Helping Clients Make Good Decisions

Q: I have been in practice 5 years. I worked in a skilled rehab center for 3 years and now work in pediatrics. Fairly often I see people make poor decisions for themselves or family members. Is there any way to help them?

A: Decision making can be difficult even at best. It is a skill which, like other life skills, can be compromised by stress, fear, lack of information or misunderstanding. In these tumultuous times, more people are having to make more and more difficult decisions. Over the years I, too, have seen people endure terrible outcomes from all types of decisions.

If your client is trying to make a decision about an issue that directly involves OT treatment, I think you should feel free to offer assistance. If you are less involved with the person trying to make the decision, you could offer to be a sounding board. But if someone doesn't want your involvement, you have to accept it.

When you work with decision making, first have the individual troubleshoot, clarify and pinpoint exactly what the decision is. People often miss key points or misunderstand the precise issue. It is hard to be objective about our lives when a part, even a small one, is suddenly out of place.

Decisions that involve money are hard for many people because they may impact heavily on lifestyle. Ones that involve health - one's own or a family member's - can be fraught with emotions and fear, and may even be life or death. Decisions about moving homes or changing jobs can turn lifestyles and personal environments upside down completely. It's easy to see how people can get mixed up, miss or overlook important factors.

When a choice is fully defined, clearly stated and backed with knowledge and information, you usually see the individual lose some of the anxiety about making the decision. I find it helpful to have a client write all of this down; try an outline form if it has components and sequences.

Explore what might happen if the individual makes (or doesn't make) a particular choice. "If I decide to say yes, this is apt to happen. If I say no, this will likely happen." From that, the person can consider what outcome he hopes to see.

The person will need to develop a plan of action, sometimes before the decision is made and sometimes afterward. For example, "Before I can decide to buy a new car, I will have to learn about different brands." Or, "After I decided to get surgery, I had to make my home safe until I got off crutches." Both decisions require plans of action. Sometimes plans are straightforward and just need to be outlined and followed. Sometimes they involve new knowledge or behaviors to learn and carry through.

Often when you see poor decision making, what you are seeing is failed planning. When someone has to make decisions about subjects he doesn't know well, he can't create a good action plan because, to put it simply, he doesn't know what he doesn't know. In grad school we called this "don't-know squared." We studied decision making in grad school experientially, using our own life situations, and then we learned how to help others. The lessons learned have positively affected my life and career.

I have started a Web site to professionally work with decision making. If you are interested in learning more, visit

Jane Sorensen, PhD, OTR, ND, practiced in all traditional OT areas more than 32 years and wellness for 25 years in private practice. She currently has a supervisory and consulting practice. She has written A Therapist's Tales ( and was ADVANCE editor E.J. Brown's co-author for An Overview of Early Intervention ( You can reach her at 212-744-5836 or

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