Circles of Support + Gradual Counselling

Circles of Support

circle-of-support¨Supported decision making is not generally a 2-person relationship, but rather a network of 3 or more people.

An older adult may want to create a structured “circle of support” that includes trusted supporters who regularly meet as a group for planning, problem-solving, and decision-making.

Usually friends and family members, along with possibly case worker or other service providers

The circle members come together to help the person with managing and budgeting goals, visualizing and expressing valued outcomes, evaluating risks and consequences, and recognizing and making full use of abilities.



velaA BC organization known as “Vela” supports the creation of Microboards™ – a small group of committed family and friends (a minimum of 5 people) who join together with the individual to create a non-profit society.

Together, they will help the individual:

  • plan his/her life;
  • brainstorm ideas;
  • advocate for what they need;
  • monitor services and ensure they are safe;
  • connect to his/her wider community; and
  • do fun things together.

If they choose, a Microboards™ can also access funding and deliver the services that the individual needs.

Gradual Counselling

gradual-counsellingGradual Counselling provides a method for inquiring into and understanding the client’s decision-making process, and may assist such clients in thinking through their underlying concerns, goals and values, and choosing a consistent course of action. This is an ‘iterative’ process to ensure a client has properly considered their options taking into account their goals and values.

It is useful in compensating for age-related differences in memory and problem-solving ability, and when there are questions about capacity.

Gradual Counselling Method

You engage the client in a process of gradual decision-making, which will involve clarification, reflection, feedback, and further investigation

You repeatedly refer to the client’s goals and values in assessing each alternative and in discussing the pros and cons of an alternative.

  • involves a great deal of clarifying and reflecting of the client’s thoughts and feelings
  • proceed to explain each relevant option and elicit the client’s reactions.
  • Confirm or reconfirm the client’s basic goal or problem to be solved.
  • Get feedback from the client to ensure he or she agrees with your statement of the problem. Listen for important client values.
  • Ascertain the most important values the client expresses. Restate these values and confirm with the client.
  • Recognize that the values of any older client may differ from those of others.

Unintended Consequence

  • Be careful though about asking for repeated clarifications/checks
  • This can be seen by the older adult as querying the possible decision
  • Can result in them changing their decision

Other ‘supportive’ approaches

  • Plain language + open ended questions
  • Simplification of decision making tasks
  • Active listening (concentrate including non-verbal cues) & reflective listening (listener repeats back)

“Uninterrupted Disclosure:”

  • Giving verbal information in one sequence
  • Older adult follows the written information on a sheet
  • Older adult asked to paraphrase the content

Wong et. al. (2000)