Use Problem Solving Therapy when the client needs a concrete next step
Problem Solving Therapy, often shortened to PST, gives clients a structured way to move from feeling stuck to testing a specific, realistic action. It can be useful when a client describes a practical life problem that is worsening mood, anxiety, stress, avoidance, conflict, or functioning.
In session, PST is not just advice-giving. The therapist helps the client define one problem clearly, generate possible options, compare those options, choose a manageable step, and review what happened afterward. The clinician remains responsible for pacing, clinical judgment, risk assessment, and connecting the intervention to the client’s treatment goals.
A PST intervention may take only 10 minutes inside a broader therapy session, or it may guide most of the session when the client presents with a pressing problem. For example, a client with depression may feel overwhelmed by unpaid bills, missed calls, and difficulty getting out of bed. PST helps narrow the focus from “everything is falling apart” to “I will call the billing office on Tuesday at 10 a.m. and ask about a payment plan.”
Clinical situations where PST may fit the session
PST works best when the client has a problem that can be defined, broken into parts, and addressed through action. It can support treatment for depression, anxiety, adjustment stress, relationship strain, work stress, caregiving stress, chronic illness management, and daily functioning concerns.
Common session scenarios include:
- A client with anxiety avoids opening email because they expect criticism or bad news.
- A client with depression reports low motivation and cannot decide where to begin with household tasks.
- A caregiver feels trapped between work demands and a parent’s medical appointments.
- A young adult wants to move out but has not identified budget, housing, or support needs.
PST may be less appropriate as the primary intervention when the session needs immediate crisis stabilization, trauma processing, safety planning, psychosis assessment, or intensive emotional regulation before problem-solving can be effective. In those cases, the therapist may first address safety, grounding, stabilization, or higher-acuity needs, then return to PST when the client can participate in planning.
How PST can appear in the therapy session
A useful PST segment usually has a clear sequence. The therapist does not need to make the process feel rigid, but the session should move toward a defined problem, options, and an action plan.
1. Name one problem in specific terms
Clients often enter session with broad statements: “I can’t handle this,” “I’m behind on everything,” or “My family is too much.” PST starts by narrowing the focus.
Therapist language may include:
- “If we worked on one piece of this today, which part would make the biggest difference this week?”
- “How would you describe the problem in one sentence?”
- “What is happening, where does it happen, and who is involved?”
- “What makes this problem harder on the days your symptoms are stronger?”
2. Clarify what the client can influence
The client may not be able to control another person’s behavior, a medical diagnosis, a custody schedule, or a workplace policy. PST helps separate what can be influenced from what cannot. This prevents the plan from depending on unrealistic outcomes.
For example, “My supervisor needs to stop criticizing me” may become “I want to prepare for our meeting by writing down two concerns and one request.” That shift creates a problem-solving target without minimizing the client’s frustration.
3. Brainstorm options before choosing one
Many clients jump from distress to the first solution that comes to mind. Others dismiss every option before considering it. During brainstorming, the therapist can invite several possibilities without evaluating them immediately.
Options might include making a phone call, asking for support, setting a boundary, using a coping skill before a difficult conversation, gathering more information, changing the timing of a task, or breaking a task into smaller steps.
4. Compare benefits, barriers, and fit
Once the client has options, the therapist helps evaluate them. This is where clinical judgment matters. A solution may be technically possible but too overwhelming, unsafe, inconsistent with the treatment plan, or likely to increase avoidance.
Useful questions include: “Which option feels realistic before our next session?” “What might get in the way?” “What support would make this easier?” and “How will you know if this step helped?”
5. Create a small action plan
The action plan should be specific enough to document. “Try harder to communicate” is difficult to follow up on. “Text partner on Wednesday to request 20 minutes to discuss weekend plans” gives the client and therapist something measurable to review.
A strong PST action plan often includes the task, timing, support, anticipated barrier, and coping strategy. For example: “Client will spend 15 minutes on Thursday identifying three childcare options, then ask sister for feedback before making calls.”
6. Review the outcome in a later session
PST is incomplete without follow-up. The client may complete the step, partially complete it, avoid it, or discover that the chosen solution was not workable. Each outcome can produce clinically useful information.
The therapist can ask, “What happened when you tried the plan?” “What did you learn?” “Did your mood, anxiety, or sense of control change?” and “What should we adjust before the next attempt?”
Documentation should show the intervention, not just the topic
A progress note should make clear that the therapist used a structured intervention, how the client participated, and how the work connects to treatment goals. “Discussed stress at work” does not show much clinical activity. A stronger note identifies the PST steps used in session.
Instead of writing:
Client talked about work stress and feeling overwhelmed. Therapist provided support.
Consider:
Therapist used Problem Solving Therapy to help client define primary work stressor, identify controllable aspects of the situation, generate three response options, and select one action step before next session.
The second version is more specific. It documents the therapist’s intervention and gives a clear basis for follow-up.
Progress note examples for PST interventions
The following examples are sample language only. Clinicians should edit documentation to match the session, client presentation, diagnosis, medical necessity requirements, payer expectations, and practice policies.
Example 1: Depression and daily functioning
Intervention: Therapist used PST to help client identify a specific functioning concern related to depressive symptoms. Client selected “laundry and dishes piling up” as the immediate problem. Therapist guided client in breaking the task into smaller steps, comparing options, and choosing a 10-minute cleaning task after dinner three nights this week.
Client response: Client initially stated the task felt “pointless” but became more engaged after identifying a smaller first step. Client reported the plan felt “doable” and rated confidence as 6/10.
Plan: Client will complete one 10-minute task on Monday, Wednesday, and Friday and track mood before and after. Therapist will review completion, barriers, and impact on mood next session.
Example 2: Anxiety and avoidance
Intervention: Therapist applied PST to address avoidance of opening work email. Therapist supported client in defining the problem, identifying feared outcomes, brainstorming response options, and selecting a graded action step. Client chose to open email for five minutes while using paced breathing before and after the task.
Client response: Client appeared tense and tearful when discussing email but remained engaged. Client identified avoidance as temporarily relieving anxiety while increasing stress later. Client agreed to test the plan twice before next appointment.
Plan: Client will open email Tuesday and Thursday at 9 a.m. for five minutes and record anxiety rating before and after. Continue PST and anxiety management skills in next session.
Example 3: Relationship conflict
Intervention: Therapist used PST to help client clarify recurring conflict with partner regarding household responsibilities. Client identified one target problem: lack of agreement about evening routines. Therapist assisted client in generating communication options and evaluating likely barriers. Client selected a plan to request a brief conversation using “I” statements and one specific request.
Client response: Client was able to shift from global statements about the relationship to one concrete concern. Client expressed mild anxiety about initiating the conversation but reported the plan felt more realistic than “bringing up everything at once.”
Plan: Client will ask partner for a 15-minute conversation on Sunday evening and will use coping skills if anxiety increases. Review outcome and adjust communication plan next session.
SOAP and DAP language for PST
PST can be documented in different note formats. The format matters less than the clinical clarity. The note should identify the problem addressed, the intervention used, the client’s response, and the next step.
SOAP note sample
S: Client reported increased stress related to missed bills and stated, “I don’t know where to start.” Client endorsed low motivation and avoidance of mail.
O: Client presented with constricted affect and slowed speech but was cooperative and oriented. Therapist used PST to help client identify one target problem, brainstorm possible first steps, and evaluate barriers.
A: Client demonstrated increased ability to define the problem and selected a manageable action step. Avoidance appears to maintain stress and depressive symptoms.
P: Client will open mail for 10 minutes on Tuesday and sort bills into “due now” and “later” piles. Therapist will review outcome and continue PST next session.
DAP note sample
D: Client described feeling overwhelmed by upcoming move and difficulty completing tasks. Therapist used PST to help client identify the most urgent problem, list options, and choose one step. Client selected calling two moving companies for estimates.
A: Client appeared anxious but engaged. Client was able to move from broad worry to a specific action plan and reported confidence as 7/10.
P: Client will call two companies before Friday and write down cost, availability, and questions. Continue problem-solving work and coping skills practice.
How to connect PST to treatment goals
Strong documentation links PST to the treatment plan instead of treating it as a stand-alone activity. If the treatment goal is to reduce depressive symptoms and improve daily functioning, the PST plan should address a functioning problem affected by depression. If the goal is anxiety reduction, the plan may target avoidance, decision-making, or graded exposure to a feared task.
Here are concise examples:
- Treatment goal: Improve daily functioning. PST link: Client created a step-by-step plan to complete one household task three times this week.
- Treatment goal: Reduce avoidance related to anxiety. PST link: Client selected a graded plan to open email for five minutes twice this week.
- Treatment goal: Improve communication. PST link: Client identified one specific request to discuss with partner rather than addressing multiple conflicts at once.
- Treatment goal: Increase coping with caregiver stress. PST link: Client compared respite options and chose one support call to make before next session.
Common PST documentation mistakes to avoid
One common mistake is documenting only the client’s problem. The note should also show what the therapist did clinically. Another mistake is recording a vague plan that cannot be reviewed later.
Watch for language such as “processed stress,” “worked on coping,” or “talked about solutions” without detail. These phrases may be accurate, but they do not show the structure of PST. Add the target problem, options considered, selected step, and client response.
It is also helpful to avoid overstating progress. A client can make meaningful progress by identifying one realistic action step, even if the broader problem remains unresolved. Documentation can reflect that nuance: “Client demonstrated improved problem definition and selected a first step; continued support needed for follow-through and emotional regulation.”
Make PST notes easier to draft and review
PST can produce clear, clinically useful documentation when the note captures the sequence: problem, options, decision, action plan, client response, and connection to treatment goals. That structure also makes the next session easier because both clinician and client can review what was planned and what happened.
AutoNotes helps behavioral health professionals create structured, editable progress note drafts from session details, including interventions such as Problem Solving Therapy. The clinician remains in control of reviewing, editing, and finalizing each note before it becomes part of the clinical record.
If you want a faster starting point for documenting PST, SOAP notes, DAP notes, treatment planning, and other behavioral health services, start your free trial.
