#collaborative problem solving

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Shifting from Thinking Alone to Systems Thinking for the Good of All

We need to eradicate stigma from the psychiatrist’s office. One way to do this would be to drop diagnoses which already carry too much stigma. We could consider these diagnoses not fit for purpose. For example, a diagnosis I do not have is Borderline Personality Disorder which has recently been changed to Emotionally Unstable Personality Disorder. There has been much criticism of the name of this disorder with many individuals voicing their discomfort with the label ‘Personality Disorder.’ A fellow student at my undergrad institution conducted a study which found psychiatrists were much more sympathetic when the same patients had a diagnosis of PTSD than when they held a diagnosis of BPD. Yet we know that the vast majority of people with a BPD diagnosis have a history of trauma. Because “dissociation” is poorly understood in society professionals frequently stigmatise individuals with trauma histories and still hold unacceptable prejudices such as that people with BPD are manipulative and vengeful, when there is no basis at all to these accusations. People with the label BPD are empathetic individuals who have PTSD. Why do we not then give them a more validating diagnosis like that one? Since all their pain and difficulty in life stems from trauma. People with BPD are never manipulative or vengeful. They believe their reality at the time and often isolate themselves from people they find difficult or painful. We cannot give these people, often with complex PTSD, meaningful treatment until we admit that the diagnosis Emotional Unstable Personality Disorder carries too much stigma to be acceptable to the APA, and therefore should not appear in the DSM. It is also a misunderstanding of the difficulties people with trauma experience. It is clear that trauma should be central to any diagnosis given to these people. But I also believe that diagnosis should be a consensual act and that service users should be able to be part of the discussion before a diagnosis is decided upon.

I want to continue with this argument, that psychiatry and the medical profession should be about alleviating pain and not adding to pain or imposing its own reality upon individuals. This is not an easy argument to make. But I fully believe it is the direction of a more progressive society which makes service users high status and collaborative partners in their treatment. Intervoice petitioned decision makers to consider changing the diagnoses related to voice hearing such as Schizophrenia and Schizoaffective Disorder. They also wrote an open letter to the English mental health charity Rethink questioning the validity of the diagnosis Schizophrenia and asking them to reconsider the language of their advocacy. This was a very brave act. I agree with them. I think we should reconceptualise voice hearing and how we respond to people who hear voices or those having other experiences. If we made the diagnoses more validating and more accurate we would realise that people who have these experiences are normal people. This would be a first step in raising the status of people who experience psychosis or voice hearing or other experiences. It is important therefore that diagnosis is not imposed upon an individual but emerges as part of a discussion between the individual and psychiatry. 

People who hear voices or who have other experiences are normal people. There is always a reason why they believe the things they do. That reason may be organic but it is not irrational. They are having a rich and complex experience. The idea that they are strange or irrational is from the dark ages. Anyone who has experienced psychosis could, if empowered, enlighten society about this. Just like people who have BPD always have a reason for their emotions and their reactions, people with psychosis have good reason to believe the things they experience. It is their experience after all. Society must realise these people are normal and not stigmatise them. The existing labels for psychosis all stigmatise because they refer to “unusual beliefs.” But that is the wrong way around. They are often unusual experiences and understandable reactions and beliefs. It will take a lot of research to change this way of seeing psychosis but it must change in the future.

We live in a time of ‘wokeness.’ What is being ‘woke’ about? It is about many things but mainly allowing marginalised people to assume their own identities and choose their own labels. It is important that in the future people with mental health difficulties choose their own labels and that diagnosis is a consensual act. We need research (but we need a wholly different kind of research that works with and not against service users). Individuals have important insights and we must not lose sight of this. Service users should work with the APA to conceive of validating diagnoses that are therapeutic, that heal rather than harm. And if an individual does not want a diagnosis that should be respected too. Some people might not want to be diagnosed with Autism for example. That should be respected. I know this is radical thinking but I know it is the direction of the future. Professionals can draw ideas from research but they need to act reflexively to the needs of the service user who is not the enemy but an empathic and wise person. Let them define who they are and then develop the tools to help them achieve their recovery. If you can do this you can help them heal.

What would that look like? What would happen if we did that?

Ideas:

Sometimes I feel gaslit by the system. We need to realise that service users are always right about their feelings, their experience, and what they say they can and cannot do.

Dismantle the hierachy. Be human with service users. Find out what their hopes, dreams, aspirations are. Have high expectations. Use the full hour to find out about the individual in front of you.

Let service users make decisions about their own psychological treatment and decide on the right therapy together. I have found group therapy and targeted therapy lacking. We need therapy that is for individuals.

Feedback should be a part of the culture. Make sure individuals are able to give feedback all the time and that the NHS receives this feedback and that it translates into research and policy.

Always find the most validating solution. Give service user’s dignity. Remember that people who suffer are always empathetic. So if you find something difficult about a service user reframe that situation in your mind. Have empathy with that person and figure out the root cause which will lead you to the underlying truth. You can validate service users. Remember “Be kind whenever possible. It is always possible.”

Be collaborative and not punitive or authoritarian.

A combined team of neuroscientists from the University of Washington and Carnegie Mellon University have successfully demonstrated a device that connects participants’ brains, enabling them to share their thoughts and cooperate while playing a Tetris-style video game together.

This three-person brain network called ‘BrainNet’ works by combining electroencephalography (EEG) and transcranial…

Hi there @schoolp3

I think that would depend on how you and I define behaviourism and whether the practices you’ve studied, used or observed incorporated an element of behaviour analysis.  Unfortunately I see a lot of bad practice done in the name of behaviour management, behaviour modification that gets lumped as ‘behaviourist’.  It is recipe style problem solving and a misapplication of behaviour change interventions.  It is those practices that Greene cites and objects too. I do as well.   

If you read through my blog and were to get to know my work with students you might see that I am quite flexible, collaborative and inter-disciplinary. I listen to other’s explanations and approaches. I ask questions. I do not shut down other professional’s ideas as if behaviourism, behaviour analysis is better. I use my training and experience in behaviour analysis to recognize when an active component of an approach is aligned with behaviour analytic concepts and theories. I challenge people to recognize their bias and misinformation about behaviourism and at times offer another explanation. Despite Greene’s desire to be as far away from behaviourist approaches, he fails to recognize (or chooses to ignore) that some of what he is preaching is behaviour analytic in nature - which is what behaviourism is supposed to be, i.e., it’s not behaviour charts, stickers, time-out rooms etc.  

I am a behaviour analyst who also practices Collaborative Problem Solving (You can read why here).  Everyday I work at defying an assumption that all I do is create behaviour management systems - armed with charts, stickers and a naughty chair. When I’m invited to the table, I can see the doubt and skepticism from a teacher or other professional who has, “Been there done that”.  Yes, you’ve been there and upon further information gathering and analysis we may come to see that what was done was not a good match for what we were trying to achieve. I look for context and function, then match intervention to that.  I recognize when there is a skill deficit and try to strike a match to the student’s motivation to do well with an environment that is ready to feed that motivation. There are no “bad” kids, just “bad” (i.e., dysfunctional) behaviour management practices.

Related posts:

Behaviourist does’t have to mean punishing and shaming

Behaviour charts in the classroom - probably not a good match for the students you think it’ll help