Frequently Asked Questions

The want/can/must (WCM) strategy is a structured CBT-based approach for mediating interpersonal conflict rather than simply solving an individual problem. It is designed to help therapists and patients collect, organize, and share information; clarify what each person wants, can do, and believes they must do; reduce distress during decision-making; and choose actions intended to minimize harm to all parties involved.

In this study, a problem was defined as a difficult-to-solve situation affecting some aspect of an individual's life, whereas a conflict was defined as a disagreement or divergence of ideas, values, and expectations involving 2 or more parties. This distinction matters because the authors argue that standard problem-solving techniques focus on rational logic and one person's perspective and may not be sufficient for conflict situations.

The intervention was delivered after 3 initial sessions used for assessment, case conceptualization, and therapeutic alliance building, followed by 5 sessions of the WCM strategy. Therapists were certified CBT specialists with more than 5 years of clinical experience and received 4 hours of training on how to apply the strategy.

1. First, the therapist helps the patient understand the conflict context by identifying what is happening, how long it has been happening, who is involved, and what harm has occurred or may occur.
2. Step 1 asks the patient 3 questions: What do I want to do? What can I do? What must I do?
3. Step 2 asks parallel questions about the other party after communication with them: What does the other person think they want, can do, and must do?
4. Step 3 focuses on choosing and implementing actions, then monitoring consequences, with the goal of more empathic connection, more assertive communication, greater psychological acceptance, and decisions that cause the least possible harm.

The study included adults aged 18 to 60 years who were experiencing a conflict situation. Participants could have no DSM-5 diagnosis or could meet diagnostic criteria for mood disorders without psychotic symptoms, anxiety disorders, or stress-related disorders, but they had to be CBT-naive and not receiving other psychotherapy during the study.

The study excluded people with intellectual disabilities, schizophrenia, personality disorders, and habit and impulse disorders. The authors reported that 32 subjects were evaluated and 2 were excluded: one woman with borderline personality disorder and one man with substance abuse and paranoid personality disorder.

No significant pre-post difference was found in mean depression or anxiety scores after the intervention. The authors noted that baseline depression and anxiety levels were low on average, with most participants at subclinical levels, which may have made a significant reduction less likely.

Yes. The study found a statistically significant reduction in perceived stress scores after the intervention, using the Perceived Stress Scale and a paired t test with significance defined as P ≤ .05. The authors interpreted this as suggesting that the intervention helped participants cope with internal and external stressors related to conflict.

At the initial assessment, 6 participants had mild depression and 7 had mild anxiety. At the final assessment, only 2 participants had mild depression scores and 2 participants had mild anxiety scores.

No. When participants were asked on the authors' effectiveness questionnaire whether they noticed any adverse effects, discomfort, or worsening of their condition, all responded that there were none.

The authors describe tailoring additional CBT-based techniques to the patient's profile and conflict context. These included cognitive restructuring, psychological acceptance, defusion, impulse control, compassion and self-compassion work, psychoeducation on empathy, training to improve empathic connection, mindfulness in social interactions, and assertive communication or broader social skills training.

The authors argue that problem-solving techniques focus mainly on rational logic and an individual's perspective to repair or reduce harm, whereas conflict involves disagreement between 2 or more parties with competing values, expectations, and beliefs. They state that CBT literature and guidebooks do not provide a specific strategy for mediating conflict, which is why they developed WCM as a more explicit framework for addressing both sides of a conflict.

According to the authors, participants reported that the strategy helped them better understand the variables present in the conflict, identify ways to gather more information, share information about the conflict with the therapist or the people involved, accept that there would be no perfect solution, and make decisions intended to cause as little harm as possible.

The study was an experimental study without a control group, and the authors acknowledge that they would have liked to include one. The sample was also selective: depression and anxiety were low on average at baseline, and patients with personality disorders, schizophrenia, intellectual disabilities, and habit and impulse disorders were excluded, which limits how broadly the findings can be generalized.

The findings suggest that WCM may be a useful structured tool when conflict is a major source of distress in psychotherapy. In this study, it was feasible, was well evaluated by participants, and was associated with reduced perceived stress over 5 treatment sessions, while also helping therapists organize information, promote empathy and assertiveness, and support decisions aimed at minimizing harm.