McLeod, J., & McLeod, J. (2011). Problem-solving and decision-making skills and strategies. Counselling skills: A practical guide for counsellors and helping professionals (2nd ed.) (pp. 223-228). McGraw Hill.
There are many techniques that have been developed by counsellors, psychotherapists, psychologists, management consultants and others to facilitate and support processes of problem solving, planning and decision-making. The single most useful method that can be employed is probably ‘just talking’. Making it possible for a person to look at a choice from all angles, and explore how they feel about all the options, in a situation where the listener has no preconceived ideas about which course is right or wrong, is enormously helpful. However, it can also be that sometimes the person circles endlessly around a problem or decision without arriving at any conclusions. It is therefore valuable to be able to offer clients some kind of structure through which they can organise the activity of decision making. An initial period of exploratory discussion can be useful, even if the counsellor feels sure that sooner or later some structuring devices will need to be introduced.
There are many common-sense cultural resources that can be used to structure conversations around decision-making and problem-solving. Some people find it helpful to construct some kind of 'balance sheet' — a piece of paper where the factors for and against each choice are listed and may then be weighted in terms of which is the most important. A slightly more elaborate version of a balance sheet is a force-field analysis, where the forces pressing in different directions can be mapped on a piece of paper. This technique can be helpful in identifying the sources of different forces ('it's my mother who wants me to follow option A, while its my boyfriend who is pressing me to take option B'). In some situations; for example, when a person is thinking about a career choice, a SWOT (strengths, weaknesses, opportunities and threats) analysis may be valuable. An important part of the value of any of these 'mapping' techniques is that they slow down the decision-making process, thus allowing more time for reflection. They also allow the person to generate a comprehensive analysis of the factors involved. Written maps 'externalize' the task, enabling the person and counsellor to work side by side to come up with ideas and move them around on the page.
Another useful strategy in relation to decision-making is to introduce the concept of implications. Using a brainstorming approach ('let's just imagine —without censoring any ideas that come up — what might happen if you decided to .. or a mapping technique, the person can be encouraged to look beyond the immediate consequences of a decision, and consider the long-term consequences. Alternatively, it may be that some imagined catastrophic long-term consequences ('if I quit this job I'll never find another one') can be seen as being not too awful once they are openly discussed with a counsellor. A further widely used strategy is to prioritize aspects of the issue; for example, how satisfactory is each of the possible solutions that have been generated in respect of a problem?
A lot of the time, the kind of everyday techniques that were outlined in the previous section are sufficient to allow a client and counsellor to work through a problem-solving or decision-making task. There are some situations; for example, if a counsellor has a high proportion of clients who present this kind of issue where it can be sensible to consider making use of more formal counselling protocols that have been developed in this area. There are two counselling models that are particularly relevant: problem solving therapy and motivational interviewing.
Problem-Solving Therapy
Problem-solving therapy is an approach that has been developed by Arthur and Christine Nezu and Thomas D'Zurilla in the USA, Dennis Gath in the UK, and others. The basic assumption in this approach is that poor problem-solving skills will result in demoralization, lack of hope, anxiety and depression. Counselling therefore has two parallel goals: to help the person to resolve specific current problems, and to develop skills and confidence around their general problem-solving ability. The problem-solving process consists of seven steps:
- Clarify and define the problem
- Set a realistic goal
- Generate multiple solutions
- Evaluate and compare solutions
- Select a feasible solution
- Implement the solution
- Evaluate the outcome.
In advance of working through these stages of problem-solving, the counsellor explains the model to the client, and makes sure that they understand the rationale for the approach being taken. Throughout the counselling, this understanding is reinforced through regular reviews of progress, and the use of handouts and work-sheets. If the client has more than one problem, it is important to decide on which problem to address first, and complete the sequence in relation to that issue before moving on to the next. The counselling process also includes identifying rewards that the client can claim on the successful completion of each problem-solving task.
The literature on problem-solving therapy represents a valuable resource for counsellors because it encompasses extensive discussion of theory and research, and a wealth of practical examples of problem-solving in relation to a wide range of client issues (D'Zurilla and Nezu, 1982; Nezu et at, 1989, 1998). A useful summary of how problem-solving therapy works in practice can be found in Mynors-Wallis (2001). The integration of problem-solving therapy into routine health care practice conducted by GPs is discussed by Pierce and Gunn (2007).
Motivational Interviewing
Motivational interviewing is an approach to facilitating decision-making that was developed by Stephen Rollnick and William R. Miller in the 1980s (Miller and Rollnick, 2002). The main area of application for motivational interviewing has been in the area of addictions in working with people with drug and alcohol problems around making a decision or commitment to change their behaviour. However, the principles of motivational interviewing can be employed in any situation in which a person is struggling to make a major life decision.
The theoretical roots of motivational interviewing are in Rogerian or client-centred/person-centred therapy. However, in classic client-centred therapy the counsellor adopts a rigorously non-directive stance in the sense of following the client's 'track' in respect of whatever topic the client wishes to explore. By contrast, in motivational interviewing the counsellor negotiates with the client that they will specifically focus on a decision that the client needs to make.
In practice, motivational interviewing relies on four basic principles:
- Empathy: the counsellor seeks to view the issue from the frame of reference of the client.
- Developing discrepancy: the counsellor explores with the client tensions between how clients wants their life to be (the ideal) and their current behaviour (the actual).
- Acceptance or 'rolling with resistance': the counsellor does not try to pressure the client to make a decision, but instead accepts that a reluctance to change is natural, and invites exploration of this resistance.
- Client autonomy: the counsellor respects the client as someone who has the capacity to arrive at the right decision for them in the present circumstances.
When these principles are implemented, a counselling space is constructed in which the client feels that they are in a relationship in which it is possible to talk honestly about all aspects of a decision, and as a result to be able eventually to make a genuine commitment to a new course of action that is grounded in a comprehensive exploration of all possible aspects of the issue.
Eleanor is a young woman who is a single parent with a two-year old son. She has had involvement with social workers for many years around a range of issues. Her current dilemma is whether to place her son (Stephen) in a nursery so she can restart her own career. Her mother strongly believes that Eleanor should make use of the nursery place that is on offer, and will not listen to any other point of view. On the other hand, Eleanor's neighbour strongly believes that the children can be emotionally damaged by nursery education. As pad of the process of making a decision on this issue, Eleanor decides to speak to her social worker:
Eleanor: I'm really desperate. I need to decide by next week whether or not to take the place at the nursery, and I don't know what to do.
Social worker: It's such a big decision for you to make. I get the sense that you're feeling under a lot of pressure and that this stress isn't helping you to get to the point that you are comfortable about what is best (an empathic response that reflects an appreciation of the client's situation, and is not trying to persuade her what to do).
Eleanor: Absolutely - I feel completely at the end of my rope.
Social worker: From what you have said to me before about this, my understanding is that ideally you think that it would be good for Stephen to mix more with other children, and good for you to meet people in a job situation and have more money, but that you are not sure whether he is ready for nursery yet (acknowledging discrepancy). Is that the way it seems to you, or are there other aspects of the situation that are important too? (acknowledging the client as the 'expert'- reinforcing client autonomy).
Eleanor: Yes, that's the main things.
Social worker: That suggests that there are other aspects of it too ...? (affirming client autonomy).
Eleanor: Yes, maybe. I just don't know if I could cope with him being upset. You know, like leaving him there if he was crying or having a tantrum.
Social worker: Because that would upset you ... and maybe also make you worried that he was being traumatized? (empathy)
Eleanor: Exactly.
Social worker: Can I say how it seems to me? (personal feedback). I'm wondering whether there are two parts to this. At one level you know that nursery is the right thing for you and for Stephen. But at another level it's scary to think about what will be involved at a practical level around things like 'can I cope with him being upset'? (reframing)
Eleanor: You're right: deep down I do know what I want (example of ‘commitment talk’).
One of the advantages of motivational interviewing is that it has generated a great deal of support materials and activities in the form of books, websites and training courses. There is substantial research evidence that motivational interviewing is effective with a range of different client groups. Motivational interviewing is a good example of a counselling protocol that consists of a set of basic counselling skills that have been packaged together in a particular way in order to enable a particular type of therapeutic task to be completed. When using motivational interviewing, it is essential to keep two things in mind. The first is that motivational interviewing strikes a subtle balance between facilitation and persuasion. In some of the motivational interviewing literature, it can come across as though the role of the counsellor is to lead the client in the direction of what is self-evidently the 'right' answer (e.g. losing weight, stopping drinking, etc.) because that option corresponds to prevailing societal values. However, the power of motivational interviewing is based on counsellor openness to whatever is right for the client at that point in their life, and genuine acceptance of the client's right to choose. The case of Eleanor illustrates this point: it could have been a good decision for her to stay at home with her child, and it could equally have been a good decision for her to use the nursery place that was on offer; her social worker favouring one choice rather than the other would probably have resulted in a continuation of the decisional impasse. The second critical aspect of motivational interviewing is that strictly speaking it is a method for making a commitment around a decision, and not an all-purpose counselling approach. For example, Eleanor might have arrived at a point where she made a definite decision to send her son to nursery, but still might need some further support from her social worker around dealing with her strong emotions around 'abandoning' him, or being assertive with the nursery staff around how she wanted them to respond to her son.
During the process of working through a decision-making or problem-solving task, one of the responses that the person may well appreciate from the counsellor is a certain degree of supportive challenging. Most people, when faced with a decision, will recognize the value of a 'critical friend' or 'devil's advocate' role. Of course, the primary task of the counsellor is to maintain a supportive and collaborative relationship, so it is important to make sure that challenging does not become over-adversarial in ways that might undermine or threaten that relationship. The most effective challenging is based on a capacity to gently point out possible inconsistencies or contradictions in what the person has said ('from what you are saying now, the key factor seems to be X ... but it seemed to me that from what you were saying a few minutes ago, the key factor was Y – I'm not sure how these factors fit together for you'). Another type of facilitative challenging can involve pointing out when the person might be avoiding some aspect of the decision ('you have written down all these 'for' and 'against' statements on the balance sheet – I'm aware that we have discussed all of them apart from these statements in the corner that you wrote in a red pen').
