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Section 14
Therapeutic Progress from Problem Formulation to Understanding

Question 14 | Test | Table of Contents

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During the last section, we discussed how to use problem orientation to let clients know that having a rational, realistic, and positive attitude towards problems was both healthy and normal. In this section we will discuss the next step in the problem-solving process with depressed clients.

5 CBT Components of Problem Solving (Continued)

♦ Component #4 - Problem Definition and Formulation Tasks
Sometimes I feel like an investigative reporter who is aware of the necessary components for a well-covered story. I need to have a list of information regarding my client's problem situation. Essential features include answering the "Five W's and an H" questions which are "Who," "What," "When," "Where," "Why," and "How."

Providing this information enables my dysthymic child or adult to objectively view the various contexts and viewpoints in the situation they are defining as a problem. More importantly, Problem Definition and Formulation Tasks help my client to understand what has actually happened. As you know, conclusions that are based only on partial information may be extremely misleading to the client.

To assist Wendy in this process of problem definition and formulation to tasks, I suggested, "Take the role of an extremely ethical reporter who gathers all the facts and uses only the most reliable sources. Additionally, particularly where personal evaluations and interpersonal relationships are concerned, a reporter nearly always seeks validation among sources of information."

Six CBT Steps to Define and Formulate the Problem
a. Seek all available facts and information concerning when she overeats.
b. Try to locate the source of her overeating.
c. Describe the facts in clear and unambiguous terms.
d. Identify the factors that actually make the situation a problem.
e. Differentiate relevant from irrelevant information and objective facts from unverified inferences, assumption, and interpretations.
f. Set realistic problem-solving goals.

As Elsa stated, "But when I saw you write down aging, I didn't even want to think about it - yet I do think about it all the time. I guess I really believe that even with the antidepressant medication, I still think about things very negatively."

On a side note regarding Elsa and Wendy concerning medication, as you know according to the Journal of the American Medical Association, antidepressants often work as well as placebos. Also as you are aware, according to the National Institute of Health, antidepressants do not work for a large percentage of the depressed population.

Take a second to reflect on your experience with your Elsa and your Wendy regarding antidepressants. What has been you experience? Do you feel antidepressants work well for most of you clients? What do you define as an antidepressant working or not working? Under what circumstances do you suggested the use of antidepressants to a client?

If you recall Elsa, age 67, initially she had not yet begun to admit to herself her aging was a problem for her. Although she later admitted she had a problem with aging, Elsa was not initially ready to be self-honest enough to share her feelings and thoughts in a treatment session. As you saw, Elsa's problem with aging carried itself to other parts of her life. This problem-definition step helped both Elsa and Wendy realize that they needed to face the problem and set goals to solve it.
Reviewed 2023

Peer-Reviewed Journal Article References:
Brinegar, M. G., Salvi, L. M., Stiles, W. B., & Greenberg, L. S. (2006). Building a meaning bridge: Therapeutic progress from problem formulation to understanding. Journal of Counseling Psychology, 53(2), 165–180.

Cummings, J. A., Ballantyne, E. C., & Scallion, L. M. (2015). Essential processes for cognitive behavioral clinical supervision: Agenda setting, problem-solving, and formative feedback. Psychotherapy, 52(2), 158–163.

Hollon, S. D. (2020). Is cognitive therapy enduring or antidepressant medications iatrogenic? Depression as an evolved adaptation. American Psychologist, 75(9), 1207–1218.

Geschwind, N., Bosgraaf, E., Bannink, F., & Peeters, F. (2020). Positivity pays off: Clients’ perspectives on positive compared with traditional cognitive behavioral therapy for depression. Psychotherapy, 57(3), 366–378.

Kajanoja, J., Scheinin, N. M., Karukivi, M., Karlsson, L., & Karlsson, H. (2018). Is antidepressant use associated with difficulty identifying feelings? A brief report. Experimental and Clinical Psychopharmacology, 26(1), 2–5.

Klein, D. N., Leon, A. C., Li, C., D'Zurilla, T. J., Black, S. R., Vivian, D., Dowling, F., Arnow, B. A., Manber, R., Markowitz, J. C., & Kocsis, J. H. (2011). Social problem solving and depressive symptoms over time: A randomized clinical trial of cognitive-behavioral analysis system of psychotherapy, brief supportive psychotherapy, and pharmacotherapy. Journal of Consulting and Clinical Psychology, 79(3), 342–352. 

QUESTION 14
What information enables the dysthymic child or adult to objectively view the various contexts and viewpoints in the situation they are defining as a problem? To select and enter your answer go to Test.