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What Is Problem-Solving Therapy?

Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." She has a Master's degree in psychology.

child problem solving therapy

Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.

child problem solving therapy

Verywell / Madelyn Goodnight

Problem-Solving Therapy Techniques

How effective is problem-solving therapy, things to consider, how to get started.

Problem-solving therapy is a brief intervention that provides people with the tools they need to identify and solve problems that arise from big and small life stressors. It aims to improve your overall quality of life and reduce the negative impact of psychological and physical illness.

Problem-solving therapy can be used to treat depression , among other conditions. It can be administered by a doctor or mental health professional and may be combined with other treatment approaches.

At a Glance

Problem-solving therapy is a short-term treatment used to help people who are experiencing depression, stress, PTSD, self-harm, suicidal ideation, and other mental health problems develop the tools they need to deal with challenges. This approach teaches people to identify problems, generate solutions, and implement those solutions. Let's take a closer look at how problem-solving therapy can help people be more resilient and adaptive in the face of stress.

Problem-solving therapy is based on a model that takes into account the importance of real-life problem-solving. In other words, the key to managing the impact of stressful life events is to know how to address issues as they arise. Problem-solving therapy is very practical in its approach and is only concerned with the present, rather than delving into your past.

This form of therapy can take place one-on-one or in a group format and may be offered in person or online via telehealth . Sessions can be anywhere from 30 minutes to two hours long. 

Key Components

There are two major components that make up the problem-solving therapy framework:

  • Applying a positive problem-solving orientation to your life
  • Using problem-solving skills

A positive problem-solving orientation means viewing things in an optimistic light, embracing self-efficacy , and accepting the idea that problems are a normal part of life. Problem-solving skills are behaviors that you can rely on to help you navigate conflict, even during times of stress. This includes skills like:

  • Knowing how to identify a problem
  • Defining the problem in a helpful way
  • Trying to understand the problem more deeply
  • Setting goals related to the problem
  • Generating alternative, creative solutions to the problem
  • Choosing the best course of action
  • Implementing the choice you have made
  • Evaluating the outcome to determine next steps

Problem-solving therapy is all about training you to become adaptive in your life so that you will start to see problems as challenges to be solved instead of insurmountable obstacles. It also means that you will recognize the action that is required to engage in effective problem-solving techniques.

Planful Problem-Solving

One problem-solving technique, called planful problem-solving, involves following a series of steps to fix issues in a healthy, constructive way:

  • Problem definition and formulation : This step involves identifying the real-life problem that needs to be solved and formulating it in a way that allows you to generate potential solutions.
  • Generation of alternative solutions : This stage involves coming up with various potential solutions to the problem at hand. The goal in this step is to brainstorm options to creatively address the life stressor in ways that you may not have previously considered.
  • Decision-making strategies : This stage involves discussing different strategies for making decisions as well as identifying obstacles that may get in the way of solving the problem at hand.
  • Solution implementation and verification : This stage involves implementing a chosen solution and then verifying whether it was effective in addressing the problem.

Other Techniques

Other techniques your therapist may go over include:

  • Problem-solving multitasking , which helps you learn to think clearly and solve problems effectively even during times of stress
  • Stop, slow down, think, and act (SSTA) , which is meant to encourage you to become more emotionally mindful when faced with conflict
  • Healthy thinking and imagery , which teaches you how to embrace more positive self-talk while problem-solving

What Problem-Solving Therapy Can Help With

Problem-solving therapy addresses life stress issues and focuses on helping you find solutions to concrete issues. This approach can be applied to problems associated with various psychological and physiological symptoms.

Mental Health Issues

Problem-solving therapy may help address mental health issues, like:

  • Chronic stress due to accumulating minor issues
  • Complications associated with traumatic brain injury (TBI)
  • Emotional distress
  • Post-traumatic stress disorder (PTSD)
  • Problems associated with a chronic disease like cancer, heart disease, or diabetes
  • Self-harm and feelings of hopelessness
  • Substance use
  • Suicidal ideation

Specific Life Challenges

This form of therapy is also helpful for dealing with specific life problems, such as:

  • Death of a loved one
  • Dissatisfaction at work
  • Everyday life stressors
  • Family problems
  • Financial difficulties
  • Relationship conflicts

Your doctor or mental healthcare professional will be able to advise whether problem-solving therapy could be helpful for your particular issue. In general, if you are struggling with specific, concrete problems that you are having trouble finding solutions for, problem-solving therapy could be helpful for you.

Benefits of Problem-Solving Therapy

The skills learned in problem-solving therapy can be helpful for managing all areas of your life. These can include:

  • Being able to identify which stressors trigger your negative emotions (e.g., sadness, anger)
  • Confidence that you can handle problems that you face
  • Having a systematic approach on how to deal with life's problems
  • Having a toolbox of strategies to solve the issues you face
  • Increased confidence to find creative solutions
  • Knowing how to identify which barriers will impede your progress
  • Knowing how to manage emotions when they arise
  • Reduced avoidance and increased action-taking
  • The ability to accept life problems that can't be solved
  • The ability to make effective decisions
  • The development of patience (realizing that not all problems have a "quick fix")

Problem-solving therapy can help people feel more empowered to deal with the problems they face in their lives. Rather than feeling overwhelmed when stressors begin to take a toll, this therapy introduces new coping skills that can boost self-efficacy and resilience .

Other Types of Therapy

Other similar types of therapy include cognitive-behavioral therapy (CBT) and solution-focused brief therapy (SFBT) . While these therapies work to change thinking and behaviors, they work a bit differently. Both CBT and SFBT are less structured than problem-solving therapy and may focus on broader issues. CBT focuses on identifying and changing maladaptive thoughts, and SFBT works to help people look for solutions and build self-efficacy based on strengths.

This form of therapy was initially developed to help people combat stress through effective problem-solving, and it was later adapted to address clinical depression specifically. Today, much of the research on problem-solving therapy deals with its effectiveness in treating depression.

Problem-solving therapy has been shown to help depression in: 

  • Older adults
  • People coping with serious illnesses like cancer

Problem-solving therapy also appears to be effective as a brief treatment for depression, offering benefits in as little as six to eight sessions with a therapist or another healthcare professional. This may make it a good option for someone unable to commit to a lengthier treatment for depression.

Problem-solving therapy is not a good fit for everyone. It may not be effective at addressing issues that don't have clear solutions, like seeking meaning or purpose in life. Problem-solving therapy is also intended to treat specific problems, not general habits or thought patterns .

In general, it's also important to remember that problem-solving therapy is not a primary treatment for mental disorders. If you are living with the symptoms of a serious mental illness such as bipolar disorder or schizophrenia , you may need additional treatment with evidence-based approaches for your particular concern.

Problem-solving therapy is best aimed at someone who has a mental or physical issue that is being treated separately, but who also has life issues that go along with that problem that has yet to be addressed.

For example, it could help if you can't clean your house or pay your bills because of your depression, or if a cancer diagnosis is interfering with your quality of life.

Your doctor may be able to recommend therapists in your area who utilize this approach, or they may offer it themselves as part of their practice. You can also search for a problem-solving therapist with help from the American Psychological Association’s (APA) Society of Clinical Psychology .

If receiving problem-solving therapy from a doctor or mental healthcare professional is not an option for you, you could also consider implementing it as a self-help strategy using a workbook designed to help you learn problem-solving skills on your own.

During your first session, your therapist may spend some time explaining their process and approach. They may ask you to identify the problem you’re currently facing, and they’ll likely discuss your goals for therapy .

Keep In Mind

Problem-solving therapy may be a short-term intervention that's focused on solving a specific issue in your life. If you need further help with something more pervasive, it can also become a longer-term treatment option.

Get Help Now

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Shang P, Cao X, You S, Feng X, Li N, Jia Y. Problem-solving therapy for major depressive disorders in older adults: an updated systematic review and meta-analysis of randomized controlled trials .  Aging Clin Exp Res . 2021;33(6):1465-1475. doi:10.1007/s40520-020-01672-3

Cuijpers P, Wit L de, Kleiboer A, Karyotaki E, Ebert DD. Problem-solving therapy for adult depression: An updated meta-analysis . Eur Psychiatry . 2018;48(1):27-37. doi:10.1016/j.eurpsy.2017.11.006

Nezu AM, Nezu CM, D'Zurilla TJ. Problem-Solving Therapy: A Treatment Manual . New York; 2013. doi:10.1891/9780826109415.0001

Owens D, Wright-Hughes A, Graham L, et al. Problem-solving therapy rather than treatment as usual for adults after self-harm: a pragmatic, feasibility, randomised controlled trial (the MIDSHIPS trial) .  Pilot Feasibility Stud . 2020;6:119. doi:10.1186/s40814-020-00668-0

Sorsdahl K, Stein DJ, Corrigall J, et al. The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: A randomized controlled trial . Subst Abuse Treat Prev Policy . 2015;10(1):46. doi:doi.org/10.1186/s13011-015-0042-1

Margolis SA, Osborne P, Gonzalez JS. Problem solving . In: Gellman MD, ed. Encyclopedia of Behavioral Medicine . Springer International Publishing; 2020:1745-1747. doi:10.1007/978-3-030-39903-0_208

Kirkham JG, Choi N, Seitz DP. Meta-analysis of problem solving therapy for the treatment of major depressive disorder in older adults . Int J Geriatr Psychiatry . 2016;31(5):526-535. doi:10.1002/gps.4358

Garand L, Rinaldo DE, Alberth MM, et al. Effects of problem solving therapy on mental health outcomes in family caregivers of persons with a new diagnosis of mild cognitive impairment or early dementia: A randomized controlled trial . Am J Geriatr Psychiatry . 2014;22(8):771-781. doi:10.1016/j.jagp.2013.07.007

Noyes K, Zapf AL, Depner RM, et al. Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC pilot study .  Cancer Treat Res Commun . 2022;31:100552. doi:10.1016/j.ctarc.2022.100552

Albert SM, King J, Anderson S, et al. Depression agency-based collaborative: effect of problem-solving therapy on risk of common mental disorders in older adults with home care needs . The American Journal of Geriatric Psychiatry . 2019;27(6):619-624. doi:10.1016/j.jagp.2019.01.002

By Arlin Cuncic, MA Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." She has a Master's degree in psychology.

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How to Teach Kids Problem-Solving Skills

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  • Steps to Follow
  • Allow Consequences

Whether your child can't find their math homework or has forgotten their lunch, good problem-solving skills are the key to helping them manage their life. 

A 2010 study published in Behaviour Research and Therapy found that kids who lack problem-solving skills may be at a higher risk of depression and suicidality.   Additionally, the researchers found that teaching a child problem-solving skills can improve mental health . 

You can begin teaching basic problem-solving skills during preschool and help your child sharpen their skills into high school and beyond.

Why Problem-Solving Skills Matter

Kids face a variety of problems every day, ranging from academic difficulties to problems on the sports field. Yet few of them have a formula for solving those problems.

Kids who lack problem-solving skills may avoid taking action when faced with a problem.

Rather than put their energy into solving the problem, they may invest their time in avoiding the issue.   That's why many kids fall behind in school or struggle to maintain friendships .

Other kids who lack problem-solving skills spring into action without recognizing their choices. A child may hit a peer who cuts in front of them in line because they are not sure what else to do.  

Or, they may walk out of class when they are being teased because they can't think of any other ways to make it stop. Those impulsive choices may create even bigger problems in the long run.

The 5 Steps of Problem-Solving

Kids who feel overwhelmed or hopeless often won't attempt to address a problem. But when you give them a clear formula for solving problems, they'll feel more confident in their ability to try. Here are the steps to problem-solving:  

  • Identify the problem . Just stating the problem out loud can make a big difference for kids who are feeling stuck. Help your child state the problem, such as, "You don't have anyone to play with at recess," or "You aren't sure if you should take the advanced math class." 
  • Develop at least five possible solutions . Brainstorm possible ways to solve the problem. Emphasize that all the solutions don't necessarily need to be good ideas (at least not at this point). Help your child develop solutions if they are struggling to come up with ideas. Even a silly answer or far-fetched idea is a possible solution. The key is to help them see that with a little creativity, they can find many different potential solutions.
  • Identify the pros and cons of each solution . Help your child identify potential positive and negative consequences for each potential solution they identified. 
  • Pick a solution. Once your child has evaluated the possible positive and negative outcomes, encourage them to pick a solution.
  • Test it out . Tell them to try a solution and see what happens. If it doesn't work out, they can always try another solution from the list that they developed in step two. 

Practice Solving Problems

When problems arise, don’t rush to solve your child’s problems for them. Instead, help them walk through the problem-solving steps. Offer guidance when they need assistance, but encourage them to solve problems on their own. If they are unable to come up with a solution, step in and help them think of some. But don't automatically tell them what to do. 

When you encounter behavioral issues, use a problem-solving approach. Sit down together and say, "You've been having difficulty getting your homework done lately. Let's problem-solve this together." You might still need to offer a consequence for misbehavior, but make it clear that you're invested in looking for a solution so they can do better next time. 

Use a problem-solving approach to help your child become more independent.

If they forgot to pack their soccer cleats for practice, ask, "What can we do to make sure this doesn't happen again?" Let them try to develop some solutions on their own.

Kids often develop creative solutions. So they might say, "I'll write a note and stick it on my door so I'll remember to pack them before I leave," or "I'll pack my bag the night before and I'll keep a checklist to remind me what needs to go in my bag." 

Provide plenty of praise when your child practices their problem-solving skills.  

Allow for Natural Consequences

Natural consequences  may also teach problem-solving skills. So when it's appropriate, allow your child to face the natural consequences of their action. Just make sure it's safe to do so. 

For example, let your teenager spend all of their money during the first 10 minutes you're at an amusement park if that's what they want. Then, let them go for the rest of the day without any spending money.

This can lead to a discussion about problem-solving to help them make a better choice next time. Consider these natural consequences as a teachable moment to help work together on problem-solving.

Becker-Weidman EG, Jacobs RH, Reinecke MA, Silva SG, March JS. Social problem-solving among adolescents treated for depression . Behav Res Ther . 2010;48(1):11-18. doi:10.1016/j.brat.2009.08.006

Pakarinen E, Kiuru N, Lerkkanen M-K, Poikkeus A-M, Ahonen T, Nurmi J-E. Instructional support predicts childrens task avoidance in kindergarten .  Early Child Res Q . 2011;26(3):376-386. doi:10.1016/j.ecresq.2010.11.003

Schell A, Albers L, von Kries R, Hillenbrand C, Hennemann T. Preventing behavioral disorders via supporting social and emotional competence at preschool age .  Dtsch Arztebl Int . 2015;112(39):647–654. doi:10.3238/arztebl.2015.0647

Cheng SC, She HC, Huang LY. The impact of problem-solving instruction on middle school students’ physical science learning: Interplays of knowledge, reasoning, and problem solving . EJMSTE . 2018;14(3):731-743.

Vlachou A, Stavroussi P. Promoting social inclusion: A structured intervention for enhancing interpersonal problem‐solving skills in children with mild intellectual disabilities . Support Learn . 2016;31(1):27-45. doi:10.1111/1467-9604.12112

Öğülmüş S, Kargı E. The interpersonal cognitive problem solving approach for preschoolers .  Turkish J Educ . 2015;4(17347):19-28. doi:10.19128/turje.181093

American Academy of Pediatrics. What's the best way to discipline my child? .

Kashani-Vahid L, Afrooz G, Shokoohi-Yekta M, Kharrazi K, Ghobari B. Can a creative interpersonal problem solving program improve creative thinking in gifted elementary students? .  Think Skills Creat . 2017;24:175-185. doi:10.1016/j.tsc.2017.02.011

Shokoohi-Yekta M, Malayeri SA. Effects of advanced parenting training on children's behavioral problems and family problem solving .  Procedia Soc Behav Sci . 2015;205:676-680. doi:10.1016/j.sbspro.2015.09.106

By Amy Morin, LCSW Amy Morin, LCSW, is the Editor-in-Chief of Verywell Mind. She's also a psychotherapist, an international bestselling author of books on mental strength and host of The Verywell Mind Podcast. She delivered one of the most popular TEDx talks of all time.

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  • Collaborative Problem Solving® »

child problem solving therapy

Collaborative Problem Solving® (CPS)

At Think:Kids, we recognize that kids with challenging behavior don’t lack the will  to behave well. They lack the  skills  to behave well.

Our CPS approach is proven to reduce challenging behavior, teach kids the skills they lack, and build relationships with the adults in their lives.

Anyone can learn Collaborative Problem Solving, and we’re here to help.

What is Collaborative Problem Solving?

Kids with challenging behavior are tragically misunderstood and mistreated. Rewards and punishments don’t work and often make things worse. Thankfully, there’s another way. But it requires a big shift in mindset.

Helping kids with challenging behavior requires understanding why they struggle in the first place. But what if everything we thought was true about challenging behavior was actually wrong? Our Collaborative Problem Solving approach recognizes what research has pointed to for years – that kids with challenging behavior are already trying hard. They don’t lack the will to behave well. They lack the skills to behave well.

Learn More About the CPS Approach

Kids Do Well If They Can

CPS helps adults shift to a more accurate and compassionate mindset and embrace the truth that kids do well if they can – rather than the more common belief that kids would do well if they simply wanted to.

Flowing from this simple but powerful philosophy, CPS focuses on building skills like flexibility, frustration tolerance and problem solving, rather than simply motivating kids to behave better. The process begins with identifying triggers to a child’s challenging behavior and the specific skills they need help developing.  The next step involves partnering with the child to build those skills and develop lasting solutions to problems that work for everyone.

The CPS approach was developed at Massachusetts General Hospital a top-ranked Department of Psychiatry in the United States.  It is proven to reduce challenging behavior, teach kids the skills they lack, and build relationships with the adults in their lives. If you’re looking for a more accurate, compassionate, and effective approach, you’ve come to the right place. Fortunately, anyone can learn CPS. Let’s get started!

Bring CPS to Your Organization

Attend a cps training.

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6 out of 10 teachers report reduced stress.

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Significant reductions in parents’ stress.

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74% average reduction in use of seclusion.

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73% reduction in oppositional behaviors during school.

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Parents report improvements in parent-child interactions.

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71% fewer self-inflicted injuries.

25%

reduction in school office referrals.

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Significant improvements in children’s executive functioning skills.

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60% of children exhibited improved behavior 

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Introduction & Theoretical Background

Problem Solving is a helpful intervention whenever clients present with difficulties, dilemmas, and conundrums, or when they experience repetitive thought such as rumination or worry. Effective problem solving is an essential life skill and this Problem Solving worksheet is designed to guide children and adolescents through steps which will help them to generate solutions to ‘stuck’ situations in their lives. It follows the qualities of effective problem solving outlined by Nezu, Nezu & D’Zurilla (2013), namely: clearly defining a problem; generation of alternative solutions; deliberative decision making; and the implementation of the chosen solution.

The therapist’s stance during problem solving should be one of collaborative curiosity. It is not for the therapist to pass judgment or to impose their preferred solution. Instead it is the clinician’s role to sit alongside clients and to help them examine the advantages and disadvantages of their options and, if the client is ‘stuck’ in rumination or worry, to help motivate them to take action to become unstuck – constructive rumination asks “How can I…?” questions instead of “Why…?” questions.

In their description of problem solving therapy Nezu, Nezu & D’Zurilla (2013) describe how it is helpful to elicit a positive orientation towards the problem which involves: being willing to appraise problems as challenges; remain optimistic that problems are solvable; remember that successful problem solving involves time and effort.

Therapist Guidance

1. The first step in problem solving is to help the client to identify a problem, difficulty, or dilemma which is bothering them, or about which they have been ruminating or worrying. This may involve defining the nature of the problem, identifying the individual’s goals, and identifying obstacles which prevent the individual from reaching their goals.

2. The next step is to help the client to generate a range of possible approaches to solving their problem, ideally solutions which are designed to overcome the obstacles that have already been identified. It is helpful to remind clients that at this stage their job is to think of as many potential approaches as possible, it does not matter how outlandish or unworkable they may be. Recommend that the client generate at least three potential solutions. Helpful prompts include:

  • “Can you think of any ways that you could make this problem not be a problem any more?”
  • “What’s keeping this problem as a problem? What could you do to target that part of the problem?”
  • “If your friend was bothered by a problem like this what might be something that you recommend they try?”
  • “What would be some of the worst ways of solving a problem like this? And the best?”
  • “How would Batman solve a problem like this?”

3. Once a selection of potential strategies have been identified the client can be helped to consider potential advantages and disadvantages for each strategy, and likely outcomes of each strategy.

  • Consider short term and long-term implications of each strategy
  • Implications may relate to: emotional well-being, choices & opportunities, relationships, self-growth

4. The next step is to encourage the client to consider which of the available options is the best solution. If clients do not feel positive about any solutions clinicians can frame this choice as “Which is the least-worst?” and may remind the client that “even not-making-a-choice is a form of choice”.

5. The last step of problem solving is putting a plan into action. Rumination, worry, and being in the horns of a dilemma are ‘stuck’ states which require a behavioral ‘nudge’ to become unstuck. One a plan has been implemented it is important to monitor the outcome and to evaluate whether the actual outcome was consistent with the anticipated outcome.

References And Further Reading

  • Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of depression . New York: Guilford.
  • Nezu, A. M., Nezu, C. M., D’Zurilla, T. J. (2013). Problem-solving therapy: a treatment manual . New York: Springer.
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An Innovative Approach for Helping ‘Explosive & Inflexible Children’

By: david rabiner, ph.d..

—————————————————————————————————————————————————— “This article was originally published in Attention Research Update, an online newsletter written by Dr. David Rabiner of Duke University that helps parents, professionals, and educators keep up with new research on ADHD and related areas.  You can sign up for a complementary subscription at www.helpforadd.com ” ——————————————————————————————————————————————————

One of the most challenging problems for parents to deal with are explosive outbursts in their child. Such outbursts occur with distressing regularity in some children – regardless of whether the child also has ADHD – and can contribute to an extremely difficult home environment.

A number of years ago I cam across a book called ‘The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, “Chronically Inflexible” Children’ that I found to provide some very useful ideas for addressing these issues. The book is authored by Dr. Ross Greene, a clinical psychologist from Harvard Medical School. Dr. Greene’s approach impressed me as a thoughtful and respectful way to deal with the behavioral volatility and emotional outbursts that often add to the challenges faced my many parents of children with ADHD.

** WHAT ARE THE COMMON CHARACTERISTICS OF INFLEXIBLE-EXPLOSIVE CHILDREN? **

The label “inflexible-explosive” child is not a diagnostic term recognized in DSM-IV, the official diagnostic guide for psychiatric disorders. Instead, it is used by Dr. Greene to capture the key features of children who are extremely difficult for parents to manage. According to Dr. Greene, the key features of such children are the following:

1. A very limited capacity for flexibility and adaptability and a tendency to become “incoherent” in the midst of severe frustration .

These children are much less flexible and adaptable than their peers, become easily overwhelmed by frustration, and are often unable to behave in a logical and rational manner when frustrated. During periods of incoherence, they are not responsive to efforts to reason with them, which may actually make things worse. Dr. Greene refers to these episodes as “meltdowns” and argues that the child has little or no control over his/her behavior during these episodes.

2. An extremely low frustration tolerance threshold.

These children often become overwhelmingly frustrated by what seem like relatively trivial events. Because their capacity to tolerate frustration develop more slowly than their peers, they often experiences the world as a frustrating place filled with people who do not understand what they are experiencing.

3. The tendency to think in a concrete, rigid, black- and-white manner .

These children fail to develop the flexibility in their thinking at the same rate as peers, and tend to regard many situations in an either-or, all-or-none, manner. This greatly impairs their ability to negotiate and compromise.

4. The persistence of inflexibility and poor response to frustration despite a high level of intrinsic or extrinsic motivation .

Even very salient and important consequences do not necessarily diminish the child’s frequent, intense, and lengthy “meltdowns”. As a result, typical approaches of rewarding a child for desired behavior and punishing negative behavior do not diminish the child’s tendency to “fall apart”. According to Dr. Greene, traditional behavioral therapy approaches for such children often don’t work at all and can make things worse.

In addition to these key features, Dr. Greene notes that a child’s meltdowns often have an “out-of-the-blue” quality, occurring in response to an apparently trivial frustration even when the child has been in a good mood. As a result, parents never know what to expect and things can seem to fall apart at any moment.

** WHAT CAUSES A CHILD TO BE THIS WAY? **

According to Dr. Greene, most children who become extremely inflexible and explosive do so because of biologically-based vulnerabilities and not because of “poor parenting”. The list of biological vulnerabilities that may predispose children to develop these characteristics include the following:

– Difficult Temperament –

By nature, some infants come in to the world being more finicky, emotionally reactive, and more difficult to soothe than others. These “innate” aspects of personality are what psychologists refer to as temperament. (Note: It is important to recognize that even very difficult temperaments can be modified over time and this in no way “dooms” a child to a life of ongoing difficulty and struggle.)

– ADHD and Executive Function Deficits –

Many children with difficult temperaments are eventually diagnosed with ADHD. As discussed in prior issues of Attention Research Update, current theorizing about the core deficits associated with ADHD focus on problems in a crucial set of thinking skills referred to as “executive functions”.

Although there is not universal agreement on the specific skills that constitute executive functions, most lists would include such things as: organization and planning skills, establishing goals and being able to use these goals to guide one’s behavior, working memory, being able to keep emotions from overpowering one’s ability to think rationally, and being able to shift efficiently from one cognitive activity to the next.

Deficiencies in these skills are believed to help explain not only the core symptoms of ADHD (i.e. inattention and hyperactivity/impulsivity), but also the poor frustration tolerance, inflexibility, and explosive outbursts that are seen in the “inflexible-explosive” children described by Dr. Greene.

For example, if a child has difficulty shifting readily from one activity to the next because of an inherent cognitive inflexibility, this child may feel overwhelmingly frustrated when parents say it is time to stop playing and come in for dinner. The child may not intend to be disobedient, but may have trouble complying with parents’ demands because of trouble shifting flexibly and efficiently from one mind-set to another. In fact, Dr. Greene argues that most “explosive children” want to behave better and feel badly about their outbursts. He believes they are motivated to change their behavior but lack the skills to do it.

– Language processing problems –

Language skills set the stage for many critical forms of thinking including problem solving, goal setting, and regulating/managing emotions. Thus, it is not surprising that children with poorly developed language abilities, as is often true in children with ADHD, would have greater difficulty managing frustration.

– Mood difficulties –

Some children are born predisposed to perpetually sunny and cheerful moods. Others, unfortunately, tend to experience sustained periods of irritability and crankiness for reasons that are rooted largely in biology. This is not just true for children who experience full-blown mood disorders such as depression or bipolar disorder, but can apply to “sub-clinical” mood difficulties as well.

Imagine for a moment how you tend to handle things when feeling cranky and irritable. If you’re like most people, you probably become frustrated more easily and lose your temper more readily. For children who are prone to these negative mood states, more chronic difficulties with frustration and temper are thus likely to be evident.

** WHAT CAN PARENTS DO? **

How can a parent help their “explosive” child become less explosive, develop greater self-control, and thereby create a better quality of life for everyone in the family?

According to Dr. Greene, the first step is to develop a clear understanding of the reasons for the child’s explosiveness. To the extent that parents – and others – regard a child’s explosiveness as reflecting deliberate and willful attempts to “get what they want”, the overwhelming tendency will be to respond in punitive ways. Dr. Greene argues convincingly, however, that punishments will not work for a child who lacks the skills to handle frustration more adaptively. That is because when these children are frustrated they are not able to use the anticipation of punishment to alter their behavior.

When one’s mindset changes from “my child is acting like a spoiled brat” to “my child needs help in learning to deal with frustration in a more flexible and adaptive manner”, it becomes easier to move from a punishment-oriented approach to a skills-building approach. At the heart of this effort is what Dr. Greene refers to as the “Basket Approach”.

** THE “BASKET” APPROACH **

Because “meltdowns” can be so difficult for everyone in the family to endure, the primary objective in working with “explosive children” is to first reduce the frequency of such episodes. Reducing the number of meltdowns from several per day to one per day, and eventually to just a handful per week, can make an enormous difference in the quality of family life and to children developing a sense of being able to control their behavior. Initially, this is accomplished largely by reducing the demands to tolerate frustration that are made on the child by sorting the types of behaviors the create problems into 3 baskets according to how critical it is to change the behaviors or to curtail them when they occur.

– Basket A –

Some behaviors are so problematic that they must remain off-limits even if enforcing the rule against them will result in a meltdown. Initially, Dr. Greene suggests that the only behaviors to be placed in Basket A are those that are clear safety issues (e.g. wearing a seat belt in the car; not engaging in dangerous or harmful behaviors such as hitting others). This is where parents must continue to stand firm and insist on compliance. Dr. Greene’s specific criteria for what goes in Basket A are as follows:

1. The behavior must be so important that it is worth enduring a meltdown to enforce:

2. The child must be capable of behaving in the way that is expected.

For example, Dr. Greene would argue that there is no point insisting that completing assigned homework be placed in Basket A when the child lacks the skills and frustration tolerance to do this consistently.

By reducing the number of behaviors for which compliance is non-negotiable to those that are really and truly essential and that the child is capable of performing, the number of exchanges that are likely to set off explosive episodes can be drastically reduced.

– Basket B –

Basket B – the most important basket according to Dr. Greene – contains behaviors that really are high priorities but are ones that you are not willing to endure a meltdown over. These can include such items as completing schoolwork, talking to parents with respect, complying with reasonable expectations, etc.

It is around Basket B behaviors that Dr. Greene believes that critical compromise and negotiation skills can be taught to your child. For example, suppose your child is watching TV and you know it is time to stop and get started on homework. You tell your child to turn off the TV and get started, and he refuses.

The temptation here would be to insist on immediate compliance and to threaten punishment (e.g. no TV for the rest of the week) if your child does not comply. But, in Dr. Greene’s framework, this is not a safety issue, and thus should not be placed in Basket A. He would ask what is likely to happen if you make such a response? One likely consequence is that your child’s frustration will increase, he or she will lose control, and a full-fledged meltdown will ensue.

Is this worth it? If standing firm and tolerating this meltdown made it more likely that your child would comply the next time you made such a demand, the answer would be yes. If, however, standing firm and triggering the meltdown does not increase the likelihood of compliance in the future, or reduce the probability of future meltdowns, Dr. Greene would suggest it was definitely not worth it.

What to do instead? Dr. Greene argues that these Basket B behaviors provide wonderful opportunities to try and engage your child in a compromise and negotiation process. In the scenario above, the parent could say something like, “I know that it is important to you to keep watching TV. I would like for you to be able to do this, but I also know that you have homework that needs to get done. Let’s try to come up with a compromise where you’ll get some of what you want, and I’ll get some of what I want.”

The goal here is not only to get the child to give in and do what you want, but to begin teaching your child the compromise and negotiation skills that will contribute to his or her becoming more flexible over time. Dr. Greene points out how this process can be extremely difficult for inflexible-explosive children, and that it is not unusual for them to become increasingly agitated when trying to negotiate a solution.

As a parent, if you observe this starting to occur, and sense your child is getting closer to a meltdown, the goal becomes trying to diffuse the tension so that a meltdown does not take place. This can mean offering compromise solutions for the child in an effort to help things calm down. When this does not work, Dr. Greene suggests just letting things go so that the meltdown is avoided. In the example above, should the efforts to negotiate fail and lead the child to the verge of a meltdown the parent might say, “Well, I can see you are getting really upset about this. I appreciate that you tried to work out a compromise with me but we have not been able to come up with a good one yet. So, why don’t you just watch a bit more TV for now and we can try again in a little while to work out a good compromise.”

This can be very difficult to do and many parents along with mental health professionals would be concerned that such actions would result in teaching the child that he or she can get what she wants by refusing to give in and becoming upset. This is what a traditional behavioral therapist would argue. From Dr. Greene’s perspective, however, insisting that the child turn off the TV when a compromise was not reached would accomplish little more than triggering a meltdown that would also prevent homework from getting started on and be much more upsetting for everyone. Because of this, he advocates doing your best to help your child develop some much needed negotiation skills, but dropping things when it is clear that an explosion is imminent. Later, when the child has settled back down, you can resume your efforts to negotiate.

Developing skills to compromise and tolerate frustration does not happen right away. Dr. Greene points out that progress in these areas can be painstakingly slow, but that over time, the approach he recommends can lead to substantial gains for explosive children.

– Basket C –

Basket C contains those behaviors that are simply not worth enduring a meltdown over, even though they may have previously seemed like a high priority. By placing a number of previously important behaviors in Basket C, the opportunity for conflict producing meltdowns between parents and their child is greatly diminished.

What kinds of things belong in Basket C? This depends on the specifics of each situation but may include such things as what a child will and will not eat, what clothes they wear, how they keep their room, etc. Dr. Greene suggests that the question to ask in determining whether a particular behavior falls into Basket C is “Is this so important that it is really worth risking a meltdown over?” If not, and you’ve already identified a number of behaviors that seem more important and worth negotiating over (i.e. those in Basket B), then into Basket C it goes.

– How does this compare to traditional parenting approaches? –

Dr. Greene’s approach to dealing with explosive children runs counter to what many parents and professionals believe, i.e., that if a child is not punished, for behaving inappropriately they will never develop the necessary self-control nor be deterred from continuing to misbehave. Thus, Dr. Greene’s thesis here is a controversial one and is at odds with traditional behavior therapy approaches that have substantial research support. Dr. Greene suggests, however, that for children whose explosiveness stems from a basic and biologically based inability to manage frustration, Dr. Greene suggests that behavioral interventions may not be effective can actually make things worse by increasing, rather than decreasing, the frequency with which a child loses control.

– Isn’t this just giving in to a misbehaving child? –

Not necessarily. Dr. Greene points out that there is an important difference between giving in and deciding what behaviors are important enough to stand firm on. It remains the responsibility and prerogative of parents to be clear about what is non-negotiable, when compromise is a reasonable way to go, and what things to let slide for the time being. As the child becomes better able to tolerate frustration and learn much-needed compromise and negotiation skills, more and more behaviors can be moved from Basket C into Basket B, thus providing your child with increasing opportunities to practice learning to compromise.

– DOES THIS APPROACH WORK? RESULTS FROM A RECENT STUDY –

Dr. Greene’s approach will resonate with some people and be sharply criticized by others. However, the hallmark of a scientist is a willingness and desire to test one’s theories through empirical research and I was thus quite pleased to recently come across a study published several years ago by Dr. Greene in which he tested the approach described above against more traditional behavioral parent training therapy with a sample of oppositional defiant children who also had symptoms of a mood disorder (Greene et al. [2004]. Effectiveness of collaborative problem solving in affectively dysregulated children with oppositional-defiant disorder: Initial findings. Journal of Consulting and Clinical Psychology, 2004, 72, 1157-1164).

Participants in this study were parents of 50 children with ODD – for a description of diagnostic criteria for ODD see www.helpforadd.com/oddcd.htm – who also had at least sub threshold features of either childhood bipolar disorder or major depression. In addition, about two-thirds of the children were diagnosed with ADHD and many were being treated with medication.

The parents of these children were randomly assigned to 1 of 2 interventions designed to help them bring their child’s behavior under better control: the collaborative problem solving model developed by Dr. Greene or a more traditional behavioral parent training program developed by Dr. Russell Barkley, one of the world’s leading authorities on ADHD.

Dr. Barkley’s parent training program is a highly structured behavior management program that lasted for 10-weeks. The focus is on teaching parents more effective discipline and behavior management strategies and sessions were attended primarily by parents, although children participated occasionally as well.

Families assigned to the Collaborative Problem Solving (CPS) treatment were educated about the biological factors contributing to their child’s aggressive outbursts, the “baskets” framework described above, and about the use of collaborative problem solving as a means for resolving disagreements and defusing potentially conflictual situations so as to reduce the likelihood of aggressive outbursts. As with Barkley’s parent training program, sessions were attended primarily by parents. The number of sessions attended by parents ranged from 7-16 and the average length of treatment was 11 weeks.

– RESULTS –

At the conclusion of treatment, parents in both groups reported a significant decline in their child’s level of oppositional behavior. At 4-months post-treatment, however, the gains reported by families who received traditional parent training were beginning to erode while those who received Greene’s Collaborative Problem Solving therapy reported that gains were fully sustained. Specifically, 80% of children in the CPS condition were reported to be either very much improved or much improved by their parents compared to only 44% in the traditional parent training program.

Parents in the CPS condition also reported that they were experiencing significantly less stress, that their children were more adaptable, and that hyperactive-impulsive symptoms were reduced. They also felt more effective at setting limits for their children and that communication with their child had improved. Significant improvements on these dimensions were not evident.

– SUMMARY and IMPLICATIONS –

The approach developed by Dr. Greene for developing self-control in children prone to emotional outbursts and melt-downs represents an important shift from traditional behavioral treatment methods. It is based on the premise that when this behavior has a strong biological underpinning, as he feels is true for many children, the use of punishments and rewards are not likely to be effective. Instead, he advocates that parents work to remove sources of frustration from their child’s life, become clear about what behaviors they truly need to take a stand on, and focus on helping their child develop the ability to negotiate, compromise, and manage their affect. Because melt-downs can be so painful for everyone to endure, parents are taught to avoid making demands on their child that would be likely to trigger a melt-down unless it is absolutely necessary.

This will be regarded by many as a controversial approach, but results from a preliminary test suggest that these ideas may have real value for children and families. Because this is only an initial study, however, it is clear that more work needs to be done, and there is currently a larger trial underway. When these results become available, I will make sure to report them in Attention Research Update.

For those of you who would like to learn more about these interesting ideas, there is an excellent web site at www.livesinthebalance.org/ where you can find a wide range of additional information on this approach. Another excellent site to visit developed by Dr. Greene is at http://cpsconnection.com/ I believe you will find these sites to be worth visiting.

(c) 2014 David Rabiner, Ph.D.

(Published with the author’s permission.)

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Improving Our Understanding of Impaired Social Problem-Solving in Children and Adolescents with Conduct Problems: Implications for Cognitive Behavioral Therapy

  • Published: 14 February 2022
  • Volume 25 , pages 552–572, ( 2022 )

Cite this article

  • Walter Matthys   ORCID: orcid.org/0000-0002-8887-0785 1 &
  • Dennis J. L. G. Schutter   ORCID: orcid.org/0000-0003-0738-1865 2  

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In cognitive behavioral therapy (CBT) children and adolescents with conduct problems learn social problem-solving skills that enable them to behave in more independent and situation appropriate ways. Empirical studies on psychological functions show that the effectiveness of CBT may be further improved by putting more emphasis on (1) recognition of the type of social situations that are problematic, (2) recognition of facial expressions in view of initiating social problem-solving, (3) effortful emotion regulation and emotion awareness, (4) behavioral inhibition and working memory, (5) interpretation of the social problem, (6) affective empathy, (7) generation of appropriate solutions, (8) outcome expectations and moral beliefs, and (9) decision-making. To improve effectiveness, CBT could be tailored to the individual child’s or adolescent’s impairments of these psychological functions which may depend on the type of conduct problems and their associated problems.

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This work was supported by an NWO (Dutch Research Foundation) Innovational Research Grant VI.C.181.005 (D.S).

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Matthys, W., Schutter, D.J.L.G. Improving Our Understanding of Impaired Social Problem-Solving in Children and Adolescents with Conduct Problems: Implications for Cognitive Behavioral Therapy. Clin Child Fam Psychol Rev 25 , 552–572 (2022). https://doi.org/10.1007/s10567-021-00376-y

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DOI : https://doi.org/10.1007/s10567-021-00376-y

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Lumiere Children's Therapy

November 6, 2019

Independent Living: Encourage Problem-Solving Skills in Children

child problem solving therapy

Introducing problem-solving strategies can improve your child’s quality of life

The ability to solve problems is critical to living a peaceful, empowered, and productive life. Whether it involves a challenging question, a social conflict, or one of life’s bigger obstacles, people of all ages and walks of life struggle with various issues on a daily basis.

As an adult, the instinct is often to step in and solve any issues that your child may face. However, teaching your child problem-solving skills and encouraging perseverance are among the most valuable and enduring qualities you can try to bestow upon them.

The ability to combine critical thinking, tenacity, and problem-solving skills to overcome obstacles can lead to more success, confidence, and independence in life. Make a lasting impact on your child’s future by teaching them how to develop problem-solving skills.

Teaching solutions

The correlation between problem-solving skills and greater ease in life is obvious, but the benefits may reach beyond simple stress reduction. A 2010 study of 439 teenagers indicated that a lack of healthy problem-solving strategies could lead to an increased chance of depression or suicide in adolescents. Helping your child learn how to solve problems independently can lead to better mental health and overall satisfaction in life.

Although all children tend to explore and investigate their environment to overcome obstacles, teaching your child strategies for solving problems can improve their self-esteem and increase their willingness to try new activities.

Your child’s ability to use creativity and critical thinking to solve problems is largely dependent on their developmental phase and cognitive capabilities. Consider the following timeline for how to coach your child to develop problem-solving skills.

Birth to 3 years old

The best way to help your baby or toddler learn to solve problems is to give them space and support to do so. Young children learn through experimentation. Let your child try to fix small issues themselves, and offer verbal guidance instead of intervention. Stacking toys, shape sorters, blocks, and balls are all age-appropriate activities that offer opportunities to learn through play.

As your child nears preschool age, let them practice new skills by giving them small responsibilities, such as setting the table or putting on their own coat. Trying new things challenges children to find solutions.

3 to 5 years old

A large part of solving problems is understanding the emotions you’re experiencing. Young children experience intense feelings, but they don’t have the experience or vocabulary to identify and express those feelings yet. Teach your child about emotions and start a dialog about how to appropriately manage their feelings.

Try reading books together and discussing the emotions and experiences of the characters, or engage in pretend play to open up opportunities to practice problem-solving in a safe space.

5 to 10 years old

Problem-solving is a multi-step process. Teach your child to identify the problem, brainstorm solutions, evaluate the consequences, and then choose the best option available to them. Encourage this strategy by asking open-ended questions to help guide your child through the steps.

Toys that involve building or creating and spending time outside playing with peers both allow children to practice finding solutions without adult help.

10 years old and up

Provide opportunities for your child to practice solving problems by presenting them with scenarios that require unique solutions. Organizations like Odyssey of the Mind encourage critical thinking and resilience to solve a variety of problems. Getting involved in sports is another valuable way to practice overcoming obstacles and navigating conflict.

Also, work to create an ongoing dialog in your family that supports independence. For example, if your child asks you to purchase a big-ticket item, ask how they could earn the money themselves. Help older children brainstorm ideas or work together to write down a plan that could act as a guide to achieving their goals.

Teaching your child to develop problem-solving skills requires a fine balance of acknowledging feelings, encouraging independence, offering opportunities, and providing gentle guidance without directly intervening.

It can be difficult to see your child struggle, but watching as they incorporate the skills learned from these challenges to succeed in other areas of life will be its own reward. Set your child up for success and feel confident about their future by teaching them how to solve problems independently.

Lumiere Children’s Therapy is a full-service, multidisciplinary pediatric therapy practice located in Chicago that serves the developmental needs of children from birth to 18 years of age. Learn more about how our team of clinicians works to improve the lives of children and their families.

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Recovery Trajectories of Child and Family Outcomes Following Online Family Problem-Solving Therapy for Children and Adolescents after Traumatic Brain Injury

Shari l. wade.

1 Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA

2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA

Allison P. Fisher

Eloise e. kaizar.

3 Department of Statistics, The Ohio State University, Columbus, OH 43210, USA

Keith O. Yeates

4 Department of Psychology, Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada

H. Gerry Taylor

5 Center for Biobehavioral Health, Nationwide Children’s Hospital Research Institute, Columbus, OH 43205-2664, USA

Nanhua Zhang

6 Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA

Objectives:

We conducted joint analyses from five randomized clinical trials (RCTs) of online family problem-solving therapy (OFPST) for children with traumatic brain injury (TBI) to identify child and parent outcomes most sensitive to OFPST and trajectories of recovery over time.

We examined data from 359 children with complicated mild to severe TBI, aged 5–18, randomized to OFPST or a control condition. Using profile analyses, we examined group differences on parent-reported child (internalizing and externalizing behavior problems, executive function behaviors, social competence) and family outcomes (parental depression, psychological distress, family functioning, parent–child conflict).

We found a main effect for measure for both child and family outcomes [ F (3, 731) = 7.35, p < .001; F (3, 532) = 4.79, p = .003, respectively], reflecting differing degrees of improvement across measures for both groups. Significant group-by-time interactions indicated that children and families in the OFPST group had fewer problems than controls at both 6 and 18 months post baseline [ t (731) = −5.15, p < .001, and t (731) = −3.90, p = .002, respectively, for child outcomes; t (532) = −4.81, p < .001, and t (532) = −3.80, p < .001, respectively, for family outcomes].

Conclusions:

The results suggest limited differences in the measures’ responsiveness to treatment while highlighting OFPST’s utility in improving both child behavior problems and parent/family functioning. Group differences were greatest at treatment completion and after extended time post treatment.

INTRODUCTION

Sustaining a traumatic brain injury (TBI) in childhood can lead to impairments across many domains, including motor skills, physical functioning, attention, executive and intellectual functioning, social competence, global functioning, and quality of life ( Catroppa et al., 2017 ; Finnanger et al., 2015 ). Deficits in executive functioning are one of the most common and persistent impairments following TBI ( Aaro Jonsson, Smedler, Leis Ljungmark, & Emanuelson, 2009 ; Beauchamp & Anderson, 2013 ; Sesma, Slomine, Ding, & McCarthy, 2008 ). In one study, 26% of children who sustained a moderate TBI and 42% of those who sustained a severe TBI demonstrated significant impairments in executive functioning 10 years post injury ( Muscara, Catroppa, & Anderson, 2008 ). In addition, rates of new psychiatric diagnoses in children with TBI are higher than in healthy controls, and most pre-injury mental health disorders continue or worsen following TBI ( Catroppa et al., 2015 ; Max et al., 2012 ; Schachar, Park, & Dennis, 2015 ). For example, the rate of secondary ADHD in children after TBI is greater than in children with orthopedic injuries and healthy controls ( Narad et al., 2018 ; Yeates et al., 2005 ). Similarly, internalizing disorders and post-traumatic stress disorders are over-represented among children with TBI ( Max et al., 1998 ; Schachar et al., 2015 ). Children with TBI also show short-term and long-term impairments in social cognition and participation, which can negatively affect friendships and other social relationships ( Anaby, Law, Hanna, & Dematteo, 2012 ; Catroppa et al., 2015 ; Dennis et al., 2013 ; Prigatano & Gupta, 2006 ; Renstrom, Soderman, Domellof, & Emanuelson, 2012 ; Yeates et al., 2013 ).

TBI is also associated with caregiver burden and distress ( Aitken et al., 2009 ; Stancin, Wade, Walz, Yeates, & Taylor, 2008 ). Caregivers of children with TBI face significant stressors during their child’s recovery, including financial strain and coping with changes in their child’s behavior and cognition, which can lead to clinically elevated levels of distress ( Ganesalingam et al., 2008 ; Hawley, Ward, Magnay, & Long, 2003 ; Rivara et al., 1992 ; Rivara et al., 1996 ; Wade et al., 2002 ). An increase in caregiver distress is particularly concerning given the well-documented association between parent and family functioning and child outcomes after TBI ( Catroppa et al., 2017 ; Chapman et al., 2010 ; Durber et al., 2017 ; Yeates, Taylor, Walz, Stancin, & Wade, 2010 ). Parental mental health is predictive of academic, behavioral, and social outcomes for children with TBI ( Catroppa et al., 2017 ). Furthermore, higher quality family and home environments are associated with better academic achievement and classroom functioning in children with TBI, whereas poorer home environments and parental mental health predict poorer quality of life ( Durber et al., 2017 ; Sluys, Lannge, Iselius, & Eriksson, 2015 ; Stancin et al., 2002 ).

Given the importance of parental mental health and family functioning for children’s recovery after TBI, parenting or family-centered interventions may be an effective strategy to improve family functioning, parental mental health, and child outcomes. All online family problem-solving therapies (OFPST) reported here teach children and their caregivers cognitive reframing, problem-solving strategies, communication skills, and behavior management. The therapy helps families define goals and involves real-life exercises and continual practice of learned skills.

Although problem-solving therapy was originally developed as a cognitive-behavioral treatment to promote more effective coping with life stresses ( Nezu & D’Zurilla, 2006 ), OFPST may be particularly beneficial for children with TBI because it also provides injured youth with problem-solving strategies for addressing post-injury challenges. Similarly, OFPST may help children and adolescents cope with stressors and symptoms of anxiety and depression following TBI. In fact, OFPST has shown promise in decreasing externalizing and internalizing behavior problems in children and adolescents after TBI ( Wade et al., 2011 ; Wade et al., 2013 ; Wade et al., 2015 ; Wade, Taylor, et al., 2018b ). OFPST may also improve executive functioning, but outcomes in this domain have been less consistent across age groups and family income levels ( Kurowski et al., 2013 ; Wade, Carey, & Wolfe, 2006a ; Wade et al., 2010 , Wade, Taylor, et al., 2018b ). However, only one study found improvements in social competence, and improvements were only seen for younger teens with moderate injuries and older teens with severe injuries ( Tlustos et al., 2016 ). Additionally, because OFPST involves both caregivers and children, it has demonstrated utility in improving family functioning and alleviating caregiver distress ( Narad et al., 2015 ; Petranovich et al., 2015 ; Wade, Carey, & Wolfe, 2006b ; Wade, Walz, Carey, & McMullen, 2012 ).

Although some benefits of OFPST may be immediate, other benefits may not appear until adolescence or later during recovery. For example, one study found that following OFPST with children aged 12–17, improvements in family functioning were not seen until 18 months after baseline ( Narad et al., 2015 ). Subtle or delayed treatment effects such as these may be more readily detected by aggregating results across multiple randomized trials. More specifically, joint analysis of results from separate OFPST randomized clinical trials (RCTs) can help us better understand the timing of treatment effects and which child and family outcomes are most sensitive to treatment.

We therefore conducted an individual-level profile meta-analysis of five RCTs of OFPST to better understand behavioral, family, and social outcomes of this intervention and the timing of improvements across domains. Researchers have used profile analysis of single studies to improve our understanding of neurological profiles and adaptive functioning in children who sustained a TBI ( Shultz et al., 2016 ; Treble-Barna et al., 2017 ). However, prior research has not used profile analysis to understand intervention effects for children with TBI, nor are we aware of similar analyses based on multiple studies in the TBI literature. We aim to further our understanding of OFPST and facilitate translation of these interventions into clinical practice by identifying those aspects of behavioral and family profiles that are most sensitive to treatment. We hypothesized that improvements following OFPST would be more pronounced for externalizing problems, executive function behaviors, and parental depression in comparison to improvements in social competence, with greater improvements immediately post treatment and with longer time post treatment.

We report on the joint analysis of five randomized trials of OFPST for pediatric TBI, conducted between 2000 and 2015. In total, the trials included 359 children between the ages of 5 and 18, randomized to treatment or control up to 24 months post injury. A research librarian’s search identified only these five trials of a telehealth problem-solving intervention for pediatric TBI. The trials were conducted by largely the same set of Principal Investigators (PIs), reducing study-to-study heterogeneity that could reduce power but also the potential generalizability of the study results. In all studies, parents and children with TBI provided informed consent/assent, completed pretreatment questionnaires, and, upon completion of the pretreatment assessment, were randomly assigned to either OFPST or a control condition. Follow-up assessments were completed 6 months later in all studies. Maintenance of treatment effects was examined at 12 months (3 studies) or 18 months (1 study) after baseline.

The project used fully de-identified data and was approved by the Institutional Review Board at the primary site. Each study used the Trauma Registries of participating hospitals to identify potentially eligible participants. Some studies used additional means of identification (see Wade, Kaizar, et al., 2018a ) All participants were hospitalized overnight following TBI and met criteria for a complicated mild (Glasgow Coma Scale score of 13–15 with positive findings on neuroimaging) to severe TBI (lowest Glasgow Coma Scale score of 3–8). Studies did not select for children already experiencing problems.

Treatment and Control Groups

Online family problem-solving therapy (ofpst).

The original eight-session OFPST program, tested in the initial two trials (Online and CDC), provided training in cognitive reframing, problem solving, behavior management, and family communication targeted to families of children aged 5–18. The content was subsequently adapted to target adolescents (TOPS, TOPS-RRTC and CAPS) with the modified modules and treatment goals placing greater emphasis on the adolescent’s self-regulation, problem solving, and anger management, with the overarching goal of promoting more independent functioning. The 10-session Teen Online Problem-Solving program, tested in two trials (TOPS, TOPS-RRTC), included two additional modules on nonverbal communication and social problem solving. Across all five studies, OFPST combined either 8 or 10 core self-guided online modules and live videoconference sessions with a therapist to teach families (i.e., the child with TBI, parents/caregivers, and siblings when available) targeted skills. Families had the option of completing up to four additional supplemental sessions to address specific issues (i.e., marital stress, sibling behavior, pain, or sleep difficulties). Videoconference sessions, during which a trained therapist reviewed online content and problem solved around a family-identified goal, were 45–60 minutes in length.

Control groups

In four studies, the control group was given access to internet resources for pediatric TBI; in one study, the control group involved usual psychosocial care. We treated these two types of groups as a single composite control group based on their similar performance across studies. Participants randomized to conditions other than OFPST or the control group in two of the trials ( n = 85) were excluded from the analysis.

The analyses relied on measures collected via interview and questionnaire completion before treatment initiation which reflected current functioning 0–24 months post injury, at treatment completion 6 months later, and, depending on the study, at follow-up assessments 12 or 18 months post baseline.

Background interview

In each study, the parent/primary caregiver completed an interview regarding the child’s medical and educational history. We used parents’ highest level of education as a proxy for socioeconomic status.

Parental Depression and Distress

The center for epidemiological studies depression scale (ces-d).

The CES-D ( Radloff, 1977 ) is a 20-item scale that assesses symptoms of depression. Parents rated the frequency of their specific depression symptoms over the past week, including depressed mood, restlessness, poor appetite, and social withdrawal. Higher scores (range 0–60) indicate more severe depressive symptoms. Raw scores of 16 and higher were used as a cut-off score to identify clinically significant depressive symptomatology ( Radloff, 1977 ).

The Symptom Checklist 90-Revised (SCL-90-R)

Parents also completed the SCL-90-R, a 90-item self-report inventory on which they rated the extent to which they have been bothered in the past week by a range of psychiatric symptoms ( Derogatis & Savitz, 1999 ). The scores are reported as a T score with a mean of 50 and standard deviation of 10. The Global Severity Index (GSI), a global scale of current level of symptomology, was examined as an overall measure of psychiatric distress. Scores of 63 were used as a cut-off to identify clinically significant levels of distress.

Injury information

A research coordinator reviewed the child’s medical chart and abstracted information regarding injury mechanism, severity, and length of stay in the hospital.

Child Behavior

Child behavior checklist (cbcl).

Parents completed the CBCL, a 112-item rating scale that asks questions about children’s problem behaviors in everyday settings. The CBCL yields Internalizing, Externalizing, and Total Behavior Problem composites. The scale is a widely used indicator of child adjustment, with high validity and reliability ( Achenbach & Rescorla, 2001 ). Our analysis focused on the Internalizing and Externalizing Problem composite scales.

Behavioral Rating Inventory of Executive Function (BRIEF)

Parents completed the BRIEF, an 86-item rating scale of executive function that has been validated in both normative and TBI samples ( Gioia, Isquith, Guy, & Kenworthy, 2000 ; Gioia & Isquith, 2004 ). The Global Executive Composite (GEC) incorporates all BRIEF subscales to provide an overall index of executive function behaviors, with elevated scores suggesting greater executive functioning deficits.

Home and Community Social Behavior Scale (HCSBS)

Parents completed the Social Competence scale of the HCSBS to assess their child’s peer relations and self-management/compliance. The HCSBS has good reliability and is well validated in relation to other social behavior measures; it yields a total score, with higher scores reflecting greater social competence ( Merrell, Streeter, Boelter, Caldarella, & Gentry, 2001 ).

Family Functioning and Parent–Child Conflict

Family assessment device (fad).

The FAD is a 60-item self-report questionnaire measuring structural, organizational, and transactional characteristics of families, with established reliability and validity ( Miller, Bishop, Epstein, & Keitner, 1985 ). Parents rated how well each statement described their own family. Examples of statements include “we don’t get along well together” and “ we confide in each other”. Scores range from 1 to 4, and higher scores indicate worse functioning ( Epstein, Baldwin, & Bishop, 1983 ). The 12-item General Function scale was used to reflect global family dysfunction ( Miller et al., 1985 ).

Interaction Behavior Questionnaire (IBQ)

The 20-item short form of the IBQ assesses parent–child communication and conflict behavior. Parents are asked to rate each statement (e.g., “we almost never seem to agree” or “at least 3 times a week, we get angry at each other”) as true or false. Total scores can range from 0 to 20 with higher scores reflecting greater conflict. The IBQ has high internal consistency ( α > .90) and has test–retest correlations ranging from .61 to .85 ( Robin & Foster, 1989 ).

Statistical Analysis

Descriptive statistics were used to summarize demographic, premorbid, and injury characteristics within each study, and simple summary statistic meta-analyses were used to characterize the combined studies. Child behavioral outcomes and parent/family outcomes in the OFPST and control groups were analyzed using a profile analysis. Profile analysis is a statistical technique for simultaneously examining differences among groups on a set of outcome variables ( Harris, 2001 ). Three primary questions are addressed:

  • Level—Does the OPFST group have improved scores across the measures compared to the control group (main effect of group)?
  • Flatness—Are some measures more improved than other measures in both groups (main effect of measure)?
  • Shape—Do improvements in scores show a distinct pattern between groups over time (interaction of group by measure by visit)?

To facilitate comparison across scores, scores on each measure were converted to Z scores based on the means and standard deviations of the corresponding measure at baseline across studies so that all scores reflected the same metric. Social competence was reverse coded so that higher values correspond to worse outcomes, to parallel the other child behavioral outcomes. The profile analysis was conducted as an initial mixed-effect model of the standardized scores on treatment group by measure by visit and the associated lower-order interactions (group by measure, group by visit, measure by visit) and main effects, with adjustment for baseline score, time since injury at baseline, child sex, age at baseline, parental education, and study site. Repeated measures on the same participant and possible dependence of participants in the same study were accounted for through random intercepts. Iterative backward elimination was used to remove non-significant higher- and then lower-order terms. Separate analyses were conducted for child behavioral outcomes (CBCL internalizing problems, CBCL externalizing problems, BRIEF and HCSBS), and parent/family outcomes (CES-D, SCL-90, IBQ, FAD). Follow-up Post hoc ‘least squares means’ tests compared treatment groups on each measure to determine which measures were responsive to the OPFST at each follow-up visit. All analyses were conducted using SAS version 9.4 (SAS Institute, Cary, NC); R version 3.4.3 was used to generate plots ( R Core Team, 2017 ).

Profile Analysis of Parent-Reported Child Behavior

Baseline characteristics by study can be found in Table 1 . The profile analysis for child behavior revealed a main effect for measure [ F (3, 731) = 7.35, p < .001], indicating that the degree of improvement varied across the measures for both groups. Post hoc comparisons of the least square means revealed significantly lower average internalizing problem, externalizing problem, and executive function scores, indicating significantly greater reductions from baseline in comparison to social competence scores [ t (731) = −2.68, p = .038; t (731) = −4.65, p < .001; t (731) = −2.85, p = .023, respectively]. The internalizing problems score showed a lower average score than the externalizing problem or executive function scores, but the magnitude of the difference was less pronounced [ t (731) = −1.99, p = .047; t (731) = −1.81, p = .07, respectively].

Baseline characteristics by study; Count (%) or Mean (SD)

Although we did not find a group by measure or measure by visit interaction for child outcomes, we found a significant treatment group by visit interaction, F (3, 731) = 3.48, p = .031, indicating distinct shapes of improvement over time between the two groups. Post hoc comparisons of the least square means indicated that the OFPST group showed a significantly greater reduction in behavior problems than the control group at both 6 and 18 months [ t (731) = −5.15, p < .001, and t (731) = −3.90, p = .002, respectively], but not at 12 months post baseline. Examination of the Post hoc average score estimates in Figure 1 suggests that these differences were predominantly due to trends in the OFPST group, while the control group showed a relatively consistent and modest improvement over baseline.

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Object name is nihms-1064461-f0001.jpg

Model-based Post hoc post-treatment Z score separately averaged across child behavior and family function measures within groups defined by time since treatment initiation (horizontal axis) and treatment group (shape; circle = online family problem-solving therapy [OFPST], triangle = control group). Vertical lines span 95% confidence intervals for the mean Z score in each group.

Profile Analysis of Parent and Family Outcomes

Examination of parent and family outcomes revealed a statistically significant main effect for measure [ F (3, 532) = 4.79, p = .003], indicating that improvement varied across the four measures in both groups. Specifically, Post hoc least squares comparisons suggested that there was a significantly greater reduction in impairment on the IBQ than the other three parent/family measures [ t (532) = 1.89, p = .059 for CES-D; t (532) = 2.54, p = .012 for FAD; and t (532) = 3.65, p < .001 for GSI]. The standardized CES-D scores were also on average lower than the GSI [ t (532) = 2.24, p = .026], but we found no strong evidence that the FAD had a greater reduction on average than the GSI or CES-D.

Although we did not find a group by measure or measure by visit interaction for family outcomes, we found a statistically significant treatment group by time interaction [ F (2, 532) = 6.47, p = .002], indicating distinct trajectories of improvement over time between the two groups. Post hoc least squares differences displayed in Figure 1 suggest trends that are remarkably similar to the child behavior profile analysis. Again, parent/family measure outcomes significantly differed between the control group and treatment group at both 6 and 18 months post baseline [ t (532) = −4.81, p < .001, and t (532) = −3.80, p < .001, respectively], but not at 12 months post baseline.

We used an individual-level meta-analytic approach to profile analyses to better understand the nature and timing of treatment effects following OFPST in children with moderate to severe TBI. By incorporating data from five RCTs involving 359 children and families, we found evidence of both main effects of measure and differential trajectories of improvement between the treatment and control group over time. Specifically, across groups, we found greater recovery in internalizing and externalizing behavior problems and executive function behaviors than in social competence. In testing group by measure and measure by visit interactions, we did not find that certain measures were more sensitive to treatment than others or distinct shapes of improvement over time across the measures. However, group differences in both child and parent/family outcomes were significant across outcomes, occurring both immediately post treatment and 18 months post baseline. Taken together, these findings provide further support for the efficacy of OFPST in improving child behavior, parent distress, and family functioning. Moreover, the results inform outpatient rehabilitation by highlighting variable recovery over time and the child and family outcomes that show greater improvement, regardless of treatment.

Main effects for child outcome measures suggest that behavioral symptoms such as internalizing and externalizing behavior problems and executive function behaviors may recover over time, without intervention; in contrast, social competence may show less natural improvement. Indications that internalizing behaviors may improve more than externalizing behaviors are counter to previously reported effects of behavioral interventions, which highlight improvements in externalizing problems and executive function behaviors rather than internalizing problems ( Kurowski et al., 2013 ; Wade et al., 2006a , 2006b , 2010 , 2011 , 2013 , 2014 , 2015 ; Wade, Taylor, et al., 2018b ). Although the treatment and control groups did not differ on time since injury, and time since injury was included as a covariate in the models, some measures may improve more due to natural recovery in the initial months post injury. For example, internalizing symptoms, such as fatigue and irritability, often improve acutely without intervention, perhaps accounting for some of the differential improvement among measures. This different pattern of results may also be attributable to the inclusion of moderators such as the child’s age/grade at baseline and injury severity in prior analyses demonstrating improvements in executive dysfunction following OFPST. Specifically, the effects on self-regulation and executive dysfunction may be more pronounced among older adolescents who can directly apply the executive heuristics of inhibition (stop and think) and problem solving to their daily lives ( Wade et al., 2013 ).

Main effects for measure on the parent/family profile analysis indicated that parent-reported parent–teen conflict was more improved than other outcomes, with parental depression showing more improvement relative to global parental distress. Parent–teen conflict may have prompted families to enroll in the trials and may show regression to the mean at follow-up; in contrast, parental distress and family dysfunction may be more entrenched and require active intervention.

For both child and parent/family outcomes, OFPST resulted in improvements immediately post treatment. Because of improvements in the control group between treatment completion and follow-up 6 months later (i.e., at the 12-month time point), treatment differences at the 6-month post-treatment follow-up were no longer significant, indicating some natural recovery in the control group. However, subsequent improvements in the OFPST group between the 12- and 18-month post-baseline follow-ups resulted in large group differences a full year following treatment. These findings suggest that treatment effects may consolidate over time. Given the focus of OFPST on problem-solving and self-regulation skills, further improvements with increasing time may correspond to more consistent and successful implementation of skills in their daily lives. Although promising, this pattern of findings merits further investigation given that only one of the five studies, involving 132 participants, followed participants beyond 12 months post baseline. Nonetheless, the results do suggest that children and families may reap intervention benefits over a longer period of time, leading to later improvements.

Consistent with research indicating reciprocal relationships between parent/family functioning and child recovery over time, child and parent outcomes demonstrated a similar pattern of improvement ( Taylor et al., 2001 ). The present data do not shed light on whether improvements in one drove improvements in the other, but do suggest that family-centered treatments such as OFPST may be valuable given their ability to improve outcomes at both levels. As noted previously, the focus on improving problem solving, self-regulation, and communication skills in both parents and adolescents with TBI may promote improved functioning in both parents and teens and facilitate the parent’s ability to scaffold behavior change in their child.

The results must be considered in the context of study limitations, including the exclusive reliance on parent-report measures, particularly given that parents completing OFPST may experience social desirability biases that increase their likelihood of reporting improved functioning. Independent ratings or diagnostic interviews with the child would strengthen the findings. Time since injury ranged from 1 to 24 months, with many children enrolled during the initial year post injury. Emerging evidence ( Wade, Kaizar, et al., 2018a ) suggests that children and adolescents benefit less from OFPST during the initial months post injury, likely due to acute neurocognitive challenges (e.g., slow processing speed, fatigue, headaches) that affect their ability to actively engage in the problem-solving training. Thus, the pattern of findings may differ if all participants were in the post-acute phase of recovery. Similar patterns of improvements in child behavior and parent and family functioning may be driven, in part, by shared rater variance. While the profile analysis benefits from the assessment of outcomes over time, only one study involving 132 participants included assessments at all four time points; as a consequence, this study had a disproportionate influence on the long-term profiles.

In summary, the results provide important new evidence regarding the child and parent/family outcomes that are most responsive to OFPST and the pattern of maintenance of improvements over time. The results highlight OFPST’s utility in improving both child behavior problems and parent/family functioning, with greater improvements immediately post treatment and with extended time post treatment. Further research is needed to elucidate the potential reciprocal relationships between improvements in parent and child functioning over time following OFPST.

ACKNOWLEDGEMENTS

We acknowledge the contributions of Amy Cassedy, Ph.D. and Nori Minich, B.S. to data cleaning and synthesis, and Jennifer Taylor, B.A. to regulatory oversight.

This work was funded by the NIH grant 1R21HD089076-01 from the National Institutes of Health.

Data from the following clinical trials were used in this study: An On-Line Intervention for Families Following Pediatric TBI, conducted prior to trial registration; A Trial of Two On-Line Interventions for Child Brain Injury, , https://clinicaltrials.gov/ct2/show/ {"type":"clinical-trial","attrs":{"text":"NCT00178022","term_id":"NCT00178022"}} NCT00178022 ?term%3DNCT00178022&rank%3D1; Teen Online Problem Solving (TOPS)- An Online Intervention Following TBI (TOPS), , https://clinicaltrials.gov/ct2/show/ {"type":"clinical-trial","attrs":{"text":"NCT00409058","term_id":"NCT00409058"}} NCT00409058 ?term%3DNCT00409058&rank%3D1; Improving Mental Health Outcomes of Childhood Brain Injury (CAPS), , https://clinicaltrials.gov/ct2/show/ {"type":"clinical-trial","attrs":{"text":"NCT00409448","term_id":"NCT00409448"}} NCT00409448 ?term%3DNCT00409448&rank%3D1; and Rehabilitation Research and Training Center for Traumatic Brain Injury Interventions—Teen Online Problem Solving Study (RRTC—TOPS), , https://clinicaltrials.gov/ct2/show/ {"type":"clinical-trial","attrs":{"text":"NCT01042899","term_id":"NCT01042899"}} NCT01042899 ?term%3DNCT01042899&rank %3D1.

CONFLICTS OF INTEREST

The authors have nothing to disclose.

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Family Conflict Resolution: 6 Worksheets & Scenarios (+ PDF)

Conflict resolution family

It is perhaps unrealistic to expect that relationships remain harmonious all the time; occasional disconnections and disagreements are a fact of life that can help a family grow and move forward, accommodating change (Divecha, 2020).

Repeating patterns of conflict, however, can be damaging for family members, especially children, negatively affecting mental and physical wellbeing (Sori, Hecker, & Bachenberg, 2016).

This article explores how to resolve conflict in family relationships and introduces strategies and activities that can help.

Before you continue, we thought you might like to download our three Positive Communication Exercises (PDF) for free . These science-based tools will help you and those you work with build better social skills and better connect with others.

This Article Contains:

How to resolve conflict in family relationships, 2 examples of conflict scenarios, 3 strategies for family counseling sessions, 6 activities and worksheets to try, a note on conflict resolution for kids, 3 best games and activities for kids, resources from positivepsychology.com, a take-home message.

“Families typically develop certain basic structural characteristics and interactive patterns that they utilize to respond to internal and external stressors.”

Goldenberg, 2017, p. 4

Built on shared assumptions and narratives that exist within the family structure, family members support the group as it adapts and copes with shifting environments and life events.

Such structures, at times, may support and even promote conflict that occurs within families. Indeed, rifts, clashes, and disagreements within the family can take many forms, including physical, verbal, financial, psychological, and sexual (Marta & Alfieri, 2014).

Therapy has the potential to help a family understand how it organizes itself and maintains cohesion, while improving how it communicates and overcomes problems that lead to conflict (Goldenberg, 2017).

As psychologist Rick Hanson writes, “a bid for repair is one of the sweetest and most vulnerable and important kinds of communication that humans offer to each other” (cited in Divecha, 2020).

Crucially, families can learn to navigate the inevitable tension and disconnection that arise from falling out of sync with one another (Divecha, 2020).

Repairing ruptures resulting from miscommunication, mismatches, and failing to attune to one another is vital for parenting and maintaining family union. But how?

While there are many ways to recover from and resolve conflict, the following four steps are invaluable for authentic repair (modified from Divecha, 2020):

  • Acknowledge the offense Try to identify and understand the hurt you’ve caused. Whether intended and with apparent good reason or not, this is a valuable opportunity to dial down your defenses and focus on how the other person is feeling.

Acknowledging the hurt without adding caveats is a powerful way to show humanity.

It can help to check your understanding, “Did I upset you? Help me understand how.” Your approach must be open and authentic; unless heartfelt, it risks escalating emotions.

  • Express remorse Sometimes, simply saying, “I’m sorry,” is enough, or at least an excellent place to start.

Take care though. Adding a comment, such as, “Well, you shouldn’t have done X,” weakens your expression of remorse, especially when dealing with children. They are learning from what you do – right and wrong.

Also, don’t go overboard. Being too quick to say sorry or going over the top with an apology can make it more about yourself than the person hurt.

  • Offer a simple explanation If the other person is ready to listen (neither too upset nor too angry), a brief explanation can clarify the thinking behind your actions.

Remember to focus on the other person’s experience rather than a litany of excuses for poor behavior. And avoid using this as an opportunity to add grievances or assign blame for issues that have arisen recently.

  • Learn and practice expressing your intentions to fix the situation and stop it from happening again. Be sincere. Say that you are sorry and mean it.

There is little point in apologizing and recovering from conflict if you intend to repeat the behavior.

Conflict is often avoidable. But if it isn’t, then it is possible to recover and maintain family relationships through authentic activities that repair damage (Divecha, 2020).

Relationship key

Family therapy can help resolve conflicts within the family unit through multiple routes, including:

  • Exploring various relationships that make up the family.
  • Bringing couples and families together to resolve interpersonal conflicts rather than treating them separately.
  • Focusing on interventions with entire families rather than individuals.
  • Establishing the role of dysfunctional families in individual mental health problems.

Family conflict can appear in all shapes and sizes. While minor disagreements between siblings may be resolved quickly, major rifts can form between child and parent, damaging previously strong bonds.

All relationships within a family can at one time or another descend into conflict. Two such examples include (modified from Goldenberg, 2017):

  • Conflict over money Bob and Tess are married with two children. In therapy, Tess claims that Bob is mean with his money: checking grocery bills and yelling at the cost of their children’s birthday presents. Along with other relationship issues, conflict had led them to sleep in separate rooms.

Bob argues he works hard for his money and gives her a generous amount each month, but Tess spends beyond their means.

During therapy, it became clear that Bob comes from a working-class family and was taught from an early age to live frugally. His long-standing beliefs underpin (but do not excuse) his outbursts.

In time, therapy helps them become more supportive of one another, giving up their underlying power struggles and successfully moving away from stereotypical gender roles.

  • Cultural and intergenerational conflict Despite Indira and Sanjay Singh moving to the United States while they were still at preschool age, they have retained the cultural and moral values of their place of birth: India. When their two children were born, they were also taught to be compliant and respect their parents, while friends from school were discouraged.

As the children grew older, it became clear that the conflict between the old and new culture was causing a rift, dividing children and parents. Despite reluctance from the parents, in time, all four attended family therapy and began to deal with cultural differences and expectations arising from multiculturalism.

child problem solving therapy

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Conflict in family situations can be “chronic and unresolved,” cycling through “periods of emotional distance and closeness with intense negative feelings” (Metcalf, 2011, p. 45).

In family therapy, the many theories offer different lenses through which to view the world and, most importantly, help families manage and resolve conflict (Metcalf, 2011).

The following strategies can help protect the family from or cope with conflict in its many forms.

Build an environment of connection and understanding

Divecha (2020) suggests that by building an environment of connection and understanding, you can “create a family culture where rifts are expected and repairs are welcomed.”

Encourage clients to make small but vital changes to the family setting (modified from Divecha, 2020):

  • Watch out for the easily missed signs that indicate a child, young adult, or partner wishes to find a way to reconnect and recover from conflict.
  • Normalize requests, such as, “I need a repair” and “Can we have a redo?” that tell us a family member is ready to fix a damaged relationship.
  • Maintain awareness. If we think we may have caused upset or harm, circle back and check in with the other person.

Building a better environment through frequent repairs can catch problems early and reduce the likelihood of escalation.

Use “I” statements

How we say something can have a significant impact on what others hear. Encourage family members to express how they feel without blaming others, such as (modified from Goldenberg, 2017):

“I am hurt by what you said last night” rather than accusations, such as, “You were out of order last night.”

Speak directly to the therapist

There may be times during a therapy session when tension between family members heightens and the emotional intensity needs to be de-escalated (Goldenberg, 2017).

A helpful communication technique is to ask the family member talking to address the therapist directly. This refocus encourages the speaker to express themselves more calmly and allows the other person time and space to listen and respond under less pressure.

Conflict resolution narrative

The following activities focus on exploring family structures, beliefs, and problem-solving behavior to avoid or resolve conflict within the group.

Recognizing Family Narratives

Family narratives provide support for coping with upsetting events and recovering from conflict (Goldenberg, 2017).

Use the Recognizing Family Narratives worksheet to identify narratives that explain and justify the structure and interactive patterns that exist within the family.

The constructs we form can enable or inhibit how we cope with conflict and other life events within the family (Goldenberg, 2017).

Parenting With Purpose

Parenting can be difficult; it is easy to lose sight of what is important. Defining meaning and purpose for ourselves as parents and our children can offer a valuable compass for day-to-day decision-making (Hart, 2006).

The Parenting With Purpose worksheet is a helpful reminder of your values and purpose as a parent.

The answers to the questions can help you understand what kind of relationship you would like with your children and why.

What Is Working Within the Family?

While it is essential to identify and fix what is causing conflict within a family, it is equally valuable to recognize what is working.

Once we recognize where we are successful in a relationship, it can remind us that not everything is terrible. We are doing some things right, and we have something upon which we can build.

The What Is Working worksheet helps identify and share the positives in the relationships within the family.

Recognize that conflict doesn’t occur in the family all the time and encourage the activities that unite you as a group.

Meeting Our Family’s Needs

Sura Hart (2006, p. 175), former teacher and education project director for the Center for Nonviolent Communication, says that “you can find conflict in every human story, and in the conflict situation you can find the needs people are wanting to meet.”

Use the Meeting Our Family’s Needs worksheet to help each family member have their needs heard, understood, and, ultimately, accepted.

Consider Your Intentions

Words have the power to share love and anger. Without clear and conscious intention, it is possible to communicate unhelpful and even harmful messages (Hart, 2006).

Use the Consider Your Intentions worksheet to identify and understand your intentions and help you respect and care for other family members’ needs.

Perform an early check on your intentions before you engage with the other family member, especially if it has the potential to turn into conflict.

Using the answers, consider how you can show positive intentions and steer clear of harmful intentions, such as proving yourself right.

Seeing Family Conflict as a Problem to Solve

Conflict isn’t always to be avoided; clashes can be productive, stimulating learning, fostering understanding, and moving a relationship forward (Hart, 2006).

However, some conflict is unnecessary and avoidable, especially regarding daily tasks, such as tidying the house, going to bed, and completing chores.

Use the Seeing Family Conflict as a Problem to Solve worksheet to help recognize everyday actions as problems to overcome rather than points of contention.

14 Effective conflict resolution techniques – BRAINY DOSE

“Life is a series of mismatches, miscommunications, and misattunements that are quickly repaired” says family researcher Ed Tronick (cited in Divecha, 2020).

Children can learn from the family environment that conflict need not be out of proportion to the situation and may, ultimately, lead to positive change.

It helps when family relationships are overwhelmingly positive. Make sure to make “special time” available for each child, where they have control over what you do and for how long, writes Divecha (2020). Learn to show gratitude and appreciation for what the child does more readily without it becoming predictable and unthinking.

Conflict resolution for kids

Board games such as Monopoly, Checkers, and Life can be played as a pair or a family. The children see that it’s okay to make mistakes and learn from their parents’ reaction to losing.

More physical, active games such as Tag or Hide and Seek allow the whole family to have fun, while, importantly, seeing each other having fun. Children need to experience their parents as humans with a wish to enjoy themselves. Parents benefit from experiencing their family laughing – a reminder that life is not all about duty and rules.

Quieter pastimes, including art and craft, can be a time to build and use mindfulness practices, considering colors, textures, and smells. Interactive activities such as making funny characters out of play dough or houses out of Lego is fun and beyond rules or feelings of failure.

Family conflict can often be avoided. The following resources help individuals gain a greater understanding of other family members’ needs and feelings.

  • Mind the Gap Identify and share the values you would like to exist within your family, such as love, trust, compassion, and teamwork.
  • Conflict at School Conflict outside the home can have an impact inside. Help your children to reflect on the relationships they have at school.

Additional reading and resources include:

  • Conflict Resolution in Relationships and Couples: 5 Strategies For more ideas on how to resolve conflict in other types of relationships, read our conflict resolution in relationships article.
  • 14 Conflict Resolution Strategies & Techniques for the Workplace This article about conflict resolution in the workplace is a helpful additional read, especially where the lines between family and work is blurred – working in the family business, working from home – these all can cause conflict so be sure to have a look at this article too.
  • 17 Positive Communication Exercises If you’re looking for more science-based ways to help others communicate better, check out this collection of 17 validated positive communication tools for practitioners . Use them to help others improve their communication skills and form deeper and more positive relationships.

It is vital that families learn to survive – and even grow – under adverse conditions. The family unit faces daily challenges from outside and conflict from within that can upset the internal stability that rests upon existing narratives, shared beliefs, and sometimes mistaken assumptions (Goldenberg, 2017).

It can become less about preventing all conflict, which is impossible, and more about creating a family environment that reduces unnecessary friction, repairs rifts and misunderstandings, grows, and moves forward.

Our communication – what we say and how we say it – remains crucial and can improve over time with practice and an improved awareness of one another’s needs. Family members can also learn skills and techniques to improve self-regulation, resilience, and coping that strengthen internal structures.

This article introduces tools and worksheets that help remove avoidable conflict and manage and resolve it within the family unit, where disagreement is inevitable. Try them out with your clients or within your own family to improve engagement, strengthen relationships, and build a more supportive and resilient family structure.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Communication Exercises (PDF) for free .

  • American Psychological Association. (2011). Family interventions. Retrieved October 6, 2021, from https://www.apa.org/pi/about/publications/caregivers/practice-settings/intervention/family
  • Divecha, D. (2020, October 27). Family conflict is normal; it’s the repair that matter s. Greater Good. Retrieved October 4, 2021, from https://greatergood.berkeley.edu/article/item/family_conflict_is_normal_its_the_repair_that_matters
  • Goldenberg, I. (2017). Family therapy: An overview . Cengage Learning.
  • Hart, S. (2006). Respectful parents, respectful kids: 7 Keys to turn family conflict into co-operation . PuddleDancer Press.
  • Marta, E., & Alfieri, S. (2014). Family conflicts. In A. C. Michalos (Ed.), Encyclopedia of quality of life and well-being research . Springer.
  • Metcalf, L. (2011). Marriage and family therapy: A practice-oriented approach . Springer.
  • Sori, C. F., Hecker, L., & Bachenberg, M. E. (2016). The therapist’s notebook for children and adolescents: Homework, handouts, and activities for use in psychotherapy . Routledge/Taylor & Francis.

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Debbie

Thank you for the resources on family conflict resolution. I am working with a family that is really challenged.

Susan Salenski

We have had major conflicts in the family with me, my husband, who is the stepdad, and my grown kids. One speaks to us but lives on the northern East Coast. Haven’t seen him in 5 years. The other grown child is my daughter. She has had no contact with us of any kind for 5 years. I look forward to learning how to defuse conflicts and then grow healthy relationships, with my kids especially.

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What Types of Therapy Are Helpful for Depression?

What is psychotherapy, psychotherapy for depression.

  • Therapy Approaches
  • How Long Does It Take to Work?
  • Choosing a Therapist

Depression is more than feeling sad or unmotivated for a few days; it’s an ongoing and persistent feeling of extreme sadness or despair affecting every aspect of a person’s life. Data from 2020 shows 18.4% of U.S. adults have received a diagnosis of depression.

Fortunately, treatment options like psychotherapy can be effective. The key is finding out what type of psychotherapy is right for you, depending on the severity of your symptoms, personal preferences, and therapy goals. 

This article covers the most effective evidence-based psychotherapy treatments for depression.

The Good Brigade / Getty Images

Psychotherapy is talk therapy . It takes place in outpatient settings (i.e., therapy offices) and inpatient settings (i.e., hospitals). Its purpose is to help relieve symptoms and prevent them from returning.

Each form of psychotherapy is unique, but typical sessions help a person identify the thought patterns, learned behaviors, or personal circumstances that may be contributing to their depression. The focus then shifts to building healthy coping strategies for managing negative thoughts, unwanted behaviors, and difficult emotions or experiences.

The following are the most common types of psychotherapy for depression.

Cognitive Therapy

Cognitive therapy (also called cognitive processing therapy) is a type of cognitive behavioral therapy shown to be effective in helping people challenge and change unhelpful or unwanted beliefs or attitudes that result from traumatic experiences such as sexual assault or natural disaster.

Cognitive therapy involves learning about symptoms like intrusive thoughts resulting from traumatic experiences and working on processing the experience and questioning and reframing negative self-thinking.  

Behavioral Therapy

Behavioral therapy (also called behavioral activation) focuses on how certain behaviors influence or trigger symptoms of depression. It works by helping a person identify and understand specific behavioral triggers and then providing behavioral activation exercises that encourage behavioral modifications or changes where possible, resulting in more positive mood outcomes.

Cognitive Behavioral Therapy (CBT)

CBT is considered the best-researched technique and the "gold standard" of psychotherapy. It's been shown effective in reducing depression symptoms and helping patients build skills to change thought patterns and behaviors to break them out of depression. It also encourages greater adherence to medications and other treatments.

CBT when combined with medication for depression has been shown more effective in treating symptoms and preventing relapse than pharmacology alone.

Dialectical Behavior Therapy (DBT)

DBT is a skilled-focused technique centered on acceptance and change. It involves acceptance-oriented skills, such as mindfulness and increasing tolerance to distress. It also uses change-oriented skills, emotional regulation (keeping emotions in check), and interpersonal development (i.e., saying no, asking for what you want, and establishing interpersonal boundaries).

Research suggests DBT is particularly beneficial for people experiencing chronic suicidal thinking .

Suicide Prevention Hotline

If you or someone you know is having suicidal thoughts, dial  988  to contact the  988 Suicide & Crisis Lifeline  and connect with a trained counselor. For more mental health resources, see our  National Helpline Database.

Psychodynamic Therapy

Psychodynamic therapy is based on the theory that moods and behaviors are directly but unconsciously related to childhood and past experiences. It involves building self-awareness of these experiences and their influence on a person while empowering them to change unwanted patterns.

Treatment with psychodynamic therapy has been shown to be as effective as other treatments in reducing depressive symptoms in depressive disorders.

Interpersonal Therapy (IPT)

IPT focuses on how relationships impact mental health. It helps people manage and strengthen current relationships, as well as looking at how different environments influence thinking and behavior. Numerous studies support the effectiveness of ITP for depression treatment and symptom relapse prevention.

Problem-Solving Therapy (PST)

PST is about strengthening a person’s ability to cope with stressful events by enhancing problem-solving skills. Several studies support the effectiveness of problem-solving therapy for people with depression, depressive disorders, and other mental health conditions.

Approaches to Therapy for Depression

Therapy is not one-size-fits-all. The best approach will depend on severity of symptoms and overall therapy goals, and may include a combination of individual therapy, group therapy , family therapy , or couples therapy . Someone experiencing ongoing depression may benefit from the one-on-one support of individual therapy, but also from a family-based approach and peer support groups .

How Long Does Therapy for Depression Take?

The length of time therapy takes to experience results will vary depending on factors such as:

  • Depression type: Acute depression (i.e. depression that does not persist over a long period of time) will typically take fewer sessions to show results than chronic depression.
  • Symptom severity: More severe symptoms like suicidal thinking may require longer or more intensive treatment.
  • Therapy goals: Focused goals are reached more quickly than broader-based goals.
  • Session frequency: People are typically advised to attend as often as they feel comfortable, but more frequent sessions typically result in quicker results.
  • Technique: Some types of therapy like cognitive behavioral therapy are more goal-focused and generally quicker than other types.
  • Trust: Higher levels of trust between client and therapist often yield quicker results.
  • Personal circumstances: A new or ongoing traumatic life experience or other health condition like substance use disorder may prolong how long treatment takes.

General Timeline

Psychotherapy can be short-term and last a few weeks to months (for situational acute depression) or long-term and last a few months to years (for persistent or chronic depression).

How to Choose a Technique and Therapist

Consider which types of therapy best align with your goals and seek a therapist who offers that type of therapy. Bear in mind that therapists may offer more than one technique and can help you determine which techniques may be most suitable.

When choosing a therapist, you may consider their credentials, such as if they have a medical degree and can prescribe medication for depression , as a psychiatrist can. It's crucial to choose a therapist whom you feel comfortable working with. It’s OK to attend a few sessions before deciding if they're the right therapist for you. 

A Word From Verywell

Making sure you feel comfortable and have rapport with your therapist is one of the most important determinants for effective therapy. Set up short introductions or consultations with a few therapists so you can pick one you feel you can build the most rapport with.

There are many types of evidence-based therapy that are suitable for treating depression. Some involve working one-on-one with a therapist, and others may include family members, spouses, or peer groups experiencing depression. Making the correct choice includes determining your therapy goals and finding a therapist you feel comfortable working with.

Centers for Disease Control and Prevention. National, state-level, and county-level prevalence estimates of adults aged ≥18 years self-reporting a lifetime diagnosis of depression — United States, 2020 .

Informed Health. Depression: How effective is psychological treatment?

American Psychological Association. Cognitive processing therapy (CPT) .

University of Michigan. Behavioral activation for depression .  

Gautam M, Tripathi A, Deshmukh D, Gaur M. Cognitive behavioral therapy for depression . Indian J Psychiatry . 2020;62( 2):S223-S229. doi:10.4103/psychiatry.IndianJPsychiatry_772_19

Wersen AD, Meiser-Stedman R, Laidlaw K. A meta-analysis of CBT efficacy for depression comparing adults and older adults . Journal of Affective Disorders . 2022;319:189-20. doi:10.1016/j.jad.2022.09.020

University of Washington. Dialectical behavioral therapy . 

American Psychiatric Association. What is psychotherapy?

Steinert C, Munder T, Rabung S, Hoyer J, Leichsenring F. Psychodynamic therapy: as efficacious as other empirically supported treatments? A meta-analysis testing equivalence of outcomes . AJP . 2017;174(10):943-953. doi:10.1176/appi.ajp.2017.17010057

American Psychological Association. APA dictionary of psychology: interpersonal psychotherapy (ITP) .

Cuijpers P, Donker T, Weissman MM, Ravitz P, Cristea IA. Interpersonal psychotherapy for mental health problems: A comprehensive meta-analysis. Am J Psychiatry . 2016;173(7):680-687. doi:10.1176/appi.ajp.2015.15091141 

Zhang A, Park S, Sullivan JE, Jing S. The effectiveness of problem-solving therapy for primary care patients' depressive and/or anxiety disorders: A systematic review and meta-analysis . J Am Board Fam Med . 2018;31(1):139-150. doi:10.3122/jabfm.2018.01.170270

American Psychological Association. How long will it take for treatment to work?

By Michelle Pugle Michelle Pugle, MA, MHFA is a freelance health writer as seen in Healthline, Health, Everyday Health, Psych Central, and Verywell.

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