Une approche psychothérapique méconnue : la résolution de problèmes sociaux

La Thérapie de résolution de problèmes sociaux (TRP) est une approche thérapeutique originale intégrant des éléments du modèle du stress de Lazarus et des thérapies comportementales et cognitives dans une orientation psychosociale de la psychopathologie. L'article présente les principaux concepts et paramètres du modèle de résolution de problèmes et ses liens avec le modèle interactionnel du stress. Une description particulière des variables d'orientation au problème et de résolution de problème propre est effectuée. Enfin, l'intérêt pratique de la TRP est souligné par différents exemples d'application clinique et de résultats dans le champ de la psychopathologie.

The capacity to solve problems can be considered as a factor reducing the impact of negative life experiences, thereby contributing to making the adaptation of the individual easier. The Problem Solving Therapy (PST) is an original therapeutic approach integrating elements of the Lazarus stress model and of the cognitive and behaviour therapies emphasizing the social context of psychopathology. In this approach, the resolution of problems plays a mediator role as a coping strategy for an individual in interaction with his environment, with stressing life events, with his emotional arousal and with his physical and psychological wellbeing. The article indicates the main characteristics of the Problem Solving Therapy model and of its link to an interaction stress model in which: “problem solving” is defined as a cognitive and behavioural self-focused process with which a person seeks identification or discovery of adaptive solutions to specific problems to which he is confronted in everyday life; the “problem”, defined as a situation in which an adaptive response or behaviour is needed to maintain an optimal functioning, and the patient does not have this response immediately; the “solution”, defined as the response given to cope with the situation and which corresponds to the solving problem process. A detailed description of the two underlying solving problem processes is also made. The problem orientation, the set of immediate cognitive and emotional responses of an individual when confronted to a problem and the solving itself, that is to say the application of four techniques, each of them having a specific objective in the process. These techniques can be perceived as a behavioural chain in which the “definition and formulation of the problem”, the “generating of alternative solutions”, the “decision making” and finally, the “implementation and the verification of the selected solution” take part. The last part of this article deals with the practical interest of PST with several examples of clinical applications and results in the field of psychopathology. Anxiety disorders (panic disorder, agoraphobia, post-traumatic stress disorder and social phobia), mood disorders (major depressive episodes, suicidal ideation), psychotic disorders, addiction disorders (alcohol dependence) and somatic disorders (handicap, chronic pain, cancer) are put forward. This literature review finally brings to the fore the diversity of the populations who could benefit from the PST (adolescents, students, adults, elderly persons, mentally disordered offenders, nurses, caregivers) and encourages an extension of its application.