Even though PST is flexible and helpful for many people, it’s not the best fit for everyone.
- People with severe major depression (with psychotic features)
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- PST alone won’t be enough if someone has delusions, hallucinations, or is strongly impaired by their depression.
- They usually need medication and/or intensive psychiatric care before or alongside any structured therapy.
- For instance, someone believing they’re being punished by invisible forces wouldn’t benefit from a goal-setting session right away.
- Individuals with severe cognitive impairments
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- PST requires the ability to think logically, analyze options, and make decisions.
- Conditions like advanced dementia, intellectual disability, or severe brain injury might make the problem-solving steps too difficult without major adaptations.
- People with acute suicidal risk
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- PST tries to solve day-to-day problems, but if someone is actively suicidal, safety planning and crisis intervention must come first.
- PST can still be added later once the immediate danger has passed.
- Those with severe trauma or PTSD (without trauma-focused therapy)
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- Trauma survivors regularly need therapies that specifically target trauma memories (like EMDR, prolonged exposure, or trauma-focused CBT).
- PST might help later on to rebuild life skills, but it won’t directly deal with trauma symptoms like flashbacks or emotional numbness.
- Highly unmotivated or resistant clients
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- PST needs at least a small willingness to engage in brainstorming and trying new steps.
- If someone feels completely hopeless, refuses to participate, or deeply resists change, it can block progress.
It should still be noted that motivation can sometimes be built.
Therapists often start very small, but if there’s zero engagement, PST isn’t the right starting point.
- People seeking deep emotional insight
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- If someone’s primary goal is emotional exploration (like uncovering childhood wounds or unconscious patterns), they might find PST too practical and structured.
- Therapies like psychodynamic therapy or emotion-focused therapy would be a better fit for that purpose.
