Why aren't more people being trained in problem-solving therapy? All of the recent policy-related material about improving access to psychological therapies (I am thinking here not only of the influential report by Lord Layard, Mental Health:Britain's Biggest Social Problem, but also the NICE guidelines for depression) focuses inevitably on how we must have more cognitive-behavioural therapy and that will be the answer to all of our problems. Here is a pragmatic, effective, easy-to-learn therapy that actually makes sense to patients and professionals and has been specifically demonstrated to be effective in primary care settings. Yet it hardly ever gets a mention. Perhaps it is quite simply because it is not dressed up in a language that is almost impenetrable to the uninitiated, it does not require years of training and it is not held to be the particular remit of a small group of mental health professionals.
Laurence Mynors-Wallis, who has been working on problem-solving therapy since its early days in Oxford, has written a very accessible and immensely practical book which guides the reader through what problem-solving therapy is, the evidence for its effectiveness, the specific difficulties that might be faced in trying to do it and finally how to teach it. Problem-solving therapy has been demonstrated to be effective for major depression in primary care, and for people who self-harm. It is less effective for minor depression and dysthymia. But why has there never been a head-to-head study of problem-solving therapy v. cognitive-behavioural therapy?
In general, the case examples in the book are realistic and useful, but I could not help wondering whether the initial patients seemed to have problems that were too straightforward; if a problem is so easy to solve, you generally don't need to use a problem-solving approach. Also, I would have found it helpful to have a section on dealing with people who present with a difficulty in making a decision, as this is a common scenario in the setting of depression and the problem is usually brought to the professional for their advice on `what to do'.
So, to answer my own question, why settle for something simple and cheap that works when you can get something so much more expensive and complicated? Maybe this is one of those intractable problems of healthcare delivery that even problem-solving therapy cannot solve.
- © 2006 Royal College of Psychiatrists