Some distress needs reframing. Some situations need a plan.
Structured problem-solving is not simply “giving good advice.”
It helps therapist and client define what can actually be changed,
generate alternatives, examine trade-offs, implement a plan, and learn from what happens next.
You’ll practice
Distinguishing thought problems from real-world problems
Defining problems precisely enough to solve
Separating problems from goals
Generating before evaluating
Comparing short- and long-term trade-offs
Operationalizing a plan
Using implementation breakdown as data
Separating control, influence, and outcome ownership
Keeping caregiving, systems, resources, and values visible
Knowing when to stop solving
Is there an actionable problem?
↓
Define it
↓
Set a workable goal
↓
Generate options
↓
Evaluate trade-offs
↓
Implement
↓
Review and revise
Case orientation
Meet Idris
Idris is 39. He lives several thousand kilometres from his mother
and has become the person in the family who is expected to be financially stable,
organized, and able to “figure things out.”
His mother lives alone. Practical needs recur: medical administration,
bills, documents, applications, and occasional financial requests.
Idris loves her. He also feels exhausted by the role.
MomVoice message · 0:47
“Can you call me when you have time? I need your help with something.”
The practical request is real. The meaning of the role is larger.
Decision 1 · Thought or problem?
Idris
“There is always something.”
“And before you say it, yes, I know that sounds like catastrophizing.”
“But there actually is always something.”
What do you do with the thought?
“If we changed the thought completely, what practical problem would still remain?”
“How many requests have there actually been recently?”
“Which part is interpretation, and which part is circumstance?”
Clinical Support
Do not force every problem into cognitive restructuring.
A client can hold an amplified interpretation of a situation and still be describing
an external problem that requires action.
Useful discriminator:
If the client's thinking changed completely tomorrow,
would there still be something practical to solve?
Decision 2 · Define the problem
Idris's mother needs help completing documentation for a public benefit.
The form is lengthy. The deadline is in three weeks.
Mother
“Can you just do it for me? You know these things better.”
Idris
“The problem is my mother is dependent on me.”
Is that a useful problem definition?
“What specifically needs to be different in the next three weeks?”
“What task is actually in front of us?”
“What part of the current way of handling it is unsustainable?”
Clinical Support
Define the problem at the level where action is possible.
“My mother is dependent on me.”
→
“A benefits application is due in three weeks,
and the current help pattern requires Idris to take over most of the task.”
Task
Benefits application
Time
Three weeks
People
Idris + mother
Pattern
Idris takes over
Decision 3 · Problem ≠ goal
You ask what a good outcome would look like.
Idris
“She becomes independent.”
How do you work with the goal?
A problem-solving goal works best when it describes an outcome the client can meaningfully influence,
not a transformation another person must produce.
Clinical Support
A problem and a goal are not the same thing.
Broad desired outcome
“She becomes independent.”
Depends on health, income, services, skills, motivation, systems, and choices.
Working problem-solving goal
Submit the application on time using a division of responsibility Idris can sustain.
Decision 4 · The therapist already has an idea
You can already imagine a plausible plan:
Idris helps with difficult sections, his mother completes the simpler ones,
and they use one scheduled call.
Idris
“What should I do?”
How quickly do you offer your solution?
Problem-solving phase · Generate
Don't evaluate yet.
Option 1
Idris completes the entire application.
Option 2
Mother completes everything herself.
Option 3
Divide the form by section.
Option 4
Complete it together during one scheduled video call.
Option 5
Contact a local assistance service.
Option 6
Mother makes a first pass; Idris reviews targeted sections.
Generation and evaluation are different tasks.
Decision 5 · “Those two are fantasy.”
Idris
“Options two and five are fantasy.”
What do you do?
Problem-solving phase · Evaluate
Not ideal is not the same as not an option.
Option
Completion likelihood
Idris burden
Long-term effect
Dependence on others
Idris does everything
Higher
Higher
Likely preserves takeover pattern
Lower
Mother does everything
Lower / uncertain
Lower
Maximum transfer of responsibility
High
Divide by section
Moderate
Moderate
Clearer responsibility
Moderate
One scheduled call
Moderate-high
Moderate
May still reproduce directing role
Moderate
Local support
Uncertain
Potentially lower
Could distribute support outside family
High
First pass + targeted review
Moderate
Moderate-low
Tests a different division of labor
Moderate-high
Decision 6 · What does “best” mean?
Idris
“Option one is obviously the safest.”
Which criterion should dominate?
The “best” solution depends on the goal. Consider what each criterion optimizes—and what it sacrifices.
Selected plan
Step 1 — Mother completes a first pass.
Step 2 — She marks sections she does not understand.
Step 3 — One 60-minute review call.
Step 4 — Idris helps only with unclear sections.
Step 5 — If major barriers remain, contact local assistance.
Step 6 — Internal deadline is three days before the official deadline.
Idris
“This sounds reasonable.”
“Which probably means it won't happen.”
Decision 7 · Implementation
You ask what needs to happen first.
Idris
“She needs to start.”
“I'll message her tonight.”
Is that specific enough?
Clinical Support
A solution is not implemented until somebody does something.
Who?
Mother + Idris
What?
Sections 1–4 first pass
When?
Sunday evening
How?
Highlight unclear items
Review?
Wednesday · 7 PM
“We'll divide the paperwork” is a solution idea.
“Complete sections 1–4 by Sunday and send the draft Monday” is an implementation step.
Sunday → Monday
The plan did not happen as expected.
Sunday evening — First pass due.
No draft received.
Monday — Idris follows up.
MomMessage
“I started. I don't understand any of it. Can we just do it together?”
Idris
“Exactly.”
“This is why I do things myself.”
Decision 8 · What does the breakdown mean?
Problem-solving is iterative. Ask what the unsuccessful implementation teaches about the original formulation.
Clinical Support
Failed implementation is a new problem definition.
Plan
↓
Was the task understood?
↓
Was the skill present?
↓
Were resources available?
↓
Did emotion interfere?
↓
Was participation accepted?
↓
Did follow-through occur?
Implementation problems produce formulation data.
Revised formulation
Initial
“Mother does not take enough responsibility.”
Updated
Mother appears unable or unwilling to complete the full first pass independently,
and Idris's usual response is to take over.
One component concerns her capacity and participation.
The other concerns Idris's response when participation is incomplete.
Decision 9 · What is actually controllable?
Idris
“So we're back to square one.”
“I can't make her do it.”
What do you emphasize?
“Which part of this outcome belongs to you?”
“What can you offer without guaranteeing what happens next?”
“Where do influence and ownership stop being the same thing?”
Locus of influence
I can control
My money
My time
My availability
What support I offer
What I communicate
I can influence
How clear the instructions are
Whether another support is introduced
How tasks are divided
What options are made available
I cannot determine
Whether she follows through
Whether she changes
Whether the application succeeds
Whether the relationship becomes what I hope
Idris
“The third column is the one I keep turning into my job.”
Decision 10 · Real downstream consequences
Idris
“If I don't do it, she could lose the benefit.”
“Then she calls me.”
“She needs money.”
“So even if I set a boundary, I still pay for the consequences.”
What do you do?
Some real-world problems contain competing costs rather than one option that eliminates harm.
Clinical Support
Some problems do not have clean solutions.
More analysis does not always reveal an option without loss.
Sometimes the clinical task is helping the client identify which costs are sustainable
and which trade-offs align most closely with their priorities.
Income
Healthcare
Public benefits
Immigration
Geography
Language / access
Family expectations
Formal support services
Family overfunctioning can occur inside systems where formal resources are incomplete or inaccessible.
The intervention should not pretend the family is operating in a vacuum.
Decision 11 · Values and trade-offs
Idris
“I do want to help her.”
“I don't want therapy to turn me into someone who says, ‘Not my problem.’”
“I also don't want love to mean I am permanently on call.”
How do values affect problem-solving?
Revised plan
Care
Dignity
Sustainability
Family connection
Financial stability
Idris will
Read instructions once.
Help identify required documents.
Schedule one 60-minute call.
Help where genuine interpretation barriers exist.
Identify one local assistance service.
Pay a defined application-related fee if needed.
Idris will not automatically
Complete every section.
Repeatedly chase documents.
Own the deadline after the agreed review date.
Promise open-ended financial replacement if the application is not completed.
If agreed steps do not happen, Idris will decide what support he can offer at that point
rather than promising in advance to absorb every consequence.
Idris
“That last part is the hardest.”
Two weeks later
✓
Application submitted.
✓
External support introduced.
✓
Idris's workload reduced from roughly six hours to about ninety minutes.
~
Mother's participation remained inconsistent.
~
Emotional burden remained substantial.
~
The larger caregiving pattern remained unresolved.
Idris
“So unfortunately the intervention did not fix my mother.”
Decision 12 · Verify the solution
How do you evaluate whether the problem-solving worked?
Clinical Support
Verify the solution at the level of the original problem.
Original goal
Application submitted using a division of responsibility Idris could better sustain.
Observed
Application submitted.
Some responsibility redistributed.
Idris's workload reduced.
External support introduced.
Not solved: the larger caregiving system, grief, role history, future requests, or the relationship Idris wishes he had.
The clinical task changes
Idris
“I feel clearer.”
“And sad.”
“Part of me keeps designing systems for a relationship I wish didn't need systems.”
“I want to just be somebody's son.”
Decision 13 · When do you stop solving?
What do you do next?
Ask whether a practical decision still needs to be made—or whether the session is now confronting a painful reality that cannot be solved by another plan.
Problem-Solving Learning Record
Presenting statement
“There is always something, and I cannot keep doing all of it.”
Cognitive component
“Always” was somewhat global. Frequent practical demands were nevertheless real.
Original problem definition
“My mother is dependent on me.”
Revised problem definition
A benefits application is due in three weeks, and the current help pattern leads Idris to take over.
Original goal
“She becomes independent.”
Revised goal
Submit the application on time using a sustainable division of responsibility.
Implementation learning
The first plan overestimated independent capacity or participation.
Revised plan
Specific task division, scheduled assistance, external support, defined limits, and contingency rather than automatic takeover.
Short-term: problem solved quickly or distress temporarily reduced
↓
Long-term: role remains polarized and responsibility feels limitless
Revised target:
Build a sustainable system for specific forms of assistance while separating care from total outcome ownership.
Intervention comparison
Cognitive restructuring
How well does this interpretation fit the evidence?
Useful when appraisal is adding distress. Not sufficient if an external problem remains.
Problem-solving
Given the real constraints, what can be changed and how?
Behavioral experiment
What can we change specifically to test a prediction?
Behavioral activation
What patterns are reducing contact with reinforcement?
Exposure
What can be learned through approaching something feared or avoided?
Communication / skills training
What competency is needed to carry out the chosen plan?
These interventions can overlap without becoming interchangeable.
Debrief
Reflect on your clinical choices.
What told you that Idris's concern could not be handled with cognitive restructuring alone?
What was wrong with “my mother is dependent on me” as a problem definition?
Why was “make her independent” a weak immediate goal?
When did therapist advice risk replacing client problem-solving?
Why generate options that initially seem unrealistic?
What did short- versus long-term evaluation reveal about Idris doing the entire form?
Why was the failed first handoff clinically useful?
What new problem became visible after implementation?
How did control, influence, and outcome ownership change the formulation?
When might family assistance represent desired interdependence rather than pathology?
How can clinicians discuss boundaries without automatically privileging individual independence?
What systemic conditions make family overfunctioning more likely?
When did the task stop being a problem to solve and become grief to process?
What would you do next?
Before you leave
Think of a client problem you have been tempted to solve through cognitive restructuring.
If the client's interpretation changed completely tomorrow,
what practical problem would still remain?
Closing question
If the most efficient solution is for the client to keep carrying everyone else,
whose problem has therapy actually solved?
Go deeper
See the CBT work behind the simulation.
The clinical material behind these modules grows out of live CBT work with guests,
followed by reflection on the decisions, tensions, formulations, and intervention process.
Continue with Transcripts, Notes and Reflections from The CBT Dive Video Podcast.
