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"Sad is How I Am!" Treating Dysthymia in Children and Adults
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Section 12
Imaginary Alternatives

CEU Question 12 | CEU Test | Table of Contents | Depression
Psychologist CEUs, Social Worker CEUs, Counselor CEUs, MFT CEUs

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On the last track we discussed the problem-solving strategy of Creating a Problem "Horoscope."

In this track, we'll discuss the brainstorming Cognitive Behavior Therapy problem-solving strategy.

5 Components of CBT Problem Solving (Continued)

Component #2 - Generation of Alternatives
During the generation-of-alternatives phase of problem solving, I assisted Elsa in developing a wide range of potential solutions for each identified problem. I helped Elsa to develop a range of coping options. The availability of many alternative actions I felt increased her chances of identifying an effective solution.

Have you found, like I, that oftentimes clients expect there to be one right answer for each problem, and that therapy, or the therapist, will provide this one right answer for them. Moreover, in trying to find the right solution to a problem, clients sometimes believe that the first idea that comes to mind is the best one. Therefore, in order to maximize problem-solving effectiveness, I found I needed to convey to Elsa the necessity of generating as many different options as possible. What do you think of this approach?

Here's how I introduced the generation-of-alternatives process or brainstorming to Elsa:
"Now that we have identified some of the key problems facing you, let's look at generating alternatives. This can be an important tool for increasing your ability to think productively. Often, when people face problems, particularly when they confront difficult problems, their thinking is ruled by their emotions. As a result, they tend to worry a lot, and the worrying usually centers their thoughts on negative parts of their lives.

...Sometimes, the more they think about it, the worse they feel, and a vicious cycle of negative thinking and negative feelings gets started. Often, the person feels helpless about changing either the problem or their feelings. This type of thinking, which is dominated by worrying and ruminating, can be thought of as "nonproductive thinking." Nonproductive thinking usually leads to an accumulation of more negative feelings; it doesn't help to resolve the problem." Obviously, the above was repeated in various ways over several sessions.

To present the next concept in brainstorming to Elsa I stated, "How would you feel about learning how to avoid negative thinking by developing those skills that lead to productive thinking? Productive thinking involves confronting the problems we discussed in our last sessions head-on by creatively developing a list of possible ways to resolve the problems facing you. Have you heard of brainstorming?

I have found brainstorming has helped other clients break out of their cycle of negative thinking and negative feelings. Brainstorming can improve your productive thinking abilities and can help you to cope more effectively with your problems of aging, gambling, and depression over the loss of your aunt.

Three Guiding Principles of CBT Brainstorming
a. The quantity principle.
b. The deferment-of-judgment principle.
c. The strategy-tactics procedure.

When using brainstorming to generate alternative solutions, I guided Elsa to develop solution ideas that are both relevant and specific. Relevant options are oriented toward accomplishing the objective or objectives necessary to resolve the identified problem. Specific options are stated in concrete and unambiguous terms so that your client can later evaluate how effective they were in meeting the goal and resolving the problem. The following sections describe in detail how to implement the procedures of brainstorming during the course of therapy with your depressed client.

The Quantity Principle
From the start, I conveyed to Elsa the importance of generating a quantity of ideas. The quantity principle suggests that the more solution alternatives a client produces, the more high-quality ideas he or she will come up with. Thus, the likelihood of an effective solution is increased.

Two Basic Rules of the Quantity Principle:
a. Generate as many responses as possible.
b. Combine and improve responses to make additional new solution-responses.

Byincreasing the number of alternative solutions, your client will improve the selection of high quality possibilities. I found with Elsa, to facilitate her creation of alternatives, occasionally I offered solution ideas. These solution ideas particularly concerned differing strategies or classes of ideas. I found it with Elsa to begin such training with an exercise that emphasizes the use of list-making in solving a simple, impersonal problem.

Two Positive Features in Making a List of Alternatives:
-- First, a list of alternatives helps to focus your client's attention and concentration on productive thinking.
-- Second, a list of alternatives results in a written record of output. I found with Elsa, her use of an initial problem that was impersonal in nature to her helped to relax her defensiveness by providing a neutral task. This neutral task was not so tangled up in her emotional factors.

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

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

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

Schaerer, M., Schweinsberg, M., & Swaab, R. I. (2018). Imaginary alternatives: The effects of mental simulation on powerless negotiators. Journal of Personality and Social Psychology, 115(1), 96–117.

Online Continuing Education QUESTION 12
What two basic rules govern the application of the quantity principle? To select and enter your answer go to CEU Test.

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