The Feeling Good Therapist - Decision Making Form Technique

Decision Making Form Technique with host, Richard Lam, LMFT, featuring Cai Chen, DO

*This Technique was developed by Dr. David Burns, American Psychiatrist and Adjunct Clinical Professor Emeritus of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine.

In this insightful video from Feeling Good Institute, therapists Richard and Dr. Cai Chen introduce a powerful tool known as the Decision Making Form Technique, developed by Dr. David Burns. If you've ever struggled with making important life decisions, whether it's related to career changes or personal choices, this video can help.

Dr. Cai guides Richard through the process, showcasing how this technique can bring clarity and direction to your decision making process. By systematically listing the advantages and disadvantages of each option, assigning numerical values, and then performing some simple calculations, you'll gain a clear understanding of which option aligns better with your values and desires.

This video isn't just about how to make a decision; it's about empowering yourself with a structured approach to tackle life's tough choices. Whether you're a therapist looking to enhance your toolkit or an individual seeking guidance on a significant decision, this demonstration offers valuable insights and practical decision-making strategies and skills to make informed choices that can shape your future.


Richard: Hi everyone, welcome to the Feeling Good Therapist. Today, we will learn about different skills and tools that can help you in your therapy practice or even in your personal life. Today we have Cai Chen, teaching us about the decision-making form, an amazing tool created by Dr. David Burns.

Cai: Hi, how's it going, everybody? I'm Dr. Cai Chen, a psychiatrist, and a level three team CBT-certified therapist. I do both medication management as well as therapy, and it's a real pleasure and privilege to be with Richard today to help teach more about the many different techniques that we have available for people.

Richard: Okay, well, Cai, would you tell us what our example today is, the role-play scenario for the decision-making part?

Cai: Yeah, sure. A lot of times, people struggle with depression or anxiety and have difficulties making decisions, which tends to fuel some of their anxiety, sometimes depression too, but a lot of times more so anxiety. It’s hard for them to make a decision. We do have something here called a decision-making form which helps elucidate all the different reasons why they're stuck in that decision. You can use this in many different scenarios, like with moving or wanting to make a new change in your life. For today's example, we'll use the example of a person who's debating between staying here in the United States or moving to a different country, the Netherlands because this person has heard about a lot of really good things about the Netherlands, compared to the United States. But he also has a lot of really cool things here in California, that are really awesome too. It's just kind of eating him up in terms of what he wants to do. We are going to demonstrate that today.

Richard: Great, that sounds like an awesome example. Let's get started.

Cai: Okay, great. I'll play the role of the therapist, and Richard, you'll play the role of the client. Would you prefer to go by Richard or different name?

Richard: Yeah, you can just call me Richard.

Cai: Okay, great. Let me share my screen so we can all work together on this. This is the decision-making form. If you're a therapist and you've purchased Dr. David Burns's toolkit, you get access to this and can fill it out on a computer or print it out, whichever is your preference. So, you just put the name up there, which would be Richard, and today's date, which is the 11th of 2023. The way that you usually start it out is by asking the patient what decisions they're weighing in their head, and then you write them down over here. So, we'll get started. How are you doing today, Richard?

Richard: I'm doing great, just feeling a little torn, so I'm not sure what to do about moving or staying.

Cai: Gotcha, that's right. I really feel for you on that because it can be a really huge commitment to move from one country to another. We've been talking about whether it would make sense for you to stay here or to move to the Netherlands where you've heard a lot of great things. But it also sounds like you've been feeling a little bit stuck on making that decision, and it's been kind of eating away at you. We have this really great tool called the decision-making form, which can help elucidate why you've been feeling kind of stuck. Sometimes it can give people a little bit of clarity in terms of what to do from here. But the idea here is not to force you to make a decision. It's more so to help you figure out why you might be stuck in terms of making a decision. Would you like to try this technique out?

Richard: Yeah, it sounds like it'd be very helpful.

Cai: Great. We have this out over here, and you see the decision-making form. We have option A and option B. Could you tell me what option A would be in your own words?

Richard: Moving to the Netherlands.

Cai: Great. Ideally, if working with the patient, the patient will also have their own copy too as I am typing this out. Let's go ahead and write that down on your end. And what would option B be?

Richard: Staying in California.

Cai: Gotcha. Now that we've put option A and option B down, we don't fill in the total points yet. We actually do that at the end. Now what we want to do is normally if we print out the piece of paper, we want to fold it in half horizontally. But the best way we can do it here on the screen is to just zoom in a little bit and focus on each side. So let's look at the advantages and disadvantages of option A, moving to the Netherlands. Richard, what are some advantages of option A?

Richard: Netherlands has universal healthcare, so that's definitely a huge plus.

Cai: Great. That’s a good one. Any other advantages?

Richard: I'd probably have to walk a lot more, so I'd probably be a lot healthier. It also has better public transit than California.

Cai: Gotcha. I can really identify with you on that. I've tried looking at the train schedule in order to get to my place of work and compared to driving it's like an extra hour and a half, just to get over here so, unfortunately, our Transit isn't as good. I agree with you on that. Now, we've come up with some good advantages. What are some disadvantages of option A?

Richard: I'd be further away from my family who are basically in California. I'd have to make new friends, and I'm shy, so it'll be challenging for me to make new friends.

Cai: Got it. So just for the sake of the video we will only stick to three per side for a cost-benefit analysis. But when you're working with yourself or with another person you can always do much more than just three. Once we do the advantages and disadvantages of option A, we flip the paper if it's printed out or we scroll down and look at the advantages and disadvantages of option B. Option B would be to stay in California. So Richard, tell me what are some advantages of option B, staying in California?

Richard: Probably the biggest one is that all my friends and family are here, so I have a really great community and support.

Cai: Yeah that's so important, having good friends and family. Having that community support because you have people that you know over here, it kind of goes hand in hand with each other. That's really great. Any other good reasons or advantages of option B?

Richard: Well, a lot of good stability as I have my career and everything here, and it's very comfortable.

Cai: Absolutely, that's a really good point too. It's the old adage that if it ain't broke no need to fix it. If everything's going all right and you feel comfortable then why like put yourself in a very uncomfortable state? You know travelling, having to relocate and all that kind of stuff. That's a really good point too. And now what are some disadvantages of option B?

Richard: Like I said earlier, the public transit here is a nightmare. It takes forever to get from point A to B. I waste a lot of time due to traffic, and it's very expensive to live in California.

Cai: Absolutely, I came from Texas where things were like on average 30 to 40% cheaper. I just blew my mind when I looked at the rent over here. I was like, wait you you have to pay what now? For my entire month's salary, just to live here, that's crazy. It is very expensive to live here in California. I agree with you on that. Now that we've filled out the advantages and disadvantages of both options, we're going to unfold the paper. We'll put some numbers in here, and the numbers will look complicated at first, but don't worry. We'll follow them in a very logical order and I'll guide you throughout the way. By the way, If you have your toolkit, there are detailed instructions on the second page. For now, let's assume we don't have those instructions. Richard, now that we've listed the advantages and disadvantages of both options, let's focus on option A. Which side wins out for you? Is it the advantages or the disadvantages of Option A?

Richard: It’s tough. I'm kind of like a 45-55.

Cai: Okay gotcha 45-55. You're so great and awesome, because I completely forgot to tell you about the numbering kind of system. So you're saying 45 for the advantages and 55 for the disadvantages. So you put a 45 on number one and then number two you put a 55. And you just followed the order of the numbers basically for those who are watching this video. The idea here is that these two numbers have to add up to a hundred. Some people sometimes ask that does it have to do with the number of items on each side? Actually, it does not, because sometimes one item on one side is so big that it trumps everything else for people. It really depends on you or the person filling out the form, what is more important for you. Sometimes, it's kind of hard to figure that out and there's a little bit of ambivalence. Sometimes it will get close to like 50-50, like over here now. It's kind of a difficult decision because the advantages of moving or the disadvantages of moving are kind of close. So we go from one to two. Now, we go down over here to three and four and we look at the advantages and disadvantages of option B. Let me ask you, Richard, which side wins out? Is it the advantages of option B of staying in California or is it the disadvantages of option B?

Richard: Oh god, I'm just kind of looking at it. I hate the traffic and the public transit. It's so expensive. I got to be a 50-50 on this one.

Cai: 50-50. Great. All right, so now, we've measured both sides so 50 50 means that there's quite a bit of ambivalence. Now, we're going to do something special and this is what makes the decision-making form unique from a typical cost-benefit analysis. We're going to fold the paper vertically along the vertical line, or if you're using the PDF form you're going to zoom in a little bit further.We're going to focus just on the advantages of option A versus the advantages of option B. Do you want to take a look at this? Which side wins out for you just looking at the advantages? Is it the advantages of moving to the Netherlands or is it the advantages of staying in California?

Richard: Probably the advantages for staying in California.

Cai: Gotcha! If you were to put a number to it keeping in mind that both numbers would have to add up to a hundred.

Richard: The one on top is more about my health and kind of time and then the bottom is like family and stability. I gotta be more on like a 40-60.

Cai: Okay, so it's 40 to the option A and 60 to option B. Now we're going to scroll over to the right-hand side and if this is a piece of paper you just flip it over and now you just look at the disadvantages of option A versus the disadvantages of option B. You do the same thing. You want to ask yourself which of these disadvantages feels worse compared to the other one.

Richard: I think family means a lot more to me than anything else. So, I think disadvantages of being further away from them is pretty tough. It'll take a mental toll on me. So probably, 75-25.

Cai: All right. Now that we've filled out all those numbers we can unfold a piece of paper or just maximize everything if you're using the share screen option. We've done one two three four five six seven and eight. Now we're going to go to number nine and it's just simple addition so we just add up these numbers 40 plus 45 would be 85, and then 55 to 75 would be 130. 60 plus 50 is going to be 110. And then 50 plus 25 is going to be 75. Now it's just a simple matter of subtraction. We'll go back to the beginning just looking at the total points you want to look at the sum of these two numbers over here 85 and minus 130 would be negative 45. You do the same thing for the for option B. 110 minus 75 is 35. Now that we're done, we'll take a look at the two options. Usually, you finish off by by asking your patient or client or yourself, Does this reflect the way that I feel about these things? And how do I feel now after going through all this? Richard, do these numbers reflect how you've been feeling inside? How do you feel right now that you've gone through this exercise?

Richard: I'm not too sure can you remind me what the the points mean again?

Cai: When we're looking at these total points, a number that's negative means that it's probably not a good option for you to consider. That’s because you're saying that there's a pretty significant part of you that's not wanting to do that. Whereas, if the number is positive, it means that there's a pretty significant part of you, that says I actually do want to do that. In these situations, where one number is negative and the other one is positive, we usually refer to that as a no-brainer. This is the decision that makes sense for you, given everything that we've just talked about. Now that I've explained that to you, Richard, tell me does this make sense to you? How do you feel about this subject right now after we've gone through this exercise?

Richard: It makes a lot of sense. A big part of staying in California is family and friends. It's kind of like on the higher side when it comes to staying in California. If my friends and family suddenly move to the Netherlands, it'd be an easy choice for me.

Cai: Absolutely. How do you feel about your decision? Do you feel more confident in terms of what you wanted to do? Or do do you still feel a little bit hazy or worried?

Richard: It does give me a lot more clarity. It helps me understand why I might choose option B.

Cai: Would that make sense to go with option B? And if you'd like I could help you if you have any doubts about going option B. We could potentially work on a mood log to help with any of those kind of worries. I could help you with any other things over there. What are your thoughts about that?

Richard: Yeah, I think that could be helpful in the next direction.

Cai: Okay awesome.

Richard: But, we can finish up here. Thank you Cai, for such a wonderful demonstration of the decision-making form. If anyone is interested in learning more about Dr Cai Chen, you can find his information below. If you're looking to learn more methods, feel free to Subscribe and Continue watching these Feeling Good Therapists YouTube videos.


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