Counseling for Effective Decision Making

Current Topics in Decision Theory

Classical decision theory continues to nourish considerable scholarly activity in fields such as administrative science, business economics, and operations research. Unfortunately, relatively few of these academic endeavors pertain to the conduct of counseling. The reader is invited to get the "big picture" from exhaustive reviews by Becker and McClintock (1967), Rapoport and Wallsten (1972), and Slovac, Fischhoff, and Lichtenstein (1977). Lest we wander too far afield, this chapter will be highly selective in the choice of topics discussed. Initially, I will explore recent attempts to apply the SEU model to several counseling concerns. Next I will point out some problematic assumptions that have caused the SEU model to undergo assault from a number of directions. As an alternative to the SEU perspective, Janis and Mann (1977) have developed the conflict model of decision making, which draws heavily from the literature of information processing and social psychology. Their work merits extensive coverage; particularly relevant are the intervention strategies they recommend. Finally, I will briefly review Greenwald's (1973) direct decision therapy, which apparently emerged outside the formal study of decision making.

Clinical Illustrations of the SEU Model

There have been numerous recent attempts to interpret such clinical problems as cigarette smoking, compulsive neurosis, criminal behavior, and occupational choice and their resolution in the language of classical decision theory. It is too early to judge whether these translations will improve treatment programming. At present most of these academic excursions traverse on long theoretical highways through widely scattered and impoverished towns of data.

Cigarette Smoking

Mausner (1973) points out that there is a puzzling discrepancy between the extreme difficulty counselors find in helping people quit smoking and the fact that some twenty-nine million individuals have given up the habit without professional assistance. This discrepancy led him to explore decision-making processes in smoking cessation apart from the study of treatment programming (see also Mausner & Platt, 1971; Vinokur, 1971). In one study Mausner (1973) examined the relevance of the SEU model by means of a psychometric pretest. Essentially all subjects were asked to indicate the value they placed on a wide variety of outcomes pertaining to smoking or not smoking. They were also instructed to give an estimate of their expectation that these outcomes would occur if they continued to smoke or if they stopped. Thus Mausner was able to calculate SEUs for smoking and not smoking on all subjects before treatment.

Mausner found that those subjects who reduced their smoking by half a pack or more following treatment had significantly higher SEUs for stopping than those subjects whose smoking behavior remained unchanged. In contrast, no differences emerged between the two groups on SEUs for continuing to smoke. Mausner concluded that "people make the decision to stop smoking not because they have a fear of the consequences of continuing to smoke, but because they have an increased expectation of benefits from stopping" (1973, p. 120). (It is interesting to note that weight loss and dental hygiene decisions may be governed by similar expectations. See Evans, Rozelle, Lasater, Dembroski, and Allen, 1970; Horan, Baker, Hoffman, and Shute, 1975; Horan, Smyers, Dorfman, and Jenkins, 1975.)

Mausner's (1973) study can be criticized on a variety of methodological grounds. Reduction was defined by self-report; there was no follow up, and verified abstinence was not a criterion (see Horan, Hacket, and Linberg, 1978; and Horan, Westcott, Vetovich, and Swisher, 1974). Nevertheless, the psychometric pretest, despite its crudity, does suggest that clients' decision-making processes concerning their smoking may influence their responsiveness to treatment programming.

Compulsive Neurosis

Carr (1974, p. 311) defines compulsion as "a recurrent or persistent thought, image, impulse, or action that is accompanied by a sense of subjective compulsion and a desire to resist it." After reviewing a number of deficiencies in various contemporary views of compulsions, he suggests that classical decision theory concepts may be relevant. In the first place, Carr maintains that his own psychophysiological research indicates that compulsive neurotics show abnormally high estimates of the probability that unfavorable events will occur. This probability estimate multiplied by the subjective cost of the event yields an index of threat that the reader will note closely resembles the concept of SEU (subjective probability times utility). Carr then asserts that "compulsive behaviors develop as threat-reducing activities, effective through their lowering of the subjective probability of the unfavorable outcome" (1974, p. 316). In other words, the client chooses compulsive behavior as a strategy for reducing the (erroneously) high likelihood that unpleasant events will follow. This would, of course, suggest that counseling interventions ought to be directed toward lowering these estimates (that is, reducing the disparity between objective and subjective probability). Unfortunately, Carr has few recommendations to make in this regard.

Criminal Behavior

Broadhurst (1976) has neatly summarized Cohen's (1970) contention that criminal behavior can be explained in terms of the SEU model:

Cohen (1970) shows that the criminal decision depends neither on the certainty of being caught nor on the severity of the punishment-both of which can to some extent be estimated from official statistics-but on the interaction of subjective probability of being caught, subjective probability of punishment if caught and convicted, subjective severity of expected punishment, and subjective probability of enjoyment of the loot irrespective of discovery, detention, and punishment, making in all a complex SEU...
The criminal offender is taking a gamble, staking his freedom and reputation against his subjective probabilities of gain and punishment, and hence his behavior is susceptible to analysis in decision theory terms (p. 281).

The Broadhurst-Cohen analysis appears quite germane to planned crimes, particularly white-collar crime such as tax evasion and embezzlement wherein the perpetrator has considerable time for deliberation. The SEUs involved in some forms of street crime, however, may be geometrically more complex, unstable, and unmeasurable. A victim's defensive behavior, for example, may produce impulsive criminal aggression that in turn alters the likelihood and severity of punishment. The SEU model assumes the panicky criminal deliberately takes these shifting probabilities and utilities into account.

In any event, the suggestion that criminal behavior can be explained in terms of classical decision theory has not been fortified by any convincing research data. This omission is largely due to the impractical experimental requirement that a criminal's decision-making processes be tapped prior to the crime. Moreover, it is difficult to conceptualize what forms of counseling intervention might flow from an SEU perspective of illegal activity. If it can be shown that some forms of crime do pay, criminal behavior may appear to be inherently more "rational" than lawabiding behavior.

Occupational Choice

Kaldor and Zytowski (1969) propose that a theory of occupational choice can be derived from the tenets of classical decision theory. They contend that there are three determinants of occupational choice: the chooser's occupational utilities (preferences), the availability of resources (for example, college tuition), and the anticipated consequences of employing given resources in various occupations with differing potential for gratification. One chooses an occupation that allows for maximization of net gain. Kaldor and Zytowski readily acknowledge some crippling limitations of their model. For example, it assumes that the individual has complete knowledge of occupational possibilities, utilities, and consequences. (Counseling strategies others have developed to shore up these assumptions are discussed in subsequent chapters.) Moreover, their model has generated relatively little research activity.

Other Clinical Illustrations

Broadhurst (1976) suggests numerous other applications of formal decision theory to clinical concerns such as abortion, alcoholism, and gambling. In her opinion the future will find us all considering behavior change in terms of utilities and probabilities. My own perspective on the destiny of classical decision theory is less optimistic. Let us now examine why.

Some Problematic Assumptions of the SEU Model

A quick reading of basic decision theory literature might leave the impression that here is a very relevant technology, the application of which has been shamefully neglected by counselors who are in the business of helping people arrive at decisions. Such an accusation, however, would be at most only partly correct because some assumptions of classical decision theory seem to defy application.

One assumption, for example, concerns the generation of possible alternatives to a decision-making problem. Decision theory leaves no room for what might loosely be called creativity (behaviorists prefer to speak of new or novel responses). The process by which we arrive at viable alternatives is ignored; classical decision theory demands that all possible alternatives already be at hand. In practice, however, the generation of possible alternatives requires a substantial amount of counselor time and effort. Many clients are not even aware that the stress they are experiencing can be operationally defined as a choice problem much less have any idea of the options open to them.

Decision theory also requires that the alternatives be independent; that is, the utilities and probabilities of one alternative (or a new alternative) should not influence another alternative. In real life, however, this may not always hold true. Generally, I prefer prime rib to shrimp, and I will invariably order it from a list of edible alternatives. But if I should notice only one beef entry on a menu laden with fish specialities, my choice is very likely to change.

The concept of transitivity has also been a problem for decision theory. Transitivity means that my preferences can be ordered. If I prefer to marry Susan over Rachel and Rachel over Laura, then logically I must prefer Susan over Laura. Yet May (1954) conducted an experiment of this nature in which 27 percent of the subjects gave intrasensitive choice triads; Lauras were preferred to Susans!

Furthermore, decision theory does not deal with the problem of maladaptive utility formation. For example, peer influence strongly contributes to the development of favorable drug attitudes (Horan, 1973e; Stone & Shute, 1976) and thus ultimately to the ingestion of illegal drugs. In the language of decision theory, a youth might decide to take drugs partly because of an inordinately high utility assigned to peer approval. Classical decision theory assumes that one's utilities are rational and ought not to be tampered with. Yet all counseling theorists acknowledge the pervasive problem of self-defeating utilities (That is, values or secondary reinforcers) in various client populations.

Decision theory acknowledges the existence of "probability preferences," but again without comment as to their origin or rationality. Edwards (1954) has shown that individuals strongly prefer low probabilities of losing large amounts of money to high probabilities of losing small amounts of money. Unless this quirk of human nature is genetically determined, we must assume it is learned. One could undoubtedly blow a theoretical bubble out of the laws and schedules of reinforcement to account for such preferences, but I am loath to do so. Probability preferences are useful in explaining why people make a decision, but they can muddy out the water in terms of which decision ought to be made.

We not only prefer certain probabilities to others, but our species also errs in probability estimation. Preston and Barra (1948) found that individuals not privy to objective probability information consistently over-estimated low probabilities and underestimated high probablities. It would thus appear that barring another genetic predisposition, our probability-estimatating behavior is very much subject to the laws of learning. And depending upon what kind of reinforcement schedule we have been exposed to, these estimates might well be consistently erroneous and thus lead to maladaptive decision making.

A final difficulty also arises from the probability component in decision theory, namely, the potentially wide variance between objective and subjective probability. If our client was considering marriage to a thrice-divorced current alcoholic, we would no doubt assume that our client's subjective-probability-for-future-happiness estimate differs from a probability estimate we might assign. On the other hand, who knows that situation better than our client? We are "wrong" in our subjective probablity estimates only if we fail to react to new information via Bayes's theorem; initial estimates by clients or counselors are neither defensible nor refutable. Cohen and Hansel (1958) have shown that subjective probabilities are very much influenced by age and experience. But the packaging of age and experience for delivery to the decision-making client remains a problem for the counselor. Other assaults on the SEU model are lucidly discussed by Fishburn (1972).

The Conflict Model of Decision Making

Apart from the problematic assumptions of the SEU model, which diminish its relevance to counseling, it might also be said that classical decision theory provides a highly reductionistic view of how we make--or ought to make-decisions. The theory is not necessarily "wrong," but further explication of its key concepts could enchance its usefulness. What factors, for example, underlie our assignment of utility values to the consequences of various alternatives? Under what conditions do these values shift or solidify? Why do we ignore pertinent information? And why do we make irrational decisions?

Various fields of inquiry have much to say in response to these questions. Studies in attitude change (Brehm, 1968; McGuire, 1960, 1969), cognitive dissonance (Festinger, 1957), conformity (Asch, 1952), and commitment (Kiesler, 1971) are particularly pertinent. Janis and Mann (1968, 1977) have developed a theory of decision making that draws heavily on this literature. They have labeled their work "a conflict model of decision making." The distinction between hot and cold decisions, the concept of vigilant information processing, and several coping patterns in deciding are major theoretical components of their model. I will briefly review these components before turning to their very important work on the development of intervention strategies for decision-making counseling.

Hot and Cold Decisions

"Cold" decisions are made in a calm detached state. Utility values are generally low and easy to calculate. The choice of a bank in which to open a checking account or what to wear on a routine day at the office, for example, would rarely be expected to evoke strong emotions. Such decisions are easily fitted into the language of classical decision theory discussed in the last chapter. In contrast, Abelson (1963) speaks of "hot cognitions" -- those aroused by vital concerns such as health and safety. Janis and Mann (1977) believe their conflict model of decision making is particularly pertinent to decisions made in the presence of hot cognitions, "when human beings are required to make decisions on highly ego-involving issues" (p. 46). Hot decisions occur in the context of stress; utility values are generally high and difficult to calculate. Examples might include one's choice of career, marriage partner, or medical intervention for a serious illness.

As with temperature conditions in the physical sciences, the terms "hot" and "cold" applied to decisions reflect differences in degree rather than process. The language of classical decision theory still applies to hot decisions. Utility, by definition, is subjective value. Hot cognitions simply make utility more volatile from the standpoint of measurement. Janis and Mann's emphasis on hot cognition, however, underscores their concern with vital personal decision making rather than the artificial or trivial sort that seems to typify much experimental work in this area.

Vigilant Information Processing

Janis and Mann (1977) have postulated seven procedural criteria they consider necessary for making "high-quality" decisions. Their notion of a quality decision bears a strong resemblance to the concept of effective or adaptive decision making introduced in chapter 1. Recall that the adaptiveness of a decision depends upon the behaviors that precede the decision rather than the events that follow it. Janis and Mann characterize the orientation of an individual meeting all seven of the following criteria as "vigilant information processing":*

The decision maker to the best of his ability and within his information-processing capabilities

thoroughly canvasses a wide range of alternative courses of action;
surveys the full range of objectives to be fulfilled and the values implicated by the choice;
carefully weighs whatever he knows about the costs and risks of negative consequences, as well as the positive consequences, that could flow from each alternative;
intensively searches for new information relevant to further evaluation of the alternatives;
correctly assimilates and takes account of any new information or expert judgment to which he is exposed, even when the information or judgment does not support the course of action he initially prefers;
reexamines the positive and negative consequences of all known alternatives, including those originally regarded as unacceptable, before making a final choice;
makes detailed provisions for implementing or executing the chosen course of action, with special attention to contingency plans that might be required if various known risks were to materialize. (p. 12)

Vigilant information processing is not an all-or-nothing affair. Janis and Mann suggest that each of these criteria could be considered as an item on a scale with a possible rating of, say, from 0 to 10. "Thus if a decision maker focuses exclusively on one course of action that someone recommends, spends no time at all thinking about what the alternatives might be, and asks no one in his social network to suggest alternatives, his score on the first criterion would be zero" (1977, p. 12). Failure to display a vigilant information-processing orientation would be reflected by a low rating on each of the seven criteria. Higher scores suggest varying degrees of vigilance. A major tenet of the conflict model is that such vigilance scores are predictive of postdecisional satisfaction or regret.

The seven criteria for vigilant information processing represent a fairly practical synthesis of what has been written about how to make a good decision. Most such formulations, however, rest on only face validity; that is, what has been postulated seems reasonable, but data existing beyond the theoretician's armchair has not or cannot be collected. Janis and Mann's suggestion that the behaviors preceding a decision can be quantified and related to postdecisional outcomes poses exciting research possibilities. The work, however, remains to be done.

Coping Patterns in Deciding

One of the most interesting features of the conflict model is its graphic depiction of coping patterns underlying our rational and irrational decisions. Psychological stress, resulting from the prospect of losing or failing to gain utility, is a hingepin variable. Extremely low stress or extremely high stress is likely to produce defective information processing; intermediate levels of stress, on the other hand, permit vigilant information processing.

Stress occurs whenever we are confronted with negative feedback or positive opportunities. Stress or lack of it breeds five basic patterns of coping, four of which often result in defective decision making: (1) Unconflicted adherence follows the decision maker's evaluation that the risks for not changing are negligible. Because little or no stress has been generated, the decision maker does not become vigilant in appraising the situation. (2) Unconflicted change may result when the decision maker recognizes that the risks are high for not changing and low for changing. Some stress is generated and a choice is made without a thorough canvassing of the alternatives. (3) Defensive avoidance exists when the decision maker believes the risks for changing and not changing are both serious and further believes that prospects for finding a good solution are unrealistic. Stress is high and pursuit of new possibilities is prematurely curtailed. (4) Hypervigilance is akin to panic. The risks for changing and not changing are serious. Although a good solution may exist, the decision maker feels there is insufficient time to find it. Stress is high and an alternative is hastily selected without careful consideration of possible consequences. (5) Vigilance, in contrast to the first four coping patterns, will often result in effective decisions. The risks for changing and not changing are high, but the decision maker feels there is hope for and sufficient time to find a satisfactory solution. Stress is moderate and an alternative is selected only after a thorough search and appraisal. Figure 5.1 depicts the five patterns of deciding and the conditions leading to them.

In order to assist individuals with decision-making concerns, Janis and Mann and their associates have developed a number of intervention strategies and culled several others from the social psychology literature. These interventions are grouped into two categories: strategies for challenging outworn decisions and strategies for improving the quality of decision making.

Challenging Outworn Decisions

Janis and Mann recommend five intervention strategies for challenging outworn decisions, The first four are cognitive confrontations; the last is an emotional confrontation. Properly speaking, these are for the most part attitude-change procedures rather than decision-making counseling techniques and are relevant only insofar as they can be useful in changing poor decisions presently in effect.

Socratic Dialoguing. McGuire (1960) maintained that our cognitive superstructures are assembled in such a way that inconsistent thoughts can be neatly tucked away in separate compartments. Socratic dialoguing involves asking a person to state how he or she feels, believes, and behaves with regard to a particular topic and why. McGuire reported that the procedure causes people to display more logical consistency. The counseling implications are obvious. Counselors who encourage clients to verbalize their thoughts about particular topics or decisions presumably should also foster increased cognitive consistency. Ironically, this phenomenon has not received any analog research attention in the counseling literature despite many counselors' widely professed allegiance to "talking out cures."
Conflict model of
decision making
Source: Reprinted with permission of Macmillan Publishing Co., Inc. from Decision Making: A psychological analysis of conflict, choice, and commitment by Irving L. Janis and Leon Mann. Copyright © 1977 by The Free Press, a Division of Macmillan Publishing Co., Inc.
FIGURE 5.1. Conflict model of decision making

Insight Induction. Katz, Sarnoff, and McClintock (1956) developed a two-stage process for shifting prejudice. First they provide subjects with information on how prejudice develops; then they "force insight" by presenting a case history of a student demographically similar to the subjects and illustrating how prejudicial attitudes were formed in the course of this student's life. Whether insight or modeling-plus-experimenter-demand s causes the attitude shift is, of course, debatable. This procedure has much in common with the modeling research discussed in chapters 2, 3, and 9. For the moment, suffice it to say that counselors who present models of faulty decision making may cause clients to question the adequacy of their own decision making, especially if the faulty models suffer adverse consequences.

Induced Cognitive Dissonance. According to Festinger (1957) dissonance between two cognitions is psychologically distressing. Dissonance exists when "the obverse of one element would follow from the other" (p. 13). Individuals experiencing such a disparity are motivated to seek a state of consonance, which can be achieved by making their cognitive, affective, and motor behaviors consistent with each other. Rokeach (1971) has observed that dissonance can be induced by exposing "a person to information designed to make him consciously aware of states of inconsistency that exist chronically within his own value-attitude system below the level of his conscious awareness" (p. 453). Theoretically, either the value or the decision could change; but according to Rokeach, because "values are determinants of attitudes as well as behavior," (p. 471), the latter occurrence would be expected.

Rokeach has produced some rather impressive decreases in racial prejudice with this technique. Moreover, induced cognitive dissonance has caused student drug attitudes to become more conservative (Swisher & Horan, 1972). If we look at Rokeach's concept of value from the perspective of utility, the phenomenon is readily explainable by the SEU model of decision making: We select alternatives with the highest utility -probability product. Should we discover new utilities inherent in other alternatives, our decisions are likely to change, In practical terms, if a counselor can identify an unknown or at least unverbalized value (reinforcer) present in a given client that is inconsistent with the holding of an outmoded decision, the decision will be effectively challenged.

The Awareness-of-Rationalizations Technique. Reed and Janis (1974) developed this procedure to make smokers aware of their self-defeating excuses for persisting in their decision to smoke. Essentially, eight common rationalizations are presented to smokers one at a time (for example, "It really hasn't been proven that cigarette smoking is a cause of lung cancer"). Interviewers then ask the smokers a number of questions designed to uncover the tendency to rely on each such excuse. Once the rationalization tendency is exposed, the subjects are given didactic information refuting their rationalizations.

Reed and Janis report that the procedure resulted in changed attitudes about smoking; however, their behavioral data, which would imply changed decisions about smoking as well, are difficult to interpret and unconvincing. The reader may have noticed that the awareness- of- rationalizations technique bears a strong resemblance to independently developed cognitive behavioral counseling procedures discussed in chapter 3. Under the name of cognitive restructuring, it serves as a treatment component in various comprehensive behavioral programs (for example, Hackett & Horan, 1977; Mahoney, 1973).

Emotional Confrontations Via Role Playing. This procedure evolved from Janis and Mann's observation that ineffective decisions can change after a dramatic emotion-arousing experience. Relatives of lung-cancer patients, for example, often realize their own personal vulnerability and quit smoking. Most of the work on emotional role playing has also occurred in the context of smoking decisions. Essentially, the technique requires that heavy smokers play the role of persons told by their physicians that they have lung cancer. The procedure is strikingly similar to another independently developed technique known as covert sensitization (see chapter 3) except that the soliloquies are generated by the client rather than the counselor.

Theoretically, one might argue that emotional role playing may be more powerful than covert sensitization because it allows for increased relevance and less "tuning out" of the aversive image. Kazdin's (1975) modification of covert modeling, which calls for clients to describe their imagery aloud, is also procedurally similar. Although a variety of studies (for example, Mann, 1967; Mann & Janis, 1968) suggest that emotional role playing is effective in changing smokers' attitudes, again the behavioral data on smoking reduction, although statistically significant, has not been clinically or operationally impressive by today's standards (see Horan, Hackett, & Linberg, 1978). Toomey's (1972) study provides a faint degree of support for the use of emotional role playing in challenging the drinking decisions of chronic alcoholics.

Improving the Quality of Decision Making

The foregoing interventions are designed to jolt clients out of poor decisional ruts. Janis and Mann (1977) suggest three other techniques for helping clients become vigilant information processors on the road to high-quality decision making.

Balance Sheeting. Balance sheet procedures in decision making really date back to the "moral algebra" of Benjamin Franklin described in chapter 1. Many variations of this theme exist, some of which will be covered in subsequent chapters. The Janis and Mann version involves setting up a grid for each alternative, as depicted in figure 5.2. In the two columns the counselor and client jointly identify all the positive and negative consequences (pros and cons) pertaining to the rows, which consist of four utility categories: gains or losses for self, gains or losses for others, self-approval or disapproval, and social approval or disapproval. Balance sheets such as this one are widely employed as a means of reducing the possibility of overlooking important information in decision-making problems.

Most users of the technique accept it on face validity, but Janis and Mann are to be commended for conducting a series of empirical studies showing that use of their version of the balance sheet results in reduction of postdecisional regret and increased adherence to the decision (for example, Hoyt & Janis, 1975; Mann, 1972). My own clinical experience, however, suggests that a red flag or two be raised in regard to their choice of utility categories, Many clients, for example, place an inordinately high value on social approval, and decisions made in pursuit of this hollow reinforcer may ultimately prove self-defeating. Moreover, the specific components of self-approval for other clients may be equally problematic. Nevertheless, counselors with a sensitivity to the issues underlying the cognitive restructuring procedures discussed in chapter 3 may use this balance sheet quite effectively.

Outcome Psychodrama. This procedure requires clients to project themselves into the future and enact scenarios involving the consequences of having chosen various alternatives. The technique closely resembles emotional role playing, but instead of being used for challenging outworn decisions, outcome psychodrama is intended to foster vigilant information processing prior to choosing. Essentially, clients are stimulated to think about and vividly experience what would happen if they, for example, got a divorce or picked a particular career. Janis and Mann report several favorable case study illustrations and suggest that outcome psychodrama can enhance the effectiveness of the balance sheet procedure by adding new entries. However, no controlled experimental evaluations of outcome psychodrama, either alone or in conjunction with other techniques, have been carried out.

TYPES OF ANTICIPATION
with examples from research on career conflicts of lawyers.
ALTERNATIVE COURSES OF ACTION

Alternative 1
(e.g. job with Department of Justice) Alternative 2
(e.g., job with a Wall Street firm) Alternative 3
(e.g., private practice in a small town)

+ - + - + -

A. Utilitarian gains or losses for self

Personal Income
Interest value of daily work
Opportunity to live in a preferred city
etc.

B. Utilitarian gains or losses for significant others

Social status for family
Reducing political corruption in community
Advancing civil rights for nation
etc.

C. Self-approval or -disapproval

Moral considerations pertaining to ethical legal practices
"Ego ideal" of being an independent thinker
Self-image as defender of innocent people
etc.

D. Social approval or disapproval

From wife (or husband)
From close friends
From a national professional organization
etc.

The cells in this schematic grid should be visualize as being filled with positive (+) and negative (-) entries of varying magnitude depicting the strength of the incentives to accept or reject each alternative. The purpose of filling out the grid is to predict vulnerabilitt to subsequent setbacks by identifying the main sources of conflict. Ordinarily the grid is set up with rows representing the alternative courses of action; the rows and columns are reversed in this table in order to list examples of subcategories within each of the four types of anticipations.
Source: Reprinted with permission of Macmillan Publishing Co., Inc. from Decision Making: A psychological analysis of conflict, choice, and commitment by Irving L. Janis and Leon Mann. Copyright © 1977 by The Free Press, a Division of Macmillan Publishing Co., Inc.
FIGURE 5.2. Balance sheet

Emotional Inoculation for Postdecisional Setbacks. The purpose of this procedure is to help clients implement or at least remain committed to a particular alternative after making a vigilant decision, Emotional inoculation Janis 1971) involves three steps: (1) calling attention to impending losses and risks (that is, education about the probability of a rough road ahead), (2) encouraging clients to work out ways of reassuring themselves about the ultimate success of the particular alternative (that is, informal coping skills training), and (3) providing new information on how to handle potential setbacks (that is, more education and coping skills training).

The reader will note this technique's very strong resemblance to Meichenbaum's (1972, see also Meichenbaum & Turk, 1976) stress inoculation paradigm, which was reviewed in chapter 3. Except for one interesting study (Langer, Janis, & Wolfer, 1975) emotional inoculation has not been subjected to experimental scrutiny. The utility of stress inoculation, however, is becoming fairly well established (for example, Hackett, Horan, Buchanan, & Zumoff, 1978; Horan, Hackett, Buchanan, Stone, & Demchik 1977; Schlichter & Horan, 1978).

Janis and Mann's comprehensive endeavors did not emerge under the rubric of any particular counseling theory. Hence their conflict model of decision making is reviewed here rather than in subsequent chapters devoted to perspectives and procedures with psychoanalytic, existential, rational, or behavioral counseling overtones. Before turning to the work of Greenwald (1973), another independent, it is significant to note that most of the important intervention strategies Janis and Mann recommended or developed are compatible with the emerging cognitive-behavioral point of view.

Greenwald's Direct Decision Therapy

Greenwald's (1973) book entitled Direct Decision Therapy arose not from a formal study of decision theory but rather from reflections on his own life and the lives of his patients. Greenwald contends that all problems in living have implicit payoffs. For example, he once asked a young hospitalized psychotic woman what the advantages of being crazy were. "She replied, There are lots of advantages.' She then listed the advantages: 1) She never had to worry about a job; 2) She didn't have to worry about dates ... ; 3) She could do and say anything she wanted" (p. 167). Essentially, then, neuroses and psychoses do not just happen upon us. We choose to adopt them because of myriad secondary gains (reinforcers).

Greenwald maintains that the therapy process first involves clarification of whether the client wants to change or remain the same. If the client decides that the payoffs for not changing are no longer adequate, direct decision therapy then proceeds to an exploration of alternatives and consequences. For example, the young psychotic woman mentioned above decided that she wanted to get out of the hospital and asked how she could be released.

I said, "It's easy. All you have to do is act sane. The only difference between you and us [the staff of the hospital] is that you act crazy and we act sane. If you want to get out, act sane."

She was going out on a weekend pass with her family. She said, "I'm going to tell them I'm going to be sane."

I said, "Do you know what will happen?"

She assured me, "They'll be happy."

So I told her, "Don't be so sure. In fact, now they will think you're really crazy." (1973, p. 168)

As is obvious in the case of this young woman, implementation of the decision to change may be difficult. Greenwald thus distinguishes between a wish to change and a decision to change. The latter demands hard work on the part of the client and a good deal of support from the therapist.

It is unfortunate that Greenwald chooses to lace his work with naive assaults on behavioral counseling. In one preposterous example he accuses behavioral counselors of wiring electric shock machines to the refrigerators of obese clients with the unintended outcome "some people get so addicted to the shock that they eat in order to get it" (1973, p. 296). Apart from these occasional lapses in scholarship, however, Greenwald's perspective on how many problems in living occur and become entrenched is highly compatible with the behavioral point of view. Certainly, his description of the reinforcers sustaining the young woman's psychosis could have been written by an ardent behaviorist.

Although Greenwald is correct in underscoring the notion that the decision to change is up to the client (at least outpatient clients), he presents no data to support his contention that a change will occur once such a decision is made. In fact, considerable evidence to the contrary exists. For example, witness the common failures of clients in both control and experimental treatments for weight loss and cigarette addiction in spite of their apparent decisions to change (Lichtenstein & Danaher, 1977; Stunkard & Mahoney, 1976). The effectiveness of Greenwald's model could be dramatically enhanced by supplementing his decision-making orientation with empirically validated techniques for helping clients implement their desired alternatives. Without such ancillary therapeutic activity, Greenwald's direct decision therapy stands as a monumental tautology: Clients change because they have decided to change. If they fail to change, it is because they really have not decided to change. We might wonder what, then, is a decision to change apart from the post hoc occurrence of changed behavior?

Summary

There have been several recent attempts to apply the SEU model to counseling concerns such as cigarette smoking, compulsive neurosis, criminal behavior, and occupational choice; but certain assumptions of the SEU model diminish its relevance to counseling. As an alternative Janis and Mann offer the conflict model, major theoretical components of which include the distinction between hot and cold decisions, the concept of vigilant information processing, and coping patterns in deciding.

The conflict model includes five attitude change strategies for challenging outworn decisions, four of which (Socratic dialoguing, insight induction, induced cognitive dissonance, and the awareness-of-rationalizations technique) are cognitive confrontations and the last (emotional confrontation via role playing) makes use of heavily affective material. Three additional techniques (balance sheeting, outcome psychodrama, and emotional inoculation) focus on helping clients become vigilant information processors and improve the quality of their decision making.

Greenwald's direct decision therapy, based on a widely accepted premise that problems in living have implicit payoffs (reinforcers), initially involves determining whether the client wants to change of remain the same- Greenwald's contention that change will occur once the client decides to change is contraindicated, for example, by research in weight loss and cigarette addiction.

So far in this book we have explored the languages of behavioral counseling and formal decision theory and have seen the compatibility of basic concepts and current work in both fields. In upcoming chapters this perspective will be supplemented with the views of various schools of counseling, but in the next chapter we turn to the pervasive problem of ethics in the conduct of decision-making counseling.

Use of the word "vigilance" in the context of decision and stress occurred before the work of Janis and Mann. Broadbent (1971), for example, devotes two full chapters to its explication. Most of this material, however, deals with advanced topics in perceptual psychology, particularly signal detection theory, one of the many subspecialities of decision making of marginal relevance to counseling.