Making Choices and Answering Questions
When it comes to making choices, I need help!
Just today I was shopping for cloth napkins at Pier One. The napkin display spread from one wall to the next and featured three shelves full of perfectly folded, perfectly stacked napkins. There were so many choices, I could hardly believe my eyes: solids, stripes, prints, fringes, beads. Oh my!
I was overwhelmed.
Actually, all of Pier One is overwhelming to me, but today, all I needed to do was pick out 10 napkins appropriate for Thanksgiving dinner. That should be easy, but there were too many options. I decided it would be much easier if there weren't so many choices.
I took a deep breath and began choosing what I thought were the prettiest napkins. Whew! That was more difficult than you might imagine. I had narrowed it down from 150 to 5. My decision making should be easier from here. I again narrowed the choices down from 5 to 2. It was at that point that I called my husband over. "Which one do you like best?"
He pointed to the left, and that was that. The great Thanksgiving napkin search was over....and it only took 20 minutes. I'm sure he was wondering, "Why does it take so long for her to do something so simple?" Instead, he just smiled and paid for the napkins.
I think I'll nominate him for Husband of the Year.
Driving home, my mind drifted back to a conversation I had with a family member earlier that same morning. She complained to me about her husband with dementia saying, "He can't remember how to feed the dog."
I asked, "What's involved with feeding the dog?' She began to describe the process. I will spare you the details, but it was 7 part process that included the precise measurement of 4 different ingredients: dry dog food, wet dog food, pumpkin and ham. It would be difficult for nearly anyone to follow all of those steps with the type of precision that is required. It's no wonder he doesn't want to feed the dog anymore.
Without stopping, she continued to gripe, saying "He's getting worse every day. Yesterday, he couldn't even tell me what he wanted to eat!" Even though I wasn't immediately sure how I was going to approach the dog feeding situation , I knew I could easily explain why it can be so difficult to express a preference or make a choice. I began explaining the different types of questioning techniques. Here were the highlights from the discussion...
1. Open ended questions: What do you want to eat?
- usually begin with a wh- question word such as who, what, where, when or why
- possibilities for responding are almost endless
- full cognitive function is necessary as formulating a response requires processing, recalling, categorizing, sorting, eliminating, choosing, reasoning, decision making, etc.
- responding appropriately requires strong communication skills since sentence length productions are typically expected
- the most broad type of question to answer, making it the most difficult type of question to answer
2. Multiple choice questions: Which one sounds best to you- Mexican, Chinese or Italian?
- typically begin with a wh- question word such as which
- possibilities for responding have been narrowed to 3 or more
- acceptable choices are provided by the speaker so that a possible answer to the question is provided
- moderate cognitive function is needed as the listener must be able to process and recall the choices provided in the question asked in order to respond appropriately
- fair communication skills are needed in that mostly word or phrase length productions are used when responding
3. Binary choice questions: Do you want enchiladas or tacos?
- also known as forced choice questions
- possibilities for responding have been narrowed to only 2
- acceptable choices are given by the speaker so that the answer to the question is already provided
- minimal cognitive skills are required for processing and responding to questions asked
- minimal communication skills are needed since responses usually have only words or simple phrases
- nonverbal responses may be possible if using gestures/ pointing
4. Yes/ No questions: Tacos?
- questions include few words, maybe only a single word
- possibilities for responding are limited to yes or no
- minimal cognitive skills are required since most of the decision making steps have already been taken care of
- minimal communication skills are needed because a response requires only a single word
- nonverbal responses such as nodding are acceptable
With just a little bit of explaining, this woman had a change of perspective. She quickly realized that her questioning techniques were preventing her husband from being able to do something as simple as think of what he wanted to eat. This wife understood that she could eliminate most of the difficulties her husband was experiencing when making choices and answering questions just by asking the right kind of questions.
As a therapist, wife, mom and friend, I ask a lot of questions throughout the course of the day. Perhaps you do too? Learning to ask the right kinds of questions can make it easier to get good quality responses that spark conversation. However, not everyone understands that questions may need to be modified as the result of communication or cognitive deficits.
Be sure to educate spouses and caregivers on the importance of asking the right types of questions. Whether a person has dementia or is recovering from a stroke, methods for asking questions may need to be modified. Please share this information with someone you know who may benefit.
Successful people ask better questions, and as a result, get better answers.