The social problem-solving model is embedded in classic principles of cognitive–behavioral therapy. It provides an excellent format for understanding and conceptualizing the problems experienced by individuals who provide daily, ongoing assistance to a family member with a severe physical disability. This approach works best within a traditional, empathic, and professional counseling relationship, although the basic elements of the problem-solving model can be taught in psychoeducational groups and brief presentations.
Counselors can best address the personal, phenomenological needs of each family caregiver by providing this training in one-to-one sessions. The flexibility of the approach permits applications in long-distance technologies (e.g., telephone sessions, video-conferencing) and in home-based interactions.
The key to effective problem-solving training resides in the ability of the counselor to help the family caregiver identify and clarify the important problems they face. Rather than assume these problems relate to the care recipient and associated activities, it is essential for the counselor to appreciate the myriad of routine and ongoing issues that families face, generally, and help the caregiver explore the problems that are uniquely and particularly stressful. Caregivers are guided into exploring all facets of these problems, including their emotional reactions and characteristics of the problem that appear to perpetuate it, and reviewing past attempts to address these issues.
Eventually, the major components of problem-solving training are presented in the course of the interaction, including brainstorming of possible options for solving the problem, considering important goals to be achieved in solving the problem and the possible consequences of possible solutions, choosing and implementing a plan, and monitoring the progress of the plan.
Throughout this process the counselor is sensitive to the emotional experience of the caregiver, as negative emotions may represent the more important barriers to effective problem-solving, and a positive orientation toward solving problems should be cultivated. This would include positive emotions, a sense of competency, and a sense of positive rewards.
Typical "caregivers" do not meet stereotypical expectations. Women are most often in caregiver roles, but the number of men is increasing. Generally, these women have prior relationships with the care recipient (e.g., wife, mother) and the quality of the prior relationship will have important implications for the nature of the caregiver–care-recipient relationship.
Caregivers may experience certain problems unique to a particular health condition (e.g., emotional disinhibition following traumatic brain injury, bowel management concerns following tetraplegia with a complete spinal cord lesion) but caregivers differ tremendously in their perceptions and experience of these issues. Moreover, many family members do not identify as a "caregiver" and they may perceive their role as an extension of their role as a parent or spouse. These issues may represent important and ongoing strengths or problems, depending on the nature and quality of these relationships.
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