goals of intervention and problem solving

22 Best Counseling Interventions & Strategies for Therapists

Counseling is highly beneficial, with “far-reaching effects in life functioning” (Cochran & Cochran, 2015, p. 7).

While therapeutic relationships are vital to a positive outcome, so too are the selection and use of psychological interventions targeting the clients’ capability, opportunity, motivation, and behavior (Michie et al., 2014).

This article introduces some of the best interventions while identifying the situations where they are likely to create value for the client, helping their journey toward meaningful, value-driven goals.

Before you continue, we thought you might like to download our three Goal Achievement Exercises for free . These detailed, science-based exercises will help you or your clients create actionable goals and master techniques to create lasting behavior change.

This Article Contains:

What is a counseling intervention, list of popular therapeutic interventions, how to craft a treatment plan 101, 13 helpful therapy strategies, interventions & strategies for career counseling, 2 best interventions for group counselors, resources from positivepsychology.com, a take-home message.

“Changing ingrained behavior patterns can be challenging” and must avoid or at least reduce the risk of reverting (Michie et al., 2014, p. 11).

The American Psychological Association (n.d., para. 1) describes an intervention as “any action intended to interfere with and stop or modify a process, as in treatment undertaken to halt, manage, or alter the course of the pathological process of a disease or disorder.”

Interventions are intentional behaviors or “change strategies” introduced by the counselor to help clients implement problem management and move toward goals (Nelson-Jones, 2014):

• Counselor-centered interventions are where the counselor does something to or for the client, such as providing advice.
• Client-centered interventions empower the client, helping them develop their capacity to intervene in their own problems (for example, monitoring and replacing unhelpful thinking).

Creating or choosing the most appropriate intervention requires a thorough assessment of the client’s behavioral targets, what is needed, and how best to achieve them (Michie et al., 2014).

The selection of the intervention is guided by the:

• Nature of the problem
• Therapeutic orientation of the counselor
• Willingness and ability of the client to proceed

During counseling, various interventions are likely to be needed at different times. For that reason, counselors will require a broad range of techniques that fit the client’s needs, values, and culture (Corey, 2013).

In recent years, an increased focus has been on the use of evidence-based practice, where the choice and use of interventions is based on the best available research to make a difference in the lives of clients (Corey, 2013).

“Clients are hypothesis makers and testers” who have the reflective capacity to think about how they think (Nelson-Jones, 2014, p. 261).

Helping clients attend to their thoughts and learn how to instruct themselves more effectively can help them break repetitive patterns of insufficiently strong mind skills while positively influencing their feelings.

The following list includes some of the most popular interventions used in a variety of therapeutic settings (modified from Magyar-Moe et al., 2015; Sommers-Flanagan & Sommers-Flanagan, 2015; Cochran & Cochran, 2015; Corey, 2013):

Detecting and disputing demanding rules

Rigid, demanding thinking is identified by ‘musts,’ ‘oughts,’ and ‘shoulds’ and is usually unhelpful to the client.

For example:

I must do well in this test, or I am useless. People must treat me in the way I want; otherwise, they are awful.

Clients can be helped to dispute such thinking using “reason, logic, and facts to support, negate or amend their rules” (Nelson-Jones, 2014, p. 265).

Such interventions include:

• Functional disputing Pointing out to clients that their thinking may stand in the way of achieving their goals
• Empirical disputing Encouraging clients to evaluate the facts behind their thoughts
• Logical disputing Highlighting the illogical jumps in their thinking from preferences to demands
• Philosophical disputing Exploring clients’ meaning and satisfaction outside of life issues

Identifying automatic perceptions

Our perceptions greatly influence how we think. Clients can benefit from recognizing they have choices in how they perceive things and avoiding jumping to conclusions.

• Creating self-talk Self-talk can be helpful for most clients and can target anger management, stress handling, and improving confidence. For example:

This is not the end of the world. I’ve done this before; I can do it well again.

• Creating visual perceptions Building on the client’s existing visual images can be helpful in understanding and working through problematic situations (and their solutions).

One simple exercise to help clients see the strong relationship between visualizing and feeling involves asking clients to think of someone they love. Almost always, they form a mental image along with a host of feelings.

Visual relaxation is a powerful self-helping skill involving clients taking time out of their busy life to find calm through vividly picturing a real or imagined relaxing scene.

Creating better expectations

Clients’ explanatory styles (such as expecting to fail) can create self-fulfilling prophecies. Interventions can help by:

• Assessing the likelihood of risks or rewards
• Increasing confidence in the potential for success
• Identifying coping skills and support factors
• Time projection Imagery can help by enabling the client to step into a possible future where they manage and overcome difficult times or worrying situations.

For example, the client can imagine rolling forward to a time when they are successful in a new role at work or a developing relationship.

Creating realistic goals

Goals can motivate clients to improve performance and transition from where they are now to where they would like to be. However, it is essential to make sure they are realistic, or they risk causing undue pressure and compromising wellbeing.

The following interventions can help (Nelson-Jones, 2014):

• Stating clear goals The following questions are helpful when clients are setting goals :

Does the goal reflect your values? Is the goal realistic and achievable? Is the goal specific? Is the goal measurable? Does the goal have a timeframe?

Helping clients to experience feelings

Counseling can influence clients’ emotions and their physical reactions to emotions by helping them (Nelson-Jones, 2014):

• Experience feelings
• Express feelings
• Manage feelings
• Empty chair dialogue This practical intervention involves the client engaging in an imaginary conversation with another person; it helps “clients experience feelings both of unresolved anger and also of weakness and victimization” (Nelson-Jones, 2014, p. 347).

The client may be asked to shift to the empty chair and play the other person’s part to explore conflict, interactions, and emotions more fully (Corey, 2013).

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“Counselors and counseling trainees make choices both concerning specific interventions and about interventions used in combination” (Nelson-Jones, 2014, p. 223).

Through early and continued engagement with the client throughout the counseling approach , the counselor and client set specific, measurable, and achievable goals and create a treatment plan with a defined intervention strategy (Dobson, 2010).

The treatment plan becomes a map, combining interventions to reach client goals and overcome problems – to get from where they are now to where they want to be. However, no plan should be too fixed or risk preventing the client’s progress in their ‘wished-for’ direction. Rather, it must be open for regular revisit and modification (Nelson-Jones, 2014).

Counseling and therapeutic treatment plans vary according to the approaches used and the client’s specific needs but should be strength-based and collaborative. Most treatment plans typically consider the following points (modified from GoodTherapy, 2019):

• History and assessment – E.g., psychosocial history, symptom onset, past and present diagnoses, and treatment history
• Present concerns – The current concerns and issues that led the client to counseling
• Counseling contract – A summary of goals and desired changes, responsibility, and the counseling approach adopted
• Summary of strengths – It can be helpful to summarize the client’s strengths, empowering them for goal achievement.
• Goals – Measurable treatment goals are vital to the treatment plan.
• Objectives – Goals are broken down into smaller, achievable outcomes that support achievement during counseling.
• Interventions – Interventions should be planned early to support objectives and overall goals.
• Tracking progress and outcomes – Regular treatment plan review should include updating progress toward goals.

While a vital aspect of the counseling process is to ensure that treatment takes an appropriate direction for the client, it is also valuable and helpful for clients and insurance companies to understand likely timescales.

“Depression is one of the most common mental health disorders with a high burden of disease and the leading cause of years of life lost due to disability” (Hu et al., 2020, p. 1).

• Exercise interventions Research has shown that even low-to-moderate levels of exercise can help manage and treat depression (Hu et al., 2020).
• Gratitude Practicing gratitude can profoundly affect how we see our lives and those around us. Completing gratitude journals and reviewing three positive things that have happened at the end of the day have been shown to decrease depression and promote wellbeing (Shapiro, 2020).
• Behavioral activation Scheduling activities that result in positive emotions can help manage and overcome depression (Behavioral Activation for Depression, n.d.).

Anxiety can stop clients from living their lives fully and experiencing positive emotions. Many interventions can help, including:

• Understanding your anxiety triggers Interoceptive exposure techniques focus on reproducing sensations associated with anxiety and other difficult emotions. Clients benefit from learning to identify anxiety triggers, behavioral changes, and associated bodily sensations (Boettcher et al., 2016).
• Using a building image Clients are asked to form a mental image of themselves as a building. Their description of its state of repair and quality of foundation provides helpful insight into the client’s wellbeing and degree of anxiety (Thomas, 2016).

Grief therapy

Grief therapy helps clients accept reality, process the pain, and adjust to a new world following the loss of a loved one. Several techniques can help, including (modified from (Worden, 2018):

• Creating memory books Compiling a memory book containing photographs, memorabilia, stories, and poems can help families come together, share their grief, and reminisce.
• Directed imagery Like the ‘empty chair’ technique, through imagining the missing loved one in front of them, the grieving person is given the opportunity to talk to them.

Substance abuse

“There has been significant progress and expansion in the development of evidence-based psychosocial treatments for substance abuse and dependence” (Jhanjee, 2014, p. 1). Psychological interventions play a growing role in disorder treatment programs; they include:

• Brief optimistic interventions Brief advice is delivered following screening and assessment to at-risk individuals to reduce drinking and other harmful activities.
• Motivational interviewing This technique involves using targeted questioning while expressing empathy through reflective listening to resolve client ambivalence about their substance abuse.

Marriage therapy

Interventions are a vital aspect of marriage therapy , often targeting communication skills, problem-solving, and taking responsibility (Williams, 2012).

They can include the following interventions:

• Taking responsibility It is vital that clients take responsibility for their actions within a relationship. The counselor will work with the couple, asking the following questions, as required (modified from Williams, 2012):

How have you contributed to the relationship’s problems? What changes are needed to improve the relationship? Are you willing to make the changes needed?

• Create an action plan Once the couple agrees, the changes will be combined into a plan, with specific actions to help them achieve their goal.

Helping cancer patients

“There is no evidence to suggest that having counseling will help treat or cure your cancer”; however, it may help with coping, relationship issues, and dealing with practical problems (Cancer Research UK, 2019, para. 16).

Several counseling interventions that have proven helpful with the psychological burden include (Guo et al., 2013):

• Psychoeducation Sharing the importance of mental wellbeing and coping with the client and involving them in their cancer treatment can reduce anxiety and improve confidence.
• Cognitive-Behavioral Therapy Replacing incorrect or unhelpful beliefs can help the client achieve a more positive outlook regarding the treatment.

Career counselors help individuals or groups cope more effectively with career concerns, including (Niles & Harris-Bowlsbey, 2017):

• Career choice
• Managing career changes and transitions
• Job-related stress
• Looking for a job

While there are many interventions and strategies, the following are insightful and effective:

• Creating narratives Working with clients to build personal career narratives can help them see their movement through life with more meaning and coherence and better understand their decisions. Such an intervention can be valuable in looking forward and choosing the next steps.
• Group counseling Multiple group sessions can be arranged to cover different aspects of career-related issues and related emotional issues. They may include role-play or open discussion around specific topics.

The ultimate goals are usually to “help group members respond to each other with a combination of therapeutic attending, and sharing their own reactions and related experiences” (Cochran & Cochran, 2015, p. 329).

Examples of group interventions include:

• Circle of friends This group intervention involves gathering a child’s peers into a circle of friendly support to encourage and help them with problem-solving. The intervention has led to increased social acceptance of children with special needs (Magyar-Moe et al., 2015).
• Group mindfulness Mindfulness in group settings has been shown to be physically and mentally beneficial (Shapiro, 2020). New members may start by performing a body-scan meditation where they bring awareness to each part of their body before turning their attention to their breathing.

17 Tools To Increase Motivation and Goal Achievement

These 17 Motivation & Goal Achievement Exercises [PDF] contain all you need to help others set meaningful goals, increase self-drive, and experience greater accomplishment and life satisfaction.

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We have many free interventions, using various approaches and mediums, that support the counseling process and client goal achievement.

• Nudge Interventions in Groups The group provides a valuable setting for exploring the potential of ‘nudges’ to alter behavior in a predictable way.
• Developing Interoceptive Exposure Therapy Interventions This worksheet explores the sensations behind panic attacks and phobias.
• Therapist Interoceptive Exposure Record Use this helpful log to track interoceptive exposure interventions.
• Motivational Interviewing This template uses the five stages of change to consider the client’s readiness for change and the appropriate interventions to use.
• Breaking Out of the Comfort Zone Making changes typically requires clients to step out of their comfort zone. This worksheet identifies opportunities to embrace new challenges.

More extensive versions of the following tools are available with a subscription to the Positive Psychology Toolkit© , but they are described briefly below:

• Benefit finding

Psychological research has identified long-term benefits to using benefit finding, with individuals reporting new appreciation for their strengths and building resilience (e.g., Affleck & Tennen, 1996; Davis et al., 1998; McMillen et al., 1997).

• Begin by talking about a traumatic event.
• Focus on the positive aspects of the experience.
• Consider what the experience has taught you.
• Identify how the experience has helped you grow
• Self-compassion box

Self-compassion is a crucial aspect of our psychological wellbeing, made up of showing ourselves kindness, accepting imperfection, and paying attention to personal suffering with clarity and objectivity.

• Step one – Begin by recognizing the uncompassionate self.
• Step two – Select self-compassion reminders.
• Step three – Redirect attention to self-compassion.
• Step four – Reflect on creating more self-compassion in life.

Over time, the client should see the gaps closing between where they are now and where they want to be.

If you’re looking for more science-based ways to help others reach their goals, check out this collection of 17 validated motivation & goal achievement tools for practitioners. Use them to help others turn their dreams into reality by applying the latest science-based behavioral change techniques.

Counseling uses interventions to create positive change in clients’ lives. They can be performed individually but typically form part of a treatment or intervention plan developed with the client.

Each intervention helps the client work toward their goals, strengthen their capabilities, identify opportunities, increase motivation, and modify behavior.

They aim to create sufficient momentum to support change and avoid the risk of the client reverting, transitioning the client (often one small step at a time) from where they are now to where they want to be.

While some interventions have value in multiple settings – individual, group, career, couples, family – others are specific and purposeful. Many interventions target unhelpful, repetitive thinking patterns and aim to replace harmful thoughts, unrealistic expectations, or biased thinking. Others create a possible future where the client can engage with what might be or could happen , coming to terms with change or their own negative emotions.

Use this article to explore the range of interventions available to counselors in sessions or as homework. Try them out in different settings, working with the client to identify their value or potential for modification.

We hope you enjoyed reading this article. Don’t forget to download our three Goal Achievement Exercises for free .

• Affleck, G., & Tennen, H. (1996). Construing benefits from adversity: Adaptational significance and dispositional underpinnings. Journal of Personality , 64 , 899–922.
• American Psychological Association. (n.d.). Intervention. In APA dictionary of psychology . Retrieved February 27, 2022, from https://dictionary.apa.org/intervention
• Behavioral Activation for Depression. (n.d.). Retrieved February 16, 2022, from https://medicine.umich.edu/sites/default/files/content/downloads/Behavioral-Activation-for-Depression.pdf
• Boettcher, H., Brake, C. A., & Barlow, D. H. (2016). Origins and outlook of interoceptive exposure. Journal of Behavior Therapy and Experimental Psychiatry , 53 , 41–51.
• Cancer Research UK. (2019). How counselling can help . Retrieved February 28, 2022, from https://www.cancerresearchuk.org/about-cancer/coping/emotionally/talking-about-cancer/counselling/how-counselling-can-help
• Cochran, J. L., & Cochran, N. H. (2015). The heart of counseling: Counseling skills through therapeutic relationships . Routledge, Taylor & Francis Group.
• Corey, G. (2013). Theory and practice of counseling and psychotherapy . Cengage.
• Davis, C. G., Nolen-Hoeksema, S., & Larson, J. (1998). Making sense of loss and benefiting from the experience: Two construals of meaning. Journal of Personality and Social Psychology , 75 , 561–574.
• Dobson, K. S. (Ed.) (2010). Handbook of cognitive-behavioral therapies (3rd ed.). Guilford Press.
• Guo, Z., Tang, H. Y., Li, H., Tan, S. K., Feng, K. H., Huang, Y. C., Bu, Q., & Jiang, W. (2013). The benefits of psychosocial interventions for cancer patients undergoing radiotherapy. Health and Quality of Life Outcomes , 11 (1), 1–12.
• GoodTherapy. (2019, September 25). Treatment plan . Retrieved February 27, 2022, from https://www.goodtherapy.org/blog/psychpedia/treatment-plan
• Hu, M. X., Turner, D., Generaal, E., Bos, D., Ikram, M. K., Ikram, M. A., Cuijpers, P., & Penninx, B. W. J. H. (2020). Exercise interventions for the prevention of depression: a systematic review of meta-analyses. BMC Public Health , 20 (1), 1255.
• Jhanjee, S. (2014). Evidence-based psychosocial interventions in substance use. Indian Journal of Psychological Medicine , 36 (2), 112–118.
• Magyar-Moe, J. L., Owens, R. L., & Conoley, C. W. (2015). Positive psychological interventions in counseling. The Counseling Psychologist , 43 (4), 508–557.
• McMillen, J. C., Smith, E. M., & Fisher, R. H. (1997). Perceived benefit and mental health after three types of disaster. Journal of Consulting and Clinical Psychology , 65 , 733–739.
• Michie, S., Atkins, L., & West, R. (2014). The behaviour change wheel: A guide to designing interventions . Silverback.
• Nelson-Jones, R. (2014). Practical counselling and helping skills . Sage.
• Niles, S. G., & Harris-Bowlsbey, J. (2017). Career development interventions . Pearson.
• Shapiro, S. L. (2020). Rewire your mind: Discover the science + practice of mindfulness . Aster.
• Sommers-Flanagan, J., & Sommers-Flanagan, R. (2015). Study guide for counseling and psychotherapy theories in context and practice: Skills, strategies, and techniques (2nd ed.). Wiley.
• Thomas, V. (2016). Using mental imagery in counselling and psychotherapy: A guide to more inclusive theory and practice . Routledge.
• Williams, M. (2012). Couples counseling: A step by step guide for therapists . Viale.
• Worden, J. W. (2018). Grief counseling and grief therapy: A handbook for the mental health practitioner . Springer.

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Open Access

Peer-reviewed

Research Article

Problem-solving interventions and depression among adolescents and young adults: A systematic review of the effectiveness of problem-solving interventions in preventing or treating depression

Roles Conceptualization, Data curation, Formal analysis, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America

Roles Conceptualization, Writing – original draft

Affiliation Centre for Evidence and Implementation, London, United Kingdom

Roles Data curation

Roles Conceptualization, Writing – review & editing

Affiliation Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States of America

Roles Conceptualization, Methodology

Roles Conceptualization, Project administration, Writing – review & editing

Affiliation Centre for Evidence and Implementation, Melbourne, Victoria, Australia

Roles Conceptualization, Formal analysis, Methodology, Writing – original draft, Writing – review & editing

Affiliation Department of Social Work, Monash University, Melbourne, Victoria, Australia

• Kristina Metz, 
• Jane Lewis, 
• Jade Mitchell, 
• Sangita Chakraborty, 
• Bryce D. McLeod, 
• Ludvig Bjørndal, 
• Robyn Mildon, 
• Aron Shlonsky

• Published: August 29, 2023
• https://doi.org/10.1371/journal.pone.0285949
• Peer Review
• Reader Comments

Problem-solving (PS) has been identified as a therapeutic technique found in multiple evidence-based treatments for depression. To further understand for whom and how this intervention works, we undertook a systematic review of the evidence for PS’s effectiveness in preventing and treating depression among adolescents and young adults. We searched electronic databases ( PsycINFO , Medline , and Cochrane Library ) for studies published between 2000 and 2022. Studies meeting the following criteria were included: (a) the intervention was described by authors as a PS intervention or including PS; (b) the intervention was used to treat or prevent depression; (c) mean or median age between 13–25 years; (d) at least one depression outcome was reported. Risk of bias of included studies was assessed using the Cochrane Risk of Bias 2.0 tool. A narrative synthesis was undertaken given the high level of heterogeneity in study variables. Twenty-five out of 874 studies met inclusion criteria. The interventions studied were heterogeneous in population, intervention, modality, comparison condition, study design, and outcome. Twelve studies focused purely on PS; 13 used PS as part of a more comprehensive intervention. Eleven studies found positive effects in reducing depressive symptoms and two in reducing suicidality. There was little evidence that the intervention impacted PS skills or that PS skills acted as a mediator or moderator of effects on depression. There is mixed evidence about the effectiveness of PS as a prevention and treatment of depression among AYA. Our findings indicate that pure PS interventions to treat clinical depression have the strongest evidence, while pure PS interventions used to prevent or treat sub-clinical depression and PS as part of a more comprehensive intervention show mixed results. Possible explanations for limited effectiveness are discussed, including missing outcome bias, variability in quality, dosage, and fidelity monitoring; small sample sizes and short follow-up periods.

Citation: Metz K, Lewis J, Mitchell J, Chakraborty S, McLeod BD, Bjørndal L, et al. (2023) Problem-solving interventions and depression among adolescents and young adults: A systematic review of the effectiveness of problem-solving interventions in preventing or treating depression. PLoS ONE 18(8): e0285949. https://doi.org/10.1371/journal.pone.0285949

Editor: Thiago P. Fernandes, Federal University of Paraiba, BRAZIL

Received: January 2, 2023; Accepted: May 4, 2023; Published: August 29, 2023

Copyright: © 2023 Metz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant methods and data are within the paper and its Supporting Information files.

Funding: This work was commissioned by Wellcome Trust and was conducted independently by the evaluators (all named authors). No grant number is available. Wellcome Trust had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The authors declare no financial or other competing interests, including their relationship and ongoing work with Wellcome Trust. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Depression among adolescents and young adults (AYA) is a serious, widespread problem. A striking increase in depressive symptoms is seen in early adolescence [ 1 ], with rates of depression being estimated to almost double between the age of 13 (8.4%) and 18 (15.4%) [ 2 ]. Research also suggests that the mean age of onset for depressive disorders is decreasing, and the prevalence is increasing for AYA. Psychosocial interventions, such as cognitive-behavioural therapy (CBT) and interpersonal therapy (IPT), have shown small to moderate effects in preventing and treating depression [ 3 – 6 ]. However, room for improvement remains. Up to half of youth with depression do not receive treatment [ 7 ]. When youth receive treatment, studies indicate that about half of youth will not show measurable symptom reduction across 30 weeks of routine clinical care for depression [ 8 ]. One strategy to improve the accessibility and effectiveness of mental health interventions is to move away from an emphasis on Evidence- Based Treatments (EBTs; e.g., CBT) to a focus on discrete treatment techniques that demonstrate positive effects across multiple studies that meet certain methodological standards (i.e., common elements; 9). Identifying common elements allows for the removal of redundant and less effective treatment content, reducing treatment costs, expanding available service provision and enhancing scability. Furthermore, introducing the most effective elements of treatment early may improve client retention and outcomes [ 9 – 13 ].

A potential common element for depression intervention is problem-solving (PS). PS refers to how an individual identifies and applies solutions to everyday problems. D’Zurilla and colleagues [ 14 – 17 ] conceptualize effective PS skills to include a constructive attitude towards problems (i.e., a positive problem-solving orientation) and the ability to approach problems systematically and rationally (i.e., a rational PS style). Whereas maladaptive patterns, such as negative problem orientation and passively or impulsively addressing problems, are ineffective PS skills that may lead to depressive symptoms [ 14 – 17 ]. Problem Solving Therapy (PST), designed by D’Zurilla and colleagues, is a therapeutic approach developed to decrease mental health problems by improving PS skills [ 18 ]. PST focuses on four core skills to promote adaptive problem solving, including: (1) defining the problem; (2) brainstorming possible solutions; (3) appraising solutions and selecting the best one; and (4) implementing the chosen solution and assessing the outcome [ 14 – 17 ]. PS is also a component in other manualized approaches, such as CBT and Dialectical Behavioural Therapy (DBT), as well as imbedded into other wider generalized mental health programming [ 19 , 20 ]. A meta-analysis of over 30 studies found PST, or PS skills alone, to be as effective as CBT and IPT and more effective than control conditions [ 21 – 23 ]. Thus, justifying its identification as a common element in multiple prevention [ 19 , 24 ] and treatment [ 21 , 25 ] programs for adult depression [ 9 , 26 – 28 ].

PS has been applied to youth and young adults; however, no manuals specific to the AYA population are available. Empirical studies suggest maladaptive PS skills are associated with depressive symptoms in AYA [ 5 , 17 – 23 ]. Furthermore, PS intervention can be brief [ 29 ], delivered by trained or lay counsellors [ 30 , 31 ], and provided in various contexts (e.g., primary care, schools [ 23 ]). Given PS’s versatility and effectiveness, PS could be an ideal common element in treating AYA depression; however, to our knowledge, no reviews or meta-analyses on PS’s effectiveness with AYA specific populations exist. This review aimed to examine the effectiveness of PS as a common element in the prevention and treatment of depression for AYA within real-world settings, as well as to ascertain the variables that may influence and impact PS intervention effects.

Identification and selection of studies

Searches were conducted using PsycInfo , Medline , and Cochrane Library with the following search terms: "problem-solving", “adolescent”, “youth”, and” depression, ” along with filters limiting results to controlled studies looking at effectiveness or exploring mechanisms of effectiveness. Synonyms and derivatives were employed to expand the search. We searched grey literature using Greylit . org and Opengrey . eu , contacted experts in the field and authors of protocols, and searched the reference lists of all included studies. The search was undertaken on 4 th June 2020 and updated on 11 th June 2022.

Studies meeting the following criteria were included: (a) the intervention was described by authors as a PS intervention or including PS; (b) the intervention was used to treat or prevent depression; (c) mean or median age between 13–25 years; and (d) at least one depression outcome was reported. Literature in electronic format published post 2000 was deemed eligible, given the greater relevance of more recent usage of PS in real-world settings. There was no exclusion for gender, ethnicity, or country setting; only English language texts were included. Randomized controlled trials (RCTs), quasi-experimental designs (QEDs), systematic reviews/meta-analyses, pilots, or other studies with clearly defined comparison conditions (no treatment, treatment as usual (TAU), or a comparator treatment) were included. We excluded studies of CBT, IPT, Acceptance and Commitment Therapy (ACT), Dialectical Behaviour Therapy (DBT), and modified forms of these treatments. These treatments include PS and have been shown to demonstrate small to medium effects on depression [ 13 , 14 , 32 ], but the unique contribution of PS cannot be disentangled. The protocol for this review was not registered; however, all data collection forms, extraction, coding and analyses used in the review are available upon inquiry from the first author.

Study selection

All citations were entered into Endnote and uploaded to Covidence for screening and review against the inclusion/exclusion criteria. Reviewers with high inter-rater reliability (98%) independently screened the titles and abstracts. Two reviewers then independently screened full text of articles that met criteria. Duplicates, irrelevant studies, and studies that did not meet the criteria were removed, and the reason for exclusion was recorded (see S1 File for a list of excluded studies). Discrepancies were resolved by discussion with the team leads.

Data extraction

Two reviewers independently extracted data that included: (i) study characteristics (author, publication year, location, design, study aim), (ii) population (age, gender, race/ethnicity, education, family income, depression status), (iii) setting, (iv) intervention description (therapeutic or preventative, whether PS was provided alone or as part of a more comprehensive intervention, duration, delivery mode), (v) treatment outcomes (measures used and reported outcomes for depression, suicidality, and PS), and (vi) fidelity/implementation outcomes. For treatment outcomes, we included the original statistical analyses and/or values needed to calculate an effect size, as reported by the authors. If a variable was not included in the study publication, we extracted the information available and made note of missing data and subsequent limitations to the analyses.

RCTs were assessed for quality (i.e., confidence in the study’s findings) using the Cochrane Risk of Bias 2.0 tool [ 33 ] which includes assessment of the potential risk of bias relating to the process of randomisation; deviations from the intended intervention(s); missing data; outcome measurement and reported results. Risk of bias pertaining to each domain is estimated using an algorithm, grouped as: Low risk; Some concerns; or High risk. Two reviewers independently assessed the quality of included studies, and discrepancies were resolved by consensus.

We planned to conduct one or more meta-analyses if the studies were sufficiently similar. Data were entered into a summary of findings table as a first step in determining the theoretical and practical similarity of the population, intervention, comparison condition, outcome, and study design. If there were sufficiently similar studies, a meta-analysis would be conducted according to guidelines contained in the Cochrane Collaboration Handbook of Systematic Reviews, including tests of heterogeneity and use of random effects models where necessary.

The two searches yielded a total number of 874 records (after the removal of duplicates). After title and abstract screening, 184 full-text papers were considered for inclusion, of which 25 studies met the eligibility criteria and were included in the systematic review ( Fig 1 ). Unfortunately, substantial differences (both theoretical and practical) precluded any relevant meta-analyses, and we were limited to a narrative synthesis.

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https://doi.org/10.1371/journal.pone.0285949.g001

Risk of bias assessment

Risk of bias assessments were conducted on the 23 RCTs ( Fig 2 ; assessments by study presented in S1 Table ). Risk of bias concerns were moderate, and a fair degree of confidence in the validity of study findings is warranted. Most studies (81%) were assessed as ‘some concerns’ (N = 18), four studies were ‘low risk’, and one ‘high risk’. The most frequent areas of concern were the selection of the reported result (n = 18, mostly due to inadequate reporting of a priori analytic plans); deviations from the intended intervention (N = 17, mostly related to insufficient information about intention-to-treat analyses); and randomisation process (N = 13).

https://doi.org/10.1371/journal.pone.0285949.g002

Study designs and characteristics

Study design..

Across the 25 studies, 23 were RCTs; two were QEDs. Nine had TAU or wait-list control (WLC) comparator groups, and 16 used active control groups (e.g., alternative treatment). Eleven studies described fidelity measures. The sample size ranged from 26 to 686 and was under 63 in nine studies.

Selected intervention.

Twenty interventions were described across the 25 studies ( Table 1 ). Ten interventions focused purely on PS. Of these 10 interventions: three were adaptations of models proposed by D’Zurilla and Nezu [ 20 , 34 ] and D’Zurilla and Goldfried [ 18 ], two were based on Mynors-Wallis’s [ 35 ] Problem-Solving Therapy (PST) guide, one was a problem-orientation video intervention adapted from D’Zurilla and Nezu [ 34 ], one was an online intervention adapted from Method of Levels therapy, and three did not specify a model. Ten interventions used PS as part of a larger, more comprehensive intervention (e.g., PS as a portion of cognitive therapy). The utilization and dose of PS steps included in these interventions were unclear. Ten interventions were primary prevention interventions–one of these was universal prevention, five were indicated prevention, and four were selective prevention. Ten interventions were secondary prevention interventions. Nine interventions were described as having been developed or adapted for young people.

https://doi.org/10.1371/journal.pone.0285949.t001

Intervention delivery.

Of the 20 interventions, eight were delivered individually, eight were group-based, two were family-based, one was mixed, and in one, the format of delivery was unclear. Seventeen were delivered face-to-face and three online. Dosage ranged from a single session to 21, 50-minute sessions (12 weekly sessions, then 6 biweekly sessions); the most common session formar was once weekly for six weeks (N = 5).

Intervention setting and participants.

Seventeen studies were conducted in high-income countries (UK, US, Australia, Netherlands, South Korea), four in upper-middle income (Brazil, South Africa, Turkey), and four in low- and middle-income countries (Zimbabwe, Nigeria, India). Four studies included participants younger than 13 and four older than 25. Nine studies were conducted on university or high school student populations and five on pregnant or post-partum mothers. The remaining 11 used populations from mental health clinics, the community, a diabetes clinic, juvenile detention, and a runaway shelter.

Sixteen studies included participants who met the criteria for a depressive, bipolar, or suicidal disorder (two of these excluded severe depression). Nine studies did not use depression symptoms in the inclusion criteria (one of these excluded depression). Several studies excluded other significant mental health conditions.

Outcome measures.

Eight interventions targeted depression, four post/perinatal depression, two suicidal ideation, two resilience, one ‘problem-related distress’, one ‘diabetes distress’, one common adolescent mental health problem, and one mood episode. Those targeting post/perinatal depression used the Edinburgh Postnatal Depression Scale as the outcome measure. Of the others, six used the Beck Depression Inventory (I or II), two the Children’s Depression Inventory, three the Depression Anxiety Stress Scale-21, three the Centre for Epidemiologic Studies Depression Scale, one the Short Mood and Feelings Questionnaire, one the Hamilton Depression Rating Scale, one the depression subscale on the Schedule for Affective Disorders and Schizophrenia for School-Age Children, one the Strengths and Difficulties Questionnaire, one the Youth Top Problems Score, one the Adolescent Longitudinal Interval Follow-up Evaluation and Psychiatric Status Ratings, one the Kiddie Schedule for Affective Disorders and Schizophrenia, and one the Mini International Neuropsychiatric Interview.

Only eight studies measured PS skills or orientation outcomes. Three used the Social Problem-Solving Inventory-Revised, one the Problem Solving Inventory, two measured the extent to which the nominated problem had been resolved, one observed PS in video-taped interactions, and one did not specify the measure.

The mixed findings regarding the effectiveness of PS for depression may depend on the type of intervention: primary (universal, selective, or indicated), secondary or tertiary prevention. Universal prevention interventions target the general public or a population not determined by any specific criteria [ 36 ]. Selective prevention interventions target specific populations with an increased risk of developing a disorder. Indicated prevention interventions target high-risk individuals with sub-clinical symptoms of a disorder. Secondary prevention interventions include those that target individuals diagnosed with a disorder. Finally, tertiary prevention interventions refer to follow-up interventions designed to retain treatment effects. Outcomes are therefore grouped by intervention prevention type and outcome. Within these groupings, studies with a lower risk of bias (RCTs) are presented first. According to the World Health Organisation guidelines, interventions were defined as primary, secondary or tertiary prevention [ 36 ].

Universal prevention interventions

One study reported on a universal prevention intervention targeting resilience and coping strategies in US university students. The Resilience and Coping Intervention, which includes PS as a primary component of the intervention, found a significant reduction in depression compared to TAU (RCT, N = 129, moderate risk of bias) [ 37 ].

Selective prevention interventions

Six studies, including five RCTs and one QED, tested PS as a selective prevention intervention. Two studies investigated the impact of the Manage Your Life Online program, which includes PS as a primary component of the intervention, compared with an online programme emulating Rogerian psychotherapy for UK university students (RCT, N = 213, moderate risk of bias [ 38 ]; RCT, N = 48, moderate risk of bias [ 39 ]). Both studies found no differences in depression or problem-related distress between groups.

Similarly, two studies explored the effect of adapting the Penn Resilience Program, which includes PS as a component of a more comprehensive intervention for young people with diabetes in the US (RCT, N = 264, moderate risk of bias) [ 40 , 41 ]. The initial study showed a moderate reduction in diabetes distress but not depression at 4-, 8-, 12- and 16-months follow-up compared to a diabetes education intervention [ 40 ]. The follow-up study found a significant reduction in depressive symptoms compared to the active control from 16- to 40-months; however, this did not reach significance at 40-months [ 41 ].

Another study that was part of wider PS and social skills intervention among juveniles in state-run detention centres in the US found no impacts (RCT, N = 296, high risk of bias) [ 42 ]. A QED ( N = 32) was used to test the effectiveness of a resilience enhancement and prevention intervention for runaway youth in South Korea [ 43 ]. There was a significant decrease in depression for the intervention group compared with the control group at post-test, but the difference was not sustained at one-month follow-up.

Indicated prevention interventions

Six studies, including five RCTs and one QED, tested PS as an indicated prevention intervention. Four of the five RCTs tested PS as a primary component of the intervention. A PS intervention for common adolescent mental health problems in Indian high school students (RCT, N = 251, low risk of bias) led to a significant reduction in psychosocial problems at 6- and 12 weeks; however, it did not have a significant impact on mental health symptoms or internalising symptoms compared to PS booklets without counsellor treatment at 6- and 12-weeks [ 31 ]. A follow-up study showed a significant reduction in overall psychosocial problems and mental health symptoms, including internalizing symptoms, over 12 months [ 44 ]. Still, these effects no longer reached significance in sensitivity analysis adjusting for missing data (RCT, N = 251, low risk of bias). Furthermore, a 2x2 factorial RCT ( N = 176, moderate risk of bias) testing PST among youth mental health service users with a mild mental disorder in Australia found that the intervention was not superior to supportive counselling at 2-weeks post-treatment [ 30 ]. Similarly, an online PS intervention delivered to young people in the Netherlands to prevent depression (RCT, N = 45, moderate risk of bias) found no significant difference between the intervention and WLC in depression level 4-months post-treatment [ 45 ].

One RCT tested PS approaches in a more comprehensive manualized programme for postnatal depression in the UK and found no significant differences in depression scores between intervention and TAU at 3-months post-partum (RCT, N = 292, moderate risk of bias) [ 46 ].

A study in Turkey used a non-equivalent control group design (QED, N = 62) to test a nursing intervention against a PS control intervention [ 47 ]. Both groups showed a reduction in depression, but the nursing care intervention demonstrated a larger decrease post-intervention than the PS control intervention.

Secondary prevention interventions

Twelve studies, all RCTs, tested PS as a secondary prevention intervention. Four of the 12 RCTs tested PS as a primary component of the intervention. An intervention among women in Zimbabwe (RCT, N = 58, moderate risk of bias) found a larger decrease in the Edinburgh Postnatal Depression Scale score for the intervention group compared to control (who received the antidepressant amitriptyline and peer education) at 6-weeks post-treatment [ 48 ]. A problem-orientation intervention covering four PST steps and involving a single session video for US university students (RCT, N = 110, moderate risk of bias), compared with a video covering other health issues, resulted in a moderate reduction in depression post-treatment; however, results were no longer significant at 2-weeks, and 1-month follow up [ 49 ].

Compared to WLC, a study of an intervention for depression and suicidal proneness among high school and university students in Turkey (RCT, N = 46, moderate risk of bias) found large effect sizes on post-treatment depression scores for intervention participants post-treatment compared with WLC. At 12-month follow-up, these improvements were maintained compared to pre-test but not compared to post-treatment scores. Significant post-treatment depression recovery was also found in the PST group [ 12 ]. Compared to TAU, a small but high-quality (low-risk of bias) study focused on preventing suicidal risk among school students in Brazil (RCT, N = 100, low risk of bias) found a significant, moderate reduction in depression symptoms for the treatment group post-intervention that was maintained at 1-, 3- and 6-month follow-up [ 50 ].

Seven of the 12 RCTs tested PS as a part of a more comprehensive intervention. Two interventions targeted mood episodes and were compared to active control. These US studies focused on Family-Focused Therapy as an intervention for mood episodes, which included sessions on PS [ 51 , 52 ]. One of these found that Family-Focused Therapy for AYA with Bipolar Disorder (RCT, N = 145, moderate risk of bias) had no significant impact on mood or depressive symptoms compared to pharmacotherapy. However, Family-Focused Therapy had a greater impact on the proportion of weeks without mania/hypomania and mania/hypomania symptoms than enhanced care [ 53 ]. Alternatively, while the other study (RCT, N = 127, low risk of bias) found no significant impact on time to recovery, Family-Focused Therapy led to significantly longer intervals of wellness before new mood episodes, longer intervals between recovery and the next mood episode, and longer intervals of randomisation to the next mood episode in AYA with either Bipolar Disorder (BD) or Major Depressive Disorder (MDD), compared to family and individual psychoeducation [ 52 ].

Two US studies used a three-arm trial to compare Systemic-behavioural Family Therapy (SBFT) with elements of PS, to CBT and individual Non-directive Supportive therapy (NST) (RCT, N = 107, moderate risk of bias) [ 53 , 54 ]. One study looked at whether the PS elements of CBT and SFBT mediated the effectiveness of these interventions for the remission of MDD. It found that PS mediated the association between CBT, but not SFBT, and remission from depression. There was no significant association between SBFT and remission status, though there was a significant association between CBT and remission status [ 53 ]. The other study found no significant reduction in depression post-treatment or at 24-month follow-up for SBFT [ 54 ].

A PS intervention tested in maternal and child clinics in Nigeria RCT ( N = 686, moderate risk of bias) compared with enhanced TAU involving psychosocial and social support found no significant difference in the proportion of women who recovered from depression at 6-months post-partum [ 55 ]. However, there was a small difference in depression scores in favour of PS averaged across the 3-, 6-, 9-, and 12-month follow-up points. Cognitive Reminiscence Therapy, which involved recollection of past PS experiences and drew on PS techniques used for 12-25-year-olds in community mental health services in Australia (RCT, N = 26, moderate risk of bias), did not reduce depression symptoms compared with a brief evidence-based treatment at 1- or 2-month follow-up [ 56 ]. Additionally, the High School Transition Program in the US (RCT, N = 497, moderate risk of bias) aimed to prevent depression, anxiety, and school problems in youth transitioning to high school [ 57 ]. There was no reduction in the percentage of intervention students with clinical depression compared to the control group. Similarly, a small study focused on reducing depression symptoms, and nonadherence to antiretroviral therapy in pregnant women with HIV in South Africa (RCT, N = 23, some concern) found a significant reduction in depression symptoms compared to TAU, with the results being maintained at the 3-month follow-up [ 58 ].

Reduction in suicidality

Three studies measured a reduction in suicidality. A preventive treatment found a large reduction in suicidal orientation in the PS group compared to control post-treatment. In contrast, suicidal ideation scores were inconsistent at 1-,3- and 6- month follow-up, they maintained an overall lower score [ 50 ]. Furthermore, at post-test, significantly more participants in the PS group were no longer at risk of suicide. No significant differences were found in suicide plans or attempts. In a PST intervention, post-treatment suicide risk scores were lower than pre-treatment for the PST group but unchanged for the control group [ 12 ]. An online treatment found a moderate decline in ideation for the intervention group post-treatment compared to the control but was not sustained at a one-month follow-up [ 49 ].

Mediators and moderators

Eight studies measured PS skills or effectiveness. In two studies, despite the interventions reducing depression, there was no improvement in PS abilities [ 12 , 52 ]. One found that change in global and functional PS skills mediated the relationship between the intervention group and change in suicidal orientation, but this was not assessed for depression [ 50 ]. Three other studies found no change in depression symptoms, PS skills, or problem resolution [ 38 – 40 ]. Finally, CBT and SBFT led to significant increases in PS behaviour, and PS was associated with higher rates of remission across treatments but did not moderate the relationship between SBFT and remission status [ 53 ]. Another study found no changes in confidence in the ability to solve problems or belief in personal control when solving problems. Furthermore, the intervention group was more likely to adopt an avoidant PS style [ 46 ].

A high-intensity intervention for perinatal depression in Nigeria had no treatment effect on depression remission rates for the whole sample. Still, it was significantly effective for participants with more severe depression at baseline [ 55 ]. A PS intervention among juvenile detainees in the US effectively reduced depression for participants with higher levels of fluid intelligence, but symptoms increased for those with lower levels [ 42 ].The authors suggest that individuals with lower levels of fluid intelligence may have been less able to cope with exploring negative emotions and apply the skills learned.

This review has examined the evidence on the effectiveness of PS in the prevention or treatment of depression among 13–25-year-olds. We sought to determine in what way, in which contexts, and for whom PS appears to work in addressing depression. We found 25 studies involving 20 interventions. Results are promising for secondary prevention interventions, or interventions targeting clinical level populations, that utilize PS as the primary intervention [ 12 , 47 – 49 ]. These studies not only found a significant reduction in depression symptoms compared to active [ 48 , 49 ] and non-active [ 12 , 47 ] controls but also found a significant reduction in suicidal orientation and ideation [ 12 , 47 , 49 ]. These findings are consistent with meta-analyses of adult PS interventions [ 21 , 22 , 23 ], highlighting that PS interventions for AYA can be effective in real-world settings.

For other types of interventions (i.e., universal, selective prevention, indicated prevention), results were mixed in reducing depression. The one universal program was found to have a small, significant effect in reducing depression symptoms compared to a non-active control [ 37 ]. Most selective prevention programs were not effective [ 39 , 40 , 56 ], and those that did show small, significant effects had mixed outcomes for follow-up maintenance [ 41 , 42 ]. Most indicated prevention programs were not effective [ 30 , 31 , 45 – 47 ], yet a follow-up study showed a significant reduction in internalizing symptoms at 12-month post-treatment compared to an active control [ 44 ]. Given that these studies targeted sub-clinical populations and many of them had small sample sizes, these mixed findings may be a result of not having sufficient power to detect a meaningful difference.

Our review found limited evidence about PS skills as mediator or moderator of depression. Few studies measured improvements in PS skills; fewer still found interventions to be effective. The absence of evidence for PS abilities as a pathway is puzzling. It may be that specific aspects of PS behaviours and processes, such as problem orientation [ 59 ], are relevant. Alternatively, there may be a mechanism other than PS skills through which PS interventions influence depression.

Studies with PS as part of a wider intervention also showed mixed results, even amongst clinical populations. Although there was no clear rationale for the discrepancies in effectiveness between the studies, it is possible that the wider program dilutes the focus and impact of efficacious therapeutic elements. However, this is difficult to discern given the heterogeneity in the studies and limited information on study treatments and implementation factors. A broad conclusion might be that PS can be delivered most effectively with clinical populations in its purest PS form and may be tailored to a range of different contexts and forms, a range of populations, and to address different types of problems; however, this tailoring may reduce effectiveness.

Although the scale of impact is broadly in line with the small to moderate effectiveness of other treatments for youth depression [ 6 ], our review highlights shortcomings in study design, methods, and reporting that would allow for a better understanding of PS effectiveness and pathways. Studies varied in how well PS was operationalised. Low dosage is consistent with usage described in informal conversations with practitioners but may be insufficient for effectiveness. Fidelity was monitored in only half the studies despite evidence that monitoring implementation improves effectiveness [ 60 ]. There were references to implementation difficulties, including attrition, challenges in operationalizing online interventions, and skills of those delivering. Furthermore, most of the studies had little information about comorbidity and no analysis of whether it influenced outcomes. Therefore, we were unable to fully examine and conceptualize the ways, how and for whom PS works. More information about study populations and intervention implementation is essential to understand the potential of PS for broader dissemination.

Our review had several limitations. We excluded studies that included four treatments known to be effective in treating depression among AYA (e.g., CBT) but where the unique contribution of PS to clinical outcome could not be disentangled. Furthermore, we relied on authors’ reporting to determine if PS was included: details about operationalization of PS were often scant. Little evidence addressing the fit, feasibility, or acceptability of PS interventions was found, reflecting a limited focus on implementation. We included only English-language texts: relevant studies in other languages may exist, though our post-2000 inclusion criteria may limit this potential bias due to improved translation of studies to English over the years. Finally, the heterogeneity of study populations, problem severity, comparison conditions, outcome measures, and study designs, along with a relatively small number of included studies, limits confidence in what we can say about implementation and treatment outcomes.

Overall, our review indicates that PS may have the best results when implemented its purest form as a stand-alone treatment with clinical level AYA populations; tailoring or imbedding PS into wider programming may dilute its effectiveness. Our review also points to a need for continued innovation in treatment to improve the operationalizing and testing of PS, especially when included as a part of a more comprehensive intervention. It also highlights the need for study methods that allow us to understand the specific effects of PS, and that measure the frequency, dosage, and timing of PS to understand what is effective for whom and in what contexts.

Supporting information

S1 file. list of excluded studies..

https://doi.org/10.1371/journal.pone.0285949.s001

S2 File. PRISMA checklist.

https://doi.org/10.1371/journal.pone.0285949.s002

S1 Table. Individual risk of bias assessments using cochrane RoB2 tool by domain (1–5) and overall (6).

https://doi.org/10.1371/journal.pone.0285949.s003

Acknowledgments

All individuals that contributed to this paper are included as authors.

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What Is Cognitive Behavioral Therapy (CBT)?

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Rachel Goldman, PhD FTOS, is a licensed psychologist, clinical assistant professor, speaker, wellness expert specializing in eating behaviors, stress management, and health behavior change.

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Cognitive behavioral therapy (CBT) is a type of psychotherapeutic treatment that helps people learn how to identify and change the destructive or disturbing thought patterns that have a negative influence on their behavior and emotions.

Cognitive behavioral therapy combines cognitive therapy with behavior therapy by identifying maladaptive patterns of thinking, emotional responses, or behaviors and replacing them with more desirable patterns.

Cognitive behavioral therapy focuses on changing the automatic negative thoughts that can contribute to and worsen our emotional difficulties, depression , and anxiety . These spontaneous negative thoughts also have a detrimental influence on our mood.

Through CBT, faulty thoughts are identified, challenged, and replaced with more objective, realistic thoughts.

Everything You Need to Know About CBT

This video has been medically reviewed by Steven Gans, MD .

Types of Cognitive Behavioral Therapy

CBT encompasses a range of techniques and approaches that address our thoughts, emotions, and behaviors. These can range from structured psychotherapies to self-help practices. Some of the specific types of therapeutic approaches that involve cognitive behavioral therapy include:

• Cognitive therapy centers on identifying and changing inaccurate or distorted thought patterns, emotional responses, and behaviors.
• Dialectical behavior therapy (DBT)  addresses destructive or disturbing thoughts and behaviors while incorporating treatment strategies such as emotional regulation and mindfulness.
• Multimodal therapy suggests that psychological issues must be treated by addressing seven different but interconnected modalities: behavior, affect, sensation, imagery, cognition, interpersonal factors, and drug/biological considerations.
• Rational emotive behavior therapy (REBT) involves identifying irrational beliefs, actively challenging these beliefs, and finally learning to recognize and change these thought patterns.

While each type of cognitive behavioral therapy takes a different approach, all work to address the underlying thought patterns that contribute to psychological distress.

Cognitive Behavioral Therapy Techniques

CBT is about more than identifying thought patterns. It uses a wide range of strategies to help people overcome these patterns. Here are just a few examples of techniques used in cognitive behavioral therapy. 

Identifying Negative Thoughts

It is important to learn what thoughts, feelings, and situations are contributing to maladaptive behaviors. This process can be difficult, however, especially for people who struggle with introspection . But taking the time to identify these thoughts can also lead to self-discovery and provide insights that are essential to the treatment process.

Practicing New Skills

In cognitive behavioral therapy, people are often taught new skills that can be used in real-world situations. For example, someone with a substance use disorder might practice new coping skills and rehearse ways to avoid or deal with social situations that could potentially trigger a relapse.

Goal-Setting

Goal setting can be an important step in recovery from mental illness, helping you to make changes to improve your health and life. During cognitive behavioral therapy, a therapist can help you build and strengthen your goal-setting skills .

This might involve teaching you how to identify your goal or how to distinguish between short- and long-term goals. It may also include helping you set SMART goals (specific, measurable, attainable, relevant, and time-based), with a focus on the process as much as the end outcome.

Problem-Solving

Learning problem-solving skills during cognitive behavioral therapy can help you learn how to identify and solve problems that may arise from life stressors, both big and small. It can also help reduce the negative impact of psychological and physical illness.

Problem-solving in CBT often involves five steps:

• Identify the problem
• Generate a list of potential solutions
• Evaluate the strengths and weaknesses of each potential solution
• Choose a solution to implement
• Implement the solution

Self-Monitoring

Also known as diary work, self-monitoring is an important cognitive behavioral therapy technique. It involves tracking behaviors, symptoms, or experiences over time and sharing them with your therapist.

Self-monitoring can provide your therapist with the information they need to provide the best treatment. For example, for people with eating disorders, self-monitoring may involve keeping track of eating habits, as well as any thoughts or feelings that went along with consuming a meal or snack.

Additional cognitive behavioral therapy techniques may include journaling , role-playing , engaging in relaxation strategies , and using mental distractions .

What Cognitive Behavioral Therapy Can Help With

Cognitive behavioral therapy can be used as a short-term treatment to help individuals learn to focus on present thoughts and beliefs.

CBT is used to treat a wide range of conditions, including:

• Anger issues
• Bipolar disorder
• Eating disorders
• Panic attacks
• Personality disorders

In addition to mental health conditions, cognitive behavioral therapy has also been found to help people cope with:

• Chronic pain or serious illnesses
• Divorce or break-ups
• Grief or loss
• Low self-esteem
• Relationship problems
• Stress management

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Benefits of Cognitive Behavioral Therapy

The underlying concept behind CBT is that thoughts and feelings play a fundamental role in behavior. For example, a person who spends a lot of time thinking about plane crashes, runway accidents, and other air disasters may avoid air travel as a result.

The goal of cognitive behavioral therapy is to teach people that while they cannot control every aspect of the world around them, they can take control of how they interpret and deal with things in their environment.

CBT is known for providing the following key benefits:

• It helps you develop healthier thought patterns by becoming aware of the negative and often unrealistic thoughts that dampen your feelings and moods.
• It is an effective short-term treatment option as improvements can often be seen in five to 20 sessions.
• It is effective for a wide variety of maladaptive behaviors.
• It is often more affordable than some other types of therapy .
• It is effective whether therapy occurs online or face-to-face.
• It can be used for those who don't require psychotropic medication .

One of the greatest benefits of cognitive behavioral therapy is that it helps clients develop coping skills that can be useful both now and in the future.

Effectiveness of Cognitive Behavioral Therapy

CBT emerged during the 1960s and originated in the work of psychiatrist Aaron Beck , who noted that certain types of thinking contributed to emotional problems. Beck labeled these "automatic negative thoughts" and developed the process of cognitive therapy. 

Where earlier behavior therapies had focused almost exclusively on associations, reinforcements , and punishments to modify behavior, the cognitive approach addresses how thoughts and feelings affect behaviors.

Today, cognitive behavioral therapy is one of the most well-studied forms of treatment. It has been shown to be effective in the treatment of a range of mental conditions, including anxiety, depression, eating disorders, insomnia, obsessive-compulsive disorder , panic disorder, post-traumatic stress disorder , and substance use disorder.

• Research indicates that cognitive behavioral therapy is the leading evidence-based treatment for eating disorders .
• CBT has been proven helpful in those with insomnia, as well as those who have a medical condition that interferes with sleep, including those with pain or mood disorders such as depression.
• Cognitive behavioral therapy has been scientifically proven to be effective in treating symptoms of depression and anxiety in children and adolescents.
• A 2018 meta-analysis of 41 studies found that CBT helped improve symptoms in people with anxiety and anxiety-related disorders, including obsessive-compulsive disorder and post-traumatic stress disorder.
• Cognitive behavioral therapy has a high level of empirical support for the treatment of substance use disorders, helping people with these disorders improve self-control , avoid triggers, and develop coping mechanisms for daily stressors.

CBT is one of the most researched types of therapy, in part, because treatment is focused on very specific goals and results can be measured relatively easily.

Verywell Mind's Cost of Therapy Survey , which sought to learn more about how Americans deal with the financial burdens associated with therapy, found that Americans overwhelmingly feel the benefits of therapy:

• 80% say therapy is a good investment
• 91% are satisfied with the quality of therapy they receive
• 84% are satisfied with their progress toward mental health goals

Things to Consider With Cognitive Behavioral Therapy

There are several challenges that people may face when engaging in cognitive behavioral therapy. Here are a few to consider.

Change Can Be Difficult

Initially, some patients suggest that while they recognize that certain thoughts are not rational or healthy, simply becoming aware of these thoughts does not make it easy to alter them.

CBT Is Very Structured

Cognitive behavioral therapy doesn't focus on underlying, unconscious resistance to change as much as other approaches such as  psychoanalytic psychotherapy . Instead, it tends to be more structured, so it may not be suitable for people who may find structure difficult.

You Must Be Willing to Change

For cognitive behavioral therapy to be effective, you must be ready and willing to spend time and effort analyzing your thoughts and feelings. This self-analysis can be difficult, but it is a great way to learn more about how our internal states impact our outward behavior.

Progress Is Often Gradual

In most cases, CBT is a gradual process that helps you take incremental steps toward behavior change . For example, someone with social anxiety might start by simply imagining anxiety-provoking social situations. Next, they may practice conversations with friends, family, and acquaintances. By progressively working toward a larger goal, the process seems less daunting and the goals easier to achieve.

How to Get Started With Cognitive Behavioral Therapy

Cognitive behavioral therapy can be an effective treatment choice for a range of psychological issues. If you or someone you love might benefit from this form of therapy, consider the following steps:

• Consult with your physician and/or check out the directory of certified therapists offered by the National Association of Cognitive-Behavioral Therapists to locate a licensed professional in your area. You can also do a search for "cognitive behavioral therapy near me" to find local therapists who specialize in this type of therapy.
• Consider your personal preferences , including whether face-to-face or online therapy will work best for you.
• Contact your health insurance to see if it covers cognitive behavioral therapy and, if so, how many sessions are covered per year.
• Make an appointment with the therapist you've chosen, noting it on your calendar so you don't forget it or accidentally schedule something else during that time.
• Show up to your first session with an open mind and positive attitude. Be ready to begin to identify the thoughts and behaviors that may be holding you back, and commit to learning the strategies that can propel you forward instead.

What to Expect With Cognitive Behavioral Therapy

If you're new to cognitive behavioral therapy, you may have uncertainties or fears of what to expect. In many ways, the first session begins much like your first appointment with any new healthcare provider.

During the first session, you'll likely spend some time filling out paperwork such as HIPAA forms (privacy forms), insurance information, medical history, current medications, and a therapist-patient service agreement. If you're participating in online therapy, you'll likely fill out these forms online.

Also be prepared to answer questions about what brought you to therapy, your symptoms , and your history—including your childhood, education, career, relationships (family, romantic, friends), and current living situation.

Once the therapist has a better idea of who you are, the challenges you face, and your goals for cognitive behavioral therapy, they can help you increase your awareness of the thoughts and beliefs you have that are unhelpful or unrealistic. Next, strategies are implemented to help you develop healthier thoughts and behavior patterns.

During later sessions, you will discuss how your strategies are working and change the ones that aren't. Your therapist may also suggest cognitive behavioral therapy techniques you can do yourself between sessions, such as journaling to identify negative thoughts or practicing new skills to overcome your anxiety .

If you are having suicidal thoughts, contact the  National Suicide Prevention Lifeline  at  988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our  National Helpline Database .

Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: A review of meta-analyses . Cognit Ther Res . 2012;36(5):427-440. doi:10.1007/s10608-012-9476-1

Merriam-Webster. Cognitive behavioral therapy .

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Lindgreen P, Lomborg K, Clausen L.  Patient experiences using a self-monitoring app in eating disorder treatment: Qualitative study .  JMIR Mhealth Uhealth.  2018;6(6):e10253. doi:10.2196/10253

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Carpenter J, Andrews L, Witcraft S, Powers M, Smits J, Hofmann S. Cognitive behavioral therapy for anxiety and related disorders: A meta‐analysis of randomized placebo‐controlled trials .  Depress Anxiety . 2018;35(6):502–14. doi:10.1002/da.22728

National Institute on Drug Abuse (NIDA).  Cognitive-behavioral therapy (alcohol, marijuana, cocaine, methamphetamine, nicotine) .

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By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

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7. Developing an Intervention

This toolkit provides supports for developing core components of a community intervention and adapting them to fit the context.

• Statement of the community problem/goal to be addressed
• Specific behaviors of whom that need to change
• Improvements in community-level outcomes that should result   Related resources : Proclaiming Your Dream: Developing Vision and Mission Statements Creating Objectives  
• Direct observation of the problem or goal
• Conducting behavioral surveys
• Interviewing key people in the community
• Reviewing archival or existing records   Related resources : Developing a Plan for Identifying Local Needs and Resources Collecting Information About the Problem Conducting Surveys Conducting Interviews Using Public Records and Archival Data  
• Targets of change or prioritized groups for whom behaviors or outcomes should change
• Agents of change or those implementing the intervention   Related resources : Identifying Targets and Agents of Change: Who Can Benefit and Who Can Help  
• Personal contacts - Who will you speak with about what?
• Interviews - What questions will you ask of whom about the problem or goal and possible interventions?
• Focus groups - From what groups will you seek what kinds of information?
• Community forums - What public situations would present an opportunity for you to discuss the problem or goal, and how will you use the opportunity?
• Concerns surveys - What questions of whom will you ask about the problem or goal and potential solutions?   Related resources : An Introduction to the Problem Solving Process Analyzing Root Causes of Problems The "But Why?" Technique Conducting Interviews Conducting Focus Groups Conducting Public Forums and Listening Sessions Conducting Concerns Surveys  
• Those for whom the current situation is a problem. Who is affected by the issue, problem, or goal?
• The negative (positive) consequences for those directly affected and the broader community. What effect does the problem or issue have on the lives of those affected?
• Personal and environmental factors to be influenced (i.e., people's experience and history; knowledge and skills; barriers and opportunities; social support and caring relationships; living conditions that put them at risk for or protect them from experiencing certain problems).
• The behavior or lack of behavior that causes or maintains the problem. What behaviors of whom would need to change for the problem (or goal) to be eliminated (addressed).
• Who benefits and how from the situation staying the same (economically, politically).
• The conditions that need to change for the issue to be resolved (e.g., skills, opportunities, financial resources, trusting relationships).
• The appropriate level at which the problem or goal should be addressed (e.g., by individuals, families, neighborhoods, city or county government), and whether the organization has the capacity to influence such changes).   Related resources : Defining and Analyzing the Problem Collecting Information About the Problem Identifying Targets and Agents of Change: Who Can Benefit and Who Can Help Understanding Risk and Protective Factors: Their Use in Selecting Potential Targets and Promising Strategies for Interventions Identifying Strategies and Tactics for Reducing Risks Creating Objectives  
• A description of what success would look like. How will the community or group be different if the intervention is successful?
• Those goals the intervention is targeted to accomplish. How will you know if your intervention is successful?
• The specific objectives the intervention will achieve. What will change by how much and by when?   Related resources : Creating Objectives  
• Potential or promising “best practices” for your situation (consider various available databases and lists of “best” or evidence-based practices)
• How strong is the evidence that each potential “best practice” caused the observed improvement? (Rather than other associated conditions or potential influences)
• Whether the “best practice” could achieve the desired results in your community
• Whether the conditions (e.g., time, money, people, technical assistance) that affect success for the “best practice” are present
• (Based on the assessment) The “best practice” or evidence-based approach to be tried in your situation (Note: If no “best practices” are known or appropriate to your situation, follow the steps below to design or adapt another intervention.)   Related resources : Generating and Choosing Solutions Criteria for Choosing Promising Practices and Community Interventions  
• Providing information and enhancing skills (e.g., conduct a public information campaign to educate people about the problem or goal and how to address it)
• Modifying access, barriers, exposures, and opportunities (e.g., increase availability of affordable childcare for those entering work force; reduce exposures to stressors)
• Enhancing services and supports (e.g., increase the number of centers that provide health care)
• Changing the consequences (e.g., provide incentives to develop housing in low-income areas)
• Modifying policies and broader systems (e.g., change business or public policies to address the goal)   Related resources : Creating Objectives Developing an Action Plan Providing Information and Enhancing Skills Modifying Access, Barriers, and Opportunities Changing the Physical and Social Environment Enhancing Support, Incentives, and Resources Changing Policies  
• Identify the mode of delivery through which each component and element of the intervention will be delivered in the community (e.g., workshops for skill training).   Related resources : Developing an Action Plan Putting Your Solution into Practice  
• Indicate how you will adapt the intervention or "best practice" to fit the needs and context of your community (e.g., differences in resources, cultural values, competence, language).   Related resources : Adapting Community Interventions for Different Cultures and Communities Designing Community Interventions    
• What specific change or aspect of the intervention will occur?
• Who will carry it out?
• When the intervention will be implemented or how long it will be maintained?
• Resources (money and staff) needed/ available?
• Who should know what about this?   Related resources : Developing an Action Plan  
• Test the intervention and with whom
• Assess the quality of implementation of the intervention
• Assess results and consequences or side effects
• Collect and use feedback to adapt and improve the intervention  
• Implement the intervention, and monitor and evaluate the process (e.g., quality of implementation, satisfaction) and outcomes (e.g., attainment of objectives).   Related resources : A Framework for Program Evaluation: A Gateway to the Tools  

School Consultation pp 17–30 Cite as

Problem Solving and Response to Intervention

• William P. Erchul 3 &
• Brian K. Martens 4  
• First Online: 01 January 2010

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Part of the book series: Issues in Clinical Child Psychology ((ICCP))

The practice of school consultation today is quite different from that of the 1990s. Why is that the case? How has school consultation changed? It is the goal of this chapter to explore these complex questions.

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Erchul, W.P., Martens, B.K. (2010). Problem Solving and Response to Intervention. In: School Consultation. Issues in Clinical Child Psychology. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-5747-4_2

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• v.62(Suppl 2); 2020 Jan

Family Interventions: Basic Principles and Techniques

Mathew varghese.

Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India

Vivek Kirpekar

1 N.K.P. Salve Institute of Medical Sciences, Nagpur, Maharashtra, India

Santosh Loganathan

Introduction.

Mental health professionals in India have always involved families in therapy. However, formal involvement of families occurred about one to two decades after this therapeutic modality was started in the West by Ackerman.[ 1 ] In India, families form an important part of the social fabric and support system, and as a result, they are integral in being part of the treatment and therapeutic process involving an individual with mental illness. Mental illnesses afflict individuals and their families too. When an individual is affected, the stigma of being mentally ill is not restricted to the individual alone, but to family members/caregivers also. This type of stigma is known as “Courtesy Stigma” (Goffman). Families are generally unaware and lack information about mental illnesses and how to deal with them and in turn, may end up maintaining or perpetuating the illness too. Vidyasagar is credited to be the father of Family Therapy in India though he wrote sparingly of his work involving families at the Amritsar Mental Hospital.[ 2 ] This chapter provides salient features of broad principles for providing family interventions for the treating psychiatrist.

TYPES AND GRADES FOR FAMILY INTERVENTIONS

Working with families involves education, counseling, and coping skills with families of different psychiatric disorders. Various interventions exist for different disorders such as depression, psychoses, child, and adolescent related problems and alcohol use disorders. Such families require psychoeducation about the illness in question, and in addition, will require information about how to deal with the index person with the psychiatric illness. Psychoeducation involves giving basic information about the illness, its course, causes, treatment, and prognosis. These basic informative sessions can last from two to six sessions depending on the time available with clients and their families. Simple interventions may include dealing with parent-adolescent conflict at home, where brief counseling to both parties about the expectations of each other and facilitating direct and open communication is required.

Additional family interventions may cover specific aspects such as future plans, job prospects, medication supervision, marriage and pregnancy (in women), behavioral management, improving communication, and so on. These family interventions offering specific information may also last anywhere between 2 and 6 sessions depending on the client's time. For example, explaining the family about the marriage prospects of an individual with a psychiatric illness can be considered a part of psychoeducation too, but specific information about marriage and related concerns require separate handling. At any given time, families may require specific focus and feedback about issues such issues.

Family therapy is a structured form of psychotherapy that seeks to reduce distress and conflict by improving the systems of interactions between family members. It is an ideal counseling method for helping family members adjust to an immediate family member struggling with an addiction, medical issue, or mental health diagnosis. Specifically, family therapists are relational therapists: They are generally more interested in what goes on between the individuals rather than within one or more individuals. Depending on the conflicts at issue and the progress of therapy to date, a therapist may focus on analyzing specific previous instances of conflict, as by reviewing a past incident and suggesting alternative ways family members might have responded to one another during it, or instead proceed directly to addressing the sources of conflict at a more abstract level, as by pointing out patterns of interaction that the family might not have noticed.

Family therapists tend to be more interested in the maintenance and/or solving of problems rather than in trying to identify a single cause. Some families may perceive cause-effect analyses as attempts to allocate blame to one or more individuals, with the effect that for many families, a focus on causation is of little or no clinical utility. It is important to note that a circular way of problem evaluation is used, especially in systemic therapies, as opposed to a linear route. Using this method, families can be helped by finding patterns of behavior, what the causes are, and what can be done to better their situation. Family therapy offers families a way to develop or maintain a healthy and functional family. Patients and families with more difficult and intractable problems such as poor prognosis schizophrenia, conduct and personality disorder, chronic neurotic conditions require family interventions and therapy. The systemic framework approach offers advanced family therapy for such families. This type of advanced therapy requires training that very few centers, such as the Family Psychiatry Center at the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India offer to trainees and residents. These sessions may last anywhere from eight sessions up to 20 or more on occasions [ Table 1 ].

Types and grades of family interventions

Goals of family therapy

Usual goals of family therapy are improving the communication, solving family problems, understanding and handling special family situations, and creating a better functioning home environment. In addition, it also involves:

• Exploring the interactional dynamics of the family and its relationship to psychopathology
• Mobilizing the family's internal strength and functional resources
• Restructuring the maladaptive interactional family styles (including improving communication)
• Strengthening the family's problem-solving behavior.

Reasons for family interventions

The usual reasons for referral are mentioned below. However, it may be possible that sometimes the reasons identified initially may be just a pointer to many other lurking problems within the family that may get discovered eventually during later assessments.

• Marital problems
• Parent–child conflict
• Problems between siblings
• The effects of illness on the family
• Adjustment problems among family members
• Inconsistency parenting skills
• Psychoeducation for family members about an index patient's illness
• Handling expresses emotions.

CHALLENGES FACED BY THE NOVICE THERAPIST

Whether one is a young student, or a seasoned individual therapist, dealing with families can be intimidating at times but also very rewarding if one knows how to deal with them. We have outlined certain challenges that one faces while dealing with families, especially when one is beginning.

Being overeager to help

This can happen with beginner therapists as they are overeager and keen to help and offer suggestions straight away. If the therapist starts dominating the interaction by talking, advising, suggesting, commenting, questioning, and interpreting at the beginning itself, the family falls silent. It is advisable to probe with open-ended questions initially to understand the family.

Poor leadership

It is advisable for the therapist to have control over the sessions. Sometimes, there may be other individuals/family members who maybe authoritative and take control. Especially in crisis situations, when the family fails to function as a unit, the therapist should take control of the session and set certain conditions which in his professional judgment, maximize the chances for success.

Not immersing or engaging/fear or involving

A common problem for the beginning therapist is to become overly involved with the family. However, he may realize this and try to panic and withdraw when he can become distant and cold. Rather, one should gently try to join in with the family earning their true respect and trust before heading to build rapport.

Focusing only on index patient

Many families believe that their problem is because of the index patient, whereas it may seem a tactical error to focus on this person initially. In doing so, it may essentially agree to the family's hypothesis that their problem is arising out of this person. It is preferable, at the outset to inform the family that the problem may lie with the family (especially when referrals are made for family therapies involving multiple members), and not necessarily with any one individual.

Not including all members for sessions

Many therapeutic efforts fail because important family members are not included in the sessions. It is advisable to find out initially who are the key members involved and who should be attending the sessions. Sometimes, involving all members initially and then advising them to return to therapy as and when the need arises is recommended.

Not involving members during sessions

Even though one has involved all members of the family in the sessions, not all of them may be engaged during the sessions. Sometimes, the therapist's own transference may hold back a member of the family in the sessions. Rather, it is recommended that the therapist makes it clear that he/she is open to their presence and interactions, either verbally or nonverbally.

Taking sides with any member of the family

It may be easy to fall into the trap of taking one member's side during sessions leaving the other party doubting the fairness and judgment of the therapist. For example, after meeting one marital partner for a few sessions, the therapist, when entering the couple, discussions may be heavily biased in his views due to his/her prior interaction. Therapists should be aware of this effect and try to be neutral as possible yet take into confidence each member attending the sessions. Therapist's countertransference can easily influence him/her to take sides, especially in families that are overtly blaming from the start, or with one member who may be aggressive in the sessions, or very submissive during the sessions can influence the therapist's sides; and one needs to be aware of this early in the sessions.

Guarded families

Some families put on a guarded façade and refuse to challenge each other in the session. By being neutral and nonjudgmental, sometimes, the therapist can perpetuate this guarded façade put forth by families. Hence, therapists must be able to read this and try to challenge them, listen to microchallenges within the family, must be ready to move in and out from one family member to another, without fixing to one member.

Communicating with the therapist outside sessions

Many families attempt to reduce tension by communicating with therapist outside the session, and beginning therapist are particularly susceptible for such ploys. The family or a member/s may want to meet the therapist outside the sessions by trying to influence the therapist to their views and opinions. Therapists must refrain from such encounters and suggest discussing these issues openly during the sessions. Of course, rarely, there may be sensitive or very personal information that one may want to discuss in person that may be permissible.

Ignoring previous work done by other therapists

It is easy for family therapists to ignore previous therapists. The family therapist's ignorance of the effects of previous therapy can serious hamper the work. By discussing the previous therapist helps the new therapist to understand the problem easily and could save time also.

Getting sucked to the family's affective state/mood

If transference involves the therapist in family structure, the therapist's dependency can overinvolved him in the family's style and tone of interaction. A depressed family causes both: Therapist to relate seriously and sadly. A hostile family may cause the therapist to relate in an attacking manner. The most serious problem can occur when a family is in a state of anxiety, induces the therapist to become anxious and make his/her comments to seem accusatory and blaming. It is very difficult for the beginning therapist to “feel” where the family is affectively, to be empathic, yet to be able to relate at times on a different affective level-to respond according to situations. It is important to be aware of the affective state/mood of the family but slips in and out of that state [ Table 2 ].

Guidelines for conducting interventions with families

FUNCTIONS OF A FAMILY THERAPIST

• The family therapist establishes a useful rapport: Empathy and communication among the family members and between them and himself
• The therapist clarifies conflict by dissolving barriers, confusions, and misunderstandings
• Gradually, the therapist attempts to bring to the family to a mutual and more accurate understanding of what is wrong
• Counteracting inappropriate denials, conflicts
• Lifting hidden intrapersonal conflict to the level of interpersonal interaction.
• The therapist fulfills in part the role of true parent figure, a controller of danger, and a source of emotional support and satisfaction-supplying elements that the family needs but lacks. He introduces more appropriate attitudes, emotions, and images of family relations than the family has ever had
• The therapist works toward penetrating (entering into) and undermining resistances and reducing the intensity of shared currents of conflict, guilt, and fear. He accomplishes these aims mainly using confrontation and interpretation
• The therapist serves as a personal instrument of reality testing for the family.

In carrying out these functions, the family therapist plays a wide range of roles, as:

• An activator
• Interpreter
• Re-integrator

BASIC STEPS FOR FAMILY INTERVENTIONS

The initial phase of therapy, the referral intake.

• Family assessment
• Family formulation and treatment plan
• Formal contract.

Patients and their families are usually referred to as some family problem has been identified. The therapist may be accustomed to the usual one-on-one therapeutic situation involving a patient but may be puzzled in his approach by the presence of many family members and with a lot of information. A few guidelines are similar to the approaches followed while conducting individual therapy. The guidelines for conducting family interventions are given in Table 2 . At the time of the intake, the therapist reviews all the available information in the family from the case file and the referring clinicians. This intake session lasts for 20–30 min and is held with all the available family members. The aim of the intake session is to briefly understand the family's perception of their problem, their motivation and need to undergo family intervention and the therapist assessments of suitability for family therapy. Once this is determined the nature and modality of the therapy is explained to the family and an informal contract is made about modalities and roles of therapist and the family members. The do's and don’ts of the family interventions are laid down to the family at the outset of the process of the interventions.

The family assessment and hypothesis

The assessment of different aspects of family functioning and interactions must typically take about 3–5 sessions with the whole family, each session must last approximately 45 min to an hour. Different therapists may want to take assessments in different ways depending on their style. Mentioned below are a few tasks which are recommended for the therapist to perform. Usually, it is recommended that the naïve therapist starts with a three-generation genogram and then follows-up with the different life cycle stages and family functions as outlined below.

• The three-generation genogram is constructed diagrammatically listing out the index patient's generation and two more related generations, for example, patients and grandparents in an adolescent client or parents and children in a middle-aged client. The ages and composition of the members are recorded, and the transgenerational family patterns and interactions are looked at to understand the family from a longitudinal and epigenetic perspective. The therapist also familiarizes himself with any family dynamics prior to consultation. This gives a broad background to understand the situation the family is dealing with now
• The life cycle of the index family is explored next. The functions of the family and specific roles of different members are delineated in each of the stages of the family life cycle.[ 3 ] The index family is seen from a developmental perspective, and the therapist gets a longitudinal and temporal perspective of the family. Care is taken to see how the family has coped with problems and the process of transition from one stage to another. If children are also part of the family, their discipline and parenting styles are explored (e.g., whether there is inconsistent parenting)
• Problem Solving: Many therapists look at this aspect of the family to see how cohesive or adaptable the family has been. Usually, the family members are asked to describe some stress that the family has faced, i.e., some life events, environmental stressors, or illness in a family member. The therapist then proceeds to get a description of how the family coped with this problem. Here, “circular questions” are employed and therapist focuses on antecedent events. The crisis and the consequent events are examined closely to look for patterns that emerge. The family function (or dysfunction) is heightened when there is a crisis situation and the therapist look at patterns rather than the content described. Thus, the therapist gets an “as if I was there” view of the family. The same inquiry is possible using the technique of enactment[ 4 ]
• The Structural Map: Once the inquiry is over, the therapist draws the structural map, which is a diagrammatic representation of the family system, showing the different subsystems, its boundaries, power structure and relationships between people. Diagrammatic notions used in structural therapy or Bowenian therapy are used to denote relationships (normal, conflictual, or distant) and subsystem boundaries, in different triadic relationships. This can also be done on a timeline to show changes in relationships in different life cycle stages and influences from different life events
• What the client is trying to convey through his/her symptoms?
• What is the role of the family in maintaining these symptoms?
• Why has the family come now?

This circular hypothesis can be confirmed on further inquiry with the family to see how the “dysfunctional equilibrium” is maintained. At this stage, we suggest that a family formulation is generated, hypothesized and analyzed. This leads to a comprehensive systemic formulation involving three generations. This formulation will determine which family members we need to see in a therapy, what interventional techniques we should use and what changes in relationships we should effect. The team will also discuss the minimum, most effective treatment plan which emerges considering the most feasible changes the family can make

• Formal Contract: A brief understanding of the family homeostasis is presented to the family. Sometimes, the full hypothesis may be fed to the family in a noncritical and positive way (“Positive Connotation”), appreciating the way in which the system is functioning the therapist presents the treatment plat to the family and negotiates with the members the plan and action they would like to take up at the present time. The time frame and modality of therapy is contracted with the family, and the therapy is put into force. The frequency and intensity of sessions are determined by the degree of distress felt by the family and the geographical distance from the therapy center, i.e., families may be seen as inpatients at the center if they are in crisis or if they live far away.

The Family Psychiatry Center at The NIMHANS, Bengaluru, Karnataka, India, is one of the centers where formal training in therapy is regularly conducted. An outline of the Family Assessment Proforma[ 5 ] used at this center is given in Figure 1 . Several other structured family assessment instruments are available [ Figure 1 ].

Family assessment proforma (Obtained with permission from the Family Psychiatry Center, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India)

Middle phase of therapy

This phase of therapy forms the major work that is carried out with the family. Depending on the school of therapy, that is used, these sessions may number from a few (strategic) to many sessions lasting many months (psychodynamic). The techniques employed depend on the understanding of the family during the assessment as much as the family – therapist fit. For example, the degree of psychological sophistication of the clients will determine the use of psychodynamic and behavioral techniques. Similarly, a therapist who is comfortable with structural/strategic methods would put these therapies to maximum use. The nature of the disorder and the degree of pathology may also determine the choice of therapy, i.e., behavioral techniques may be used more in chronic psychotic conditions while the more difficult or resistant families may get brief strategic therapies. We will now describe some of the important techniques used with different kinds of problems.

Psychodynamic therapy

This school was one of the first to be described by people like Ackerman and Bowen.[ 1 , 6 ] This method has been made more contextual and briefer by therapists like Boszormenyi-Nasgy and Framo.[ 7 , 8 ] Essentially, the therapist understands the dynamics employed by different members of the family and the interrelationships of these members. These family ego defenses are interpreted to the members and the goal of therapy is to effects emotional insight and working through of new defense patterns. Family transferences may become evident and may need interpretation. Therapy usually lasts from 15 to 30 sessions and this method may be employed in persons who are psychologically sophisticated, and able to understand dynamics and interpretations. Sustained and high motivation is necessary for such a therapy. This method is found useful in couples with marital discord from upper middle-class backgrounds. Time required is a major constraint.

Behavioral methods

Behavioral techniques find use in many types of therapies and conditions. It has been extensively used in chronic psychotic illnesses by workers such as Fallon et al. , (1986) and Anderson et al. [ 9 , 10 ] Psychoeducation and skills training in communication and problem-solving are found very useful among families which do not have very serious dysfunction. Techniques such as modeling or role-plays are useful in improving communication styles and to teach parenting skills with disturbed children. Obviously, motivation for therapy is a major requisite and hence techniques such as contracting, homework assignments are used in couples with marital discord. Behavioral techniques used in sexual dysfunction are also possible when adapted according to clients’ needs.

Structural family therapy

Described by Minuchin; Fishman and Unbarger[ 4 , 11 , 12 ] has become quite popular over the past few years among therapists in India. This is possibly because of many reasons. Our families are available with their manifold subsystems of parents, children, grandparents and structure is easily discerned and changed. In addition, in recent years most clients present with conduct and personality disorders in adolescence and early adulthood. Hence, techniques like unbalancing, boundary-making are quite useful as the common problems involve adolescents who are wielding power with poor marital adjustments between parents. These techniques are useful for many of our clients.

Strategic technique

We have found that these brief techniques can be very powerfully used with families which are difficult and highly resistant to change. We usually employ them when other methods have failed, and we need to take a U-turn in therapy. Techniques employed by the Milan school[ 13 , 14 ] reframing, positive connotation, paradoxical (symptom) prescription have been used effectively. So also have techniques like prescription in brief methods advocated by Erikson, Watzlawick et al. ,[ 15 , 16 ] been useful. Familiarity and competence with these techniques is a must and therapy is usually brief and quickly terminated with prescriptions [ Table 3 ].

Summaries of the different schools of therapies

SES – Socioeconomic status

FAMILY INTERVENTIONS IN SPECIFIC DISORDERS

Techniques to promote family adaptation to illness.

• Heighten awareness of shifting family roles – pragmatic and emotional
• Facilitate major family lifestyle changes
• Increase communication within and outside the family regarding the illness
• Help family to accept what they cannot control, focus energies on what they can
• Find meaning in the illness. Help families move beyond “Why us?”
• Facilitate them grieving inevitable losses–of function, of dreams, of life
• Increase productive collaboration among patients, families, and the health-care team
• Trace prior family experience with the illness through constructing a genogram
• Set individual and family goals related to illness and to nonillness developmental events.

Schizophrenia

Family EE and communication deviance (or lack of clarity and structure in communication) are well-established risk factors for the onset of schizophrenia.

Psychoeducational interventions aim to increase family members’ understanding of the disorder and their ability to manage the positive and negative symptoms of psychosis.

Simple strategies would include reduction of adverse family atmosphere by reducing stress and burden on relatives, reduction of expressions of anger and guilt by the family, helping relatives to anticipate and solve problems, maintenance of reasonable expectations for patient performance, to set appropriate limits whilst maintaining some degree of separation when needed; and changing relatives’ behavior and belief systems.

Programs emphasize family resilience. Address families’ need for education, crisis intervention, skills training, and emotional support.

Bipolar mood disorder

To recognize the early signs and symptoms of bipolar disorder.

Develop strategies for intervening early with new episodes and assure consistency with medication regimens.

Manage moodiness and swings of the patient, anger management, feelings of frustration.

Family conflict and rejection, low family support, ineffective communication, poor expression of affect, abuse, and insecure attachment bonds are primary focus of family therapy associated with depression cognitive-behavioral and interpersonal interventions for depression.

Family-based treatment for anxiety combines family therapy with cognitive-behavioral interventions.

Targets the characteristics of the family environment that support anxiogenic beliefs and avoidant behaviors.

The goal is to disrupt the interactional patterns that reinforce the disorder.

To assist family members in using exposure, reward, relaxation, and response prevention techniques to reduce the patients’ anxieties.

Eating disorders

Target the dysfunctional family processes, namely, enmeshment and overprotectiveness.

To help parents build effective and developmentally appropriate strategies for promoting and monitoring their child's eating behaviors.

Childhood disorders

The primary focus is the development of effective parenting and contingency management strategies that will disrupt the problematic family interactions associated with ADHD and ODD.

Family-based interventions for autism spectrum disorder

Parents taught to use communication and social training tools that are adapted to the needs of their children and apply these techniques to their family interactions at home.

Substance misuse

Enhance the coping ability of family members and reduce the negative consequences of alcohol and drug abuse on concerned relatives; eliminate the family factors that constitute barriers to treatment; use family support to engage and retain the drug and/or alcohol user in therapy; change the characteristics of the family environment that contribute to relapse Al-Anon, AL-teen.

Termination phase

This last phase of therapy is finished in a couple of sessions. The initial goals of therapy are reviewed with the family. The family and the therapist review together the goals which were achieved, and the therapist reminds the family the new patterns/changes which have emerged. The need to continue these new patterns is emphasized. At the same time, the family is cautioned that these new patterns will occur when all members make a concerted effort to see this happen. Family members are reminded that it is easy to fall back to the old patterns of functioning which had produced the unstable equilibrium necessitating consultation.

At termination, the therapist usually negotiates new goals, new tasks or new interactions with the family that they will carry out for the next few months in the follow up period. The family is told that they need to review these new patterns after a couple of months so as to determine how things have gone and how conflicts have been addressed by the family. This way the family has a better chance of sustaining the change created. Sometimes booster sessions are also advised after 6–12 months especially for outstation families who cannot come regularly for follow-ups. These booster sessions will review the progress and negotiate further changes with the family over a couple of sessions. This follow-up period, after therapy is terminated is crucial for working through process and ensures that the client-therapist bond is not severed too quickly. It is easy to deal with the clients’ and therapist’ anxieties if this transition phase is smooth.

SPECIAL SOCIOCULTURAL ISSUES IN THERAPY SPECIFIC TO INDIA

Most Indian families are functionally joint families though they may have a nuclear family structure. Furthermore, unlike the Western world more than two generations readily come for therapy. Hence, it becomes necessary to deal with two to three generations in therapy and also with transgenerational issues. Our families also foster dependency and interdependency rather than autonomy. This issue must also be kept in mind when dealing with parent–child issues. Indians have a varied cultural and religious diversity depending on the region from which the family comes. The therapist has to be familiar with the regional customs, practices, beliefs, and rituals. The Indian family therapist has to also be wary of being too directive in therapy as our families may give the mantle of omnipotence to the therapist and it may be more difficult for us to adopt at one-down or nondirective approach. Hence, while systemic family therapy is eminently possible in India one must keep in mind these sociocultural factors so as to get a good “family-therapist fit.”

Constraint factors in therapy

The economic backwardness of most out families makes therapy feasible and affordable, in terms of time and money spent, only to the middle and upper classes of our society. The poorer families usually drop out of therapy as they have other more pressing priorities. The lack of tertiary social support and welfare or social security makes it less possible to network with other systems. We are also woefully inadequate in terms of trained family therapists to cater to our large population. In our country, distances seem rather daunting and modes of transport and communication are poor for families to readily seek out a therapist. We work with these constraint factors and so the “family-therapy” fit is an important factor for families that are seeking and staying in family therapy. 17

CONCLUSIONS

Over the last few years, a systemic model has evolved for service and for training. The model uses a predominantly systematic framework for understanding families and the techniques for therapy are drawn from different schools namely the structural, strategic, and behavioral psychodynamic therapies.

Appendix: Glossary of terms

The repetitive patterns of interaction that organize the way in which family members relate and interact with each other.

Boundaries are the rules defining who participates in the system and how, i.e., the degree of access outsiders have to the system.

It may comprise of a single person, or several persons joined together by common membership criteria, for example, age, gender, or shared purpose.

When alignments stand in opposition to another part of the system (i.e., when several family members are against another member/s.

The joining together of two or more members. It popularly designates appositive affinity between two units of a system.

Channels of communication are a mechanism that defines “who speaks to whom.” When channels of communication are blocked, needs cannot be fulfilled, problems cannot be solved, and goals cannot be achieved.

Enmeshed families

In which, there is extreme sensitivity among the individual members to each other and their primary subsystem.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

Crisis Interventions Techniques and Why They Are Helpful

Read about Crisis Intervention Techniques and how they can be used to help people manage a crisis. Discover example worksheets you can use in your practice.

By Joshua Napilay on Feb 29, 2024.

Fact Checked by Ericka Pingol.

Crisis Intervention Techniques are designed to help people cope with an immediate crisis, such as a traumatic event or another emotionally and physically intense scenario. By recognizing and addressing the needs of someone in distress, these techniques can protect individuals from harm and help them gain control over the situation.

In this guide, we'll discuss some of the most commonly used Crisis Intervention Techniques and how they can be applied to help people manage a crisis. We'll also provide example worksheets you can use to better support clients in need.

What are Crisis Interventions Techniques?

Crisis intervention is a solution-focused psychological treatment to help people manage and stabilize crises. It is often implemented within the first 48 hours of an individual's or group's experience of distress, trauma, or emergency. This intervention focuses on helping people identify their symptoms and behavior patterns, assess their current situation, and develop a plan to manage the crisis.

Crisis Intervention Techniques are varied and can be adapted for different crises. These include techniques such as reality testing, active listening, problem-solving, empathic responding, providing support, and offering resources. The goals are to help the individual or group recognize a crisis and intervene to minimize disruption, distress, and danger.

However, crisis intervention is not intended to be a long-term treatment, nor should it replace more comprehensive therapies. Instead, its purpose is to intervene quickly and provide support for the individual or group to return them to a more stable state.

Why are they helpful?

Crisis Intervention Techniques can provide individuals and groups in crisis with the necessary tools to manage their emotions and work through their difficulties. They can also be used to recognize warning signs of potential crises, enabling those at risk to take steps to prevent them from occurring.

Here are some of the other advantages of using Crisis Intervention Techniques:

Provide a space for people to discuss complex topics

Crisis Intervention Techniques can provide an opportunity to process and explore complex topics in a safe, non-judgmental environment. This allows people to talk openly and honestly about their feelings without fear or shame.

Encourage problem-solving

You can use these techniques to help individuals find constructive solutions for resolving their issues. By exploring different strategies and hypotheticals, those in crisis can often find new ways to approach their problems.

Reduce guilt or shame

Crisis Intervention Techniques may help reduce feelings of guilt or shame that can be associated with difficult topics. By talking openly and honestly about their issues, your clients may better understand their feelings and begin to take steps to address them.

Create better relationships

These techniques can also help to create more robust and healthier relationships between those in crisis and their support system. Through open dialogue and constructive feedback, individuals can learn to better communicate their needs and those of their loved ones, which can help create an environment of trust and respect.

Facilitate healthy decision-making

Crisis Intervention Techniques can assist individuals to make better decisions in difficult situations. By helping individuals to look at the pros and cons, weigh options, and explore potential consequences, they can gain a greater insight into their current problems and make more informed decisions.

10 Crisis Interventions Techniques and Exercises

Crisis Intervention Techniques are designed to be both proactive and reactive to provide the most effective support possible. Proactive techniques involve prevention and building resilience, while reactive techniques focus on the immediate stabilization of an individual in crisis. Using both approaches, people can more effectively reduce distress, develop coping skills, build social connections, and move towards wellness. 

Here are some techniques and exercises you can utilize to help clients in a crisis:

Active listening

Active listening involves giving undivided attention to the person in crisis and demonstrating empathy and understanding. It includes maintaining eye contact, nodding to show comprehension, and providing verbal or nonverbal cues that indicate genuine interest. Active listening allows clients to express their feelings and thoughts, fostering a supportive and non-judgmental environment.

Calming strategies

Crises often involve heightened emotions, anxiety, or panic. Calming strategies are Crisis Intervention Techniques that help individuals regulate their emotions and reduce stress. Examples of calming strategies include deep breathing exercises, progressive muscle relaxation, visualization techniques, or engaging in activities that promote relaxation, such as listening to soothing music or taking a warm bath.

Safety planning

This technique is crucial when dealing with crises involving self-harm or suicidal ideation. It involves developing a comprehensive plan to ensure the individual's safety, identifying triggers, creating coping strategies, and establishing a support network. You can use safety planning to empower clients to take control of their situation and access the appropriate resources when needed.

Problem-Solving

During a crisis, individuals may feel overwhelmed and unable to see a way out. Problem-solving techniques help them break down their challenges into manageable steps and explore possible solutions. This can be done by encouraging brainstorming, evaluating pros and cons, and considering alternative perspectives. Problem-solving techniques promote critical thinking and empower individuals to find practical solutions.

Psychoeducation

This technique involves providing individuals with information and knowledge about their crisis. This can include explaining the common signs and symptoms associated with a crisis, teaching coping skills and self-care techniques, and providing resources and referrals for further assistance. Psychoeducation empowers individuals by increasing their understanding of their situation and providing them with tools to navigate it effectively.

Expressive therapies

Expressive therapies, such as art therapy, music therapy, or dance/movement therapy, can be effective Crisis Intervention techniques. You can use these strategies to give individuals alternative ways to express and process their emotions, thoughts, and experiences. Engaging in creative activities can promote self-discovery, reduce stress, and facilitate emotional healing during times of crisis.

Reality testing

Crises may distort an individual's perception of reality. Reality testing involves gently challenging and helping individuals evaluate their thoughts, beliefs, and perceptions. This technique encourages individuals to examine evidence and consider alternative viewpoints, promoting a more accurate understanding of the situation and reducing distress associated with distorted thinking.

Cognitive restructuring

Cognitive restructuring focuses on challenging and modifying negative or irrational thoughts contributing to crisis distress. It involves helping individuals identify and replace negative thoughts with more realistic and positive ones. By changing their thought patterns, individuals can reduce anxiety, improve coping strategies, and develop a more balanced perspective on the crisis.

Narrative therapy

This Crisis Intervention Technique can help individuals in crisis explore and reframe their personal stories and experiences. It involves identifying dominant narratives contributing to distress and collaboratively constructing alternative narratives highlighting the resilience, strengths, and positive aspects of the individual's life.

Social support networking

This technique involves creating a network of supportive people who can provide emotional support during difficult times. This may involve family members, friends, counselors, or even online communities such as social media groups. Social networking can help your client feel less alone, build their resilience and cope more effectively with the stress of a crisis.

5 Crisis Interventions Worksheets

Crisis Intervention Worksheets are interactive tools individuals can use to reflect on their thoughts, emotions, and strategies during a crisis. Here are 5 crisis intervention worksheets you can use to facilitate crisis intervention and support as part of therapy:

Emotional Regulation Worksheet

This worksheet provides a framework for individuals to identify their current emotions, explore the triggers that contribute to them, and develop coping strategies to regulate and manage them effectively. The worksheet may include prompts for deep breathing exercises, grounding techniques, or other strategies that promote emotional well-being.

Safety Planning Worksheet

This worksheet is designed to help individuals identify steps they can take if they find themselves in an unsafe situation. In addition to brainstorming safety strategies, the Safety Planning Worksheet may require individuals to create a list of emergency contacts for quick access or develop a plan for seeking medical attention and other support.

Thought Challenging Worksheet

A Thought Challenging Worksheet can help clients identify and challenge their negative or unhelpful thoughts. It may ask them to examine the evidence for and against each thought and summarize the facts contradicting their distorted perceptions. Individuals can increase self-esteem and develop healthier perspectives by recognizing and refuting irrational beliefs.

Problem-Solving Worksheet

Problem-solving worksheets are designed to help individuals develop realistic solutions to their problems. Such worksheets may ask individuals to brainstorm possible solutions, create a list of pros and cons for each option, identify potential obstacles, and plan how to take action. This type of worksheet can be an effective tool for helping people learn how to set realistic goals and take action to overcome their issues.

Coping Skills Inventory Worksheet

The Coping Skills Inventory Worksheet helps individuals identify their existing coping skills and develop new ones to manage stress and navigate a crisis. It prompts them to list their current coping strategies, assess their effectiveness, and explore additional coping skills they can adopt. The worksheet encourages individuals to broaden their coping repertoire and promotes self-awareness and self-care.

When to use Crisis Interventions techniques

Crisis Intervention Techniques are utilized when individuals are experiencing acute distress or are in immediate crises. These techniques provide immediate support, stabilization, and assistance to individuals facing overwhelming emotional, psychological, or situational challenges. 

Some scenarios in which you can employ Crisis Intervention Techniques include the following:

• Suicidal ideation or self-harm
• Acute depression or anxiety
• Substance abuse and addiction
• Grief, trauma, or other psychological distress
• Domestic violence, sexual assault, or other violent situations
• Emotional and psychological crises

Crisis Intervention Techniques are powerful tools that can help individuals navigate difficult times and create more positive outcomes. However, it is important to remember that crisis intervention is just a part of the process. Once an individual is stabilized and their basic needs are met, ongoing therapy or other forms of mental health treatment can be explored to help them cope with underlying issues and learn better ways of managing their life.

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Commonly asked questions

The most effective crisis intervention techniques vary depending on the individual and their needs.

Many mental health professionals, such as psychologists, psychiatrists, social workers, and counselors, use Crisis Intervention Techniques. Other individuals, such as teachers, law enforcement personnel, clergy members, and family members, may also use crisis intervention techniques to help someone in a crisis.

Yes, crisis intervention techniques can be used with children and adolescents. However, these techniques should be adapted to the individual's age and needs.

Crisis Intervention Techniques can be highly beneficial for individuals in a crisis. However, there are some risks to consider. For example, individuals may become overwhelmed and experience a traumatic reaction to the intervention. Additionally, individuals may become more agitated if they feel their autonomy is being removed.

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Math Interventions

• Introduction
• Subitizing Interventions
• Counting Interventions: Whole Numbers Less Than 30
• Counting Interventions: Whole Numbers Greater Than 30 (Place Value)
• Counting Interventions: Fractions
• Counting Interventions: Decimals
• Composing and Decomposing Numbers Interventions
• Rounding Interventions
• Number Sense Lesson Plans
• Addition and Subtraction Facts
• Multiplication and Division Facts
• Computational Fluency Lesson Plans
• Understanding the Problem Interventions
• Planning and Executing a Solution Interventions
• Monitoring Progress & Reflecting on a Solution Interventions
• Problem-Solving Process Interventions

Problem-Solving Process

Response to error: using the problem-solving process, feedback during the lesson, strategies to try after the lesson.

• Problem-Solving Lesson Plans
• Identifying Essential Variables Interventions
• Direct Models Interventions
• Counting On/Back Interventions
• Deriving Interventions
• Interpreting the Results Interventions
• Mathematical Modeling Lesson Plans
• Math Rules and Concepts Interventions
• Math Rules and Concepts Lesson Plans

A student who has difficulty understanding the problem, planning and executing a solution , self-monitoring progress toward a goal, and evaluating a solution will benefit from intervention around the problem-solving process. The following interventions  support  students  in internalizing this process from start to finish. This page includes intervention strategies that you can use to support your students in this area. Remember, if you're teaching a full process from start to finish, you probably want to use the Self-Regulated Strategy Development approach, which spreads explicit instruction of a full process across a series of intervention lessons.  As you read, consider which of these interventions best aligns with your student's strengths and needs in the whole-learner domains.

Self-Regulated Strategy Development 

Self-Regulated Strategy Development (or SRSD) is one way to teach the problem-solving process. The SRSD model "requires teachers to explicitly teach students the use of the strategy, to model the strategy, to cue students to use the strategy, and to scaffold instruction to gradually allow the student to become an independent strategy user." (Reid, Leinemann, & Hagaman, 2013). The steps of teaching SRSD are slightly different from the steps of explicit instruction because, in SRSD, each step must be mastered before the next one is started. For example, you might spend an entire lesson on Developing Background Knowledge before moving on to Discuss It (see below). The longterm goal of SRSD is for students to be able carry out the strategy independently, and so time is dedicated to teaching each step of the strategy in such a manner as enables students to internalize the material. 

Teaching SRSD model requires six steps:

• Develop Background Knowledge. Define the key ideas that students need to know in order to apply the strategy.
• Discuss It. Tell the student what the strategy is called, and describe each step.
• Model It. Use a think-aloud to demonstrate the strategy.
• Memorize It . Internalize strategy.
• Support It. Gradually release responsibility to students.
• Independent performance. Give students opportunities to practice strategy without support.

SRSD Explicit Instruction Six-Step Model: 

To support your students' ability to apply SRSD, you should start by explicitly teaching the six-step model. Keep in mind that this type of explicit instruction may take place over a number of days. 

Step 1: Set the Context for Student Learning and Develop Background Knowledge.  

• Introduce Word Problem Mnemonics, and discuss the use of the mnemonic: "Today you will be learning a new trick to help you solve problems. This strategy is called CUBES." (Teacher gets out chart paper and markers and writes down C, U , B, E, and S vertically.) "CUBES is a self-regulated strategy, which means that you will learn to memorize the strategy and use it without my support. Let's go through each step of CUBES and see how it will help you go through the problem-solving process. First, C-Circle the Numbers" (Teacher write this next to C.) "U - Underline important words." (Teacher writes next to U.)  B- Box the question " (Teache r writes next to B). E- Eliminate unnecessary information. S - Solve and Check. (Teacher writes these terms next to E and S). "Now, what do we need to know when we are doing CUBES?  We need to know which words are important. We also need to eliminate unnecessary information" (Teacher goes on to define these terms.)

Step 2: Discuss It. 

• Discuss the significance and benefits of using CUBES. Discuss and determine goals for using the strategy. At this point, students can examine their past work to set an individual goal: "So, how is a self-regulated strategy going to help us? Well, it gives us an easy way to remember the five steps to solving the problem. How else does it help us?" (Teacher elicits student responses.) "When we are using a SRSD, we ask ourselves questions to make sure we are following the steps. We call these self-statements.  My self-statements are 'What's my first step?' and 'What am I supposed to do now?' I ask myself self-statements so I can make sure that I am using each step of the strategy, and that I don't miss any steps." (Teacher and students discuss benefits of self-statements.)  "Now let's take some time to set goals for using this strategy...." (Teacher and students set goals, such as "students will each have two self-statements they use when employing the CUBE strategy.")

Step 3: Model It.

• The teacher models the strategy using think alouds and self-statements: "Watch as I show you what CUBES looks like when I use it. See if you can notice my self-statements. What am I supposed to do? I'm supposed to to follow the five steps to solve a problem. What is my first step? C. That's right, C. I need to circle the numbers. I'll do that now, and then check that off my CUBE S  list. (Teacher circles numbers). Okay, I'm going to check my CUBES list again. I've already completed C. Now, on to U. I have to Underline important words. (Teacher continues to model the entire CUBES process with 1- 3 problems. The session ends. Teacher starts Model It with new problems on Day 2.)

Step 4: Memorize It . 

• Students memorize the mnemonic and each of the steps of CUBES. The idea is that the students will not be able to implement the strategy if they cannot recall the steps. "Next, we are are going to take some time to memorize each step. What is C?" "Circle the numbers!"What is U?" (Teacher completes this process for all the letters. At this time, students also write the mnemonic down so they can use it as a reference. If they need to, they can come up with a beat or a chant to remember the mnemonic.)

Step 5: Support It.

• In step 5, the teacher gradually releases responsibility to the students. This is the most important stage, especially for struggling readers. In order for students to be able to implement this strategy on their own, they must be supported as needed. Graham, Harris, Mason, and Friedlander (2008), SRSD experts and authors, often tell their teachers, "Please Don't P.E.E. in the Classroom - P ost, E xplain, E xpect. Success with SRSD depends on using all the stages for students who have difficulty with [reading]." SRSD instruction and implementation are only successful when students are given multiple opportunities to practice using their strategy with teacher support before trying it on their own.  "Let's read the next problem and do CUBES together this time..." Teacher follows the steps of gradual release to transfer responsibility to students. The teacher first engages students with guided support. She might read the problem and allow students to complete different parts of the strategy. Then, students might do CUBES in groups. This part of the strategy might take multiple days, until students are effectively completing the strategy by using self-statements. 

Step 6: Independent Practice

• In the final step, students practice using the strategy independently. "Now, you are ready to use CUBES on your own! Remember to use your self-statements, like What do I do next? and What am I supposed to do now? and I'll look at my CUBES sheet to see what I do next. as you employ this strategy!" Teacher circulates and provides support for students who are not yet ready to work independently.  

Activity A: Word Problem Mnemonics

One way to support your student's problem-solving ability is to teach her a mnemonic for a series of steps to take whenever she encounters a story problem. The following brief, developed by the Evidence Based Intervention Network at the University of Missouri, describes this strategy. As you read, consider how each mnemonic breaks down the problem-solving process.

Click here  to read the brief. 

Word Problem Mnemonics in Action

In the video below, Emily Art explicitly models how to use the word mnemonic, CUBES, to teach the problem solving process.

As you watch, consider: How do mnemonics support a student's ability to independently carry out the problem solving process?

Another strategy to use to teach your student the problem-solving process is called Self-Organizing Questions. Gifford (2005) advocates for teaching students a series of questions to ask themselves that will guide them through the problem-solving process. Read through each prompt below and consider its purpose. 

• Getting to Grips:  What are we trying to do?
• Connecting to Prior Knowledge:  Have we done anything like this before?
• Planning:  What do we need?
• Considering Alternative Methods:  Is there another way?
• Monitoring Progress:  How does it look so far?
• Evaluating Solutions:  Does it work?   How can we check? Can we make it better?

  Self-Organizing Questions in Action 

Give the student a problem. Then, go through the six self-organizing questions to guide the student through the problem-solving process. This example refers to the problem below. 

Lamont had 14 pumpkin seeds. He also had 32 apple seeds. He planted 41 of the seeds. How many seeds did Lamont have left?

Teacher: We are going to use the self-organizing questions to solve this problem. Frank, what are we trying to do?

Frank: We are trying to figure out how many seeds Lamont has left, after he plants the pumpkin and apple seeds.

Teacher: Let's think about similar problems we've had in the past. Have we done anything like this before?

Frank: Yes, yesterday, we solved a problem about how many baseball and soccer balls Jamie had. 

Teacher: So, what do we need to do to plan to solve this problem?

Frank: We need to add up the total number of seeds, and then subtract how many he planted.

Teacher: Is there another way to solve this problem?

Frank: We could probably draw it, or use manipulatives to help us. 

Teacher: Okay, go ahead and execute it! How does it look so far?

Frank: It's working for me. I added the types of seeds together, which gave me 46. Then, I subtracted the 41 seeds he planted. That gave me 5 seeds leftover, which seems about right. 

Teacher: How can we check our answer?

Frank: I'll see if I can add it back up. My solution was 5, so I'll add that to 41, which gives me 46. Then, I'll add the number of seeds he had total, which gives me 46! So, it matches!

Activity C: Solve It

If your student has particular struggles with understanding the problem, use Solve It, which is an explicit approach to teaching the problem-solving process, with an emphasis on understanding what the problem is about. The following brief, developed by the Evidence Based Intervention Network at the University of Missouri, describes this strategy. As you read, consider how this approach supports student understanding of problems.

Click  here  to read the brief. 

Solve It in Action Read the sample lesson plan (Montague, 2006) below to see what Solve It looks like in action. For your reference, click here to access a  self-regulation script  for students.

SolveItLesson.pdf

Gifford, S. (2005). Teaching mathematics 3-5: Developing learning in the foundation stage. Berkshire:  McGraw-Hill Education. Graham, S., & Harris, K.R. (2005).  Writing better: Effective strategies for teaching students with learning difficulties.  Baltimore, Maryland: Paul H. Brookes Publishing Co. Hughes, E.M. (2011). Intervention Name: Solve It! Columbia, Mo: The Evidence Based Intervention Network, The University of Missouri. Retrieved from https://education.missouri.edu/ebi/math-acquisition/ Hughes, E.M. & Powell, S. (2011). Intervention Name: Word-Problem Mnemonics. Columbia, Mo: The Evidence Based Intervention Network, The University of Missouri. Retrieved from https://education.missouri.edu/ebi/math-acquisition/ Montague, Marjorie. (2006). Self-regulation strategies for better math performance in middle school. In M. Montague and A. Jistendra (Eds.), Teaching mathematics to middle school students with learning disabilities. New York: The Guilford Press.   Reid, R., Lienemann, T. O., & Hagaman, J. L. (2013). Strategy instruction for students with learning disabilities. New York: The Guilford Press.

Think about the following scenario, which takes place after a teacher has explicitly taught a student to use the problem-solving process. The following example refers to the problem below. 

Lamont had 14 pumpkin seeds. He also had 32 apple seeds. He planted 41 of the seeds. How many seeds did Lamont have left?      Teacher: "Now that you understand the problem, what are you doing to do next?"      Student: "Solve it! 41-32 = 9. He had nine seeds left." 

In such a case, what might you do? 

When you are planning your lessons, you should anticipate that your student will make errors throughout. Here are a series of prompts that you can use to respond to errors. Keep in mind that all students are different, and that students might respond better to some types of feedback than to others.

If your student struggles to meet your objective, there are various techniques that you might try in order to adjust the activity so as best to meet your student's needs. 

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• Last Updated: Feb 14, 2024 6:46 PM
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Goal Setting Is Not the Problem

Goals are key to living the life you want..

Posted April 6, 2024 | Reviewed by Tyler Woods

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Recently, I saw a post on LinkedIn promoting a TED talk about setting goals. I was really interested in the headline because I’m a big fan of goals. With that in mind, you can perhaps imagine my surprise when I discovered that the TED talker took the position that goal-setting was something to be avoided . Not only that, but after about seven minutes and 45 seconds, the TED talker told the audience that “the only way to fail in life is to set a goal.”

To say I was amazed at this suggestion would be a severe understatement. Kind of like calling the Grand Canyon a bit of a ditch.

If I had to make a statement about goals and their importance, I would say exactly the opposite! My position is that the only way to succeed in life is to set a goal. In fact, I would go so far as to say that nothing happens in the absence of goals. Even traumas , tragedies, and mayhem are what they are only because they wreak havoc with goals.

I could push things a bit further and suggest we can’t not have goals. Even avoiding goals is a goal. We are designed as goal-achieving creatures. Goals are us.

The different views about goals that the TED talker and I have might be definitional. The TED talker defined goals as “the end towards which effort is aimed” and then went on to discuss how limiting something like “the end” is. Even if we accept this as a definition of goals, “the end” doesn’t have to mean “kaput.”

Achieving my goal of getting a Ph.D. didn’t ever feel like the end. Quite the opposite. For me, the Ph.D. signalled a whole new beginning with a much greater range of options. I felt the same way about achieving my goals of getting married and becoming a dad. Both of these events marked the beginning of wonderful new adventures.

Yet there’s absolutely no reason why “goals” have to be defined the way the TED talker said they were defined.

But the TED talker did say how he thought goals were defined and then, based on this definition, his suggestion was that, instead of setting goals, we focus on objectives because “objectives” are limitless.

Well, maybe objectives are limitless, and maybe they aren’t. A quick Google search reveals that the terms “goal” and “objective” can be considered to be very similar and, in fact, are sometimes even used interchangeably.

We could get caught up in how similar or different goals and objectives might be but surely the much more important matter is, are you living the life you want? Call the activity that fills your day whatever you like. To what extent are you doing what you want to be doing?

After listening to the TED talk, it seemed to me that we might get a lot further in being all that we want to be if we focused more on the “thing” a word depicts rather than the word itself. Do the words “goal” and “objective” describe two different “things”?

In fact, there’s a whole bunch of words that all signal the same process. Words like aim, dream, intent, purpose, ambition, point, desire, motive, aspiration, and mission indicate the same process described by the words “goal” and “objective.”

It’s the process that’s crucial to understand if you want contentment and well-being to be more constant features of your daily landscape. What you call that process is much less important.

The process, in this case, is the business of creating and maintaining experiences we care about. There’s an even simpler way of saying all that. Actually, one word will do. The word is “control.” Control is what every living thing does to keep itself living.

Bonsai trees control and so do pink fairy armadillos. The bonsai process is a very cool example of interacting controllers. A few years ago, I was an avid bonsaier. I’m sure I will be again. With each of my bonsais, I had a clear idea of how I wanted the miniature tree to look, and I nipped and cut leaves and branches to get the look I wanted. I used wire as well to make sure the branches grew as I wanted them to.

The reason I had to do all that artful manipulating was because the itty bitty trees were controllers, too. The trident maple and the swamp cypress forest sprouted leaves and branches according to their own design, not the ideas I had. And I had to make sure that, in all my clipping and snipping, I didn’t interfere too much with the tree’s controlling. On occasion, a branch I had been coaxing to take a particular form would actually whither and die. A couple of times, a whole tree stopped controlling and ended up as a lifeless twig.

The same process can be spotted in lots of other daily activities. Pets offer great examples. At the moment, I have several pairs of finches in cages in our house. The reason the cages are necessary is because the little feathered controllers’ ideas of where they would like to roost and spend their time are different from my ideas. I get evidence of that if I forget to pay attention when I open a cage door to top up their seed containers.

We frequently see people walking their dogs past our house. The reason that people have leashes connecting them with their dogs is because dogs are controllers, too. The paths of a dog on or off a leash are very different.

Control is all around us. Our towns and cities are the way they are because people have certain ideas, dreams , and, dare I say it, goals. These inklings produce buildings and bridges and the daily bustle of social life . Perhaps the most incredibly ironic and fabulous quirk of our goal-achieving nature is that having a goal to help others achieve their goals actually helps with our own goal satisfaction.

Understanding the beautiful, ubiquitous, natural phenomenon of control might help us all do what we do more efficiently and harmoniously.

Tim Carey, Ph.D. , is the Chair Country Health Research and Innovation at Curtin University.

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10.1.1: Interventions and Problem Solving

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Social issues impair social functioning and negatively impact the lives of individuals, groups, and organizations (Bruhn and Rebach 2007). People effected by a particular social issue may face a variety of obstacles and challenges associated with the problem including labeling, stigma, discrimination, and isolation. Sociological practitioners work to address the problem by changing the social setting, arrangement, norms, and behaviors surrounding the issue and the people involved. A sociological practitioner may serve as the facilitator of this social change, a broker by acting on the behalf of others for change, or a clinician by providing direct services or help to change the situation of individuals and families.

There are six approaches most commonly used by sociological and other professional practitioners, communities, and clients to address social problems and create change. To resolve or improve situations, different problems require different approaches based on the client needs and social resources available to them. Each sociological approach incorporates a different level of analysis to assess the problem with a specific focal area of intervention. When social change requires different levels of analysis, sociological approaches must identify and explore multiple solutions across continuums. Not all approaches result in an expeditious solution. Sociological approaches and interventions take planning and time to implement and can take years to gain permanent change or improve people’s lives.

Process of Intervention

Regardless of approach, sociologists follow an incremental process of intervention to remedy a social problem. Each sociological approach includes a process of intervention that includes an assessment, planning, implementation, and evaluation phase. There are no timelines of completion defined within each phase. Rather the sociological practitioner, clients, and other impacted individuals or groups set deadlines and completion parameters based on context and need.

The first phase examines the social problem and needs of those it impairs. This is an investigative stage to gather information and understand the situation to define the problem (Bruhn and Rebach 2007). A sociological practitioner must first identify the presenting problem and client(s). The presenting problem refers to the client’s perspective of the problem as they see it in their own words (Bruhn and Rebach 2007). The assessment is a discovery phase of the history and evolution of the problem within the geographic region to find out who is seeking help and why. The assessment also helps determine the role or involvement of the sociological practitioner in the intervention.

An assessment is a case study guided by the nature of the problem and clients (Bruhn and Rebach 2007). Data collection may include interviews, focus groups, surveys, and secondary analysis (e.g., analytic data, educational records, criminal records, medical files, etc.). Findings and results are presented and discussed with clients and other involved parties to formulate solutions and objectives of intervention.

The next stage in the process is to plan the steps for achieving intervention objectives. The plan is a formal (written) agreement among interventionists (including the sociological practitioner) and client(s) outlining the objectives and roles and responsibilities of each person involved. The plan will include observable, measurable objectives that include: 1) subject and verb stating the condition to achieve, 2) amount or percentage of reduction or improvement of the condition, and 3) timeframe or deadline for completion (Bruhn and Rebach 2007). Both process and outcome objectives must be delineated in the plan. Process objectives will focus on program operations or services, and outcome objectives concentrate on the results of the intervention against baseline data (i.e., data collected prior to intervention). Interventionists and clients work together to develop a plan so everyone has an equal voice and understanding of their duties, obligations, and work to complete in the implementation phase.

Consider a social problem you would like to address in your community. Conduct secondary analysis of the issue to identify the presenting problem, clientele, and existing community services. Explore nonprofit and public agencies in your community working on the problem you chose to help you gather information.

After completing your analysis, draft four observable, measurable objectives of intervention for the problem and population you wish to address. Two objectives must focus on process and two on outcomes. All outcomes must include a verb and subject stating the condition to achieve, amount or percentage of reduction or improvement of the condition, and timeframe or deadline for completion.

The third phase in the process centers on implementation. In this stage, the plan commences according to the steps outlined in the formal agreement. Implementation puts the plan into action by following the proposed sequence and schedule. This phase engages strategies in order to accomplish objectives. For example, solving chronic poverty in your community might require employing several strategies such as improving K-12 education, increasing higher education enrollments and job skills training, providing access to health care, and developing employment opportunities. During the implementation phase, interventionists and collaborators will initiate and work on each strategy for change.

The final phase in the process of intervention is evaluation. Sociologists use evaluation to find out if a program, service, or intervention works (Steele and Price 2008). There are two types of evaluation. A process or formative evaluation gathers information to help improve or change a program, service, or intervention. Did everything occur and work according to plan? Sociological practitioners work with clients to determine program strengths, weaknesses, and areas of improvement to strengthen or adapt the program (Steele and Price 2008). An outcome or summative evaluation measures the impact of the program, service, or intervention on clients or participants. Were benchmarks achieved or changes made? Practitioners measure changes in clients over the duration of their participation from start to completion. The impact evaluation determines if change occurred, any unintended outcomes, and the long-term effects.

Evaluation is an ongoing task tracking program progress from beginning to end (Bruhn and Rebach 2007). Interventionists and practitioners must monitor the program continuously to ensure the service or intervention is advancing toward change, and adjustments or alternatives are deployed to increase effectiveness in a timely manner. The goal of evaluation is to know why a program, service, or intervention succeeded or failed to reform or adapt present and future support and solutions. Evaluation is a mechanism of continual improvement by regularly providing information and identifying unintended consequences.

Evaluation requires both quantitative and qualitative data (see page 5) using a variety of data collection methods and tools to gather information (e.g., tests, questionnaires, archival data, etc.). Data collection tools vary from program to program, sometimes tools exist to conduct an evaluation, and other times practitioners must develop them (Viola and McMahon 2010). Practitioners lead in the development of data collection protocols, tools, and instruments for review by participants (e.g., clients and community members) before they are ready to use.

As a contributing member of an evaluation team, sociological practitioners (see page 3) must be aware of role-conflict . It is imperative to avoid role-conflict in a participatory evaluation model. In other words, practitioners must be aware of their role within the evaluative context or situation as to whether one is serving as a researcher, practitioner, or interventionist (i.e., clinical sociologist). It is difficult to implement the scientific method (process and procedures) in the field within the standards of academic research when serving as a practitioner (Bruhn and Rebach 2007). Sociological practitioners or interventionists do not always have control over the evaluation research, study environment, or time to complete an evaluative study as prescribed by the scientific method.

The Workforce Internship Networking (WIN) Center at West Hill College Lemoore in California connects and supports students and alumni by providing employment, occupational readiness, and job placement information and resources to advance personal career goals. The WIN Center provides a space for employers and students to connect. At the WIN Center, students and alumni receive skills training, employment and internship application assistance, and support in creating a professional profile.

• Describe why it might be important to evaluate the WIN Center.
• Considering the importance of evaluating college campus programs, how often would you recommend evaluating the WIN Center’s programs and services? What should the evaluation examine?
• What role could program monitoring play in the overall evaluation of the WIN Center?
• If you were responsible for overseeing program monitoring and the evaluation of the WIN Center, what data would you collect to assess its impact?

In addition, evaluations may cause tension between practitioners (interventionists) and evaluation associates. Interventionists are responsible for providing data and keeping records while implementing program activities. Conflicting demands for an interventionists’ time and energy during the program implementation process may lead to a delay in gathering and sharing data with evaluators. Evaluation is not always equally valued, and some interventionists may consider evaluation unimportant or a threat to their work or process resulting in uncooperative behavior or interest.