In this section, you will learn to:
- Use alternative models of decision making, including the Z model, the decisional balance tool and the four option approach.
Supplementary materials relevant to this section:
- Reading C: Problem-Solving and Decision-Making Skills and Strategies
The previous section of this module outlined the seven step problem solving model that counsellors often use to help clients engage in a structured decision-making process. While this is an excellent model (and one that is applicable to almost any decision or problem) there are a variety of decision-making/problem-solving models available and alternative models may be more useful depending on client preference, style of decision-making, and the client’s issue.
In this section of the module, you will learn about three alternative models that may be used to support client decision-making – the Z model, the decisional balance tool, and the four option model.
This model is based on the idea that there are a number of different ways to process information and make decisions in different ways. It is based on the personality styles determined from a particular personality inventory – the Myers Briggs Type Indicator (MBTI). The MBTI offers insights into how people perceive the world and make decisions, and defines four principle psychological functions: sensing (S), intuition (N), thinking (T) and feeling (F).
Although most people have a preferred mode of psychological functioning (for example, using a thinking (T) (i.e., rational) model of decision-making), considering all four dimensions should result in a more holistic, well-informed decision. This model of decision-making may be useful to use with clients who tend to over-use or under-use a particular mode of psychological functioning and therefore fail to fully consider all dimensions of a problem and solution.
The Z decision-making model connects sensing (S) to intuition (N), and then thinking (T) to feeling (F), in four steps:
- You begin by encouraging the client to investigate and gather information (S).
- You then move to intuition, where you brainstorm ideas together based on these facts (N).
- Once you have a number of options, you facilitate decision-making, using the thinking function. This allows your client to examine the alternatives in an objective way, to determine which might be the best choice (T).
- Before the final decision is made, you help your client to tap into the feeling function, and consider whether the decision fits in with the client’s values and the impact of each of the possible options (F).
The following questions show how the Z model may be applied to a career decision-making process.
- Gathering Information (Sensing):
- What are the basic functions of this career path?
- Do you possess the necessary skills?
- What are common work environments associated with the position?
- Are there other resources needed to gather additional information?
- Consider possibilities (Intuition):
- What are potential promotional opportunities?
- Will you have the freedom to implement some of your own ideas?
- Will you be able to tailor the work within this field to align with your interests?
- Is the future of the career path adaptable to accommodate changes over time?
- What is your gut feeling or hunch about this possibility?
- Use analytical reasoning to weigh your options (Thinking):
- What are the advantages of this option?
- What are the disadvantages of this option?
- Is this a realistic direction for you financially, socially, and geographically?
- Reflect based on your values (Feeling):
- How does this decision impact others?
- Does this decision disrupt harmony in your relationship network?
- How does this choice align with your values?
- How do you feel about this choice?
Adapted from Career Services, Seattle University, 2012
Case Study
Alice works as a student counsellor in a university counselling centre. Rhian comes in, confused and overwhelmed, for help related to her university course. She is currently studying literature as this is ‘what her gut told her to do’ and was the first thing that came to mind as she had done well in English at school. However, she hates her course and is considering changing her major. She is hoping Alice will be able to help her decide what to do. Alice guides Rhian through the following steps based on the Z model of decision-making.
Step 1: Sensing (S). This involves gathering information based on facts. Consider the details and facts associated with each major choice so that you have all the information you need.Alice, as a student counsellor, has easy access to information such as prerequisites and required courses and talks through what Rhian would need to do if she wanted to switch majors and the options that might be available to her.
Step 2: Intuition (N). Consider the possibilities and potential outcomes.
Now that Rhian knows what would be involved in switching majors, Alice and Rhian explore various major options and career possibilities. They identify three options that appeal to Rhian:
- Psychology major
- Economics major
- Journalism major.
Alice and Rhian work through all of the options in turn, weighing up the benefits and costs (pros and cons) of each. This is the process that Rhian did not carry out when choosing her major, having purely utilised the feeling (F) dimension of psychological functioning.
| Options | Pros | Cons |
|---|---|---|
| Psychology major | Wide range of career opportunities. Interesting. |
Statistics course. Will have to complete an extensive unpaid internship. |
| Economics Major | Well-paid jobs. Job security. |
Not really interested in business. |
| Journalism | Be able to use writing skills. | Not many jobs available. Not very well paid. Very competitive |
Step 4: Feeling (F). Reflecting on a decision. After collecting information and logically weighing up implications and consequences, the last step is considering personal feelings and those of others in the potential decision, as well as which decision aligns best with values and circumstances.
Rhian decides that money and financial security are not her main motivation at this time.
Check your understanding of the content so far!
The decisional balance tool was developed to help individuals to better understand their motivation behind continuing or discontinuing a particular behaviour. It is based on Motivational Interviewing, a client-centred counselling approach designed to elicit and build on the client’s own motivations for change. Motivational Interviewing is used extensively in the field of addiction, helping individuals make a decision regarding behaviour change, as well as in the field of health (where lifestyle changes are recommended).
Read
Reading C - Problem-Solving and Decision-Making Skills and Strategies further elaborates skills and strategies to facilitate decision-making in clients. You will also see an example of motivational interviewing in action.
According to McLeod and McLeod (2011), Motivational Interviewing relies on four basic principles:
- Empathy - the counsellor seeks to view the issue from the frame of reference (or point of view) of the client.
- Developing discrepancy - the counsellor helps clients to explore the gap between how they would like their life to be (the ideal) and their current behaviour (the actual).
- Acceptance or ‘rolling with resistance’ - the counsellor does not try to pressure the client to make a decision, but instead accepts that a reluctance to change is natural and invites exploration of the resistance.
- Client autonomy - the counsellor respects the client as someone who has the capacity to arrive at the right decision for him or her in the present circumstances.
It is important for counsellors not to manipulate or lead clients down what they consider to be the ‘right’ decisional path. Like all client-centred counselling approaches, Motivational Interviewing is grounded in facilitation rather than persuasion. The aim is for the client to decide whatever is appropriate for him or her at that moment in time but for that choice to be informed by an in-depth analysis of the costs and benefits of the decision to change or not.
The aim of the decisional balance tool is to help clients explicitly see that:
- They get some benefits from their risky behaviour/problem.
- There will be some costs if they decide to change their behaviour.
The counsellor can do a decisional balance exercise with clients by simply asking them open questions related to the costs and benefits of their risky/problem behaviour and what it would take to change their behaviour. For example, asking, “What are some of the good things about smoking?” followed by, “Okay on the on the flipside, what are some of the things you don’t like about smoking.” After the client discusses the benefits and costs related to their behaviour, the counsellor can use a reflective, summary statement with the intent of having the client address their ambivalence about changing. For example:
So on one hand, you enjoy the increased alertness you experience when smoking and the social aspect of it. But you are also saying it’s becoming increasingly difficult to find somewhere to smoke when you’re at work; also that it’s become very expensive. It seems there are pros and cons to whatever you choose and that makes it tricky to decide doesn’t it?
This method aims to help clients articulate for themselves the reasons for concern and the arguments for change. Talking with clients about the ‘good’ and ‘less good’ things they have identified and noting these down visually can help them understand and acknowledge that change has benefits and costs and may help them make a more informed, considered decision.
To help you better understand this model, let’s look at an example.
Case Study
Sally is a 40 year old mother of three whose medical tests indicate that she is at a high risk of developing Type II diabetes in the next few years if she does not change her diet. Both her doctor and husband are placing increasing pressure on her to make some lifestyle changes and she is feeling overwhelmed and stressed. As such, Sally has come to counselling.
The following graphic is the worksheet that Sally and her counsellor develop together to evaluate the costs and benefits of making a lifestyle change.
| Benefits (Pros) | Costs (Cons) | |
|---|---|---|
| Making a change |
|
|
| Not making a change |
|
|
| The change I'm considering is: | Changing diet to manage diabetes risk. |
It is important to realise that although decision-making is generally considered a rational process, considering emotional implications (which are often the most influential factor) is critical in order to form a balanced decision. In the case study, Sally’s pros and cons list includes both practical (‘will require extra time and effort to prepare meals’) and emotional elements (‘will feel annoyed and cross with constant nagging’; ‘won’t risk failing’). If a client has only identified practical, rational benefits and costs, you should encourage them to consider emotional consequences as well, as these may actually be the most powerful facilitators or barriers to change. For example, inviting a client who is abusing alcohol to “Imagine not drinking – how would you feel about yourself? How would your family feel?” may introduce other costs and benefits otherwise overlooked (Ivey, Ivey & Zalaquett, 2014).
Although the decisional balance tool is used extensively in substance abuse and health contexts, the technique can be employed in any situation in which a client is struggling to make a decision. For example, the following extract is a transcript of a counselling session focused on a mother struggling to decide whether to put her son in a nursery.
| Eleanor is a young woman who is a single parent with a two-year-old son. She has had involvement with social workers for many years around a range of issues. Her current dilemma is whether to place her son (Stephen) in a nursery so she can restart her own career. Her mother strongly believes that Eleanor should make use of the nursery place that is on offer, and will not listen to any other point of view. On the other hand, Eleanor’s neighbour strongly believes that children can be emotionally damaged by nursery education. As part of the process of making a decision on this issue, Eleanor decides to speak to her social worker, Pete. | |
| Eleanor: “I’m really desperate. I need to decide by next week whether or not to take the place at the nursery, and I don’t know what to do. | |
| Pete: “It’s such a big decision for you to make. I get the sense that you’re feeling under a lot of pressure and that this stress isn’t helping you to get to the point that you are comfortable about what is best.” | Empathetic response that reflects an understanding of the client’s situation, and is not trying to persuade her what to do. |
| Eleanor: “Absolutely – I feel completely at the end of my rope.” | |
| Pete: “From what you have said to me before about this, my understanding is that ideally, you think that it would be good for Stephen to mix more with other children, and good for you to meet people in a job situation and have more money, but that you are not sure whether he is ready for nursery yet. Is that the way it seems to you, or are there other aspects of the situation that are important too?” |
Acknowledging discrepancy Acknowledging client as ‘expert’ Reinforcing client autonomy |
| Eleanor: “Yes, that’s the main things.” | |
| Pete: “That suggests that there are other aspects of it too…?” | Affirming client autonomy |
| Eleanor: “Yes, maybe. I just don’t know if I could cope with him being upset. You know, like leaving him there if he was crying or having a tantrum.” | |
| Pete: “Because that would upset you… and maybe also make you worried that was being traumatised? | |
| Eleanor: “Exactly.” | |
| Pete: “Can I say how it seems to me? I’m wondering whether there are two parts to this. At one level, you know that nursery is the right thing for you and Stephen. But at another level, it’s scary to think about what will be involved at a practical levels around things like ‘Can I cope with him being upset’? | |
| Eleanor: “You’re right: deep down, I do know what I want.” | Example of commitment talk |
Adapted from McLeod and McLeod, 2011, p. 22
In this example, Pete presents the pros – Eleanor will be able to engage in employment if Stephen attends nursery, which will mean being able to meet other adults and have more money. However, he encourages Eleanor to identify issues that are making the decision difficult – she is worried about Stephen being upset and not being able to cope with that. By explicitly stating the benefits and costs in this way, Eleanor will be able to make a more conscious decision about what is best for her and her son. The difference between this decision-making process and those Eleanor has engaged in with her mother and neighbour is that, in the counselling process, Eleanor has the space and freedom to identify costs and benefits for herself. The social worker has not attempted to influence or one way or another.
A demonstration of decisional balance
In this nail-biter, it is not immediately clear what Kathleen will choose to do. See it in action!
watch
Check your understanding of the content so far!
Another approach to decision-making comes from a counselling approach called Acceptance and Commitment Therapy (ACT) which you will be learning more about later in your Diploma. One of the key principles of ACT is that people should act on values important to them, be fully engaged in the moment (i.e., aware, attentive, open to, and engaged in their experience) and practise acceptance of things that they cannot change. The four option model uses these principles to offer choices in challenging situations and is particularly useful when clients are stuck in a “Should I stay or should I go” type of dilemma – often regarding a partner or job.
The four options of the model are:
Option One: Leave the situation
It is not always possible to leave a problematic situation however, if there is a choice, you could ask clients to consider whether they think their quality of life would be better if they left or if they stayed – invite them to imagine what their life might be like in 10 years if they stayed and what it could look like if they left.
Option Two: Stay, and change what can be changed
If your client decides to stay in a difficult situation, you should help them to explore solutions and ideas that may improve things. These should be actions or solutions that the client has control over rather than those dependent on others changing. For example, a client may decide to stay in a difficult work situation but work on assertiveness or communication skills to help him manage conflict with his manager.
Option Three: Stay, and accept what can’t be changed
If your client has chosen to stay, and taken every action possible to improve the situation but it is still difficult, you should encourage clients to try to remain fully engaged in the moment (and not rely on unhelpful emotional control strategies), despite uncomfortable feelings. It is also important to encourage clients to focus on living by the values they have identified as important. People may be willing to put up with a lot if this means that they can still fulfil the overarching goals that are important to them – the bigger picture.
Option Four: Stay, and rely on (unhelpful) coping strategies
All too often, people stay in a problematic situation, but they don’t do everything possible to improve it, and nor do they practice acceptance. This may lead to feelings such as anxiety, depression, frustration and anger leading, in turn, to unhelpful coping strategies such as drugs, alcohol, food, self-harm and suicidality. Invariably, these strategies create even more suffering in the long term, however, it is important to recognise that choosing this way of coping with a problematic situation is a choice.
Case Study
Maria, a 44-year-old mother of three, has been married to her husband, Rudi, for 24 years. They have had their ups and downs as a married couple, however, in the last few years, Maria has been feeling increasingly lonely and unhappy in her marriage. Rudi has a demanding job as a national sales manager and travels frequently, as well as putting in long hours at the office when he is at home. Maria feels things have deteriorated to the point where she and Rudi are ‘just roommates.’ She has tried to address the issue with Rudi, but he says he is happy with the way things are and refuses to talk about it. Maria does not want to remain in a loveless marriage; however she is worried about the implications of divorce for both her and her children. Maria’s counsellor helps her explore her options using the four option model of decision-making.
Option One: Leave the situation. Maria considers whether her overall quality of life would be better if she left her marriage. She knows that she would struggle financially, and it would be difficult to re-enter the workforce after years of being at home. She also considers the impact a divorce may have on the children.
Option Two: Stay, and change what can be changed. Although Maria has tried to talk to Rudi, she and the counsellor discuss other options that might improve Maria’s situation if she decides to stay in the marriage. These include developing interests and friendships outside of the marriage, which might decrease her feelings of loneliness and unhappiness.
Option Three: Stay and accept what can’t be changed. Maria might decide to stay in her marriage as it is important to her that her children grow up with two parents. She might decide to accept that this is how things are for now and let go of the anger and frustration she feels about Rudi’s behaviour, focusing on her long-term goal of keeping her family together.
Option Four: Stay and rely on (unhelpful) coping strategies. Of course, Maria could stay and do what she has been doing up until now, which involves feeling angry, depressed and drinking a lot in the evening on her own.
The alternative models we have discussed in this section may be used for a range of decision-making situations – it is up to you as the counsellor to decide which model might be more appropriate for each client.
Helping clients make tough decisions
The following video is a great reflection of the differences between the types of decisions clients have to make.
watch
In this section of the module, you learned about three alternative models that counsellors may use to facilitate the decision-making/problem-solving process with clients. In the next section of the module, you will learn more about the obstacles and challenges that you might encounter in the decision-making process and learn how to ensure the decision-making process you engage in with clients is ethical.
- Career Services, Seattle University (2012). Decision-making and goal setting. Retrieved from https://www.seattleu.edu/media/career-services/files/services/advising/Decision-Making-and-Goal-Setting-Hand-out--final-draft_10-5-12.pdf
- Ivey, A.E., Ivey, M.B., & Zalaquett, C.P. (2014) Intentional interviewing and counseling: facilitating client development in a multicultural society. Belmont, CA: Brooks/Cole.
- McLeod, J. & McLeod, J. (2011). Counselling skills: A practical guide for counsellors and helping professionals. (2nd ed.). Berkshire, UK: Open University Press.
