SOLVING THE PROBLEMS OF A CHRONIC ILLNESS: 6-Step Problem Solving

SOLVING THE PROBLEMS OF A CHRONIC ILLNESS: 6-Step Problem Solving We all know how to solve problems. However, when you have a chronic illness, you face problems most people do not. For these complex and ongoing problems, systematic problem solving skills are useful. For example, you might be great at figuring out how to get to the store when your car breaks down. But communicating problems with family, your health care providers, your insurance company, or co-workers may be more difficult problems to address. Although interpersonal and major life problems are more complex, and therefore more challenging, it is possible to learn how to deal with them effectively. That s where problem solving training and practice come in! Balancing the demands of: Family Work the Health care system Self-management Physical difficulties Social/Recreational activities Problem Solving 1

How can problem solving help with a chronic illness? Studies have shown that problem solving training helps people with many different chronic illnesses to improve health related outcomes. For example, when people with chronic illnesses such as heart disease, stroke and arthritis learned problem solving skills, they increased their level of exercise, had fewer hospitalizations, reduced pain (and also use of pain medication), and improved overall health status.* *Lorig, K., Sobel, D., Stewart, A, and colleagues. (1999) Medical Care 37(1), pp. 5-14. What s the first step of problem solving? IDENTIFY THE PROBLEM = Describe behaviors instead of labeling In all the steps of problem solving, always describe things in terms of observable behaviors. This helps you target some thing you can change. A good behavioral description: My husband raises his voice and waves his hands when telling me how he wants the checkbook organized. It makes me nervous. A not-so-good, labeling description: My husband s such a control freak about everything, it drives me crazy! It s not easy to discuss touchy issues in any relationship. If you are interested in learning more about how to improve communication in your relationships and increase your chances of making solutions win-win, the Assertive Communication module can help you. = Be aware that there may be more than one problem to solve. Often there are many interrelated problems and after solving one problem you re still having difficulty because the root problem was not addressed. Finding the root problem can be difficult, but will speed your progress toward solving it. 2

For example, the problem of having too much responsibility on a project at work or home might be solved through communication and negotiation with others who are involved, but the root problem of not being able to say no to every project that comes your way might get you into the same fix soon after the first problem was solved. Another example: Susan wants to have more time to pursue her career after spending three years at home taking care of the baby. Her husband Jim would like for her to have her own career, but is worried about finding good childcare and thinks it may not be financially worthwhile for Susan to work full time. He also secretly wonders if she will find him less interesting if she has her own life and acquaintances outside the home. Susan senses Jim s reluctance and, after mentioning her desire to work once or twice, stops bringing it up. She begins to feel she lacks the confidence to enter the workplace again and does not explore her work options. She is afraid of bringing up the topic and starting an argument because she is afraid of losing Jim. When they have a small financial crisis, Susan angrily states that this would not have happened if Jim had let her look for work. In this scenario, several potential problems might be identified: 1) the difficulty in finding good childcare 2) Jim and Susan s difficulty communicating to each other their true feelings and concerns, 3) Susan s lack of confidence about returning to work, 4) mismatched expectations between Jim and Susan about how long she would delay her career, 5) Susan s fear that she might lose her husband, 6) Jim s fear that he might lose Susan if she re-enters the workplace. Jim and Susan might initially identify the first problem (childcare) as the most important one. If Jim and Susan are able to solve the problem, they may still find that one month later they are arguing about Susan s career. In this case, mismatched expectations between the two of them might be driving their arguments, and the childcare issue may simply be a related problem. 3

SEEK OUT INFORMATION & SET GOALS = To help insure you ve defined the problem accurately, you should seek out information from as many other people as possible. This will help you gain a more objective view of the problem. = Know your source some people are very good at being objective, but most people have a bias of some sort. Be aware that everyone you talk to will have a different slant. Judge the input you get from others and do not automatically discard ANY information, but don t just accept it at face value, either. = Set goals for changing the problem. Be realistic. Describe what you want and what you don t want. Also consider what you would compromise on, that is, what would be good enough. BRAINSTORM = Generate alternatives/potential solutions to the problem at hand. = The most important thing is to generate as many potential solutions as possible, the more the better. = Don t forget to include any self-management strategies you think might help you solve the problem. = Reserve judgment. Don t judge or censor ANY ideas or prematurely throw them out, no matter how wacky they seem at the time. Sometimes wacky ideas help lead you to a better solution. = Remember, others can share different perspectives and fresh ideas get others involved in your brainstorming. They might come up with just the idea you need. 4

CHOOSE A SOLUTION = To help you do this, estimate the consequences of the solution. Remember to think about the probable short-term and long-term consequences, to you and important people in your life. = Do a cost-benefit estimation of each good potential solution. Detail the pros and cons of each. DESCRIBE THE PLAN = Come up with a workable plan for putting the chosen solution into place. = Find out what potential roadblocks there are to the plan and ask yourself and others about ways to eliminate those roadblocks. = Find out who else should be involved and how to get those people committed to the plan. = Also ask What is the endpoint? How will I know when I ve reached a satisfactory resolution? = Put your plan in place, making sure to note problems with implementing it. REVIEW AND REVISE = Develop your own monitoring/rating system for the outcome. Did it work like a perfect 10 or a 5? = Always note what went well with the plan and what you feel good about having accomplished. Even if it wasn t perfect, you probably made some positive changes in your behavior that will help next time. 5

= Evaluate the differences between your expected outcomes and the way it actually turned out. = Use this information to help you plan for similar problems the next time. Forewarned is forearmed. = Problem solving is an ONGOING process, not a one-shot deal. Big life problems probably won t get solved the first time you use these steps. But with repeated attempts, you can make changes each time that lead you closer to where you d like to be. = It is a good idea to have a specified time and place to keep track of your progress on a particular problem and to plan what you will do about it in the future (Remember the Goal Setting module.). A weekly planning meeting is a great place to do this. Now let s put problem-solving into action! 6

SKILL: Problem Solving Purpose: to help you more effectively handle complex problems Goal:1) to break down large problems into solvable ones and 2) to spend less time stuck on large problems Use the homework sheet to help you through these steps. Step 1: Identify the problem. Be aware that there may be more than one problem. Step 2: Seek out information and set goals. Get others input into the situation and its potential causes. Set reasonable, achievable goals and make sure that you have a fall back goal. Step 3: Brainstorm. Think of potential solutions to the problem without censoring any far-out ideas. If you can, get help from others. Step 4: Choose a solution. Evaluate each idea you had by examining the likely pros and cons of each. Choose the one you think holds the most promise. Step 5: Describe the plan. Be detailed, noting what potential problems you might encounter and how to overcome these. Get important people involved in putting the plan into place. Have a specific endpoint in mind and know how you will evaluate how close you came to meeting it. Finally, put the plan into action. Step 6: Review and Revise. Note what went well and what did not go as planned. Use this information to refine the plan the next time you attempt it. Revise goals if necessary. Go through the process again until you are satisfied with the outcome. 7

SKILL: Problem Solving (Sample) Think of a problem you could begin to change this week. Step 1: Identify the Problem 1-2 factual sentences describing the root issue What is it that you want to change? What do you want to be different? Ask: What is the specific problem? What is not going the way I would like? What is going wrong? I am not in regular contact with old friends because I get caught up in the demands of work and family. I am not setting aside time specifically for old friends. Step 2: Seek Information and set Goal Ask for help from others in defining the issue(s) Clearly define the goal you want to achieve Step 3: Brainstorm Think of as many potential solutions as possible Can you use any of your self-management skills (tracking, deep breathing, goal setting, problem solving) to improve the situation? Step 4: Choose a Solution Examine the pros and cons of each potential solution Choose one you think is most likely to succeed Step 5: Describe the Plan Detail each step of the plan and how they fit together Step 6: Review and Revise Evaluate how the plan went and Go back and revise the problem solving process again until the situation is acceptable to you. Ask: What do I want to be different? How do I want it to look in the end? What is my fall back goal? I want to e-mail, telephone, or write letters to at least one old friend a week. Ask: What can I do to change the situation? What do others think may be potential solutions? I could schedule a time every Saturday morning to contact friends; I could ask them to contact me; I could go buy nice stationary to encourage me to write; I could buy a cheaper long distance phone plan; I could buy plane tickets to visit friends; I could invent a Star-Trek teleporter to whisk me away to visit a friend Ask: What are the advantages and disadvantages of each potential solution? Which one holds the most promise? The disadvantage of writing is that it takes a long time and is easy to avoid advantage is that people like to get letters and might respond; the disadvantage of phoning is that it costs money the advantage is that I like talking to friends and would be more likely to do it. I think phoning would be best. Ask: How can I make this solution work? What has to happen for this to work? 1) I need to call around during tomorrow s lunch break to find good long distance plans 2) schedule every Sat.at 10am for calling 3) write notes on the refrigerator and bedroom mirror to remind me 4) tell the friend in advance so they ll be there when I call Ask: What went well? What didn t go as planned? And what do I want to do differently next time? I had a great conversation with my friend! But I need to make sure I set a timer when I m talking so that I don t spend more on my phone bill than I can afford!! 8

Let s Summarize Problem solving steps can help you break down and begin to solve complex, thorny problems. Always use descriptions of behaviors or observable events to describe problems. In order to solve a problem you must: 1. Identify it as a problem. 2. Target one particular aspect of the problem. 3. Seek out information on the potential causes of the problem. 4. Brainstorm with others to generate potential solutions. 5. Select a solution you think is workable. 6. Put the plan in to action, including all the small details that are important for success. 7. Review the success of your attempt. Identify what went well and what didn t go as planned. 8. Revise the plan and keep going through these steps until you have arrived at a successful stopping point. Keep trying even the most difficult problems can be improved if you don t give up! 9

SKILL: Problem Solving Step 1: Identify the Problem 1-2 factual sentences describing the root issue What is it that you want to change? What do you want to be different? Step 2: Seek Information and set Goal Ask for help from others in defining the issue(s) Clearly define the goal you want to achieve Think of a problem you could begin to change this week. Ask: What is the specific problem? What is not going the way I would like? What is going wrong? Ask: What do I want to be different? How do I want it to look in the end? What is my fall back goal? Step 3: Brainstorm Think of as many potential solutions as possible Can you use any of your self-management skills (tracking, deep breathing, goal setting, problem solving) to improve the situation? Step 4: Choose a Solution Examine the pros and cons of each potential solution Choose one you think is most likely to succeed Step 5: Describe the Plan Detail each step of the plan and how they fit together Ask: What can I do to change the situation? What do others think may be potential solutions? Ask: What are the advantages and disadvantages of each potential solution? Which one holds the most promise? Ask: How can I make this solution work? What has to happen for this to work? Step 6: Review and Revise Evaluate how the plan went and Go back and revise the problem solving process again until the situation is acceptable to you. Ask: What went well? What didn t go as planned? And what do I want to do differently next time? 10