Guiding Parents Through Decision Making During the COVID 19 Pandemic

Guiding Parents Through Decision Making During the COVID 19 Pandemic

Learn how to guide parents through decision-making during the pandemic

In this video, Erika Hulse and Lindsy Koroly introduce a decision-making process worksheet to help parents make the right decisions. Before using this tool, the speakers emphasize the importance of building empathy with the client. 

The therapist should then address the potential resistance of clients by understanding why they are reluctant to change and ensuring they are motivated to engage in decision-making. This step involves inviting the client to work on the problem. This simply means empathizing with the client to make them feel better and guiding them towards measurable change.

Once these elements are in place, therapists can introduce the decision-making form as a CBT method. The therapist and client identify all available options and narrow them down to two competing choices. With the help of a shared document, the therapist guides the client in listing the advantages and disadvantages of each option. The client is further encouraged to weigh the importance of each point, highlighting those that are of the most importance.

After a complete listing, a scoring system helps analyze the pros and cons of each option. This analysis may reveal a clear choice, a win-win scenario or a lose-lose situation. In a win-win situation, either option is beneficial, and in a lose-lose situation, both options have drawbacks. If it's a lose-lose situation, the process is implemented again based on other options or by examining the listed points.

Throughout the webinar, emphasis is put on agenda setting. This ensures that the session remains focused on the client's stated goals.

This webinar emphasizes the worksheet as a guide to consider all options thoughtfully. Watch the entire webinar to understand how to guide parents in optimizing decision-making during the pandemic.

IN THIS VIDEO:
 

Jill Levitt: With Lindsy Koroly and Erika Hulse from the Feeling Good Institute. So I'm just going to start with a couple of little housekeeping details and then we'll get to the good content of today's presentation. Throughout the presentation if you have questions that you want to submit to the presenters use the Q&A box. So you'll notice that there's a chat box and there's also a Q&A box and the chat box is closed so submit any questions that you have about the presentation through the Q&A box and I'll answer some of your questions during the presentation and we'll also hold some of the longer presentations for a 10-minute Q&A toward the end. And know that not all of your questions will be answered today so if you end up having any burning questions that we don't answer at the end of the presentation you'll have access to the presenter's email addresses and you can always follow up with us via email or take another training with us to learn more. The other housekeeping thing is that many of you are attending and planning to get continuing education credit. Please know that you do need to attend the whole webinar in order to get CE credit. The attendance is taken electronically and automatically if you're here for 50 minutes or more but not less than 50 minutes you'll receive the survey that you need to complete via email. So that survey will come to you within a day or two of this presentation. You have to complete the survey and then you'll be emailed the certificate of completion. So I'll just start briefly by telling you a little bit about Feeling Good Institute and introducing the presenters and then I'll turn it over to them. So Feeling Good Institute, we are leaders in the advancement of effective therapy. We train and certify therapists in advanced cognitive behavioral therapy which is called TEAM-CBT. We have treatment centers in New York City, in Silicon Valley, in Canada, and in Israel. And we also have video therapy available across the United States, Canada, and Israel. We also have an ongoing cognitive therapy or TEAM-CBT research program. And so your presenters today are Lindsy Koroly and Erika Hulse and I'm the director of training at Feeling Good Institute and I'll be facilitating the Q&A part of the presentation. Let me just tell you a little bit about your presenters. So Lindsy is a psychologist and level three TEAM certified clinician. She works with individuals experiencing challenges including anxiety, depression, obsessive-compulsive disorder, low self-esteem, life transitions, and relationship difficulties at Feeling Good Institute in New York City. Erika Hulse is the coordinator of the adolescent intensive therapy program at the Feeling Good Institute. She's a level three TEAM certified therapist and she provides therapy for anxiety, depression, and relationship concerns for families and individuals of all ages using cognitive behavioral therapy at the Feeling Good Institute in Mountain View. And now we'll turn the presentation over to Lindsy and Erika.

Lindsy Koroly: Hi everyone, thank you for joining us today and we're excited to present on guiding parents through decision making during this pandemic. So just to go over the learning objectives that we're aiming for today, we're going to teach you to identify situations in which you would utilize a simplified decision-making form with your clients and then we're going to discuss how to implement using the simplified decision making form when working with parents. And so I'm just going to give a quick overview of TEAM-CBT for those who aren't familiar. And so TEAM is a structure or roadmap for providing therapy that was developed by author and psychiatrist Dr. David Burns. And TEAM is an acronym and so it kind of walks us through the steps of providing therapy. And the T in TEAM stands for testing and so we put a lot of emphasis on measuring clients' symptom presentation and progress from session to session. And so at FGI we use Dr. Burns's brief mood survey and we have clients fill this out at the beginning and end of every session so that we can really track how they're feeling from beginning to end of each session and from one week to another to assess for is there any improvement, is there any reduction in negative feelings, what's working, what's not working, and so on. On this measure we're asking them about symptoms like depression, anxiety, anger, frustration, positive feelings, relationship satisfaction, and we also have clients fill out an evaluation of therapy form after each session. And so this is an opportunity for them to comment on whether they feel like the session was helpful, whether they felt fully empathized with and supported, what did they not like about the session. And so that also serves as an empathy-building tool for us to open up a conversation with clients about what's working and what may not be working, what needs to be shifted. And so that's in the service of ensuring there's a solid therapeutic relationship and that leads us into empathy. And so you know it sort of goes without saying in therapy that empathy is super important but on in TEAM we have teachable empathy skills that we use ourselves as therapists and that we also might teach to our clients who are wanting to improve a relationship or work on their communication skills. And so we really stress the importance of having this solid foundation before moving into getting into CBT work with clients. We feel that unless the therapeutic relationship is solid and the client feels fully empathized with and understood then the methods are not going to be effective. And so we are pretty direct in asking clients are they feeling empathized with and understood and is this at 100 which they have an opportunity to communicate to us through testing in their evaluation of therapy form that they fill out. And so once the empathy is where we want it to be then we move to assessment of resistance or agenda setting. And so in this step we're really looking in a really thoughtful way at what are some of the reasons that the client might not want to change or some what are some of the good reasons to hold on to some of their negative symptoms. And this is a really important step because it can serve as motivation in a paradoxical way for the client to take the side of wanting to argue for change. And it's something that a lot of people probably haven't thought about you know they might assume well of course I wouldn't want to feel anxious of course I wouldn't want to feel depressed when you start to explore some of the ways in which those symptoms are serving you then they can really make an informed decision about to what degree they might want those things to change. And then finally that brings us to the M which stands for methods. And so those are traditional TEAM CBT methods and different methods that we have incorporated and that David Burns has developed within this model. And there's really a place for all different types of interventions under the M. And so today in our presentation we're going to be talking about the simplified decision making form. And so that's an example of a TEAM-CBT method so it would fall under the M.

Erika Hulse: Okay so let's get to decision making in a pandemic world. So I know I can speak for myself when having to make decisions as a parent or having to help parents through decisions as a therapist there are times when all the decisions feel bad when you kind of look through your decisions and it seems like okay there's nothing here that works. And so we have this little graphic up here for you to look at. This is just grabbed off of social media this is the kind of thing you see when people are feeling overwhelmed when their emotions are high and they have to make some decisions. And so we're specifically thinking about school decisions and so this one is is kind of funny it's like here are the options on the back to school parents survey: remote school, in person school, every other week, hybrid school, every fourth Tuesday hybrid robot school and you see it's getting more and more intense and then she's just giving up right find a family of friendly wolves who will teach the children survival skills twice a week and then just hope for the best. So that's kind of how we're feeling emotionally in this situation. So what do we do as therapists when people are bringing this to us? What we really want is a procedure something for us to be able to fall back on so we also don't get sucked into feeling like all the choices are bad and there's nothing good to do. So we're going to talk about a case example to help illustrate how this can go in real life for specifically making a decision around what to do with school when the choices are hard. So we're going to talk today about a 37 year old Asian American mother of two children and her kids are ages five and seven and she is really struggling around how to do their schooling right now in light of the pandemic. Both she and her husband are working full-time from home online so they have a lot of responsibilities throughout the day meetings and things they need to accomplish and then they're also trying to support their kids in doing school. So something she observed in the spring when her kids came home from virtual school is her younger child is not doing well independently on the computer at this point. That child is hiding from the video camera getting out of the view and then she's running and hiding when she they even say it's time to get on a meeting. And this mom is really concerned that her child is so young and losing her love for learning like really not being interested even at the mention of it. And then her older child her seven-year-old does have some respiratory issues so she's really concerned about exposure to the virus. And then this child can get on the computer but wants a lot of help kind of doesn't know how to type doesn't know how to navigate between different applications on the computer and so is asking for parental help all the time all the time when on the computer. So it's a really hard situation for this family. And so if this is brought to therapy how do we do what do we do how do we help them get through this? So the situation we're currently looking at is school has started and here we are. Mom is observing the kids aren't happy the kids aren't happy having to do this on their own and she's having second thoughts about is this computer school working for them and she's thinking about their mental health and their relationship to education and then her own feelings her own feelings of guilt and her own feelings of anxiety. So you can see from this picture the kid's not in the screen is just having a hard time. So what this mom is recognizing is other parents are struggling with this too and some people that she knows they're actually pulling their kids out of the online-only option from the public school. They're deciding it doesn't work for them and that feels super overwhelming to her but she's not sure what to do in this situation where her kids seem unhappy she's stressed with work what does she do? And so she schedules an appointment with her therapist.

Lindy Koroly: And so in orienting this case example to the TEAM model before jumping into decision making with this client. Right, Erica's made it clear that this client is struggling with making decisions surrounding her children's schooling. But before we offer her the opportunity to use a decision-making tool, we have to make sure that we've sort of covered the other foundations of TEAM. So again, we want to make sure we've done testing right, so we are assessing her mood symptoms, how is she presenting in terms of her anxiety level, depression, other areas of challenge. And we also want to make sure that we provide her with empathy prior to getting to work. And so this is just something to illustrate that no one's alone in this situation right? And so it's so important we can't stress enough how valuable it is in and of itself to provide our clients with empathy because every parent right now is struggling with this who has children and is in school and is struggling with this situation of no option looking like a good one and it's super stressful, super frustrating, super confusing and we want to make sure that they feel this is understandable that they're feeling this way, it's normal that they're feeling this way in this situation and that we really understand and that they're not alone. Following the empathy phase then we move to the assessment of resistance. And part of assessing a client's resistance is making sure that they're actually ready to get to work. And so in order to do this what we want to do is we want to offer them what we call an invitation to get to work on the problem that they're bringing to us. And it's really important that we communicate to our clients the difference between feeling better and getting better. And so empathy can make you feel much better in the moment right? You might feel some relief after a therapy session you might feel super understood or supported but it's actually not sufficient for measurable change in in what a client might be wanting to see. And so we have to communicate to our clients that there is a difference between just providing empathy and support in therapy and actually providing skills that can help someone make decisions or changes in their life that they're wanting to make. And so in this step of offering the client in invitation what we're asking them is how am I doing on empathy? Are you feeling fully understood? Is now a good time to get to work on this or does it feel like we might need to just spend some more time talking about what's going on and and me providing you with support? And so we really want to make sure that we're assessing whether the client is actually asking us for help with their just the decision that they're struggling with. And you know I as a therapist have definitely experienced pressure right when a client is coming to me with this really challenging decision or something that's really stressful for them I feel this pull to want to help and jump in and offer advice and offer a solution but it's so important not to rush to that before before we've offered them empathy and unless we've really gotten from them that they're actually wanting help with the decision rather than just wanting support in how difficult it is. And so Erika and I are going to do a little role play now. I'm going to play the therapist and so I'll illustrate offering an invitation to Erika as the client and then she's going to respond. And so Erika you know you've told me how challenging and and difficult it's been in navigating this decision of what will be best for your children's school and I know how hard that's been for you and I wonder if now feels like it would be a good time to really get to work and making a decision or whether it feels like we might need to spend some more time just talking about it.

Erika Hulse: Yeah I just I don't know what to do it's so concerning anxiety provoking and frustrating just to see my child struggle.

Lindsy Koroly: And so we want to bring all all of our our viewers and participants into this and actually run a little poll asking is this client ready to get to work and make a decision based on how she's responded? So we invite you now to kind of pick what you think if it's yes no or you're not sure. And we'll just give a few moments for everybody to respond and then we'll see what most people think in terms of whether this client's ready to get to work based on how they've responded. Maybe take a couple more seconds and have everyone get a chance to to cast their answer and if it feels like most people have responded Suzanne we can check out the results. So an overwhelming 77 said no the client isn't ready to get to work and we agree with you that's definitely what we would say in TEAM that based on this client's response it's not so clear to me that she's accepted the invitation that she's ready to jump in and get to work and make a decision. And so what we would do in this case is we would continue to provide empathy. So I might then respond to this using you know empathy skills and saying you know yeah it makes so much sense that you would feel this concerned and anxious and frustrated. I know how good of a mother you are and how hard working you are and how important it is for you to see your children do well and and make sure that they're feeling their best and so it just must be so hard to see them struggle. Can you tell me a little bit more about what that's like for you? And then following that the conversation would continue and maybe a few moments down the line I might offer another invitation to get to work depending on how it's going. And so we're going to illustrate one more role-play of another possible way a client might respond when I offer the invitation. And so again I'll play the therapist and Erika will be the client and I'll say something like Erika you've told me a bit about how frustrating and challenging it's been in in making these decisions surrounding your children's schooling and man it sounds so tough and I wonder if if now might be a good time for us to to get to work in making a decision what do you think?

Erica Hulse: Yeah I really would like help to make a decision about whether I should switch from virtual schooling and do another option.

Lindsy Koroly: And so we're going to open it up to everyone again based on this response what would you say do you think the client is ready to get to work and make a decision would you say yes no or you're not sure? Again just take a couple more moments for everybody to have a chance to respond and think about it. And so 87 said yes and again we would agree based in based on this response in in TEAM-CBT we would think yeah you know the client has made it clear that they are ready to move forward into getting to work on this. And so I might say something like that's great I'm excited to work together and coming to a decision and I actually have this really cool tool called the decision-making form that we can use and I'd love to introduce it to you. So for the purposes of this case presentation I do want to make clear that there are a couple of assumptions that we're making in order to get to the step of the decision making form. And so in the invitation that I just offered the client I'm assuming that we only have two options as therapists that we can offer. We can either offer them empathy or we can offer this decision-making form tool. But it is important to keep in mind that the reality is that there are several things that we could really be offering them in this situation. So for example perhaps the client might not actually want to make a decision but she might want some support in reducing her negative feelings surrounding the situation. So she might want to you know stay in this phase of not deciding but she might want to feel less guilty about it less anxious about it. And so these are all things that we could potentially offer her. But for the sake of simplicity in this case were we in the invitation only offered to get to work using the decision-making tool. We just wanted to point this out because as therapists it is really important for us to think through what it what are all the things that I can offer to my client. And then once I know that then I can really present them to the client and let them make an informed decision about which would be most helpful or effective for them. And the other major assumption that we're making is that we fully addressed the client's resistance. And so we are assuming that the client's motivation to go ahead and make a decision outweighs the good reasons not to make a decision. And in our work with this client before jumping in and showing them this tool we would really want to talk this through with them. We would paradoxically want them to start thinking about well what are some of the reasons why it might not make sense to make a decision or however how is sort of not making a decision serving me in some way? And so that's a step that we would want to take to make sure that we're fully convinced that the client actually wants to use this tool in order for it to be most effective. But so we're assuming in this case that our client is motivated and they do want to use the tool and so we will go go ahead and Erika will introduce what this form is all about.

Erica Hulse: Yeah so this is what we're calling a simplified decision making form and the reason we've moved to this is there is actually an awesome decision-making form that's in David Burns' toolkit which we definitely encourage everyone to purchase to have access to all these amazing tools and what this is in response to moving things to onto telehealth and having to respond to not having all of our worksheets there in our offices which we can just pass to our clients so this is a simplified decision making form which we would just be using in terms decision-making of creating a shared document with our clients. So what we do in this age of telehealth and the pandemic making us have to rethink things and do things in a simplified way is we can ask our clients to open a Google Sheet which is a free thing you can do with a Google account and then they are just going to use the columns to to make this form. What we're going to do here is then ask them to share the form with us and then we can on our screens we can be looking at the form and they're looking at the form and we can actually edit it at the same time. So what it does is it gives us a chance to go through decision making with them both as we're talking on screen as and as we're writing as we're typing into the document. So what it's doing is it's teaching them a procedure for being able to make decisions and this is the kind of thing that we've done in light of the pandemic kind of how can we still teach a good procedure for making decisions. So we're going to go through the simplified decision making form and show what all the elements are to it.

Lindsy Koroly: So in this step you're going to want to help the client identify all the possible choices that they're experiencing that they have available to them and so in this case in terms of the schooling options and then you're going to write them down in list form and you really want to encourage the client to kind of think through every possible option even if it might be something they don't think they would consider and you want to have it out there in front of them written down.

Erica Hulse: Yeah I'm just saying that this is kind of something we would do before we get to the actual form right this is us just as therapists trying to open them up to see different options because when all the options feel bad things seem to seem constrict get constricted so what we want to do is just try and say well let's look at this from all the perspectives there are no bad ideas here what are all the choices things actionable things that we could do to try and change the situation. So thinking back to our case example of the family here are some choices that we came up with that we could potentially do and we actually have more choices than this but this is just a sampling. So the first choice here is this mom could get up earlier to do her work right? She could start work at 5 am and the kids don't start school until 8:30 and then when the kids start school she could help the kids during the day because she has got a head start on her work she's not always being pulled. A second choice is she could actually hire someone hire someone to come into the house during the day when they're doing this public virtual school and that person can sit and help the kids with their schoolwork so mom can be in her own meetings and get her work done. Another choice is she's looking at there's some smaller private school in the area that is able to do in-person schooling so the kids could go to school and she could get her work done without them being at home and meeting her. Another choice we came up with is kind of this public online school is brand new the district is just struggling with this but there are other virtual schools that have been around longer and they kind of know the game maybe those would be better schools for her kids and so she has this option of enrolling in one of these seasoned virtual schools as maybe a better option than a school that is brand new for them. Another thing that she you know we can come up with is she could say you know what I don't need to follow the public school schedule at all I could pull the kids out um homeschool them on nights and weekends then it doesn't conflict with my work and that might that might be an option they could still be learning but it wouldn't be such a time um conflict. Another one is you know get together with some other families they're calling this pod schooling right? So these are these families maybe each family would have a group of kids in their house every day and so then those parents would be in charge that day but it would only be one or two days a week when they'd be helping with school and they'd have the other days uh to to get their work done uninterrupted. And then this last one I think is kind of funny because once we've kind of opened up to lots of possibilities lots of things can come out. So this other one is saying well maybe we need to move in with the grandparents for a little bit and let the grandparents help with the kids so we can get our work done. And so as we kind of make it okay to think of different options even this step in and of itself can be freeing not to feel like I only have two options and they're bad options like let's let's keep opening it up and see where we go. So this is an important first step of the process before we even start the decision making form.

Lindsy Koroly: Absolutely and and so once the client and therapist have all of the available options listed then we do want to hone in on two competing choices. And we don't want to put too much pressure on sort of picking the right two choices because we we can always go back and and plug other things into the form but we do want them to kind of take a step back look at all of the options that they've outlined and then think okay which of these two do I want to sort of compare and measure up to each other and see which which option might win out in terms of advantages and disadvantages. And so in this case example she narrowed it down to the option of either hiring child's care to help in the home during the day or homeschooling children on a schedule that doesn't conflict with work obligations. And so the therapist and client would have their shared spreadsheet open right at the same time in teletherapy and so you would type those two options into the table so both option one and option two. And then once you have those in there then we start to look at what are the pros and cons to each option. And so we want to encourage the client to focus on one column at a time and so for example if they're starting by looking at the advantages of hiring in-home child care we want them to not be thinking about that in light of disadvantages of other options or advantages of other options we really want them to be honing in on that in isolation and just really writing down what comes to mind in terms of why this this could be an advantageous option and we want them to be as comprehensive as possible. As therapists we could even offer some ideas about what might go down on the forum and and then they can always say nah that doesn't really fit or I don't think that resonates with me but we want to kind of take the time to be as thoughtful as we can about really fleshing out all the advantages and disadvantages of each option.

Erika Hulse: Yeah so let's kind of walk through what it looks like with this case example because it kind of helps bring it to life what is this is like. So imagine again you have your Google Sheet and up at the top you have your two choices. Now remember sometimes choosing two choices can be hard and that's okay we're just choosing two choices for now we can go back and repeat the form with other ones later. But in this case as you can see at the very top we have higher in-home child care as our first option and now we want to fill in the advantages for that particular decision. So what we do is we ask the client to imagine this is happening you have hired someone who is now coming in to sit with the kids during the day so they can do their schoolwork and have an adult present so what is good about that what are the advantages of that how do you see that working well? And we come up with several things and here's a sampling. So one thing is mom's work day can be uninterrupted that feels like a huge advantage. Another thing is the kids have an adult to consult with so they don't get stuck and frustrated. And then a third advantage is the kids can be more engaged and on task they're not running away they're not kind of getting distracted by other things. And then once we've really done a lot of advantages of course trying to be comprehensive and really thinking about what could be good about this then we look at the disadvantages of this option and this is again saying okay imagine this is true this is happening that you have this person coming into your home and helping the kids what do you see being the downside what are you seeing not going well what are the disadvantages? One thing we say it costs money so that's kind of generally considered a disadvantage if it costs money. Another thing is gosh the kids may not even listen to her and then I might still have to get involved so then I'd be paying for something and the kids may still be interrupting me or causing issues with this new person so that would be a downside. Third thing she talked about is that there's potential exposure to the virus so she's bringing a new person into her home and she hasn't done that for a long time so there's some concern there. And then this fourth one I think is so indicative of how it doesn't always have to be about school like I feel this pro for house cleaner which feels like another oh I need to make school are more acceptable for another person to see and so that's just an example of kind of some of the things that might weigh on her if she went with this option and so once we've really fully done the advantages and the disadvantages of option one then we look at option two and again we want to kind of try and forget about option one don't try and compare it yet that's going to happen later we really want to give these options there their fair chance. So let's look at this section second option which is homeschool during the nights and weekends and this is kind of trying to get out of the conflict during the day of the time of the meetings occurring so the advantages coming up with here is work in school would not conflict. Another one is there's not pressure from the school to get on the Zoom meetings because this parent is also getting you know messages from the school hey your kid wasn't on today is something wrong and that's kind of causing some issues too so like get rid of that particular pressure. And then the third one is imagining if homeschooling is happening she's thinking you know maybe I could help the kids enjoy school instead of dreading it it could be something we do together as a family and not something that's that we're pressuring. And then the disadvantages she would have to find curriculum which feels like a huge task she's not trained as a teacher. She also was worried about she wouldn't get to relax she wouldn't have down time because nights and weekends would be taken up with schooling. And then the third thing is kind of an honest look at it like all these frustrations that she's feeling toward the school and the teacher that wouldn't be something she could kind of put off anymore then it would all fall on her she'd feel super responsible and that would be hard that would be hard to say this is actually on me now I have to be the teacher and that feels like a real struggle. So if you can see we're really trying to give them their individual attention the advantages and disadvantages of each option individually and so our next step here and this is important in terms of knowing as a therapist what you want to do is after you have these lists some things are going to start emerging they're going to have some realization about what's important to them which particular things they want to say this feels like a bigger deal to me than the other things this is maybe I have 10 things on one side but this one thing really matters. And so what we want to do is help them determine which things hold more weight. So for example we kind of look through her reasons here and she says well you know what's actually really important to me when I look at hiring home child care what if it doesn't work? What if I'm hiring someone they're coming in and I still have to be out there managing the kids helping them get to know her and get comfortable that would that would kind of nullify the whole thing for me. So we went ahead and bolded that one that's a bigger deal to her. And then kind of looking on the other side what what really matters to you? And for her one of the advantages of homeschooling is she really wants her kids to enjoy school and she's really concerned about that and so she's thinking if they didn't have to do it on their own and they didn't have to do it on the computer that might help them enjoy it and not dread it. And then she was worried though about homeschooling that she has to find the curriculum she doesn't know where to start and then she was also concerned about losing her down time she felt like she would have zero down time if she chose that option. So you really want to go through and help them think about this what matters to you what's bigger of an importance than some of these other things and once you've done that then you want to help them bold those items because what we're going to do is we're now going to score we're going to go through and score the whole sheet.

Lindsy Koroly: It doesn't always have to be the case right that there's a bolded item in each column right in this example there's multiple bolded items in one of the columns so it really depends on for them if there are certain ones that feel more significant really just to communicate that it's not necessarily which column has more items that's going to win out or be stronger because each point holds different weight.

EriKa Hulse: Yeah and this part is just really important because it is kind of getting to what their values are and who they are and so that's the kind of thing you want to go slow on and really give them a chance to let this come out and so as that's coming out then we're able to give some points really help them move it from just what they're thinking and feeling into something that they can evaluate. So what we do is we just give one point for each item listed in the columns and then we give more points so two points to the particularly important ones. Now I've done this before where sometimes people say oh no that's not worth two points that's worth five points or that's worth ten points and that's totally fine we want them to lead on figuring out what's significant to them and how significant but most often what we do is do one point for each item and then two points for those that are more important. And so when you do that you can total each column and you can find out kind of how does it look when you just are giving us or interpretation. So on this particular form she found the advantages of hiring in-home child care to get three points the disadvantages was five points because she had a bolded item there there were four items but one of them was folded so that put it up to five points and then on the other side the homeschooling the advantage is she had three items but number three was bolded so it ended up being four points and then the disadvantages she had three of homeschooling she had three items but two of them were bolded so that was five points. So it just helps kind of give a a way to evaluate and measure okay what happened because we're going to be looking at what are the higher point values to make a decision. So if we look this over what we see in the full form is we can now compare the point scores and we're looking for high points. So if we look quickly at this form we can see the disadvantages are actually the highest points on both sides and this is this is life in the pandemic right we have a lot of choices that have disadvantages things we don't like about them and so it's really important to kind of recognize hey this happens this is what happens when we're looking for highest points it's sometimes not that simple and it's not supposed to be simple it's supposed to help them recognize what's important to them and help them think through when I know what's important to me what do I do with that how do I process that. So we will give an interpretation for their scores. So the easiest one is when one of the columns has a really high number especially if it's one of the advantages. If one of the columns has a high number that helps you see okay this is a clear choice I had more advantages here or they're more significant to me so this is the choice I need to make. And then at that point as we're assisting them with this process we want to help them be able to commit to that. So that seems like that's the best choice what do you want to what are you still feeling stuck about how can I help you do you need to reduce your anxiety what do we need to do to help you to go forward with this choice or do you want to do the decision-making form again and make sure there aren't other things. But you know it's nice when it's a clear choice when there's a high point value. Um and then there's another option of the win-win that means that there's high points on the advantages of both choices. So what this means is really either choice is good. This means they can pick either one and just work on tolerating the uncertainty right saying okay this I'm not sure that this is better than the other but they're both good choices and so we can use kind of a problem solution log for any issues that are still coming up well okay what is might still come up with this okay let's problem solve that let's figure that out and so a win-win is nice in terms of you really can choose either it's just a matter of getting some support and moving forward with the choice. Now we'll go back to our case example here we we actually didn't have any of these we didn't have a clear choice or a win-win instead we had the situation of the lose-lose and that's when the disadvantages are high on both options and that's our hardest one right that's nothing's clear here. So we have a couple of options when we have a lose-lose. So we of course we still have our big list of options we can go through and choose some other things and plug them in and that might help us get a clear choice or a win-win. And then our other choice is we can go back and look at our list and see you know are there any cognitive distortions in these particular advantages and disadvantages are there things that are not um really accounting for what might be going on? And so if we do that then we might be able to actually help the list become more clear. So in our particular case example we had actually done this form several times and we're starting to get kind of discouraged about what are the good choices and so we went back and we were looking for cognitive distortions. Is there anything in this particular list that might have some distorted thinking in it? And what we found was that on the the second choice homeschooling and nights and weekends the disadvantages she folded this idea I don't get to relax after work. And so we talked about that a little bit and said um you know is it true that you will never get to relax anymore when you're not working? And what we realize is there's some black and white thinking there there's either relaxing or not and the truth is is she's not getting a lot of down time anyway when she's not at work she's always doing things for the kids and her relaxation has to come in these little bits anyway that won't necessarily change that much and so we actually ended up unbolding that item and saying okay it's a bit of an issue but it's not quite the issue that I thought it was. And so helping her think through what is her reality and how is she thinking about it helping her make those decisions. So once we did that then we were able to actually modify the form and what we came up with was her points changed. So once she put her disadvantages for option two is a little bit lower now when we look at the points we see that her disadvantages are actually higher on hiring in-home child care so that seems like that's a worse option. But the disadvantages for homeschooling nights and weekends doesn't have as many disadvantages and the advantages for homeschooling nights and weekends is higher than the advantages in hiring in home child care. And so it kind of emerged as this thing she never thought she would do or even consider but it's emerging as when she's really thought through her values once she's really thought through where she may have some distorted thinking this becomes a choice that she can live with because she's really looked at all of her options. Oh and Lindsy maybe you can go back one slide I was just going to show this little graphic. Part of this whole thing is knowing that it's okay to not know right away it's okay to take time making these decisions it's okay if you have to start over it's okay if you're not sure it's okay if you fail and then you start late for school all of that stuff is still okay and that's a really important point of what we're supporting in decision making we're supporting all of this is acceptable we just want to figure out what is best for you if you can have a procedure to go through it that gives you as the therapist some some confidence that you'll be able to help them through it and it also models for them it's okay to slowly go through this and figure it out.

Lindsy Koroly: Okay absolutely and I think too it's great as therapists to sort of have the reminder of the form doesn't have to work seamlessly the first time around because there are so many options and ways to interpret it and so when you're first having the client write down the advantages and disadvantages you're not going to be sort of you know calling them out every second for potential distortion you know you just want to get all the options down on there and all the advantages and disadvantages written down but then you can take some time to then go back and assess that afterwards and and look at everything even more closely than you did the first time around. And so we hope the presentation was helpful just to to sum up we think of the simplified decision-making tool as a great way to guide clients who are motivated to move forward in making a decision. We do want to keep in mind that providing empathy and ensuring that they're ready to get to work and making a decision is essential before we provide them with this tool. So we want to make sure they're fully understood and feel listened to and supported and we want to make sure their motivation is there that they are they've convinced us that they do want to make a decision. And like we said the form in and of itself won't always provide a clear choice right away but there's so much opportunity to assess for distortions plug in different options and really help the client in guiding through their decision by utilizing this form.

Q&A Session