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Teaching Wisdom: Best practices for decision-making to support your clients

Curt and Katie chat about decision-making best practices. We look at how we make decisions, what the decision-making process looks like, what can get in the way of effective decision-making, and how therapists can support their clients in making the best possible decisions.

This is a continuing education podcourse.


Click here to scroll to the podcast transcript.

In this podcast episode we talk about how therapists can support clients in decision-making

When therapists are asked “what do I do?!?” by their clients, we can often redirect our clients back and encourage them to make their own decisions. But what if we could provide them with best practices to support their decision-making process? This workshop is designed to help therapists learn more about how people typically make decisions, the cultural differences that can show up in the decision-making process, and best practices to support clients in making informed decisions.

How do we make decisions?

  • We don’t often choose what is in our best interest
  • Emotions, mood, bias impact how we make decisions
  • The DBT concept of Wise Mind, is a strong space to make decision
  • Individual differences, including age, generation, family structures
  • Cultural differences, including individualistic versus collectivist, tight or loose cultures (how many norms and how strictly they are enforced), cognitive style (wholistic versus analytic)
  • Intersectionality also plays a part in how these factors can impact decision-making

What does the decision-making process look like?

“Is there an opportunity here? Is there actually a threat here? And this is very impacted by what you pay attention to. Some cultures are more likely to look at opportunities, some cultures are more likely to look at threats and the risks that are involved. Whether or not there’s a decision to be made is truly impacted by what you see and how you interpret that information.” – Katie Vernoy, LMFT

  • Does a decision need to be made?
  • Who/what makes this decision?
  • How is the decision?
  • How much time and energy are invested in the decision-making?
  • What are the alternatives?
  • What could happen if the decision is implemented?
  • What would happen if I make this decision?
  • What values are relevant?
  • What are the tradeoffs?
  • How acceptable is this decision to the people around me?
  • Implementation

What can get in the way of effective decision-making?

“Confirmation bias is really strong. Looking for people who disagree with you is really hard…It is our responsibility [as therapists] to potentially disagree with our clients at times to help them get some of this ‘considering the opposite’ happening. Because if we’re just going, ‘well trust your instincts, and how does that sound to you,’ and if we’re not pushing back… we might be doing a disservice to our clients.” – Katie Vernoy, LMFT

  • How someone has been parented
  • Mental health concerns like anxiety
  • Cognitive biases like confirmation bias, anchoring, and availability bias
  • Misalignment with values
  • Errors from Decisive by Dan and Chip Heath: narrow framing, confirmation bias, short-term emotions, overconfidence
  • Defensive decision-making when there is a lack of resources or safety
  • Low sleep impacts both at overall cognitive and metacognitive levels

What are best practices for decision-making?

  • Looking at opportunities for moral development when there are misalignments or conflicts between core values when making a decision
  • From Decisive: WRAP techniques to improve decision-making

Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide

Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!

Once you’ve listened to this episode, to get CE credit you just need to go to, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed – you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out

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Continuing Education Approvals:

When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information

CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.

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Dr. Ben Caldwell: Psychotherapy Notes


References mentioned in this continuing education podcast:

Aidman, Eugene; Jackson, Simon A.; Kleitman, Sabina.(2019). Effects of sleep deprivation on executive functioning, cognitive abilities, metacognitive confidence, and decision making. Applied Cognitive Psychology. Mar/Apr2019, Vol. 33 Issue 2, p188-200.

Berthet, V. (2022) The Impact of Cognitive Biases on Professionals’ Decision-Making: A Review of Four Occupational Areas. Front. Psychol. 12:802439. doi: 10.3389/fpsyg.2021.802439

Heath, C., & Heath, D. (2013). Decisive: How to make better choices in life and work. Crown Business. Chicago Style (17th ed.).

Luebbe, A.M.,  Mancini, K.J., Kiel, E.J., Spangler, B.R., Semlak, J.L., & Fussner, L.M. (2016). Dimensionality of Helicopter Parenting and Relations to Emotional, Decision-Making, and Academic Functioning in Emerging Adults. Assessment 25(7), 1-17.

Marx, F. S., Junker, N. M., Artinger, F., & van Dick, R. (2021). Defensive decision making: Operationalization and the relevance of psychological safety and job insecurity from a conservation of resources perspective. Journal of Occupational & Organizational Psychology, 94(3), 616–644.

Morelli, M., Casagrande, M., & Forte, G. (2022). Decision Making: a Theoretical Review. Integrative Psychological & Behavioral Science, 56(3), 609–629.

Padilla-Walker, L. M., & Nelson, L. J. (2012). Black hawk down? Establishing helicopter parenting as a distinct construct from other forms of parental control during emerging adulthood. Journal of Adolescence, 35, 1177-1190.

Steiner, C. (2020). Emotion’s influence on judgment-formation: Breaking down the concept of moral intuition. Philosophical Psychology, 33(2), 228–243.

Westaby, J. D., Probst, T. M., & Lee, B. C. (2010). Leadership decision-making: A behavioral reasoning theory analysis. Leadership Quarterly, 21(3), 481–495.

Yates JF, de Oliveira S. (2016). Culture and decision making. Organ Behav Hum Decis Process. 2016 Sep;136:106-118. doi: 10.1016/j.obhdp.2016.05.003. Epub 2016 Sep 14. PMID: 32288179; PMCID: PMC7126161.


*The full reference list can be found in the course on our learning platform.


Relevant Episodes of MTSG Podcast:

Smarter Than SMART: How therapists can improve goal-setting with their clients

It’s the Lack of Thought That Counts: Ethical decision-making in dual relationships

What Therapists Should Actually Do for Suicidal Clients: Assessment, safety planning, and least intrusive interventions

Making Every Practice Profitable: An interview with Julie Herres

Who we are:

Picture of Curt Widhalm, LMFT, co-host of the Modern Therapist's Survival Guide podcast; a nice young man with a glorious beard.Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at:

Picture of Katie Vernoy, LMFT, co-host of the Modern Therapist's Survival Guide podcastKatie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at:

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

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Music by Crystal Grooms Mangano

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).

… 0:00
(Opening Advertisement)

Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm 0:15
Hey, modern therapists, we’re so excited to offer the opportunity for one unit of continuing education for this podcast episode. Once you’ve listened to this episode, to get CE credit, you just need to go to, register for your free profile, purchase this course, pass the post test and complete the evaluation. Once that’s all completed, you’ll get a CE certificate in your profile, where you can download it for your records. For a current list of our CE approvals, check out

Katie Vernoy 0:47
Once again, hop over to For one CE once you’ve listened.

Curt Widhalm 0:54
Welcome back modern therapists. This is The Modern Therapist’s Survival Guide. I’m Curt Widhalm, with Katie Vernoy. And this is the podcast for therapists about things that we do in our practice, the things that we help our clients with. And this is another one of our continuing education eligible episodes. So listen to the instructions at the beginning and end of the episode on how you can get continuing education. Or check out our show notes and transcripts over on If you want to not just have to remember off of your memory about this. But in our continuing education episodes, this is a very Katie Vernoy led episode around making decisions and helping our clients do these kinds of things while totally just walking the line into being like put I’m your therapist, not your decision maker. So we don’t make decisions for clients, Katie, but spend the next 59 and a half minutes telling us how we can help clients do this better.

Katie Vernoy 1:56
Well, I think there’s many of us that have heard that refrain. What should I do? And I was talking to a therapist earlier today. And she was like, I tell them, Well, this is your decision to make. And I said, Yeah, that’s true. The question I ask is, well, how are you going to make that decision? I think there’s not a lot of information in our field that talks about the process of decision making. There’s definitely that in business. There’s definitely that in coaching. But I feel like therapists are very well situated to help people with this process. Because there’s so many things that can come up along the way,

Curt Widhalm 2:29
Maybe where our field has kind of naturally lined up with this is something around like motivational interviewing, which is just kind of like a wonderful kind of process to be able to help people think of what their options are, think of their commitment to things. And I’m guessing that that’s not totally where you’re going with this today.

Katie Vernoy 2:49
No, I’m sure a lot of this is impacted by my awareness of motivational interviewing, as well as some of the CBT practices. But this really is a different look. And then also looks at kind of how we as people make decisions. There’s cultural differences and how decisions are made. It’s broader than just motivational interviewing.

Curt Widhalm 3:11
And it’s also broader than, you know, just when you’re making a decision looking in the mirror, because that’s where reflection happens.

Katie Vernoy 3:23
Exactly. So to get clear on what we mean by decision making, there’s different definitions. And a lot of the stuff I’m talking about in this first section is from an article on culture and decision making by Yates and de Oliveira 2016, as well as Casagrande and Forte in 2022, which is a theoretical review of decision making. And one of them said, it’s input, process, output, feedback, which is not helpful at all. Other places I was looking, a lot of the articles I was looking at was kind of committing to a course of action when faced with options. We often don’t recognize that how we should make decisions. So what’s in our best interest? What makes logical sense? What’s practical for us? That is not usually how we actually make decisions. Those things are oftentimes confounded by incomplete or changing information, which is the uncertainty principle kind of thing. Our emotions, like the perception of risk or our mood going into the situation. If we go into a situation in a bad mood, we’re likely to make a more negative decision. This is stuff that therapists know, right? And then there’s also social factors, but we’re most likely to be able to make rational decisions when we’re in a stable environment and our emotions are regulated. So what does that sound like to you?

Curt Widhalm 4:39
Well, as somebody who’s DBT trained and informed and this kind of stuff to sounds like wise mind.

Katie Vernoy 4:47
Yeah, so maybe for our friends at home, can you tell me what wise mind is?

Curt Widhalm 4:51
So wise mind is not operating just solely out of this emotional mind and it’s not operating just out of a completely rational mind but it’s being able to bring the two of them together to be able to make a well informed decision that appeases both sides. Being able to handle both what’s best and healthy emotionally as well as what makes the most common sense.

Katie Vernoy 5:14
Yes, yes, I love the concept of wise mind. And it actually showed up in a lot of places in what I was reading is that there have been theories that emotions are horrible for decision making. You make your decisions too quickly; irrational choices or immoral choices. But in truth, it was really about kind of being able to regulate the emotions sufficiently so they can inform you, but not drive the decisions to be too quick. The other thing I’ve noticed in a lot of the research are from a very western individualistic culture framework. And so I wanted to speak to the differences. And so there’s going to be things to consider when we’re looking at how to help somebody making a decision, and how people make decisions based on some of the cultural or individual differences. So when you think about kind of the different cultures and how that may play out, what are the things that come to mind for you.

Curt Widhalm 6:07
So I work a lot with teens, teens tend to grow into young adults, if I’m especially successful in keeping them healthy and alive. And then as they move into adulthood, a lot of questions go through higher education, sometimes the changing family dynamics that end up happening around that, and especially when it comes to things like setting limits, or boundaries, or moving into careers post college that a lot of questions become what the family of origin says is best for them based out of what mom and dad or whatever other family members are saying, versus what my clients want to do with their lives. And so there’s kind of this balance of how much dependence do they still have financially, emotionally on their families. Not everybody’s going to come from a culture where cutting people off is necessarily the easiest thing when some of those boundaries are really overstepped and continued to be violated, despite trying to set healthier boundaries or limits with those family members. So I see it a lot in kind of, as it deals with life changes, as it deals with the cultural ideas around what family structures are and a person’s responsiveness within that family as being some of the major things that come up.

Katie Vernoy 7:28
Well, and one thing that I was thinking about, as you were talking is it also is there’s generational differences. And I think about, you know, the joke is like Gen Xers you got a key and you were just told to deal with it. Whereas then there’s, you know, kind of subsequent generations had helicopter parents. And I actually saw research on helicopter parenting and how there was a lot of positive attachment stuff that happened. But these are folks that don’t know how to make decisions. And so that’s another reason of why to do this. Because I think there are folks that just have never been given the opportunity to make decisions. But even when they are and they’re, they’re kind of in that young adult place, and they’re dependent on their families, either emotionally, or financially, practically all of those kinds of things. Those are huge impacts on how somebody makes a decision. Like, I mean, it sounds like we’re both really pragmatic, but I think I’ve heard from other folks or some of my clients that a decision making that is in the best interest of their mental health is privileged over the actual pragmatic needs. For example, you should cut off your parents or you should move out of your parents house has no bearing on emotional needs, cultural norms, and/or truly pragmatically, I cannot afford to move out of my parents home. And so it doesn’t honor where this individual is in their own life, what their pragmatic needs are. And so I think when therapists don’t look at those individual differences, they could potentially be pushing towards a, a decision that supports mental health but doesn’t support the reality of the situation.

Curt Widhalm 9:07
It looks at one particular aspect of the mental health, not the whole picture altogether.

Katie Vernoy 9:14
Sure. To get a little bit broader. So moving up from the individual differences into the cultural differences. The one that we hear a lot is like individualism, or independence versus collectivism versus interdependence. And decisions are very different. And I’ll go through different types of scenarios that as we go along, but that’s, that’s the most common one. And I think that one kind of gets a checkbox and your cross cultural class, that you just have to understand that some people are in an individualistic culture and some people are in a collectivist culture. And so I know that subsequent students and generations of therapists have learned more than that. But it needs to be said but it’s just the tip of the iceberg. So some other cultural differences that impact decision making is how many norms you have, and how strictly they’re enforced. And so it’s tight or loose cultures. And so so that’s something to pay attention to. Because obviously, if there is a very tight culture, lots of norms that are strictly enforced, those are going to play into how someone makes a decision as well. And we’ll talk about some of the implications as we go along.

Curt Widhalm 10:21
I wonder, then, even just looking at intersectionality, within some of this kind of stuff, that, you know, there could be very tight things. But if you’re just slightly outside of that, you know, somebody coming from a very tight culture, but is against LGBTQ+ sort of things. I’m sure that this is what you’re referring to is like, looking at, like how that decision making process quickly gets altered, as intersectionality stuff then becomes maybe an exception to some of these things, or a reasoning or something to explore behind some of the decision making process?

Katie Vernoy 10:59
Well, and I think that’s why you ask someone: How do you make this decision and what’s weighing in on that? Because I think oftentimes, because of the amount of intersectionality, different levels of acculturation or, or integration into a culture. There’s so many elements of how someone is taking in their identity, that you want to be aware of these things. But it is truly a very individual thing on how the different elements of identity are going to impact how you make a decision. And it could be like, I know that there are times when, you know, whether it’s old biases or things that are from kind of how I grew up, oftentimes those things will pop in, I will feel the pull to them, but not feel them to be aligned, and then have to pull back and say, Okay, well, no, actually, what are my goals? What are my priorities? What are the things that I value, not just what had been kind of the indoctrination or whatever, right. And so I think that’s a really good point around making sure that even if you have these broad categories, that you also actually look at the person that’s right in front of you. And that’s actually interesting, because the the additional cultural difference that was cited in this article was about cognitive style. And this is holistic versus analytic. And this is exactly what you were saying. Holistic thinking, which is kind of looking at all the context and seeing all the relationships and understanding the world as in constant flux and being very comfortable with contradiction that holistic style is actually more often found in collectivist cultures. And so for those of us who are, like you and me, white therapists that are more in this individualist culture, we’re more likely to be analytical, we’re going to look at, you know, kind of what’s the main object? What’s the, what’s the category, you know, things are stable and predictable. We’re going to use formal logic. And we’re not going to be as comfortable with contradiction. Now, obviously, that’s very oversimplified. And I think you and I are actually pretty holistic in how we think of it.

Curt Widhalm 12:57

Katie Vernoy 12:58
But I think that there’s, there’s both of those styles and they have benefit to them. There’s and we’ll we’ll talk about some different things as we go along. But if you think about someone who can really look at a situation holistically, they’re going to have so much more context and understanding of the situation versus someone who’s analytic that’s kind of laser focused, but the person who is laser focused might move forward more quickly on that particular thing. Because they’re very analytical, and they’re very structured in how they think about things. It’s really interesting. And there was part of this, this article that said, you know, kind of cultural differences can be stable, this is what you grew up in. But there also are times when they’re very context dependent. In certain situations, what your cultural background is like in really challenging decision making, some elements are not going to be impacted by culture, because everyone spends a lot of time deciding versus in in other parts, it’s going to be I have to spend a lot of time deciding because I need buy in from my community versus I’m gonna make this decision because it pleases me. And so there’s there are differences that are stable, and there’s differences that are more context dependent. But in truth, like you said before, we really just need to understand our client and how all these things interplay in how they might be making decisions and what might be impacting their decision making.

Curt Widhalm 14:14

Katie Vernoy 14:14
So the next thing I want to talk about is some more from this Yates and de Oliveira 2016 article, which is ‘The process of decision making.’ And I read a lot of different articles and this one both has the cultural context with it, which I really appreciated, but it was really the article I found describe this process the best for more of a kind of observer spot versus how do you fix it, which was, you know, which always ties into it like, Okay, I just want to know what it is not how to fix it yet. So the first stage is: does a decision need to be made?

Curt Widhalm 14:49
You know, I look at it in kind of that very mindful sort of way of like being like, am I getting pulled into something that I don’t need to get pulled into plate but even that is a decision to not react.

Katie Vernoy 15:03

Curt Widhalm 15:04
So, on principle, I disagree with this because making a decision to not make a decision is making a decision.

Katie Vernoy 15:13
That is fair. The process I’m talking about is not do I engage or not, in small ways? These are really for larger decisions. Because whether I take a sip of my coffee or not, it’s an is a decision. But it’s not one that requires a lot of extra thought, except maybe if you’re in a therapy session, and you’re like, do I take a sip of water? This is a really intense moment.

Curt Widhalm 15:38
I’m getting the sense that where this ultimately comes to is coming to some sort of process around setting a threshold of what kinds of things need to have decisions that you get into deeper thought about.

Katie Vernoy 15:51
There’s that but there’s also is there actually something here? Is there a here here, right? I mean, it’s Is there an opportunity here? Is there actually a threat here, and this is very impacted by what you pay attention to. Some cultures are more likely to look at opportunities, some cultures are more likely to look at threats and the risks that are involved. Whether or not there’s a decision to be made is truly impacted by what you see and how you interpret that information.

Curt Widhalm 16:19
Okay, go on.

Katie Vernoy 16:20
So then the next stage is: who or what decides, and how, and this is the I think the simplest one that speaks to kind of is this an individual decision? Or is this a group decision? And collectivist cultures are more likely to give and to take advice, whereas individualistic cultures are more likely to not seek advice and want to make the decision on their own. So: how do you make the decision? So we’ve got, you know, for looking at the stages here: Is there a decision? Who’s needs to make the decision? And how is the decision made? To be more specific, it’s looking at do you follow your own principles and values? Or do you incorporate others into the into what you’re doing? There’s also the different process. And some of this is based on Kahneman’s work, like Thinking Fast and Slow, that kind of stuff. But do you do a deliberative, thorough, slower process? Or do you have more of a rapid and intuitive process? Which is simpler, but potentially needs some backstopping to make sure you’re not jumping to the wrong conclusion right away.

Curt Widhalm 17:17
A part of this what you’re talking about is making your clients stand up. So that way, they get better at making decisions on their feet. But more seriously though, there’s a lot of dualism that you’re bringing up here. There’s a lot of either/or situations. And I’m maybe feeling a little bit of a pushback of like, there has to be a pluralism when it comes to being able to brainstorm some different ideas on this. That, you know, do you follow your own preferences? Or do you incorporate others? Or is this a situation that does both?

Katie Vernoy 17:54
Yeah, that’s a really good point. Because I think I wrote this down simply to be able to say it simply. But I think it is way more complicated than that. And I think part of it is looking at how much do you incorporate your own preferences? How much do you pay attention to others values and what they’re wanting from you? How do you balance those things? What are the other things that would be implicated there? And I think in truth, that is an excellent point, I think it really is about understanding that all of these things are pieces to look at, and they’re not absolutes. So very good feedback, Curt. Thank you.

Curt Widhalm 18:26
You’re welcome.

… 18:27
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Katie Vernoy 18:28
The next one is I think, one that’s pretty simple: investment, what will it cost to make this decision? And so that’s mental energy, time, money, you know, are you indecisive are you decisive? And this is where we actually see the least cultural differences when there’s a big decisions that require a high investment. Like, what am I doing with my whole life? And so most cultures are going to spend a lot of time and energy being able to make these larger decisions. And for some, it’s like, I have to know who I am to make a decision based on my values and what I want. And this is a big decision, and I might be incorporating a little bit of other folks things. And for very collectivist cultures, I need to get all the information from everybody to determine what is the best decision and I need to get buy in, and all of that. The investment is big, regardless of the culture, if it’s a really big kind of high stakes decision. Which is to be expected. The next one is: what are the alternatives? Being able to think about the alternatives in a decision making process is important because if it’s just one or the other, yes or no, you may not have the full best choice set or option set. And so this is where I think being able to do what you’re talking about having potentially cross cultural exposure, which is helpful because there’s different ways cultures are going to approach things and so you learn a lot. There’s different ways that there’s bargaining. There’s different ways that there’s coming up with creative ideas and this is where I think analytic cultures, individualistic cultures can be very helpful. And so for therapists who are in more of an individualistic culture, this is something you could potentially bring because individualist cultures promote deviance, uniqueness, divergent thinking, which all of those things provide creativity. Whereas in some collectivist cultures, it’s more about fitting in, not standing out, compliance. And that’s obviously broad generalizations. And I’m not saying this is true for every single person, it certainly is not. But being able to combine those two things to really understand what the options truly are present and getting as creative as possible. That can be very helpful for getting that the best choice set so that you can really have the alternatives present to be able to make the right choice.

Curt Widhalm 20:46
In your reading on this kind of stuff. I’m wondering if you’re coming across anything where it’s looking at where the therapists biases in these kinds of things might come in too. Like it seems like there could be some huge blind spots that would just kind of be like, if I’m coming from an individualistic culture and you’re coming from an individualistic culture is this something where if this is a decision in a work setting that has a more collectivist environment, that there could be some oversight sorts of things just in kind of that working alliance between therapist and client here.

Katie Vernoy 21:19
I think that’s a good point, I did not see that research. For me, the idea truly is to potentially supercharge creativity, not to enforce any of my own bias into the situation. We are subject to all of these biases, we are subject to all of these blind spots. The difficulties of being able to see what how our own positions are going to impact what our client is deciding. And so to me, the more we can step out and really be an observer and kind of a generator of creativity versus assuming that a client is going to behave a certain way or make decisions a certain way or think about a situation in a certain way. I think I think the therapist curiosity helps a lot here. The next two phases of this decision making process are possibilities and judgment. And they’re pretty similar. And it’s what could happen if the action we’re taking and then some of looking at intended results as well as unintended consequences. And this is where holistic thinking and collectivist cultures really shine, because they oftentimes take in a lot more of the context and the relational information than, you know, kind of stereotypically individualist cultures do. And so I think being able to play off the strengths of whoever’s in the room, I think can be very helpful, because each person is going to have a different layer of some people are going to be more foreground, some people are going to be more background. And if we can have people that are looking at both the fine details, as well as the big picture, I think you can oftentimes get to really, really great decision. And so hopefully, as a therapist, you have some flexibility there. But I think, especially if you’re getting into family sessions, or into group settings, like maybe supervision or different things like that, being able to really allow for a lot of perspectives can be helpful. And and that’s one of the things that we’ll talk about later, but trying to figure out what could happen, being able to see all all of the consequences, the results, and the consequences, I think can be very helpful for making a decision is informed.

Curt Widhalm 23:21
Now I can see this going off the rails with children of narcissistic parents, or you know, kind of…

Katie Vernoy 23:29
With a lot of anxiety.

Curt Widhalm 23:30
…a lot of anxiety, a lot of relational trauma sorts of things where it’s just kind of there, it’s a great skill set to have to imagine what could happen, but it could lead to that paralysis overwhelm in this stage here. So you know, being a…

Katie Vernoy 23:46
We will get to this, we will get to this.

Curt Widhalm 23:48

Katie Vernoy 23:49
Part of the how to do it. So that we’re just looking at what the process is now. We’ll be there in a second. The judgment piece is what would happen if the action were pursued. And so that’s probability judgments and this can be very subject to overconfidence bias. And when I was saying overconfidence bias, of course, all of us in you know, America think we’re like, you know, super smart, know everything but in fact, because of the decrease in nuance in in cultures that have more collectivist compliance based stuff, they’re more certain about their answers because there’s less gray area. And obviously, again, very broad strokes from this article that they they were studying this, but it was something where it’s interesting that very analytic cultures are more deliberative in their processes and like and less likely to be confident with their quick judgments. Whereas some holistic or collectivist cultures are more likely to make those rapid decisions, because they know what to do. Society has told them what to do. Attribution is also a part of this where we’re thinking is this something that’s based on the situation or something that’s based on me? So the next one is actually the one and when we were preparing that, that you mentioned is something that you definitely focus in on, which is value. What will what will particular people like dislike and how much. And so there are obviously cultural differences in what is valued. I mean, if you even look at kind of a capitalist culture versus someone who’s an anti capitalist, there’s going to be different things that are valued. And success is going to be seen differently. Right?

Curt Widhalm 25:23

Katie Vernoy 25:24
So understanding your client, because even a client who’s living in a capitalist culture may be anti capitalist, obviously. But I think there’s also kind of understanding the desire for personal versus social impact. So is this going to impact me better? Or is it going to impact the society better, like, you know, those types of things. And I know, this is where bias for me as a therapist can come in really, really easily in that there is my own personal judgments of what I think is valuable, and what is righteous, and what people should be doing with their lives, and all of those things, and I have to really pull that back. But I think it’s also that thing of understanding that even if you have clients you’re very resonant with they may have very different values than you. And so being able to really understand what it is they’re valuing in the decision can be very important.

Curt Widhalm 26:14
I often pull out Acceptance and Commitment Therapy techniques here to be able to help my clients be able to figure out not only what their values are, but how closely aligned that they’re living to them. And so and I help them to kind of get to this process of being able to continuously come back to that evaluation, and to be able to be within the habit of this, you know, some ways it sounds like, you know, just kind of a ongoing reflective process. And other people they call it, you know, just kind of mindfulness about their values. But this is what this sounds like to me.

Katie Vernoy 26:49
And I think that’s fair. And that’s actually later in kind of how you best make decisions. It’s exactly that it’s, you know, you determine what your values are, you really lay them out. And then you also see how well you’re committed to them and see how you can continue to kind of bind yourself to them more. But the other piece that can be very interesting here, and this is where loss aversion and that that bias can come in, it’s kind of how much would the upside have to be for me to risk a loss. And so that’s also an element of value. There’s some cultures that have very low loss aversion, like they don’t care and, and other cultures, you know, there’s very high loss aversion. In this study, they said, Eastern Europeans have the highest loss aversion and African groups have the lowest loss aversion. And so understanding how fearful someone is of losing something can be helpful, because oftentimes, when we make a choice, we risk loss versus pursue gain. And so being able to frame it in a way that helps a client to kind of move in the direction that they want to move into getting them to frame it both ways, so that they can kind of have that element of pursuing what’s valuable to them and understanding from a way that aligns with their values. One piece of this loss aversion thing is if as, as there is an increased individualism, it correlates more with an increased loss aversion because it’s like, This is mine, I own it. It’s about my enjoyment. And so losing those things feel more fearful.

Curt Widhalm 28:18
And the inverse would seemingly be common sense here that if it’s more collectivist, then if there was a mistake to be made, there’s more of you, the people around you to help support you and lift you up.

Katie Vernoy 28:33
Exactly that actually, very good. That’s what it said in that article. Now, I’m remembering that. So excellent. Excellent. So the next stage is trade offs, every alternative has a flaw. So what now and so this is one where there are different ways that folks will resolve trade off dilemmas. And some are, you know, nothing can compensate for this trade off. And for other things. And then this is seen in American culture, more specifically, what they were talking about, it’s like, well, if I’m going to have to live further away, I will compensate with that for a better home, or I’m going to have a shorter commute, so it’ll compensate for the crappy apartment that I have. Again and I think that goes to that pros and cons list that I think have been ingrained in Western cultures, it’s like, doesn’t exactly work. It’s a little bit too simple. I mean, there’s a whole bunch of methods that actually potentially suggest that could work. But it’s like a lots and lots of math and it doesn’t feel psychologically to me intuitive. But I think that’s the whole compensation thing is a western cultural thing.

Curt Widhalm 29:41
And maybe this is my bias of working with the populations that I do, but I gave up on kind of some of these pros, cons lists a while ago, and I started putting it into terms of min maxing, because most of the most of the teens that I work with have done creative character either in like video games, or Dungeons and Dragons. type stuff where it’s being able to maximize the stats with some limitations and kind of being able to create a balance out of this. And so there’s already kind of a natural language that most of the younger generation seems to get with some of this stuff.

Katie Vernoy 30:16
And I think that can be good for simple decisions. A lot of what I read is that pros and cons is oftentimes not the most effective, because it is limited in scope. The last two stages, I’ll talk through quickly, because I want to get to what gets in the way of decision making. One is acceptability. How can we get others to agree with our decision? And sometimes there are moral decision making things that can happen here. There are sacred and protected values, in some cultures, and even in some sub cultures around, you can’t compensate or negotiate for these. So like, if you do this thing, you are forever, like horrible. And you will have to greatly apologize versus if you don’t do this thing, then you’ll it’ll be acceptable. But this is where social decision making requires knowing what everyone’s thinking and feeling and their personality and past intentions. And so this is where acceptability can be a lot longer in more folks who are more on the collectivist end of the of the spectrum versus people who are kind of on their own and very individualistic. It works for me, F everyone else. And so there’s that and then implementation, we have a whole episode on implementing a decision. And this is kind of understanding the benefits of concrete actionable plan. So if you want more on that, you can head over to the the one on goal setting. So that’s the process and some of the cultural differences. The fun part is what can get in the way. So let’s talk cognitive biases. What are some of the cognitive biases that you remember from like, undergrad Psych 101 that you think might impact decision making?

Curt Widhalm 31:50
Well, you’ve already talked about confirmation bias. There’s the fundamental attribution bias. It’s where we attribute to other people, intentions that they may not actually have.

Katie Vernoy 32:03
It’s their fault. It’s not our fault, because it’s the circumstances. So we it’s a temperament for them. It’s a situation for us. So yeah, I think a lot of the ones that we think about frequently like fundamental attribution bias, or confirmation bias, or those kinds of things. I think there was a lot of discussion of the Dunning Kruger effect a while back, I think those things are easy to come to the top of our minds. But based on an article by Berthet 2022, ‘The Impact of Cognitive Biases on Professionals’ Decision-Making’ there are a lot of different biases. So there’s groupthink and social consensus, and this is actually from an article by Wang et all in 2021, that the higher the social consensus, obviously, the harder it is to choose something different. But it’s not impacted by emotional state, which is interesting. When there’s low social consensus, positive emotions are more likely to lead to positive decisions. And negative emotions are likely to immoral decisions. But if there’s really high social consensus, it doesn’t matter what you’re feeling, you’re going to follow the group most of the time. So this is why when teens parents are like they’re hanging out with the wrong crowd. Yeah, that’s probably having an impact on their decision making.

Curt Widhalm 33:11
Sure, yeah.

Katie Vernoy 33:12
Okay, so other biases, praying availability, confirmation bias, disposition effect, hindsight bias, omission bias, outcome bias, overconfidence bias, relative risk bias, susceptibility to framing, the sunk cost fallacy, the halo or horn effect, the status quo effect, and in group bias. So there’s a lot of things that can impact therapists in supporting their clients. There’s a lot of stuff that can impact clients and their decision making. Ones that I think are really relevant to decision making are anchoring. Do you know what that one is?

Curt Widhalm 33:51
Yeah, it’s kind of where you get stuck on something from the beginning. And then make all of your judgments from that first point of view, rather than kind of taking that more dynamic look at things.

Katie Vernoy 34:02
Yeah. And that’s especially good to know when you’re pricing things, because you anchor it at a higher price. And then you have, you know, lower prices, because people are mostly going to pick the one in the middle. So for everybody wanting business advice, anchoring is especially helpful for getting people to pay what you want them to pay. Availability bias is actually one that I think is really important. But availability bias is evaluating the probability of events based on which relevant instances come to mind. And so this can also tie into confirmation bias. You’re searching for interpreting, favoring, recalling information that supports your personal beliefs or hypotheses. And so when people are only looking at what’s readily in front of them, and they’re searching for information that confirms what they already think and know, it’s really hard to make good decisions when you aren’t looking at the whole picture.

Curt Widhalm 34:50
So in the supervision process, you know, this is kind of where those countertransference discussions go. That it’s like, all right, who else does this client remind you of? And how is this informing what you’re doing in the room?

Katie Vernoy 35:05
Well, even if we talk about anchoring, I mean, I know it’s typically meant to be for numbers and that kind of stuff. But if you go in and you’re like, this is a referral from somebody, they’re like, Yeah, this client has ADHD. And so you anchor on a diagnosis, the availability is based on the questions that you’re asking. And potentially, you’re have a confirmation bias, where you’re now pulling all of the information that supports your previous the anchoring information of ADHD, you may miss a lot of things. So similar to bias, but not exactly the same, or oftentimes errors. And the rest of the talk here is going to be really focused in on this really good book. And I would recommend it to anybody that’s getting that’s excited about decision making. And it’s called Decisive, it’s got two sections here that I think are really, really good for us helping to get better at decision making. So according to the Heaths, there are four villains of decision making. There’s narrow framing, which we’ve kind of talked about, which is this kind of yes, or no options, very limited options, should I or shouldn’t I, it’s framed as one example I’ve given to somebody is like, do I stay with my current boyfriend? Or do I go back with my ex. It’s that kind of, I’m only seeing the things that are in front of me. The second one, our favorite confirmation bias, we know what that is. The third villain of decision making is short term emotion. And this is oftentimes a lack of perspective. And this is where wise mind comes in. But we’ll talk about some other things based on that. And then the fourth one is another bias is overconfidence, we think we know more about the future than we actually do. That’s one set of common errors. The next one is defensive decision making. This is when you don’t choose what’s in your best interest, you’re just choosing what is the lowest risk. And these are things where and this is from Mar-Fleck in 2021. And people will engage in this type of decision making to kind of protect resources. And oftentimes, this happens when people are not feeling safe, when they don’t have enough resources. And I’m sure we can think about a lot of places in society where this may be happening. But in our profession, I think sometimes defensive decision making can happen in like agencies where you’re overworked, you don’t have you know, like you have a group and like so you’re hoarding the art supplies, and no one else can look at it, and you’re not willing to take on a new client, because I don’t have the art supplies for that client for this group. You know, like, it can be something where we’re in such an unsafe space with with very little resources. Some of it is just, you know, some of it is in our best interests, like no, I can’t take another client. Some of it is like, if I move into a supervisory role in this setting, I will actually have a better control over my workload, but I feel just so overwhelmed, I can’t, I’m not going to do it, I’m not going to do it, I’m going to I could fail, I could, if I’m a supervisor, I can mess things up, you know, they could fire me like if you go into defensive decision making, oftentimes the way to counteract that is to increase resources, and feelings of safety. And for therapists, sometimes that’s just leaving those organizations. But sometimes it’s actually trying to, to get to that place of being able to improve your environment. There was an interesting one that I saw that I just wanted to say before we go into best practices, which is low sleep. We know when we have little sleep, our our brain doesn’t work as well. But what this study and this is a Aidman 2019, what they found was it impacts you at a cognitive level, my brain is not working as well. But it also decreases self monitoring. It’s kind of that like, my, my boundaries, my filters are gone. And so it also impacts you at a metacognitive level. And so it really is a one two punch on decision making when you’re not getting enough sleep. So as therapists, obviously, we’re recommending folks take good care of themselves, all of those things. But if we’re able to help them get to safer places, having sufficient resources, getting enough sleep, and all of that stuff that does help people to get to be more likely to be able to overcome some of these errors.

Curt Widhalm 39:18
I have to assume that this is a not exhaustive list, right?

Katie Vernoy 39:22
Oh, it’s not exhaustive at all. Like there’s a whole thing on emotions that we didn’t talk about because we’re therapists we get how emotions impact our thinking. Like there’s there’s a lot of stuff that impacts decision making. This was just a flavor.

Curt Widhalm 39:34

Katie Vernoy 39:36
So, best practices. An article I read by Steiner 2020 was really interesting because it talks about how we make really efficient decisions, which is everything’s aligned your emotions, your habits, your instincts, your intuition. When it’s super aligned you just you know what decision to make. It’s like, Okay, do I go to this family event? I value family, I don’t have any concerns with my family at the moment, yes, I’m gonna go to that family event. But when there’s a misalignment, then there’s this like, Okay, I value family, but I there’s like lots of conflict with my family right now, do I go? Do I not go? How do I, how do I navigate that? It gets into potentially morals that’s competing core values. I value family, but I also value my mental health, and how do I do that? And so there’s opportunity there to be able to for moral development, because you really have to grapple with two different core values, or potentially more of that, or emotions that are in one place and values that or in another place. That is the stuff of therapy, I think is when there are those those conflicts. But when people are super aligned, you know, one, one thing to be concerned about is that you can it can also lead to complacency. And so so this is just a little side note before we kind of get into the structure to try to help folks with with some of these other things, but I just thought that was so interesting. And I know for you as an ethicist, that that that may be more interesting to kind of touch on for a few minutes, because it’s, we want people to feel aligned in what they do. But if they are, then they may not be getting any real moral development, because it’s just like, it’s so efficient, it’s so complacent.

Curt Widhalm 41:19
Well, and I think too, you know, our ethical decision making episode and just kind of this is the part of the ethical decision making process, as it pertains to an ethics discussion of what do the code say? Where are the relevant laws and ethics that come into this? When it comes to working with clients, though, this is where it comes to being able to look at, as you were saying, your your values or your morals and being able to say, alright, in some situations, it’s going to be guided by this. And in other situations that’s going to be guided like that. And being able to kind of work through a decision making process based on pros and cons min maxing, any of that kind of stuff seems to be…

Katie Vernoy 42:01
The other stuff I’m going to talk about.

Curt Widhalm 42:03

Katie Vernoy 42:05
Yeah, I think it’s something where if we get to a place where we can actually write rules, or rubrics or decision trees, I think we get back into that place where decisions become much more easy. But I think there’s that element of oftentimes, the complexity of it is why they’re in therapy, right? Because it isn’t just like, well, in this situation, if it’s this then I do this, but in this situation, if it says I do this other thing, it’s like, no, this doesn’t fit into it, or it kind of does, but it feels wrong. And so then it’s really being able to kind of go through a robust process, a process where you’re able to get clients to a place where they can really understand the decision and make it from a more informed, grounded, potentially wise mind space. And so, back to Heaths 2013, the Decisive book, their acronym, is WRAP: Widen your options, Reality test your assumptions, Attain distance before deciding and Prepare to be wrong. So widen your options: the way that it was described in the book is that oftentimes, we put a spotlight on something and we’re deciding yes or no or one or the other. And so we want to avoid a narrow frame by shining the spotlight around to all the context, all the things around it, looking at, is there a better way? What else could we do? Are there opportunity costs, we’re not looking at? The one I really liked was a vanishing options test. If those two options if you could not do either one, what would you do? And so really being able to open the frame up, I think those things are ripe for really widening it out and getting a bit more creative, where somebody that already feels like they have 27 million options, you don’t you don’t need to do this, you actually need to simplify that one down. So you don’t want people to get overwhelmed by how many options there are. But oftentimes, when we’re in this space, people are more frustrated by, you know, the few little options they have that none of them seem like good options, or they have some options, but they can’t decide which ones cause they are all good, which is much less angst ridden, but still a hard decision. It helps to kind of wide it out to really get to understand the lay of the land really clarifying that and kind of imagining other opportunities. Another one called multi tracking. And it’s actually considering several options simultaneously. It’s basically doing two things at once. So it’s not choosing right away. It’s actually going forward with should I look for a new job? Or should I go for a promotion? It’s like, we’ll do both. Right. It’s keeping your options open. I mean, that one’s I think that one’s an obvious one for a lot of folks. But but the in the book they were talking about, like should I hire this person or that person? It’s like we’ll hire them both for a short contract, and then you hire the person that does the best job. It’s potentially looking at what’s the track that’s going to prevent risk. What’s the track that’s going to promote the most benefit, and you try both. And see which one works better. And it really is an opportunity to kind of gather more information, which as you’ll see becomes more and more important as you continue forward versus feeling like I need to do something right away, or I need to do it sequentially. You know, a lot of folks are like, I want to pursue this. But I also want to pursue this and I want to pursue that. And it’s like, Well, is there an opportunity to pursue more than one of those things at one time without totally overwhelming you?

Curt Widhalm 45:31
You know, where I see that come up a lot is the applying for one job at a time or waiting until after a vacation to start applying for jobs. Like there’s just kind of this like…

Katie Vernoy 45:42
It’s hard to think about more than one thing at a time.

Curt Widhalm 45:44
This existential procrastination.

Katie Vernoy 45:49

… 45:50
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Katie Vernoy 45:50
The next one is something that we’ve actually, we’ve actually used, it’s finding someone else who solved your problem. And so it’s looking at who else is grappling with the same problem, you could potentially benchmark your competitors, and absorb industry best practices. But but I think as therapists we do this all the time, I think the strongest therapists have what the Heaths called a playlist versus a checklist. And this is I’m sure, we could talk about how this is in your suicide training that we did a few months back, you know, if you do a checklist, yes or no, yes or no, yes or no, yes or no, done, done, done, done, done. A playlist is generative. It’s asking the questions to get the information to to generate the ideas. And so if you if you move into, like, what are other people doing? How do I assess what they’re doing? How do I create a playlist for myself? So when I get in situations like these, these are the types of questions that I can ask myself. And it’s really getting creative, and looking at potentially people that are doing something completely different, but they’re doing it quickly. And you want to do something quickly, for example. And so how are they moving quickly? What ideas can I pull from there? And the further away from your exact situation, the less likely it’s going to be like, great, wonderful, this is perfect, let’s move on. But it may create more aha moments, the further you get away from your exact situation. But finding other folks who’ve grappled with a problem help here to widen kind of the options, because they may have done something different. But it also will help later in some of these other other stages. So the next one is this reality test your assumptions. And this is where we really address bias. The first one is consider the opposite. Seek out seek out people who disagree with you push back against confirmation bias. Find a devil’s advocate, and know where to look for the right information. challenge conventional wisdom, test assumptions, plan to make mistakes, look at other possibilities. So basically just be

Curt Widhalm 47:49
Just just embrace your inner Curt. Just…

Katie Vernoy 47:54
Embrace your inner Curt. And I think people have a really hard time with that. I mean, confirmation bias is really strong. I mean, looking for people who disagree with you. It’s really hard. And I will do our bi-monthly reference to Ben Caldwell therapists are also have a hard time with conflict. And so it is our responsibility to potentially disagree with our clients at times to help them get some of this considering the opposite happening. Because if we’re just going, well trust your instincts, and what does that sound to you? And if we’re not pushing back and needle a little bit embracing our inner Curt a little bit, we might be doing a disservice to our clients.

Curt Widhalm 48:37
Yeah. And I always look at it as the ability to look at what could undermine something, change something, require you to change something about it makes whatever you’re coming in with more robust.

Katie Vernoy 48:50
Yes. I call it just arguing with my clients. And sometimes like it’s like, I feel like a bad therapist. I’m arguing with my clients a little bit. But I enjoy this one. But I recognize that therapists may feel a little bit cautious about it, to be that devil’s advocate, so to speak. So the next reality tests are assumptions, zoom in and zoom out. And so this is looking at an outside view versus an inside view. So you zoom out to see the larger picture something beyond the information you have. And and this is where you might seek out experts. But reading this chapter was hilarious, because experts are notoriously bad at predicting anything.

Curt Widhalm 49:33

Katie Vernoy 49:34
Like super bad. And so you…

Curt Widhalm 49:37
I could have predicted that.

Katie Vernoy 49:39
And you would have been wrong because no experts are better than novices at predicting things. But as a species, we are bad at predicting. We get marginally better if we become experts in the subject. But what we’re really good at when we are experts is understanding the base rates, what’s happened in the past, what’s usually gonna happen. And potentially we might even have statistics and data that will support this is what has happened. And in truth base rates are way better at predicting the future. What has happened is way more more solid in predicting the future than humans trying to. But people oftentimes will go to well, but it’s special in my situation, because I have this unique situation. And that can be true, but base rates are actually way more likely to be accurate than your own predictions about your unique situation. But you also want to zoom in and potentially get very close up, talk to folks with other with lived experience, and what you’re talking about are people who are solving the same problems or that kind of stuff, because that will help with intuition and just give you more information. The example that they had in the book was a medical decision making where there was somebody that was making kind of a life or death decision. It’s like, do I risk dying now to potentially have a longer life? Or do I confirm that I’ll have I will live for the next five years. The the way you can use lived experience is potentially identifying other things that you need to be aware of that you wouldn’t necessarily know from base rates, like, Will I need additional help? Or might I need to move? Or you know, those kinds of things where were just going at base rates was a successful or not is only going to tell you where you’re at whether or not you should make the decision, not the other elements of what might be part of the decision. The next one is called oohching.

Curt Widhalm 51:29

Katie Vernoy 51:30
Yeah. Do you have any sense of what oohching is?

Curt Widhalm 51:32
Ooch, ooch, ooch.

Katie Vernoy 51:37
It’s basically constructing small experiments before making a big leap. So it’s not trying to predict or plan. It’s testing. And but the idea is you don’t bog yourself down with predicting and planning, you just start testing likely options.

Curt Widhalm 51:54
You preview, you do a behavioral experiment sort of thing. And then you take that information and you scale it up.

Katie Vernoy 52:02
Yes. So does do you think that works every single in every single situation?

Curt Widhalm 52:07
No, I don’t. And that’s why we have p values.

Katie Vernoy 52:13
No, it’s actually it’s really good for big decisions where you don’t have to commit right away. And you can do that kind of multi tracking thing. It’s really bad for procrastinators who know what they need to do and just don’t want to do it.

Curt Widhalm 52:25

Katie Vernoy 52:25
That’s the reality test your assumptions. The next one is attain distance before the sighting. The first one is overcoming short term emotion. So here’s some quick tactics 10-10-10, what would you feel about this in 10 minutes, 10 months, 10 years? So pulling out to get some perspective on how this might have long standing impacts? Or not, right? Like, I’m going to be embarrassed forever. And it’s like, no, in 10 minutes, you won’t be embarrassed anymore. In 10 months, you’ll be happy you did it. And 10 years, you might be with the love of your life, right, like so. So it’s being able to pull back from the short term emotion. What would you tell your best friend to do? Now, this feels like a very coachy statement. But I think we can still use it.

Curt Widhalm 53:07
I like this as an idea, because it’s one of the ways of helping to bring some of the context sort of things out.

Katie Vernoy 53:16
Yeah. And I think for me, my clients, because I don’t do it exactly that way. Or like, what would you have told your younger self to do? And they’re like, Okay. It doesn’t always work. I don’t always pull out from my own situation to try to abandon someone else grappling with this. So it doesn’t always work. But I think it is helpful, because sometimes it really does. I mean, especially I know, you work with a lot of teens. So it might be like, what would you tell your best friend to do? For me when I’m working with adults, and they have, like young adult children, or were teens or whatever? Asking them what they would tell their child to do is so powerful, because all of a sudden, they have compassion that they don’t have for themselves, and they have, they have so much more clarity on what’s in their child’s best interests. Like it’s it, that one’s rich. I love that. But yeah, but it does feel kind of like like a coachy question, or one that you might find in like a magazine. The other one is really trying to figure out how you overcome the status quo bias. There’s what’s familiar and we like what’s familiar, and we we have loss aversion, and so being able to recognize that and try to pull back into will, yes, being in this horrible relationship is very familiar to you. And I know you’re afraid to be alone and the loss of this relationship. But let’s let’s pull back. This is familiar. Why is this familiar to you? What what other things are you wanting in your life? Let’s let’s move past what’s familiar into some other options. And then the final one in this overcoming short term emotion is the observer’s perspective. And this one is I think, especially good for business decision making, I think we can extrapolate it to therapy decision making. The example was like a CEO and a COO were trying to grapple with huge industry changes and a product line. And they were bound by, you know, they had this product line that had been doing well, forever, it was starting to dip, it seemed like society was changing, and they just couldn’t figure out what to do is like, it’s heartbreaking. We’re gonna lose this product. It’s our star, our flagship, whatever, blah, blah, blah. And the question that opened it up for them was what what our successors do, because it’s like, if we don’t figure this out, we’re gonna get fired. And so what would the next CEO and COO do? And then it opened it up? Well, they would get rid of this product. And they would do this, they would do this, do this, like it was clear once there was an outside perspective, what what should be done when you’re not mired down in like all the drama and relationships and all this stuff? And so I think that can be helpful to obviously, it could just be like, well, what would your friend do in this situation? Right? You know, so what would you tell your best friend, and then now, what would your friend do in this situation. And then the final one in attain distance before deciding is honor your core priorities. And as we talked about for agonizing decisions are evidence that the core priority is in conflict. But I won’t go too deep into this, because you’ve already talked about this, but it’s really identifying and enshrining your core priorities, making it really clear to yourself what is most valuable, so it can help inform your decisions, both current and future decisions. But having those core priorities and making them very clear doesn’t necessarily mean that you’re binding yourself to them, that you’re, they’re actually following them. And for me, that’s very rich conversation. Because sometimes people will say that they really value these core priorities. And then the the misalignment is more kind of self hatred, it might be more like just really challenging, you know, themselves and just not feeling like they deserve it. But sometimes it’s the reverse, right? It’s that they’ve said, this is a core priority, because they feel like it should be a core priority. And in fact, it’s not, you know, they say family is super important. But every single time they choose their job over their family, and they choose the the mission of their company over their family. Maybe it’s not, maybe you you’re supposed to value your family, but you don’t, or the reverse, it could be I’ve got this big mission, and that’s supposed to trump everything else. But in fact, every single time I choose my family and doing stuff for them over what I’ve set out to do. And so I think I think that’s where there’s really rich conversations about values that inform decision making, too.

Curt Widhalm 57:43
And I think, you know, this is also where having the right core values be identified, like, and this is either done in some of the earlier work that we were talking about earlier. But this is also times where it’s like, I know that family should be really important, because my family told me so and they keep just treating me like garbage. And so I have this idea that it should be important. And I say that it’s important, but it’s not really.

Katie Vernoy 58:12
Yeah, yeah. And with all of my clients, but I like to get really clear on values as early in the process as possible. Because I think for me, it, it frames everything, because I don’t feel like you can really work with a client, if you don’t have a really good sense of of what their core values are. There’s so much potential for bias. And then the final part of this is, when you have strong core values, and you know what you’re going to say yes to, you have to be really, really good at figuring out what to say no to and that can be the big thing that helps clients make some choices is that you talk about okay, well, what are you saying yes to you know choice 4a is what you’re saying yes to? Okay, that means choices, 1 through 3 and 4b through d, are all nose. Let’s imagine saying no to those things. What does that how does that feel? How do you make sure that that’s really aligned. And the last stage of decision making is prepared to be wrong. And this is where I think there’s especially in the first one, this is where you’re going to need a lot of potentially coping strategies and CBT. But I like this one. Anyway, I work with a lot of clients who have anxiety, and who have had traumatic childhoods, who would go into there’s 27 million things that could go wrong. So I do this a lot because I kind of I like to adress it head on but it’s called bookending the future. And so there’s the lower book end and the upper book end. So what’s the the lower book end is what is the kind of worst case of what could happen? The upper book end is what’s the best case? And I think for the clients that are very anxious that have are very pessimistic, we spend a lot of time on the lower book and because it’s like everything could go wrong, I could lose my job and end up homeless. I’m like, wait a second. Let’s let’s actually dig into that fort more and do some reality testing there to actually get a real lower book end. And then, you know, for clients that are a little bit more overconfident. We might have to work on the upper book end and really try to get as close as possible to what is the actual range of possibilities here and understand it. But the thing that I thought was really interesting, and these are just small mindset shifts, it’s to get to a lower book end with somebody that’s not going to predict chaos and failure and doom. It’s doing a pre mortem, let’s say, in six years, this failed, why did it fail? Or in six months, it failed? Why did it fail? People are better able to come up with realistic reasons to that question, then why could this fail? And so it’s kind of going forward to a appropriate time point and saying, why did this fail? That’s the thought experiment, right. And then for the upper book, and they call it a pre-parade, which is okay, it’s in six months, it’s been successful. But beyond our wildest dreams, what does that look like? That actually is very helpful, because some people say they want something and they go towards it. And then when they actually get there, they’re like, Oh, I didn’t want this, this is horrible. This is exhausting, or this is too much work, or I wasn’t prepared for, you know, all the things that are coming my way. And I don’t have the bandwidth for it, or whatever it is. And so both the pre mortem and the pre parade are both very helpful, because it gives you even more information about the decisions you’re making, and being able to really look at consequences, versus just kind of what’s going to happen in the next little bit. The next one is pretty funny. It’s called set a tripwire. And this one I will remember forever. The idea of a tripwire is that you set something out that will signal to you that you have to pay attention to something versus be on autopilot. I know I’m dating myself, but I heard about this that like Van Halen had a thing in their contract where in the rider it was like, so they had to have a bowl of green m&ms. And so Van Halen would walk in. And if there was either a bowl of all colored m&ms or no m&ms, or whatever, immediately, they would go through and check everything. Because they had so many pieces to their show, it was hugely dangerous. Like they had like huge amounts of trucks that were coming in, they had to load them in all properly. And so if the venue had not read and saw the green m&ms as part of the that, that level of detail, then Eddie Van Halen knew that he had to go through, like and check everything, have his people check everything to make sure that like, lights weren’t gonna fall down and burn them up, or you know, whatever it is like that they had done everything to a tee. And of course, he just seemed like he was kind of an asshole. But it was really for a reason it was a tripwire, to be able to identify, Has everything been looked at this closely? There’s other things like setting a deadline, hey, six months ago, you said you were going to do this. And so as a therapist, we can be part of that accountability, if they if that’s something that you do within the relationship, you can look for partitioning. And we have a whole episode on profit first, which is a very specific example of partitioning. So you only do the things based on how much you’ve allotted to it. But tripwires, theoretically can kind of cap the risk a little bit, I know when I have to look at something, but I don’t need to look at it before then. I can kind of play around and be available to the experience until a tripwire flipped or whatever. And then the final is, is trusting the process. And being able to recognize that actually having a decision making process, getting a little bit more into the weeds on what the context is, and being able to really process through the different feelings that come up, being able to look at how it fits into your morals and values, how it fits into how you work with your family. Having that process, although it is not beautiful, wonderful, maybe sometimes not even fun, it actually gives you permission to be able to feel better about the process. I mean, like when we think about, you know, meetings, and everybody’s got to weigh in, if everybody has weighed in and everybody feels like there there is a consensus and people feel heard, even if they don’t completely agree with the outcome, they at least trust the process happened and the decision made was was made reasonably. And I think we can do that both in groups as well as individually. Like I did my due diligence. So even though the decision may, you know, this is the outcome bias, even if I come back later, and the outcome said that this wasn’t a good decision, it was still I know I made the best decision I could with the information I had at the time. So that’s the process. I think some of this is reminder, some of it may be new tactics that you can try. But I think just being conscious about it can be really helpful.

Curt Widhalm 1:04:38
So I really liked that this lays out still putting all of the work on clients. Like this is teaching people how to think, how to apply the process as opposed to what to think. And I think that that’s, you know, a lot of times where in our field we get down to these really simple pieces of advice that don’t have the context of what’s behind them. So it’s you know, don’t make decisions for your clients. Well, broader version of that is helping your clients learn how to think, rather than putting you into this guru position of making decisions for them is really more of what your job is than it is like, now, sounds like you want this?

Katie Vernoy 1:05:19
Well, and I think the other piece is it also doesn’t leave your clients without anything, because I think some therapists get really nervous around helping with decisions, because they’re not supposed to tell them what to do. And so they’re like, well, it’s up to you. It’s, it’s, you know, it gets pushed back on the client without having the infrastructure to help them go through that process.

Curt Widhalm 1:05:39

Katie Vernoy 1:05:39
And so so this is, this is potentially just a very conscious way to do what people are already doing. And it might also be new information. So people can really be thinking more specifically about how they support their clients in making decisions.

Curt Widhalm 1:05:52
So if one of the decisions that you’re making is where to get your CEs, you’d have more options than you think, including over at modern therapist community where you can get this episode as well as some of our other offerings. And you can get the directions on how to do that both the intro and outro of the show as well is our show notes available over at Follow us on our social media, join our Facebook group, the Modern Therapists group, and until next time, I’m Curt Widhalm with Katie Vernoy.

… 1:06:27
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Katie Vernoy 1:06:28
Just a quick reminder, if you’d like one unit of continuing education for listening to this episode, go to, purchase this course and pass the post test. A CE certificate will appear in your profile once you’ve successfully completed the steps.

Curt Widhalm 1:06:43
Once again, that’s

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