Interpersonal problem-solving competency: Review and critique of the literature

Clinical Psychology Review, Vol. 6 pp. 337-356, 1986 Printed in the USA. All rights reserved.

0272-7358/86 $3.00 + .00 Copyright © 1986 Pergamon Journals Ltd.

INTERPERSONAL PROBLEM-SOLVING COMPETENCY: REVIEW AND CRITIQUE OF THE LITERATURE Debra A. Tisdelle Medical College of Virginia

Janet S. St. Lawrence University of Mississippi

A B S T R A C T . Interpersonal problem-solving skill has been identified as one subset of socially competent behavior which is highly correlated with, and predictive of successful life adjustment. The present paper reviews the theoretical and research-based evidence underlying cognitive~behavioral interpersonal problem-solving training. Current assessment strategies, treatment techniques, and the methodological shortcomings in the existing literature are critically evaluated. The assessment and treatment implications which extendfrom the review are discussed and suggestions for future research directions are offered.

J u d g m e n t s of "emotional disturbance" implicitly presume ineffective behavior and its consequences (D'Zurilla & Goldfried, 1971). Lack of social competence has been cited as one such cause of ineffective behavior. The skills required for competent social functioning have been defined as "identifiable, learned behaviors that individuals use in interpersonal situations to obtain or maintain reinforcement from their environment" (Kelly, 1982, p. 5). This global definition of social competence, however, subsumes qualitatively different behaviors such as assertion, conversational skill, and interpersonal problem-solving competency. It is important in clinical practice to evaluate which particular behavioral constellation is deficient in an individual's repertoire in order to intervene most effectively since competency levels for each subset do not necessarily correlate within individuals, nor is the exhibition of any one skill area consistent across all situations (Kelly, 1982). Therefore, social competency cannot be considered a undimensional construct and should be evaluated with respect to its specific behavioral skill complexes. Reprint requests should be addressed to Janet St. Lawrence, Department of Psychology, University of Mississippi, University, MS 38677.

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Interpersonal problem-solving is one identified sub-set of social competence which has been correlated with emotional and behavioral adjustment in differing populations. As a result, assessment and training of problem-solving skills became a popular focus for cognitive/behavioral treatment programs during the past decade. The research to date suggests problem-solving skills are deficient in a wide range of maladjusted individuals and that improvement in problem-solving skills does, in fact, lead to more adaptive functioning (cf., Coche & Flick, 1975; Goldsmith & McFall, 1975; Spivack & Shure, 1974). Problem-solving is most often defined as an overt or covert process which: (a) makes available a variety of potentially effective responses for dealing with a problematic situation, and (b) increases the probability of selecting an effective response from among alternatives (D'Zurilla & Goldfried, 1971). Several component skills have been identified as relevant precursors for successful resolution of interpersonal problems: 1. 2. 3. 4. 5. 6. 7.

Identification of the core problem Identification of the desired goal Generation of alternative solutions Comparison of solution consequences Selection of the best solution Attempting the social strategy Evaluation of the environmental impact

(D'Zurilla & Goldfried, 1971; Krasnor, 1982; Sarason, 1981; Siegel & Platt, 1976). Exactly how deficits in these problem-solving skills contribute to emotional and behavioral maladjustment remains unclear. Intuitively, the ability to think through and effectively respond to social problem situations should enhance interpersonal relationships more than responses which are emotionally triggered, pursue selfgratifying goals, or do not consider interpersonal consequences. Peer evaluation studies do indicate that poor problem-solvers are more likely to be disliked by peers than good problem-solvers (Spivack & Shure, 1974). This may lead to interactions characterized by negative expectations, social rejection, and unsuccessful problem resolution. In turn, this state of affairs may result in reduced levels of positive reinforcement from the environment, withdrawal, hostility, negative self-labeling (Combs & Slaby, 1977; Kelly, 1982), or what Bandura (1977) has labeled low self efficacy. Such negative feedback may render future problem-solving attempts even more inept. A further confound may actually strengthen deficient interactional styles since inappropriate problem resolution may be reinforced periodically (Patterson, Littman, & Bricker, 1967; Solomon & Wahler, 1973). For example, aggressive solutions may receive attention, or force peer submission, through dominance. Social incompetence seriously affects the life adjustment of both children and adults (cf., Combs & Slaby, 1977; Krasnor & Rubin, 1981). In fact, socially skillful functioning has been conceptualized as a prerequisite for adjustment rather than its consequence (Kelly, 1982), a view supported by both correlational and longitudinal data. Correlational evidence suggests that socially ineffective children (those with poor peer relations and deficient communication skills) are more likely to have future life adjustment problems, such as dropping out of school, delinquency, and academic underachievement, and to exhibit high levels of physical or verbal aggression (Roff, Sells, & Golden, 1972; Ullmann, 1957). C o m b s and Slaby (1977) suggest that

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children's social skills deficits are implicated in the etiology of aggression and subsequent social maladjustment such as bad-conduct discharges from the military and adult mental health problems. Two longitudinal studies assessed childhood factors which discriminated adjusted from maladjusted adults. The first investigation found social factors in clinic-referred children were the only differentiating variables, while factors such as absenteeism, grades, intelligence, self-concept, and anxiety were not significantly related to adult adjustment status (Cowen, Pederson, Babigan, Izzo, & Trost, 1973). In the second study, Robins (1966) conducted a 30-year follow-up of 500 + individuals seen in a child guidance clinic and compared their adult adjustment with 100 normal controls. In general, the clinic-referred children remained more maladjusted as adults than the controls. Their maladjustment was manifested in high arrest rates, low occupational achievement, multiple psychiatric hospitalizations, fewer friendships, higher rates of alcohol abuse, and children who manifested more behavior problems than the children of controls. Only 8 % of the control subjects exhibited disabling symptoms at the 30-year follow-up, compared with 34 % of the patient group. Taken together, the evidence strongly suggests that satisfactory childhood adjustment is related to adult social adjustment and mental health. POPULATIONS DEFICIENT IN SOCIAL PROBLEM-SOLVING SKILL

Several investigators believe that knowledge and use of interpersonal problemsolving skills are central aspects, or even prerequisites, of mental health and behavioral adjustment (Foster & Ritchey, 1979; Jahoda, 1958; Spivack & Shure, 1974). Several studies support this viewpoint.

Maladjusted Children Maladjusted children have been shown to be deficient in both the quantity and quality of their solutions to interpersonal problem situations when their responses are contrasted against those of well-adjusted youths. For example, Shure, Spivack, and Jaeger (1971) found problem-solving skills distinctly superior among 4-year-old children who were judged "adjusted" by their teachers. Children who were judged "impulsive," "aggressive," or "inhibited" evidenced inability to think through problems and were more likely to offer aggressive solutions. Similar results.were found with an older sample of 10- to 12-year-old disturbed children who were compared against a public school sample. Differences were irrespective of social class or intellectual functioning (Shure & Spivack, 1972). In addition, 4-year-olds who were labelled "emotionally disturbed" by their teachers were inferior to normal peers in the sheer number of perceived solutions to hypothetical problems (Shure & Spivack, 1979). Renshaw and Asher (1982) hypothesized that unpopular children are more likely to select inappropriate goals, resulting in strategies which appear deficient. For example, popular children tend to pursue goals such as being liked and accepted, while rejected children attempt to elicit attention or to control events. Krasnor and Rubin (1981) also stress the significance of goal-selection in social problem-solving skill.

Emotionally Disturbed Adolescents When compared with normal high school students, maladjusted adolescents have been found to give more ineffective and irrelevant solutions to social problems, generate fewer alternative solutions, and to be less capable of viewing the problem

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from another's perspective (Platt, Spivack, Ahman, Ahman, & Peizer, 1974; Siegel & Platt, 1976). Similarly, Spivack and Levine (cited in Spivack & Shure, 1974) found that inpatient adolescent males characterized as impulsive were less able to conceptualize means of reaching a goal than were normal peers. The clinical sample was also less prone to consider the positive or negative consequences of possible actions.

Adult Psychiatric Patients Platt and Spivack (1972a) found adult psychiatric patients exhibited fewer problemsolving means than hospital employees and the solutions produced were often irrelevant to the social problem at hand. This deficiency in content of problem solutions was later confirmed by Platt and Spivack (1974). Adult psychiatric patients reacted with immediate action, but neglected the thinking or planning stage characteristic of nonpatients. Further validation was provided by Platt and Spivack (1972b), who reported that adult psychiatric patients were generally less able than controls to provide relevant solutions and appropriate means to solve interpersonal problems. In addition, ability level was positively associated with premorbid social functioning. Platt and Siegel (1976) also found premorbid social competence to be associated with higher levels of problem-solving ability in hospitalized male psychiatric patients. Those with low problem-solving skills demonstrated a more clearly schizophrenic pattern on the Minnesota Multiphasic Personality Inventory (MMPI), leading the investigators to characterize poor problem solvers as "socially inadequate" individuals. Psychiatric patients typically have poorer social networks and fewer intimate relationships than normals to aid them in times of stress (Froland, Brodsky, Olson, & Stewart, 1979). Mitchell (1982), in his study of 35 outpatient adults and their families, reported that interpersonal problem-solving style was positively and significantly related to the number of intimates and degree of family support. He concluded that increasing problem-solving skills may aid in producing positive social support networks.

Other Populations Other groups evidencing significant deficits in social problem-solving skills when compared to controls have included adult male alcoholics (Intagliata, 1978), depressed college students (Gotlib & Asarnow, 1979), depressed geriatric patients (Hussian & Lawrence, 1981), heroin addicts (Platt, Scura, & H a n n o n , 1973), and incarcerated delinquents (Costello, Cohen, Goldstein, & Almanta, 1983). While a variety of studies attempt to establish a relationship between social problem-solving skill and maladaptive behavior, and although the evidence suggests that maladjusted individuals are deficient in problem-solving abilities when compared to normal control groups, one must be cautious in making definitive interpretations from this data. Methodological flaws in the studies include inadequate population descriptions and a failure to validate either the treatment group's behavioral deficiencies or the control group's "normalcy." As a result, the adequacy of group classification is unclear. In addition, many studies employed raters who were not blind to the experimental conditions, introducing obvious measurement bias. Another problem is the use of narrow criteria for assessing problem-solving skill. For example, most studies measure only one or two of the components in the

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overall problem-solving process. The results of such a constricted focus may not generalize to global social problem-solving ability. In addition, there are problems with the assessment devices themselves, which will be reviewed in the next section. There are also important conceptual difficulties in the social problem-solving literature. Researchers fail to adequately define concepts such as "social inadequacy," "adjustment," "impulsivity," and "emotional disturbance." This makes it particularly difficult to compare results across studies or generalize findings across populations. Another conceptual issue, pointed out by D'Zurilla and Nezu (1982), involves the authors' failure to distinguish verbal problem-solving solutions from implementation and behavioral competence. Although these skills overlap, competency in one does not always guarantee competency in another. Together with inadequate conceptual formulations, imprecise definitions, and a narrow assessment focus, it is possible that results which have been attributed to problem-solving skills may be confounded by moderator variables such as anxiety-level, conversational skill, assertion, or verbal fluency. Inferring that problem-solving variables are core mediators of adjustment is a difficult assumption to defend when behavioral competence is influenced by so many complex variables. A final consideration to be kept in mind when evaluating the evidence for a link between problem-solving and adjustment is that the data in these studies are largely correlational. Thus, a cause-and-effect relationship cannot be established. While poor problem-solving skills may lead to maladjustment, it is equally possible that individuals become poor problem-solvers because they are maladjusted. Equally plausible is the contribution of some other factor (e.g., cognitive deficiency or thought disorder) which results in both maladjustment and poor problem-solving. Thus, while causal relationships have not been adequately established and remain speculative, evidence of positive outcome effects from training improved problemsolving skills in maladjusted individuals suggests that there may be a convincing, clinical relationship with important treatment implications. ASSESSMENT OF PROBLEM-SOLVING SKILLS

Most of the problem-solving research has focused on the assessment of impersonal, intellectual tasks such as puzzles, anagrams, and arithmetic (Sarason, 1981 ; Spivack & Shure, 1974). However, a distinction must be made between such impersonal tasks and the behavior necessary for dealing with interpersonal problems. The latter task involves handling daily difficulties, seeking help, planning a course of action to obtain a social goal, and considering future implications of various behaviors. Research indicates that causal thinking about impersonal events is not the same as causal thinking about social events (Spivack & Shure, 1974). For example, Gotlib and Asarnow (1979) found no relationship between anagram performance and planning the means to reach a social goal in depressed college students. In addition, although solving puzzles and arithmetic problems is related to intelligence, interpersonal problem-solving skills are independent of I Q (Platt, Spivack, Altman, Altman, & Peizer, 1974; Sarason, 1981; Shure, Spivack, &Jaeger, 1971; Spivack & Shure, 1974). Interpersonal problem-solving skills should also be differentiated from emotional problem solving, which involves the ability to cope with one's own negative emotional states (e.g., anger or anxiety). This latter task has been found to correlate with IQ, but does not differentiate clinical from normal populations (Plattet al.,

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1974; Siegel & Platt, 1976). Therefore, when attempting to improve interpersonal adjustment through problem-solving skill training, the focus of assessment and training should be specific to social problem-solving.

Cognitive Assessment Measures Several assessment techniques developed by Platt, Spivack, Shure, and their colleagues have become widely utilized measures of interpersonal problem-solving skill. The Preschool Interpersonal Problem Solving (PIPS) test is the most widely used assessment method with young children (Spivack & Shure, 1974). The PIPS consists of verbally presented stories with identified outcome goals and accompanying pictures. PIPS stories reflect two types of social problems: (a) adult-oriented (e. g., the child attempts to avoid his/her mother's anger after damaging an object), or (b) peer-oriented (e.g., the child attempts to obtain a toy from another child). Each subject verbally responds to questions concerning means and solutions to the situations. The final score is based on the number of different and relevant solutions generated by the subject. Some investigators have adapted the PIPS to suit different ages. A relatively common variation for older children and adults has subjects generate as many solutions as possible to peer- and adult-oriented interpersonal dilemmas. Planning step-by-step means to reach specific social goals is measured by the Means-Ends Problem-Solving (MEPS) task (Platt & Spivack, 1977). The MEPS consists of six hypothetical stories with only the beginning and end presented. The ultimate social goal is clearly indicated and the subject is asked how the goal could be achieved. Responses are elicited in written or verbal form, then judged and scored according to a priori criteria. Consequential thinking in pre-schoolers is often measured by the "What Happens Next" game (Spivack & Shure, 1974). The child is given a m i n i m u m of five social problems and their solutions, then asked what might happen next. After each response, new characteristics are presented in order to elicit further responding. The subject's score is the sum of different and relevant consequences produced. Older children and adults are typically given an adapted version in which stories are presented which tempt the main character to transgress. The score is the number of pros and cons generated by the subject. The major problem~with all of the above instruments is that their psychometric properties have not been established and normative data are not available. Specific strategies for their use vary widely from study to study, and the sampled content areas are narrow, making generalization difficult. In addition, validational support has been inconsistent (Krasnor & Rubin, 1981). For example, no direct relationship of test scores with actual behavior (external validity) has been demonstrated. Unstandardized use of the MEPS and its many variations makes it difficult to establish their validity. It is common for investigators to modify the measures to suit their particular preferences. For example, a common modification involves alterations in scene content to adapt the situations to the population under study. The frequency with which this occurs suggests investigators may feel it is more beneficial to employ an individualized assessment. Indeed, if assessment is to reflect situationally relevant changes in behavior, the social situations which are difficult for the particular group to handle should be identified. Since different clients are not deficient in the same social situations, deter-

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mination of the precise, troublesome social encounters appears desirable if researchers are to avoid abstract or hypothetical situational assessment (Kelly, 1982). It is also possible that the use of relevant, as opposed to hypothetical, situations may foster generalization since there are fewer abstract associations for subjects to make between training and "real life" behavior. The advantages of an individualized approach lead to a further assessment problem; that is, how the specific problem situations are to be identified. Typically, this is done on an intuitive basis with no empirical support documenting a valid relationship between the assessment situations and patients' difficulties in daily life. Objective determination of specific and problematic assessment situations would be desirable. Such empirical support has not been demonstrated to date. Beha vioral Assessmen t

The existing literature generally assumes a relationship between verbal cognitive performance and in rive behavior. Whether a client's self-report reflects actual problem-solving skill in troublesome situations is the single most important evidence of competency. Unfortunately, this is rarely done. Thus, conclusions about treatment efficacy are frequently based on self-report measures or indirect measures of adjustment. At the present time, the lack of behavioral assessment is the most neglected aspect of the problem-solving literature, though recommendations for improvement are common. Krasnor and Rubin (1981) suggested behavioral assessment involve observation of actual problems as they arise in an individual's daily social interactions. Such a technique would, indeed, provide evidence of competence in in vivo settings and of problem-solving sequencing and effectiveness. However, its considerable disadvantages include major costs in time and effort, as well as the host of problems inherent in an uncontrolled observational environment. Another potential strategy, described by Evans and Nelson (1977), is the "simulated situation" procedure. In this method, situations are arranged with confederates to evoke problem-solving behavior. This technique offers a cost-efficient compromise between naturalistic observation and structured assessment. However, identifying relevant situations which are readily contrived yet effectively assess in rive utilization of problem-solving skill presents procedural difficulties. Also, the possibility that contrived performances may not reflect generalization to the natural environment has not been addressed. However, given the inherent limitations of in rive assessment, contrived analogue assessments may offer a viable alternative. Several studies have attempted some form of behavioral assessment. For example, one investigation offered young subjects a monetary incentive to obtain an object from a confederate (Weissberg, Gesten, Rapkin, Cowen, Davidson, de Apodaca, & M c K i m , 1981) while the confederate presented several obstacles to success. Another study simulated a grocery store and required adult subjects to purchase food while the cashier precipitated a "problem" by overcharging the subjects (Edelstein, Couture, Cray, Dickens, & Lusebrink, 1980). Another example of efforts to develop behavioral problem-solving assessment involved the grouping of six children in a room to collectively answer a "contest" question (McClure, Chinsky, & Larcen, 1978). However, the arrangement produced two "problems": (a) the room was short one chair, and (b) the children were to assign officer positions but were short one title.

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The few efforts to utilize behavioral assessments to date have been methodologically flawed. Several investigations evaluated behavioral performance only after training (e. g., Goldsmith & McFall, 1975; McC lure et al., 1978; Sarason & Sarason, 1981 ; Weissberg et al., 1981), and thus could not substantiate effects due to the intervention since baseline comparisons were lacking. An additional criticism can be directed to the scoring procedures. For example, in the Weissberg et al. (1981) study, only the number of problem-solving attempts and the time required to solve the problem were reported. Information on response quality was not addressed, although qualitative effectiveness may be the most important variable from a clinical standpoint. Another significant consideration when evaluating behavioral problem-solving assessment is the choice of problem situations. Theoretical difficulties arise when the behavioral assessment situations do not specifically assess the trained skills. For example, social problem-solving studies have measured assertion skills during roleplaying situations (Ollendick & Hersen, 1979), conversational skills such as eye contact (Goldsmith & McFall, 1975), and interview skills during a simulated job interview (Sarason & Sarason, 1981). These studies assessed social skills without narrowing their focus to problem-solving skills. Since different social skills do not necessarily correlate with one another (Kelly, 1982), measures which are not equated to the problem-solving training may be insensitive to treatment-related change. Not surprisingly, several of the studies failed to find generalization from training effects to in vivo behavior since the behavioral assessment measures were unrelated to the problem-solving training which was being evaluated. This is an important theoretical and measurement issue which has not received adequate attention in the social problem-solving literature.

Social Validation of Problem-Solving Interventions An additional, though neglected, assessment issue involves whether problem-solving training with clinical populations produces effects which are comparable to the behavior of nonclinical individuals. Although several investigators recommend such a social validational approach to clinical intervention (Hansen, St. Lawrence, & Christoff, 1985; Holmes, Hansen, & St. Lawrence, 1984), social validation is rarely attempted despite its crucial importance as the ultimate determinant of treatment efficacy (Urbain & Kendall, 1980). To date, there is only one published report which assessed problem-solving competencies in the community and then trained clinical samples to approximate the criteron skills of"normal" individuals (Hansen et al., 1985). If the aim of clinical intervention is to teach disordered individuals more adaptive living skills, then such social validation is critical. Recently, Holmes et al. (1984) used such a social validation approach for training psychiatric patients' conversational skills. Hansen et al. (1985) adapted a similar interpersonal problemsolving training program. U p to the present time, statistical significance has been the major criterion in problem-solving research, and social validation issues of clinical significance remain a glaring deficiency in the existing literature. SOCIAL PROBLEM-SOLVING TRAINING

Social problem-solving is not a unidimensional skill, but encompasses a variety of behaviors. The specific intervention strategies for training problem-solving skills differ from study to study. Common overlapping components include verbal instruction and rationale, modeling, feedback and reinforcement, behavioral rehearsal,

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and group discussion. The three most popular approaches emphasize different conceptual underpinnings: (a) a skills training approach in which deficient component behaviors are sequentially targeted for intervention, (b) social learning, and (c) selfinstructional training through cognitive modification. Component Skills Interventions One approach for training problem-solving is to teach the target population a stepby-step strategy for problem resolution. This involves formal training in sequential component skills which have been identified for successful resolution of interpersonal problems: 1. 2. 3. 4. 5. 6. 7.

Statement of the problem Statement of the goal Generation of alternative solutions Comparison of solution consequences Selection of the best solution Attempting the social strategy Evaluation of the environmental impact

(D'Zurilla & Goldfried, 1971; Krasnor, 1982; Sarason, 1981; Siegel & Platt, 1976). Comprehensive component programs have demonstrated that social problemsolving training may have a preventive effect as well as improving the quality of young children's problem resolution skills. For example, a program designed for preschoolers (Spivack & Shure, 1974) showed that trained children significantly decreased their use of coercive, violent, and aggressive solutions on the PIPS compared to untrained controls. Initially, adjusted children improved on the PIPS and received more favorable teacher ratings regardless of group assignment, suggesting that practice or developmental maturation produced a positive effect on performance. However, by the 6-month follow-up, only 67 % of the controls initially judged well-adjusted by their teachers remained so, while 93 % of the treatment group remained adjusted. Thus, continued favorable adjustment was more likely in those children who had been exposed to problem-solving training. An obvious potential for bias existed since teachers both trained and rated behaviors. However, a replication of this study (Shure & Spivack, 1979) utilized parents as mediators of change and blind teacher ratings. Results showed that not only did trained children's behavior improve compared to control children, but effects generalized to the school setting and maintained for 2 years after the conclusion of problem-solving training. Although the generalization and follow-up data in this study are impressive, it is unclear what specifically accounted for the measured changes. It is possible that training resulted in some unidentified or non-specific cognitive change or that the extra adult attention given to these underprivileged inner-city preschoolers resulted in academicially better students than controls. More specific control groups are needed to account for potentially active variables such as attention. Unfortunately, the Shure and Spivack studies (1972; 1979) did not assess whether the children actually used the trained problem-solving skills. McClure et al. (1978) emphasized the importance of behavioral assessment after finding that elementary school subjects did not transfer trained problem-solving skills to analogue interpersonal situations. Similarly, several studies training problem-solving skills with

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families in conflict failed to establish generalization effects across home and training situations (Blechman, Olson, & Hellman, 1976; Kifer, Lewis, Green, & Phillips, 1974; Robin, Kent, O'Leary, Foster, & Prinz, 1977). Thus, behavioral and generalization assessments appear particularly important when evaluating the effectiveness of these programs, although these issues are rarely addressed in the literature. Another important point concerning the Shure and Spivack studies was identified by Weissberg et al. (1981), who presented evidence that the therapeutic and preventive effects of social problem-solving training with inner-city preschoolers failed to replicate with suburban preschoolers or older children. The Weissberg et al. study (1981) evaluated these differential effects using two matched groups of third-graders: one from suburban, middle socioeconomic status (SES) areas and one from low SES urban areas. The results indicated that all trained children improved more than assessment-only controls on cognitive problem-solving skills. Behavioral evidence of improved problem-solving performance was measured by a simulated problem situation. Although the results suggested that cognitive training generalized to actual behavior, the assessment was made post-training only, thus precluding any pretreatment comparisons. In addition, there was no indication that response quality was better for trained children than for controls. Another significant finding was the failure to identify a relationship between problem-solving improvement and overall adjustment, a direct contrast to Spivack and Shure's (1974) results with younger children. Evidently, many undelineated variables are operating to influence skill acquisition, and it remains unclear just what the relevant problemsolving variables are and how differential treatments affect them. Component skill training programs have also been developed and evaluated for adult psychiatric patients. Studies including placebo and no treatment control groups indicate that non-specific factors, such as attention, account for some change. For example, Coche and Douglas (1977) found both the experimental and placebo groups (but not the no treatment group) improved on a personality inventory after training. However, only adults trained in problem-solving skills demonstrated improved M E P S scores, decreased depression, increased self-esteem, better impulse control, and earlier hospital discharges (Coche & Douglas, 1977; Coche & Flick, 1975). Typically, actual behavior in interpersonal problem situations is not assessed in the problem-solving research. An exemplary study attempting to correct this deficiency was conducted by Goldsmith and McFall (1975), who empirically derived an interpersonal skills training program specifically for adult male psychiatric inpatients. Through extensive interviews and judges' ratings, the investigators developed a list of problematic situations for use in assessment and training. Although this procedure was not entirely new (cf. Goldfried & D'Zurrilla, 1969), it transcended the usual practice of relying on clinical intuition for the identification of performance deficits. It is a model effort in the literature. This study also controlled for attention and exposure to problematic situations by including two control groups: an assessment-only control and a pseudotherapy group which discussed problems but received no training. The training group received three individually administered sessions which taught appropriate responses to problem situations through rehearsal, modeling, and feedback. Perhaps the weakest aspect of the study was that subjects received training in assertion and conversation skills as well as in interpersonal problem-solving. As a result, it is difficult to disentangle which particular skills contributed to change and to what degree. Nevertheless, skill training

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was found superior to the other two conditions on the pre- to post-treatment measures. After training, subjects were also assessed in an in vivo conversational situation and the training group was rated as more skillful. However, this can be considered only preliminary evidence for transfer of training because baseline competence levels were not assessed and a limited subset of the trained skills was assessed. In other words, the measure primarily tapped conversation skills and, to some extent, assertion, but demonstration of problem-solving skills is questionable. Edelstein et al.'s (1980) inclusion of behavioral assessment of actual problemsolving ability was a definite step forward in the literature. Their procedure involved training psychiatric patients in problem-solving components in separate "modules" and assessing progress in a multiple baseline design across problem-solving components. Generalization was assessed in analogue situations before and after each module. The results indicated that patients who were initially deficient in problemsolving skills were better able to identify problems and choose correct alternatives and consequences following training. Their improvement maintained when new problem situations were presented within sessions and with in vivo simulation assessment. However, the behavioral assessment situation was structured, and subjects were aware of being assessed. They were also prompted during the analogue assessment if they did not spontaneously recognize the problem, thus confounding the final results. It is also possible the repeated assessment of one situation could produce improvement through practice alone. Along with the need for more behavioral assessment, evaluation of a treatment's clinical validity is an issue often neglected by problem-solving researchers. One unique investigation in this regard was conducted by Hansen, St. Lawrence, and Christoff (1985) with formerly hospitalized patients in a day treatment program. They demonstrated improvement in component skills using a multiple baseline design and showed maintenance of change 3 months post-training. Their study included a social validation sample which consisted of normal, independently functioning adults from the community. Such a comparison established that the patients were deficient prior to treatment and that, post-treatment, the patients evidenced more appropriate and effective solutions to interpersonal problems. Lack of long-term follow-up assessments is another common deficiency in the problem-solving literature. One study conducted by Chaney, O'Leary, and Marlatt (1978) was unique in demonstrating clear maintenance of improvement 1 year following training in the component skills of social problem-solving. The results were impressive, given the chronicity of their inpatient male alcoholic population. The treatment group was compared to both placebo and no-treatment control groups on self-report of drinking behavior and verbal responses to problem situations relating to alcohol use. Post-treatment results showed the treatment group was more verbal in problem-solving attempts and generated more alternative behaviors than both comparison groups. The most significant finding, however, emerged at the 1-year follow-up assessment. As compared to the other two groups, the treatment group reported fewer number of days drunk, fewer total number of drinks, and a shorter mean length of drinking relapses. While their data are encouraging, reliance on only a self-report measure for follow-up assessment limits the conclusions which can be drawn. Assessment of actual problem-solving ability would have provided more direct evidence regarding maintenance of the learned problemsolving skills. Interpretation of their follow-up results is further complicated by the

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fact that post-treatment differences in verbal problem-solving had diminished by the 3-month follow-up assessment. This makes it particularly difficult to attribute changes over time to the acquisition of cognitive changes in problem-solving strategies. Clearly, more rigorous follow-up data are needed to articulate the degree and duration of treatment effects.

Social Learning Interventions The social learning approach to problem-solving emphasizes exposure to appropriate models as the mechanism to produce optimal change. The initial studies (e.g, Sarason, 1968) limited the conclusions which could be drawn due to small sample sizes, lack of problem-solving assessment, and the omission of reliability checks and follow-up evaluations. However, more rigorous recent studies suggest that modeling interventions are effective in the training of social problem-solving skills. For example, Sarason and Sarason (1981) developed a modeling program for students in an urban high school. Treatment was carried out as a part of a classroom course. One group saw live models of social and cognitive skills, another saw the same models on videotape, and a control group participated in regular class sessions. Relevant skill deficits were identified through interviews with significant adults, a marked improvement over the subjective choice of training situations so commonly used in the literature. Dependent measures included a modified MEPS, an alternatives test, and evaluation of performance in an in vivo interview situation several months after training. Perhaps the most clinically important finding was that both trained groups evidenced lower rates of tardiness, school absence, and behavior referrals than controls at a 1-month follow-up. In addition, both experimental groups were significantly better at generating effective means and alternatives to problem situations than the control group. Unfortunately, these measures were only evaluated after training. Therefore, comparisons with pretraining skill levels were unavailable. In addition, initial differences between groups on problem-solving ability were not addressed and could account for post-training differences. Results of the in vivo interview showed the live modeling group received more favorable ratings from the interviewer than either of the other groups. Again, this behavioral measure was only introduced post-training for students who volunteered to participate. As a result, a biased sample may have been evaluated. A theoretical issue should also be mentioned in regard to the choice of this behavioral situation. Job interview skills may be distinct from interpersonal problem-solving skills. For example, variables such as grooming, assertiveness, conversational ability, and qualifications for the job influence overall performance. In fact, the students were not rated on problem-solving behaviors such as generation of alternatives, but on such variables as eye contact, posture, and representation of job qualifications. Thus, the skills targeted during training were not evaluated by the assessment situation. A similar criticism regarding choice of assessment measures can be made for Ollendick and Hersen's (1979) study and may account for why they failed to find significant change after treatment. Training consisted of presenting relevant, interpersonal problems and providing instructions, modeling, rehearsal, and feedback on how to respond. However, assessment of skill acquisition was designed to measure assertive responses to simulated role-play situations. These scenes included responses to commendatory situations which may not have emerged in training as "problems" or may not have been perceived by subjects as problems and,

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therefore, did not stimulate appropriate problem-solving cognitions. Whatever the hypothesized reason, training clearly did not generalize to untrained situations. The variety of training techniques used in combination with modeling interventions (e.g., role-playing and performance feedback) make it difficult to isolate modeling as the ingredient leading to change. In fact, Sarason and Ganzer (1973) found no differences between a modeling and discussion group after problem-solving training. Both groups were significantly better adjusted than controls and displayed significantly less recidivism up to 3 years after treatment. Similarly, McClure et al. (1978) attempted to tease out confounding treatment effects by comparing the efficacy of modeling alone versus modeling in combination with role-playing and discussion. Though there was a trend for children participating in the role-playing condition to be more effective problem-solvers, the authors concluded that no one treatment component was unequivocally supported. It shguld be noted, however, that subjects were normal elementary school students. It is possible that a wide range of treatment programs may be effective with "normal" populations, but more maladjusted groups may require circumscribed strategies. For example, Ollendick and Hersen (1979) included modeling as one of several behavioral components in their treatment for incarcerated juvenile delinquents. Other components included rehearsal, feedback, reinforcement, and homework assignments. Their discussion group focused on talking over problems and solutions with no behavioral procedures. Their results did show significant differences between the skills group and both the discussion and control groups after training. Differences were evidenced in reduced anxiety, increased internal locus of control, and a greater n u m b e r of points earned in the token economy. These findings suggest that strategies in addition to modeling may render skills treatment clearly superior over discussion procedures alone. More systematic research is clearly needed to isolate the most important treatment components for specific populations. Self-Instructional Interventions

Luria (1961) and Vygotsky (1962) stress the importance of internalized language in the acquisition of motor behavior, abstract thought, and as a general mediator of functioning. Investigators have adapted their verbal mediation theory into cognitive-behavioral programs teaching self-control techniques (e.g., Kendall, 1977; Robin, Schneider, & Dolnick, 1976). Such programs typically involve teaching children how to self talk, coaching themselves verbally, and eventually subvocally, on problem-solving steps, focusing attention, reinforcement, and coping skills. Training is usually accomplished with techniques such as instruction, modeling, rehearsal, and feedback. Most self-instructional programs have centered around impulsive and hyperactive children within school settings (cf. Ault, 1973; Drake, 1970). The majority have trained nonsocial, intellectual tasks such as maze performance (e.g., Kendall & Finch, 1978; Meichenbaum & Goodman, 1971; Palkes, Stewart, & Freedman, 1972) rather than social problem-solving skills. This focus is problematic since the evidence overwhelmingly suggests that performance on such impersonal, cognitive problemsolving tasks is not highly correlated with interpersonal problem-solving (Gotlib & Asarnow, 1979; Platt et al., 1974; Sarason, 1981; Shure et al., 1971; Spivack & Shure, 1974). In addition, self-instructional programs which focus on impersonal problem-solving do not find generalization to overall adjustment in the classroom

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(Camp, Bloom, Herbert, & van Doorninck, 1977; Meichenbaum & Goodman, 1971). Several researchers have attempted to alter interpersonal problem-solving skills using self-instructional techniques. As yet, the results do not affirm the efficacy of self-instructional methods. While verbal mediation training was effective with normal children (Bornstein & Quevillon, 1976; Monohan & O'Leary, 1971), its effectiveness with problem children remains elusive. For example, although Kendall and Wilcox (1980) taught children who were classroom behavior management problems to use self-instructional problem-solving in response to social situations and impersonal tasks, it is impossible to ascertain whether or not the children acquired social problem-solving skills since these skills were not assessed. In summary, it is difficult to disentangle the individual effects stressed by each treatment model. Studies comparing modeling with other problem-solving treatment strategies have not demonstrated the superiority of modeling. Therefore, given the time constraints and restricted budgets of many therapeutic settings, modeling may not be the most cost-effective approach. Studies utilizing self-instructional training methods have focused primarily on young children and lack long-term follow-up data. Although initial results are promising, Urbain and Kendall (1980) concluded that "final conclusions regarding the utility of self-instructional methods in the treatment of social and interpersonal problems would be premature" (p. 130). It appears that the most fully supported, timeefficient, and cost-effective approach to improving social problem-solving skills is simply the training of component behavioral skills. SUMMARY A N D CONCLUSIONS

The theoretical and conceptual underpinnings of problem-solving training are virtually unexplored, despite their relevance to assessment, treatment, generalization, and maintenance issues. Although there is some empirical support for the relevance of each of the common problem-solving steps (D'Zurilla & Nezu, 1981), the relative contribution of each sequential step to behavioral competence remains unproven. Similarly, the specific pattern of sequencing popularly employed in the literature is only assumed to be the most efficacious strategy. More careful evaluation of the efficiency, and even necessity, of each of the sequential problem-solving stages could prove helpful in articulating and operationalizing the nature of effective problemsolving. In contrast to experimentally controlled problem situations, when problems arise in the natural environment they tend to be more ambiguous than experimental situations. Thus, the available information and environmental cues for detecting outcome goals may be considerably more subtle than most research investigations. Problem-solving in real life rarely proceeds according to the neatly ordered stages which characterize the research literature (D'Zurilla & Nezu, 1982). Given the vague parameters of in vivo problems and the complex nature of human information processing, problem-solving stages may well overlap and interact, with impressions formed in one-stage modifying or stimulating later stages. Thus, effective problemsolving may be more complex and multifaceted than is suggested by the literature to date. McFall (1982) described a conceptual model for social interaction which can usefully be adapted here to illustrate the myriad of factors which are potentially implicated. His first stage, "decoding," involves the perception and interpretation

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of incoming stimuli. This corresponds to the problem recognition stage and is influenced by sensory skills and attentional factors, as well as environmental stimuli. His "decision" stage involves searching among alternatives, evaluating potential consequences of each alternative, and ultimately selecting an appropriate response. This is compatible with the cognitive steps in the problem-solving process. His final stage, "encoding," requires translation of decisions into behavioral performance-- an aspect of problem-solving which is all too often neglected in the literature. A host of individual differences may influence performance, such as fatigue, practice, behavioral skills repertoire, attitude, social anxiety, frustration tolerance, memory, achievement needs, and so on. To date, problem-solving interventions tend to ignore all other potential variables and focus exclusively on the second stage, the learning of cognitive "rules" for more effective problem solving. However, problem-solving knowledge by itself does not fully account for an individual's observed behavior and cannot, at this time, be considered the primary mediating factor influencing performance. Given the complexity of social interactions, an exclusive emphasis on problem-solving is too narrow and constricted a focus. Populations identified as deficient in problem-solving competency are usually deficient in other social skills as well, such as conversational ability or assertion (cf. Conger & Keane, 1981; Holmes, Hansen, & St. Lawrence, 1984; Kelly & Lamparski, 1985). Thus, it is unlikely that any single intervention in isolation is adequate to produce social competency in impaired clinical populations. An interrelated, though overlooked, theoretical question is whether more direct behavioral interventions (such as assertion training, relaxation training, or systematic desensitization, for example) may also result in the acquisition of cognitive problem-solving skill through a different behavioral mechanism. It is entirely possible that the different labels attached to specific interventions mask underlying similarites in the cognitive end-point which each produces. In other words, although cognitive processes play a crucial role in social behavior, it does not necessarily follow that cognitive treatment strategies are the most effective or efficient means to bring about change. Cognitive "rules" can be taught through a variety of techniques (Rathjen, Rathjen, & Hiniker, 1978) which have not been evaluated against one another. Bandura (1977) has argued for the supremacy of behavioral procedures over verbal, imaginal, or vicarious techniques for producing measurable change. At present, the behavioral literature reflects emerging support for the relative effectiveness of direct behavioral, rather than cognitively-based, treatment for phobic behavior (Mavissikalian & Barlow, 1981 ; O'Brien, 1981). Participant modeling is more effective than covert modeling (Bandura, 1969; Bandura, Blanchard, & Ritter, 1969; O'Brien, 1981; R i m m & Lefebvre, 1981). In vivo techniques have been found superior to imaginal procedures in both flooding (Emmelkamp & Wessels, 1975) and systematic desensitization (Barlow, Leitenberg, Agras, & Wincze, 1969). Thus, research on problem-solving should take a closer look at the most effective and efficient ways to achieve desired cognitive and behavioral outcome goals. Research comparing more direct behavioral approaches with cognitively oriented problemsolving would prove helpful in this regard. Another serious omission in the problem-solving literature to date is an almost complete failure to address generalization issues. Generalization from trained to untrained problems, to behavior within sessions, or to in vivo behavior, is rarely addressed. By definition, no social skill can be assessed or trained in isolation. However, the problem-solving literature seems to reflect an underlying assumption that generalization will be an automatic phenomenon. As indicated by Ur-

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bain and Kendall (1980), "a major hypothesis based on the social-cognitive problemsolving model is that training at the level of the cognitive processes that presumably mediate competence across a broad range of situations will 'build in' generalization as an integral part of treatment" (p. 110). This hypothesis requires empirical support. The acquisition of problem-solving skills is typically evaluated with inventories such as the M E P S , behavioral adjustment checklists, various self-report measures, and occasionally, in-session role-play. The self-report inventories, while informative, need to be augmented by more behavioral measures. First, there are basic problems with self-report, such as response set and demand characteristics. Second, self-report of problem-solving skills is wrought with difficulty. Rubin (1982) discoverd children who could verbalize appropriate strategies rarely employed them when actually faced with a social problem in the natural environment. What individuals say they would do in a situation and what they, in fact, do when it actually occurs may have little correspondance (Krasnor & Rubin, 1981). Therefore, it is essential to demonstrate generalization from the cognitive domain to behavior. In addition to the potentially narrow focus of current assessment strategies, current methods of data analysis may be overly constricted. Descriptions of thought content and frequency counts of cognitive categories may blind researchers to the process or function of cognition, "creating an inventory of the separate trees, and missing the forest" (Glass & Arnkoff, 1982, p. 37). Sequential analysis of thought patterns may reveal rich information with important theoretical and treatment implications. To illustrate, Notarius (1981) proposed the following hypothetical scenario: Males identified as high or low in heterosocial anxiety may actually report comparable frequencies of positive, negative, and neutral self-statements. However, high-anxious subjects may display a sequence of negative thoughts followed by other negative thoughts, while low-anxious subjects may evidence negative cognitions tbllowed by positive thoughts. Similarly, Schwartz and Gottman (1976) were able to discriminate assertive from unassertive individuals based on time series analysis of their positive and negative cognitive sequences, and Klass (1981) found the type of self-statement which followed an assertive response differentiated between highand low-guilt subjects. Therefore, the pattern of an individual's self-statements may be an important consideration. Bandura's (1977) evidence that judgments of low self-efficacy are related to perceived inability to solve problems offers further support to this issue. Thus, study of cognitive sequencing during problem-solving may be a promising and innovative avenue for future research. To date, the problem-solving literature has not addressed the likelihood that differences in situational parameters may influence problem-solving effectiveness. D'Zurilla and Nezu (1982) identified five classes of social problem-solving situations: threat of punishment, loss of reinforcement, frustration or prevention of goal attainment, interpersonal conflict, and personal conflict. The literature on assertive responding suggests situational contexts are vitally important and produce differences in responding (St. Lawrence, Hansen, Cutts, Tisdelle, & Irish, 1985). However, the problem-solving literature has not yet addressed issues regarding response differentials as a function of the situation. Given the substantial empirical support for a situation-specific definition of assertion, this is an issue which should be carefully evaluated in the problem-solving literature. Another interesting possibility for the future would be an evaluation of the worth of problem-solving training when used adjunctively with other intervention strate-

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gies. O n a theoretical level, it seems plausible that problem-solving training m a y produce some incremental benefit to the generalization or m a i n t e n a n c e of therapeutic change. Cognitive skills training is often advocated for this purpose (Kanfer, 1979), and self-regulatory training, in particular, has often been promoted as a maintenance strategy (Brightwell & Sloan, 1977; M a h o n e y & Mahoney, 1976; Perri, Richards & Schulthesis, 1977). However, there has been little empirical support for the value of self-regulation training over time (Leventhal & Cleary, 1980; Stunkard & Penick, 1979). Following their review of the self-regulatory literature, K i r s c h e n b a u m and T o m a r k e n (1982) concluded that "part of self-regulatory failure is inadequate planning of activities, misrecognition of potentially problematic situations, and underestimation of the riskiness of certain situations" (p. 144). Recognizing a problem, planning how to cope with high risk situations, and learning to evaluate the consequences of alternative solutions are part and parcel of problemsolving training. Thus, such training m a y aid therapeutic maintenance. Empirical evaluation of programs which incorporate problem-solving into the final phases of t r e a t m e n t m a y produce useful information. As a case in point, a study which exa m i n e d the effectiveness of problem-solving in preventing smoking relapse found significantly fewer relapses in smokers who were taught problem-solving strategies (Karol & Richards, 1978, reported in D'Zurilla & Nezu, 1981). At present, few problem-solving studies make any effort to compare their subjects with u n i m p a i r e d peer groups. The usual m e t h o d of comparing a treatment group with other maladjusted individuals does not permit a meaningful evaluation of social problem-solving's effectiveness as a clinical intervention. In other words, though statistically significant i m p r o v e m e n t m a y be documented, it does not ensure that treatment subjects were rendered "normal" responders. Comparisons with adjusted peers are essential in establishing the social validity of problem-solving training although only one study to date has attempted such an approach (Hansen, St. Lawrence, & Christoff, 1985). REFERENCES

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