How to Use Want Can Must for Conflict Mediation
How can clinicians apply the want/can/must CBT strategy to mediate interpersonal conflict in therapy?
Patients commonly bring conflict into therapy, but standard problem-solving does not adequately address situations involving competing values, expectations, and perspectives across 2 or more people. This guide applies to adults with conflict-related distress similar to the study sample and outlines the structured CBT process used to help patients gather information, communicate more empathically and assertively, and choose lower-harm actions.
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Confirm fit for the intervention
Use this strategy with adult patients aged 18 to 60 years who are experiencing a conflict situation. In the study, eligible participants either had no DSM-5 disorder or had mood disorders without psychotic symptoms, anxiety disorders, or stress-related disorders; they also had never undergone CBT and were not receiving other psychotherapy during participation. People with intellectual disabilities, schizophrenia, personality disorders, and habit and impulse disorders were excluded.
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Assess diagnosis and baseline symptom burden
Conduct a diagnostic assessment with the SCID-5 before starting the intervention. In the first session, administer the BDI-II, BAI, and PSS-10 to document depressive symptoms, anxiety symptoms, and perceived stress. This establishes baseline distress before the conflict-mediation phase begins.
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Use 3 sessions to build alliance and conceptualize the case
Before applying WCM, spend 3 sessions evaluating the patient, developing a case conceptualization, and establishing a good therapeutic relationship. In the first session, use open-ended questions and active listening to create a safe environment and gather detailed information about thoughts, feelings, and behaviors; the downward arrow technique can be used to identify deeper-rooted beliefs. In the second session, review identified anxious, depressive, and excessive stress symptoms and introduce a cognitive conceptualization diagram linking core beliefs, thoughts, emotions, and behaviors. In the third session, focus on the current conflict, including when and how it started, who is involved, the relationship history, communication skills, empathic connection, and personal values.
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Clarify the conflict context
Before beginning the WCM questions, define the conflict using four prompts: What is happening, since when, who is involved, and what damage the conflict has caused, is causing, or will cause. This organizes the situation as a shared conflict rather than only an individual problem. It also prepares the patient to examine both their own perspective and the other party's perspective.
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Ask the patient what they want can and must do
In Step 1, ask the patient three questions: What do I want to do, what can I do, and what must I do. Help the patient examine whether their desires are minimally compatible with reality and with the desires of the other people involved, whether real-world limits or restrictions make an option unfeasible, and which beliefs may be activated. Specifically look for all-or-nothing thoughts using words such as always, never, nothing, everything, and every time, as well as accusatory or recriminative statements such as I have to, I must, and I should; also identify values the patient sees as nonnegotiable.
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Add tailored CBT strategies during Step 1
Based on the patient's profile and context, use complementary strategies during this first stage to support reflection and reduce distress. The article identifies cognitive restructuring, psychological acceptance, defusion, impulse control, and activation of compassion and self-compassion as options that may be used here. The choice should depend on the individual patient and conflict context.
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Have the patient communicate with the other party and map their perspective
In Step 2, after communication with the other party, ask three parallel questions: What does the other person think that they want, what do they think they can do, and what do they believe they must do. Then help the patient consider whether the other person's wishes are minimally compatible with reality and with others' wishes, whether real-world restrictions make alternatives unfeasible, what beliefs may be activated, and which values the other person is unwilling to negotiate. Listen for the same absolutist language markers in the other person's position, including always, never, nothing, everything, and every time.
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Train empathy mindfulness and assertive communication as needed
During Step 2, add clinical practices as needed to improve the patient's ability to engage the other party constructively. The article describes psychoeducation on empathy, training to enhance empathic connection, mindfulness in social interactions, assertive communication training, and interventions that support psychological acceptance and compassion. Most patients in the study needed social skills training to speak with the other person and better understand what that person wanted, could do, and believed should be done.
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Choose actions aimed at minimizing harm
In Step 3, guide the patient to choose and implement actions after both perspectives have been examined. The intended direction is toward greater empathic connection, more assertive communication, and psychological acceptance of what is and is not controllable, so that the selected action is intended to minimize harm to all involved. Patients should also be prepared to accept that there may be no perfect solution and that some discomfort or harm to one or both parties may be unavoidable.
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Monitor consequences and acknowledge each party's efforts
After action is taken, monitor consequences over the remaining sessions. In this final phase, both parties should acknowledge efforts to understand the conflict from the other person's perspective, communicate intentions and expectations about actions and outcomes, and accept that any unavoidable harm may be mitigated over time. In the study protocol, 5 sessions were sufficient to apply WCM, although the authors note that conflicts requiring longer time management may need additional sessions.
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Reassess outcomes after the final session
After the last session, reassess symptoms using the same preintervention measures to compare baseline and posttreatment status. In this study, perceived stress decreased significantly, while mean depression and anxiety scores did not significantly change, likely because those symptoms were low on average at baseline. Participants also reported no adverse effects, discomfort, or worsening on the authors' effectiveness questionnaire.
Clinical Considerations
- This study had no control group, so the guide reflects a feasible structured intervention rather than a protocol compared against another active treatment.
- The findings come from a selective sample of adults aged 18 to 60 years who were CBT-naive and not receiving concurrent psychotherapy.
- Patients with schizophrenia, personality disorders, intellectual disabilities, and habit and impulse disorders were excluded, so applicability to these groups is uncertain.
- The clearest measured benefit was reduced perceived stress; mean depression and anxiety scores did not significantly change in this sample, which had low baseline symptom levels on average.
Bottom Line
Use WCM as a structured CBT process that first clarifies the patient's own wants, limits, and obligations, then the other party's perspective, and finally guides lower-harm action with psychological acceptance, empathy, and assertive communication.
