almost 60 years have passed since Perlman (1957) noted “a conception of human life as being in itself a problem-solving process” (p. 53). Certainly, this foreshadowed the very beginnings of generalist models of social work practice extending the use of a problem-solving process, by one name or another, to work with all levels of client systems (groups, families, organizations, and communities).

The term problem-solving method is meant to convey the notion that problem-solving is not a theory per se; rather, it is “a series of interactions between the client system and the practitioner, involving integration of feeling, thinking and doing, guided by a purpose and directed toward achieving an agreed-upon goal” (McMahon, 1996, p. 43). Thus, the problem-solving model is a critically important element in our generalist-eclectic approach to direct practice because its flexible structure and general guidelines for practice facilitate an eclectic use of theory and technique (the science of practice), and the use of reflective, intuitive-inductive processes (the art of practice).

Third, In the last five decades, the problem-solving model has continued to be revised and redefined, reflecting a shift in social work practice and the social sciences that is far less focused on the early psychodynamic foundations and dysfunction and more focused toward positive and healthy outcomes. Here, a more contemporary approach to problem-solving aims to reduce psychopathology by supporting new positive behaviors in a direction that maximizes one’s quality of life and well-being (Nezu et al., 2013). This shift has likely come from the gradual focus on identifying the cognitive processes that maintain self-control/behavior change, along with the positive skills leading to problem-solving.

Fourth, eclectic practice does not enjoy the clear structure and explicit guidelines for practice that are afforded by following a single theory. We propose the use of a contemporary problem-solving model to help remedy the difficulties of eclectic practice. The phases of the problem-solving model (from collaborative engagement to termination) provide a flexible structure and general guidelines for practice while allowing for the eclectic application of theories and techniques.

Finally, Pierce (2012) has described the problem-solving model as pragmatic, effective, and easy to learn. He has suggested that using this approach does not take years of training and can be used efficiently in many different practice settings, often taking minimal time to implement. What at times may intuitively feel like complexity can be resolved via a straightforward manner. For example, clients may disclose life problems and not know where to start to resolve them. A problem-solving approach allows clients to break down a big problem into smaller, potentially more solvable problems, or may enable clients to brainstorm ideas for change or what could be different. Here, problem-solving through a questioning process such as probing (“How do you typically sort things out?”) or reflective (“What are your best skills when it comes to managing these sorts of tough problems?”) can sometimes break the impasse. We suggest that some of the general guidelines that the problem-solving process provides for assessment allow for the tentative application of multiple theoretical perspectives to help develop understanding of each unique client situation. Similarly, the general guidelines for intervention in the problem-solving model allow for the eclectic use of techniques from different theories to help clients overcome or cope more effectively with problems (we liken this to an interdisciplinary social science process that will be helpful to social workers [Shier, 2017]).

To summarize, the knowledge base of effective problem-solving of any kind might be construed as the rigorous blending of knowledge and skill with imagination and creativity. Following this line of thinking, we believe that the effectiveness of a problem-solving approach will depend upon blending the scientific (theoretical/technical) and relationship aspects of practice. Our review next considers the early development of social work’s response to problem-solving, followed by changes within psychology that today continue to be applicable.

EARLY DEVELOPMENT: PERLMAN’S PROBLEM-SOLVING MODEL

The application of the problem-solving model to social work practice was first suggested by Perlman (1957) in her book Social Casework: A Problem-Solving Process. Perlman was influenced by Dewey’s (1933) description of learning as a problem-solving process. She believed that the operations of casework are essentially those of the process of problem-solving (p. v). Perlman’s problem-solving model represented an attempt to integrate or at least bridge the differences between the two dominant schools of social casework of the time. Perlman had been trained in the scientifically oriented Freudian or Diagnostic school of social casework but was attracted to many of the ideas of the humanistically oriented Functional or Rankian school of social casework. Perlman (1957) believed that the problem-solving model met the need

for some dependable structure to provide the inner organization of the (casework) process … In no sense is such a structure a stamped out routine. It is rather an underlying guide, a pattern for action which gives general form to the caseworkers inventiveness or creativity. (p. vi)

She blended the Diagnostic school’s emphasis on applying psychodynamic theory through the scientific process of study, diagnosis, and treatment, with the Functional school’s emphasis on starting where the client is in the present, partializing problems into manageable pieces, and developing a genuinely supportive relationship that serves to motivate clients and free their potential for growth (Perlman, 1986). Perlman (1986) has identified the problem-solving model as an eclectic construct, with theoretical roots in psychodynamic ego psychology and selected ideas from existential, learning, and ecological systems theories.

Toward the close of her professional career, Perlman (1970) stressed that the problem-solving process does not always take place as a linear, logical progression and that in the spontaneity of action (p. 158), the steps or phases can blend together, occur out of order, and repeat in a cyclical manner. In professional helping terms, these steps/phases included: (a) identifying the problem, (b) identifying the person’s subjective experience of the problem, (c) examining the causes and effects of the problem in the person’s life, (d) considering the pros and cons of various courses of action, (e) choosing and enacting a course of action, and (f) assessing the effectiveness of the action.

In addition, Perlman (1970) emphasized that problem-solving is not just a cognitive, rational process and that the development of a good relationship with clients is intertwined with the problem-solving process:

A relationship is the continuous context within which problem-solving takes place. It is, at the same time, the emerging product of mutual problem-solving efforts; and simultaneously it is the catalytic agent. (p. 151)

Perlman’s conceptualization of and central ideas about the relationship places an important emphasis on collaboration and partnership between the worker and the client in all phases of the process—in Perlman’s model there was more of an emphasis on the worker’s primary responsibility for assessment and treatment planning (Compton & Galaway, 1999). We think these changes in emphasis are positive and they are reflected in our current conception of the problem-solving process. We understand and support the trend toward depathologizing the concerns that clients typically bring to counseling—and it should be noted that Perlman was a pioneer in this regard. Rather than deny the existence of problems and the utility of a problem-solving process, however, we prefer to promote the understanding that problems are a normal part of life. We agree with Compton and Galaway’s (1994) early contention that “describing a change process as a problem-solving model is quite different from characterizing it as a problem-focus model …. the model might well be called problem-solving but strength-focused” (p. 7). The reader is referred to other social practice texts (e.g., Hepworth et al., 2002; Sheafor & Horejsi, 2006; Locke, Garrison, & Winship, 1998; O’Melia, DuBois, & Miley, 1994) that provide a more detailed but similar review of the problem-solving phases.

CURRENT DEVELOPMENT: THE CONCEPTUAL AND EMPIRICAL EXPANSION OF THE PROBLEM-SOLVING MODEL

Although the basic steps of problem-solving remain fairly constant for social work, within the last 40 years the conceptual underpinnings have evolved apart from the early writings of Perlman (Shier, 2017). Essentially, there have been at least three developments to explain problem-solving, which will be relevant to the practicing social work.

In its current state, problem-solving is seen as

the self-directed process by which individuals attempt to identify, discover, and/or develop adaptive coping solutions for problems, both acute and chronic that they encounter in every day living. (Nezu et al., 2013, p. 8)

Here, problem-solving has long been used interchangeably with social problem-solving (D’Zurilla & Nezu, 1982) as a process that occurs for individuals in their natural environment or as has been termed the real world. Thus, adaptation to problems comes in part from functioning in the real-life social environment (i.e., the impersonal, intrapersonal, interpersonal, and broader community). The conceptual underpinnings of problem-solving has undergone some iterations and currently has established itself as a significant evidence-based practice model that continues to be useful for a generalist social work practice. In the following we summarize the three expansion phases of problem-solving as a model of practice.

Phase 1: Social Problem-Solving

In 1971, D’Zurilla and Goldfried published a first review of the theory and research related to problem-solving in the real world (later termed social problem-solving). This review was part of the growing change in the field of behavior modification toward a greater understanding of cognitive processes in an attempt to help develop new skills related to self-control that might also be generalized to other behavior changes.

The theory on which problem-solving therapy (PST) had been revised included three major concepts: (a) social problem-solving, (b) the problem, and (c) the solution, as summarized by D’Zurilla and Nezu (2010).

Social problem-solving was seen as dealing with all types of real-life problems, including impersonal problems (e.g., personal/intrapersonal problems [cognitive, emotional, behavioral, health], as well as interpersonal problems (e.g., interpersonal disputes, family/marital conflicts) along with problem-solving solutions. A “problem” (or problematic situation) is defined as an imbalance or discrepancy in, say, the environment or within a person between adaptive demands and the availability of effective coping responses. Any problem might be time limited or an ongoing series of challenges that include obstacles and/or roadblocks. A solution is one that achieves the problem-solving goal (e.g., changing the situation for the better, reducing negative emotions, increasing positive emotions) and that also maximizes positive consequences and minimizes negative consequences.

Based on the review herein, the authors developed a prescriptive model of problem-solving composed of problem orientation and problem-solving skills. Problem orientation consisted of a set of common cognitive-emotional schemas that reflected a person’s beliefs, appraisals, and feeling about problems. Problem-solving skills referred to a number of cognitive and behavioral activities aimed at finding effective solutions or ways of coping with them. The model summarized four skills for problem-solving including defining the problem, coming up with alternative solutions, decision-making, and implementing new solutions.

A major contribution of this development was the authors’ integration of the work of Lazarus (1999), which drew on a relational model of stress. Here, “stress” was seen as a person–environment relationship in which demands are appraised by the person as taxing or exceeding coping resources and threatening their well-being (Lazarus & Folkman, 1984). In this relational problem-solving model, stress was viewed as a function of the reciprocal relations among three major variables: (a) stressful life events, (b) emotional stress/well-being, and (c) problem-solving coping. Their clinical application produced a generic relational problem-solving manual (D’Zurilla & Nezu, 2007) consisting of 14 modules with the explicit goal to increase positive problem-solving and decrease negative orientation through the development of skills that could be applied to every day life. Consistent with the technical and relationship stance cited previously, there is a specific emphasis on the importance of developing a positive client–practitioner relationship and assessment process along with a host of cognitive and practical strategies to mitigate problems.

Phase 2: Social Problem-Solving and Neurodevelopment

More recently, Nezu et al. (2013) have built on the social problem-solving and relational problem-solving model and added a neurodevelopmental component. This heuristic model is seen as more expansive in nature, integrating individual problem-solving within a biopsychosocial framework. In this case, the authors focus on the relationship between psychosocial and neurobiological variables that impact stress, emotions, coping, and outcomes.

The diathesis-stress model of problem-solving is made up of three separate but interrelated systems including (a) the distal variable where the individual’s early life history and experience in combination with their genotype create vulnerabilities for ongoing negative coping and problem-solving, (b) the proximal variable in which major events and daily problems interact with one another, and (c) the immediate or microanalytic variable of how both systems are mediated by various neurobiological functions (e.g., amygdala vs. cortex processing).

In system (a), one’s genotype or the genetic constitution of an individual in combination with early life stress may produce certain biological vulnerabilities that will influence one’s reaction or coping with stress at different points in the life cycle (e.g., adolescence, early or late adulthood) as it relates to social problem-solving. As an example, a case is made in understanding the coping of children responding to stressful life events. The authors make the point that because a child’s brain is still developing, the role of social problem-solving may be limited, overtaxing coping responses with resulting sensitivity to negative biological consequences.

With respect to system (b), the authors focus on two accumulated sources of stress, major negative life events and chronic daily problems, increasing the likelihood of developing major clinical problems such as depression. This occurs through activation of one’s biological systems, including the sympathoadrenal medullary (SAM) and the hypothalamic–pituitary–adrenal (HPA) axes. One outcome is the activation of the flight–fight response. The point made here is that chronic stress can result in much poorer social problem-solving and subsequent negative physical and immunological health outcomes.

System (c) moves beyond an earlier analysis of problem-solving of being a primary cognitive process (Lazarus, 1999). Here, problem-solving is seen to be mediated by a host of neurobiological processes involving brain functioning. The brain acts as a conduit for processing stress, emotional reactivity, and social problem-solving via the thalamus, amygdala, and frontal cortex. This process is described as two pathways to emotions (LeDoux, 1996): the low road that can trigger fast or automatic reactions that are not helpful to problem-solving, or the high road in which emotional processing can be analyzed, reasoned, and logically thought through with respect to solving issues.

Nezu et al. (2013) have revised the practical application of social problem-solving in Phase 1 to a shorter manualized process that relies on emotional regulation and positive thinking as a core feature of their work. Again, the work comprises and highlights the importance of a respectful therapeutic relationship that is oriented toward setting goals for the future. Skills such as open questioning and active listening with attention to detailing subjective experiences are seen as an essential

In this model, effective problem-solving and decision-making is as much an emotional as cognitive response and ultimately impacts problem-solving. Thus, for example, minimal emotional responding coupled with poor problem-solving may be moderated by how neurological systems process information. Conversely, effective problem-solving may be a function of processing both emotional responses and how one solves problems and makes decisions.

Phase 3: Emotion-Centered Problem-Solving Therapy

The last and most recent development of PST has been termed emotion-centered problem-solving therapy (EC-PST; Nezu & Nezu Maguth, 2019). The authors see their work as an “evolutionary process” (p. x) as to what came before. The current approach puts an emphasis on teaching individuals to understand and manage their emotional reactions to stressful events than what was included in former problem-solving protocols. EC-PST then is seen more as a psychosocial intervention within a social learning framework. Clients have a set of skills aimed at building their ability to cope effectively with a variety of life stressors. To compare the current evolution of EC-PST with their former work, two goals of Nezu and Nezu Maguth’s work are summarized and include:

1.Successful adoption of adaptive problem-solving attitudes (e.g., optimism, enhanced self-efficacy, recognition and appreciation of the notion that problems are a normal aspect of living;

2.Effective implementation of certain behaviors (e.g., emotional regulation, planful problem-solving) as a means of coping with life stress and thereby attenuating the negative effects of stress on physical and mental well- being.” (p. 6)

The current model carries over the diathesis stress model and neurodevelopmental perspective from Phase 2 with greater reference to brain sciences including neuroplasticity. Emphasis is also given to developing the therapeutic relationship with detail toward empathy and building hope. Clearly in this text, the authors are conveying that EC-PST is not mechanistic and rather is interactive and experiential where clients are allowed to learn, grow, and build new skills.

EC-PST consists of the following major interventions across treatment. What follows has been updated from earlier work (Nezu et al., 2013):

1.introduction, relationship development with the client and assessment/treatment planning;

2.Toolkit 1—Training in problem-solving, multitasking, and overcoming cognitive overload;

3.Toolkit 2—The Stop, Slowdown, Think, Act (SSTA) method of problem-solving under stress: overcoming emotional dysregulation and ineffective problem-solving coping;

4.Tookit 3—Healthy thinking and positive imagery: overcoming negative thinking and low motivation

5.Toolkit 4—Planful problem-solving and fostering effective problem-solving;

6.Guided practice; and

7.Future forecasting and termination.

Each of the interventions are manualized with handouts and exercises that are facilitated by the social worker/therapist. It should be noted that EC-PST also includes an integrated host of mindfulness and experiential exercises that can be used in session or for home use.

Empirical Support for the Problem-Solving Approach

In the last 40 years, the scientific and clinical application of PST has been a relatively unknown but burgeoning field to the social work profession. Since the initial publication of the model (D’Zurilla & Goldfried, 1971), major summary reviews of empirical studies in the literature have been carried out and published in multiple formats encompassing various professional fields including social work. Although a detailed summary of the research evidence is beyond the scope of this chapter, the outcome literature remains broad featuring various clinical problems (e.g., health and behavioral health) and populations (e.g., older adults, children, adolescents, ethnic minorities, veterans, the disabled). To date, the most rigorous evaluations carried out include systematic reviews and meta-analyses. As an example, extensive systematic reviews have been done evaluating PST and depression (Nieuwsma et al., 2012; Simon et al., 2015), older adults (Kiosses & Alexopoulos, 2014), diabetes and self-management (Fitzpatrick et al., 2013), vision-impaired adults (Holloway et al., 2015), adolescent suicidal behaviors (Speckens & Hawton, 2005), and problem behaviors in school settings (Merrill et al., 2017). Likewise, a number of meta-analyses have been carried out in relation to PST and depression (Bell & D’Zurilla, 2009; Cuijpers et al., 2007, 2018), depression and anxiety disorders (Cape et al., 2010; Zhang et al., 2018), depression and the elderly (Kirkham et al., 2016), primary care settings (Linde et al., 2015), and school settings (Barnes et al., 2018). The studies listed do not include the wide ranges of clinical issues and trials published in texts using a problem-solving approach (e.g., Chang et al., 2004; McMurran & McGuire, 2005; Nezu et al., 2013).

From the host of studies cited earlier, there appears to be overwhelming evidence supporting the efficacy of PST across age groups, targeted populations, and clinical problems. These studies point to a flexibility of applications that appear to reduce problem-defined behaviors. Clearly, problem-solving as it is now seen represents an evolving model, applicable of being helpful to social workers practicing with difficult and complex issues.

THE STAGES OF PROBLEM-SOLVING FOR GENERALIST SOCIAL WORK PRACTICE

The final section of this chapter summarizes the stages of problem-solving for generalist practice. Different examples of these stages in the problem-solving process proliferate in the social work literature. Here, one can find the term “stages” identified as cycles, steps, phases, or processes with a host of numerically different methods from beginning to end. As Sheafor and Horejsi (2006) have noted, subsequent to Perlman’s description of the phases of the problem-solving process, “various authors divided these phases into more discrete units, described them in more detail, and demonstrated their application in a range of helping approaches and in work with client systems of various sizes” (p. 125). We have divided the problem-solving process into four phases for the purposes of our discussion. These phases are: (a) collaborative engagement and problem definition; (b) data collection and assessment; (c) planning, contracting, and intervention; and (d) evaluation and termination. In the following, each phase is reviewed briefly with regard to general goals and strategies for achieving them. The problem-solving approach contains no assumptions about the causes of and solutions to client problems. Instead, the general guidelines of the problem-solving process provide for assessment that may allow for the tentative application to help develop understanding of each unique client situation. Similarly, the general guidelines for intervention in the problem-solving model allow for the eclectic use of techniques from different theories to help clients overcome or cope more effectively with problems.

Collaborative Engagement and Problem Definition

We agree with Perlman’s (1979) contention that the social work relationship is the heart of the helping process and we believe that the engagement phase is crucial to creating the conditions from which a good helping relationship can grow. Perlman’s contention along with the most recent work of Nezu and Nezu Maguth (2019) about the importance of relationship has long been supported by the literature on collaborative working relationships or therapeutic alliance. Indeed, Wampold (2001) and colleagues (e.g., Fluckiger et al., 2012, 2020; Wampold & Imel, 2015) have long argued that the quality of the alliance between client and practitioner can predict outcomes of the helping process.

We see alliance/engagement as a complex but important process that may begin prior to meeting the client for the first time. Workers will often have some information (e.g., via a referral letter or intake assessment) that allows them to do some preliminary preparation, which “involves the worker’s effort to get in touch with potential feelings and concerns that the client may bring to the helping encounter” (Shulman, 1999, p. 44). If referral information is available, this may include a tentative ecological assessment of the particular problems and life circumstances of clients.

At the same time, it is important for workers to focus on themselves; that is, to become more aware of how they are feeling with regard to what they know about the client (e.g., presenting problem, cultural background, voluntary versus involuntary status). It is particularly important for workers to prepare themselves to work with clients who are involuntary and who may present as being hesitant about the helping process. Understandably, workers are often leery of dealing directly with such issues; however, if these issues are not discussed openly and worked through, engagement can remain superficial. In reflecting on to how one might engage with such clients around problem-solving, it is necessary to prepare for responding empathically and in a transparent manner without judgment versus defensively. The intent of this process prior to initial contact with clients is for workers to establish a positive internal condition that can facilitate the engagement process.

The first session with clients is important for setting the tone, the focus, and the parameters for the helping process. Wherever the first meeting may take place, it is important for the worker to attend to basic issues such as privacy and comfort. If the meeting is in the worker’s agency, it is appropriate for the worker to play host and attend to social amenities. For example, a handshake with the initial introduction is usually appropriate, as is some brief social chitchat (e.g., commenting on the weather or asking clients if they had any trouble finding the agency) to “break the ice.” Following this, a number of basic issues need to be attended to. Workers need to clarify their role and purpose and reach for client feedback about these issues (Shulman, 1999). Clients’ problem situations need to be explored in more depth, and it is important to establish some tentative goals. Questions such as “If our work together is helpful for you, what will be different? What do you think needs to be changed in your life? or What will be important for us to work on together?” are sample questions, setting the stage for building a helping relationship and working on what the client wants.

In attending to these engagement tasks, it is imperative that the worker’s manner reflects warmth, empathy, and respect for the client. Workers need to normalize clients’ problems appropriately, communicate empathy and support for their struggles. This kind of early engagement also includes attention to a client’s strengths and coping abilities, reaching out for help, and desire to work on a particular goal for change. Where appropriate, engagement can be deepened by the worker’s sensitive exploration of how issues of diversity (e.g., race, culture, class, gender, sexual orientation, physical capacity, age, religion/spirituality) may be related to the presenting problem or to concerns about engaging in counseling.

There is no reason to think that all of these tasks must be accomplished in a first session. We see engagement as an ongoing process that blends together with initial data collection and assessment. In fact, aspects of later phases of problem-solving are also evident in the engagement phase. For example, the provision of empathy and support is a type of intervention that can have an important impact even as early as the first session. Initial planning and contracting are evident in arriving at a tentative agreement to work together. Evaluation should be attended to with respect to eliciting client feedback about the first session, including how it fits with the client’s expectations and whether they have any questions or concerns. Also, it is important to address the issue of termination in the first session with respect to the anticipated time frame for working together.

Although relationship building is an ongoing process throughout all phases of the helping process, the important foundations for this process are laid in the engagement phase but continue on throughout the entire helping process. There are a number of general strategies that can be useful in initiating a positive and therapeutic relationship. The value of social worker preparation has already been discussed as a way of developing preparatory empathy and readying oneself psychologically to be supportive and non-defensive. Another related strategy is to explore in the first session the client’s thoughts, feelings, and expectations, along with their hopes about coming for counseling. As part of this exploration, it is often helpful to acknowledge and normalize the common difficulty many people have in coming for counseling and to ask about any negative preconceptions or fears about counseling that the client may have. It is also important to ask the client about any prior experience with counseling and what they did or did not like about it. The goal of such discussions is to identify any issues and show an understanding of and empathy for such issues, along with a mutual agreement about a preferred way of working together (e.g., that counseling will be a collaborative problem-solving process and/or that the client will always have the last say about what they will/will not do).

A similar process should be used on an ongoing basis to assess the quality of the helping relationship with a client and to identify and work through any problems. Research has found that problems in helping relationships are rarely identified and discussed and that, unless this happens, the relationship does not improve and the outcome is likely to be poor (Safran et al., 1990). Safran et al. (1990) developed helpful guidelines for addressing and ameliorating “ruptures” in the helping relationship. They suggested that workers should (a) continually watch for and be sensitive to signs of negative reactions from clients, (b) encourage clients to express any negative feelings and show understanding and empathy, (c) validate clients’ views and experiences, and (d) take responsibility and apologize for one’s contributions to the difficulties. Their research showed that when workers followed these guidelines, initially poor helping relationships could be improved dramatically (see Safran & Muran, 2000, for a more in-depth consideration of repairing relationship ruptures). In a similar vein, a key element in Miller et al.’s (2005) and others’ (Hubble et al., 1999; Miller et al., 2013) outcome-informed model is to solicit and respond supportively to client feedback about the therapeutic relationship on an ongoing basis.

Data Collection, Assessment, and Generating Alternative Solutions

Data collection involves fact and information gathering with regard to issues that are most critical to the client’s problem situation, and should include a focus on strengths, personal resources, and one’s support network, as well as on stressors. Assessment is the culmination of data collection and involves distilling the facts that are most central to the client’s worry and developing these into a succinct, coherent summary that reflects the social worker’s and client’s overall understanding of the problem situation. As mentioned, initial data collection often begins even before the first meeting with a client (e.g., referral information) and it is intertwined with the engagement process. In fact, as Perlman (1970) pointed out, ideally, relationship development and data collection each deepen the other. Data collection and assessment blend together and in some sense continue to evolve throughout the problem-solving process. An assessment leads to an intervention plan but carrying out the intervention plan provides new data that may build on or alter the original assessment.

Our generalist-eclectic approach to practice adheres to a person-in-environment (or ecological systems) view that emphasizes the need to consider the entire range of factors, from micro (e.g., biological and intrapsychic) to macro (e.g., environmental and sociocultural), that could impact positively or negatively on a client’s circumstances. The eclectic nature of our approach also necessitates the consideration of possible multiple theoretical perspectives to help develop understanding of client’s problem situations. In addition, in order to arrive at a comprehensive assessment, it is usually important to consider client history such as the genogram and their potential social network along with factors that may have impacted on the development of the situation over time. The four Ps—predisposing, precipitating, perpetuating, and protective factors (Weerasekera, 1993)—offer one useful framework for data collection and assessment that integrates the historical dimension, as well as a consideration of strengths (i.e., protective factors). The grid presented in Table 2.1 offers a conceptual framework that combines a consideration of (a) the broad person-in-environment perspective, (b) the range of theoretical perspectives covered in this book, and (c) predisposing, precipitating, perpetuating, and protective factors. Although a grid such as this could prove useful as a tool for organizing data collection, its primary utility is in providing a way of conceptualizing the range of data and perspectives that could be important to understanding any given client’s problem situation.

The factors listed in Table 2.1 are only examples of the types of factors that could be considered in data collection and assessment. Obviously, the scope of information that could be relevant to any given client’s problem situation is enormous. Although this may conjure the intimidating prospect of a long process of detailed, structured data collection and analysis, in practice most data collection usually flows naturally from allowing and encouraging clients to tell their stories. Aided by sensitive questions and probes that flow from the natural curiosity of the worker and their desire to be more fully understanding, clients’ accounts often provide detailed information about the who, what, when, why, where, and how of their problem situations. As the worker and client collaboratively review and summarize their developing understanding of the issues, further questions usually emerge to clarify and deepen understanding.

The grid in Table 2.1 also suggests how workers might use professional knowledge to guide data collection and assessment. First, in exploring the possible predisposing, precipitating, perpetuating, and protective factors related to clients’ problem situations, workers should employ a person-in-environment perspective and be cognizant of the possible influence of micro (e.g., biological) and macro (e.g., environmental and sociocultural) factors. Second, workers should also have the option of using their knowledge of various theoretical perspectives to explore the possible impact of a wide variety of factors. This is not to say that workers should explicitly check with clients about every conceivable theoretical explanation for their difficulties. Workers need to use their developing understanding of the client’s story in order to ascertain whether certain lines of inquiry seem relevant. For example, if it becomes apparent that there is a clearly identifiable, recent precipitating factor for a client’s difficulties and that the client had a high level of social functioning prior to this, then it would make no sense to pursue an exploration of predisposing psychodynamic factors. Thus, workers need to exercise their judgment in order to keep the data collection process focused and pertinent.

The issue of worker judgment is related to the fact that data collection and assessment are also guided by intuitive-inductive processes. As Derezotes (2000) has noted, “of all the artistic factors in social work assessment, probably the most used, yet least recognized, is intuition” (p. 24). Workers often develop intuitive hunches about various aspects of clients’ problem situations as they tell their stories. If these are shared tentatively and checked out with clients, this can often lead to deeper understanding. For example, if a client is talking about an intimate relationship in glowing terms but a worker develops a sense that this is masking some underlying ambivalence about the relationship, this thought should be shared tentatively and empathically (e.g., “From how you describe your relationship, it sounds like you and your partner care very much about each other, but I am also hearing that you might have some concerns about the relationship. Is that possible?”).

Furthermore, as workers hear more and more of clients stories, they often begin to put pieces together or make links in their minds. This type of inductive thinking should also be checked with clients in a tentative manner. For example, in hearing a client describe a number of different relationships, if a worker develops a sense that there may be an underlying theme of discomfort with intimacy, this idea should also be shared tentatively and empathically (e.g., “Intimacy can be very uncomfortable for many people and I get the impression you may have struggled with this issue in a number of different relationships”).

In the preceding example, if the worker’s hypothesis about an underlying discomfort with intimacy was confirmed by the client, the worker’s knowledge of psychodynamic theory (Chapter 7) might be used to explore the potential connection with early experiences of intimate relationships as undependable or unsatisfactory. In turn, this theoretically informed exploration might lead to additional theory building that might be shared in conversations with the client. The social worker may hear certain summaries that may be cognitive distortions (Chapter 8; i.e., “No one has ever really asked about my welfare”), which in turn may lead to a dialogue that could broaden narrow thinking (i.e., “What make you say that” or “Tell me about the last time anyone might have come close to showing a small interest in you”).

Oftentimes, the data collection and assessment process may involve more than client verbal reports and direct observation of the client. This might include, with client consent, the gathering of information and viewpoints from family members or other professionals who know the client or referral for psychological (e.g., measures of anxiety or depression) or medical (e.g., neurological) testing. Decisions about how much information to collect from the variety of sources available should be based on the joint judgment of the worker and client as to the potential benefits and costs. There are also a number of potentially valuable tools that can be employed to facilitate data collection and assessment. Two such tools commonly used by social workers are the eco-map and the genogram. The eco-map (Hartman, 1978, 1994) depicts clients in their social environment, with attention to identifying supports and stressors (see Chapters 4 and 5). The genogram (McGoldrick & Gerson, 1985; McGoldrick et al., 1999) depicts relationships within a family over two or three generations (see Chapter 5). Another more recently developed tool is the culturagram (Congress, 1994; Congress & Kung, 2005), which helps to understand clients within their cultural context (see Chapter 5).

Although data collection and assessment processes continue to some extent throughout the problem-solving process, this phase culminates in the development of an understanding shared by the worker and client about the client’s problem situation. This understanding needs to include an identification of not only the predisposing, precipitating, and perpetuating stressors (micro and macro) but also of the client’s strengths and other protective factors (Weerasekera, 1993). The shared nature of this understanding is crucial and can only evolve from a truly collaborative exploration that is grounded in a relationship characterized by mutual trust, liking, and respect. Even when such a strong relationship seems to exist, it is important to check with the client that the general understanding of the problem situation fits for them. Thus, it is helpful to ask questions such as “Does this understanding of your situation fit for you?” or “Is there anything that doesn’t fit for you or that I’ve missed?” (Barnard & Kuehl, 1995).

It is usually helpful, and usually required by agencies, that an assessment be summarized in a structured, written report. There is no definitive structure for an assessment report, but an example of a fairly comprehensive structure is provided in Table 2.2. Again, worker judgment should be used to decide how much detail should be afforded to the various issues that are included in an assessment format. The complexity of human life prevents any client assessment from being definitive and fully comprehensive. To a large degree, however, the effectiveness of the helping process depends on the quality of the assessment because it leads directly to ideas for intervention.

Planning, Contracting, and Solution Implementation

Once the worker and client arrive at a shared understanding of the client’s problem situation, they need to plan and contract with each other about a course of action or intervention and then implement the plan. Again, collaboration is key in these processes. The more clients are involved in and take ownership of the plan of action, the more likely it is that they will be motivated to implement the plan. Planning and contracting involve (a) clarifying and prioritizing the problems to be worked on; (b) identifying realistic goals that are concrete, specific, and achievable; (c) considering the pros and cons of various strategies for achieving goals; (d) deciding on a course of action; and (e) specifying the roles and responsibilities of the worker and client and the anticipated time lines for working together. Intervention involves carrying out the plan.

TABLE 2.2 SAMPLE FORMAT FOR AN ASSESSMENT REPORT

Identifying information (name, age, family constellation, employment, etc.)

Referral source and information

Presenting problem(s)

History of:

 Current and previous difficulties and coping

 Family of origin and individual development

 Family development

Personal functioning (strengths and difficulties):

 Physical functioning and health

 Emotional functioning

 Cognitive functioning

 Interpersonal functioning

 Spirituality

 Sociocultural factors (culture, ethnicity, class, gender, sexual orientation, etc.)

 Motivation

 Life cycle stage issues

Family functioning (strengths and difficulties):

 Functioning of various subsystems

 Communication patterns

 Affective expression and involvement

 Role performance

 Values and norms

 Spirituality

 Sociocultural factors

 Life cycle stage issues

Environmental stressors and supports (strengths and difficulties):

 Social supports

 Social stressors

 Economic situation

 Housing and transportation

 Sociocultural factors

Summary/formulation (understanding of presenting problem[s] with regard to predisposing, precipitating, perpetuating, and protective factors)

Goals and intervention plan

A client’s need and preference, as opposed to a worker’s theoretical orientation, should determine the goals and the action strategies, as well as the degree to which the plan and contract are specific and explicit. This is not to say that the worker is a silent and passive partner in such determinations. Workers have a right, and in fact a responsibility, to share their viewpoints on goals and action strategies. Ideally, decisions on these issues are consensual; however, where there are differences in opinion, workers should follow client preferences (unless of course these are illegal or involve threat of harm to self or others). As with assessment, planning and contracting should be construed as flexible and open to revision, always being mindful of client input. Clients should be asked questions such as “Do these ideas for addressing your difficulties make sense to you” and “Do you have any other ideas of how to make the changes you want?” (Barnard & Kuehl, 1995).

Planning, contracting, and implementation of solutions should be guided by the assessment. Sometimes, the determination of problems, goals, and action strategies is relatively straightforward. For example, if it has been determined that a client’s most pressing problem is related to suicidal ideation, there is then an obvious need to determine risk factors for harm, whether there is a plan and if other life options are available. Most times, problems a client may bring are not easy to clarify or prioritize and solutions can seem hard to reach or a long way away. Nevertheless, the assessment provides a good place to start and the specification of problems to work on along with the potential courses of action should be guided by both deductive/eclectic theory application and intuitive-inductive processes.

The systematic treatment selection (STS) approach of Beutler et al. (2005) and the transtheoretical model (TTM) of Prochaska and DiClemente (2005), both of which were discussed in Chapter 1, offer examples of a deductive theory application approach to the process of intervention (see Chapter 1). Although empirical support has not been firmly established for any of the attempts to match client or problem characteristics with therapeutic approaches, there are a number of promising ideas with intuitive appeal in this regard. A client’s natural coping style is one variable to consider in choosing a therapeutic approach. Thus, for example, the STS model suggests that clients who tend to cope by externalizing blame and punishing others are best suited to cognitive-behavioral approaches, whereas clients who tend to cope by internalizing blame and punishing themselves might best be suited to psychodynamic approaches. Another variable to consider in choosing a theory to guide intervention is the level/depth of the client problem. Thus, the TTM model contends that problems at the symptom/situational level are best suited to cognitive-behavioral approaches, whereas problems at the intrapersonal conflict level would be best suited to psychodynamic approaches.

It should be kept in mind that an eclectic use of theory might involve the sequential use and/or the simultaneous application of different theoretical perspectives. With regard to sequencing approaches, although a problem at the level of intrapersonal conflict might suggest a psychodynamic approach, a particular client may not be stable enough to tolerate painful introspection and revisiting difficult childhood issues. A cognitive-behavioral approach to building interpersonal skills and changing irrational beliefs might be a necessary step for preparing a client to do more emotional, insight-oriented work. With regard to simultaneous application of different theoretical perspectives, any combination of approaches may be appropriate to address different aspects of a client’s problem situation and assist them in highlighting their inherent and environmental resources. For example, as cognitive-behavioral techniques are used to help a client become aware of irrational thoughts, solution-focused techniques are used to help the client identify exceptions to the problem and associated resources. The holistic/eclectic grid presented in Table 2.1 provides useful guidance to workers in choosing intervention approaches. This type of grid can function to remind workers of the range of theoretical perspectives to choose from, as well as of the possibilities for biological, environmental, and sociocultural intervention.

The helping process is never a straightforward application of theory and technique. Workers need to be reminded that a rigid or formula-like approach to using theory and technique in practice will take away from the collaborative process and that the quality of the relationship with the client is the best predictor of outcome. The complexity of human life precludes certainty in the helping process and necessitates that workers combine their intuition and inductive reasoning with an eclectic use of theory. Thus, throughout the intervention process, workers need to continue to listen, to provide empathy and support, to instill hope, and to use their intuition and commonsense reasoning to help clients achieve their goals. If it becomes apparent that the intervention is not achieving the desired outcome, the plan and contract, as well as the assessment, should be revisited.

Evaluation and Termination

Evaluation is an ongoing process that should begin in the early phases of helping and continue as work makes progress. Evaluation should address the process and outcome of helping: By meeting and engaging with clients are goals being met, and is what one is doing helpful and/or meaningful to the process of change? Workers need to constantly check with clients about their satisfaction with the helping process (e.g., “Are you getting what you need here?,” or “How do you feel about our work together thus far?”), and they should use client feedback to make adjustments (this is often referred to as formative evaluation). For example, the work of Scott D. Miller attests to the evidence for client feedback as a form of treatment progress. Here, Miller et al’s work (e.g. Duncan et al., 2009; Miller, Hubble, & Chow, 2020; Miller et al., 2015; Prescott et al., 2017) has extensively covered FIT or feedback informed treatment, which has been included in the move towards deliberate practice. Here, evaluation of outcome relates to social workers being to develop those deliberate practice skills (Ericsson et al., 2006) skills by reflecting on and assessing the effectiveness of the interventions in relation to client goals (referred to as summative evaluation).

Evaluation of outcomes may be more or less formal and comprehensive, and as with all aspects of the helping process, clients’ needs and preferences should take precedence in such decisions (i.e., the outcome and session rating scales). Outcome evaluation can be as simple as client self-reports and worker judgment. On the other hand, it has become increasingly common to use more formal tools, including standardized rating scales, task achievement scaling, goal attainment scaling, outcome checklists, individualized rating scales, and client satisfaction questionnaires (see Sheafor & Horejsi, 2006, for examples). In some situations, particularly where a client’s presenting problems involve risk of harm to self or others, standardized scales and reports from others in the client’s social milieu can add valuable information to client self-reports and worker evaluation. Some clients, however, find the use of more formal measurement unnecessary and alienating.

As progress toward achieving client goals becomes evident, and/or as any prescribed time limitations on the helping process approach, the worker and client should begin to discuss and negotiate the end of their work together. As mentioned previously, termination should be addressed at the beginning of the helping process with regard to contracting about the time period of work together. It should also be addressed regularly throughout the helping process by way of periodic discussions about progress toward goals and time limitations (e.g., “Given that we have three sessions left in our time together, what do you see as being most useful for us to work toward?”)

Client reactions toward termination vary widely. Although some clients are more than happy to leave counseling, others may be hesitant or fearful. The quality of the helping relationship and clients’ previous experiences with endings may provide some indication of their probable reactions to termination. To maximize the likelihood of a positive experience with termination, it is usually helpful to (a) discuss termination well in advance, (b) anticipate and explore feelings/ambivalence (the worker’s as well as the client’s feelings) about termination, (c) review the process to date of the work done, (d) articulate the gains made and compliment the client for achievements, and (e) discuss potential future difficulties, roadblocks, or red flags and develop coping strategies and supports.

SUMMARY

From a review of the early social work literature with respect to problem-solving, there remains some questions regarding the role of problem-solving in the field of social work. This chapter has provided an overview for social work practitioners of the problem-solving model and its utility as it relates to direct practice. The flexible structure and the general guidelines of the problem-solving model were highlighted through the developmental and extensive evidence-based changes in problem-solving that extends beyond social work. The chapter culminated in a discussion of a four-stage problem-solving process encapsulating a series of steps from assessment to termination. This interdisciplinary process can help the profession of social work develop a deeper knowledge base for practice that might have a continuing impact on work with diverse client populations.