Choice Components

The overall aim of the Choice appointment is to find out what the person and their family are concerned about and give them enough information to allow them to make an informed choice about what to do next. This includes explaining the variety of services and interventions that they could find useful and planning an appropriate way forward in partnership. The Choice appointment experience should be one that builds a Therapeutic Alliance by reaching a joint understanding of the problem with choices made as to future actions – reaching a Choice Point.

What do we think you should actually do in the session?

We think that Choice involves eight basic components. These eight aren’t linear but the first three are used until a joint formulation is made:

Components

Curious

Being curious and following their concerns. Really listening to their views, understandings and hopes

Risk and Possible Diagnoses

Being active in thinking and discussing risk and screening for any relevant diagnoses

Honest Opinion

This is us presenting our advice or opinion (so far) to discuss together which leads to a

Joint Formulation

To gradually form an understanding with them as to roughly what is going on

Then…

Discuss alternatives

That might help which lead to the…

Choice Point:

Agreement as to their goals and to use the evolved joint understanding and discussion of alternatives to help them make an informed choice about the next step

And finally…

Engagement:

Engage them in their own change by considering how they think they can help with their concerns perhaps discussing any ‘homework’ they might do.

The majority of the initial part of the Choice appointment is being curious and feeding our opinion into the discussion to gradually create a Joint formulation. A key part of our task in this phase is also to consider risk and possible diagnoses so they can be discussed collaboratively.

Choice style

So how does this look in practice? Well, we think the person and their family should experience a conversational style that is relaxed and not following a rigid semi-structured interview. This is much easier when we remain curious rather than trying to complete an ‘assessment’.

We hope that they will experience us as human and respectful without an imposed professional hierarchy.

However for the clinician it is a very active process. We need to be considering possible diagnoses and risks in our head as we go along. The skill is to ‘park’ these ideas and return to them as the Choice appointment progresses. It can be harder to do if you feel tired and some teams have developed a prompt sheet to make sure the risk items are covered at some point.