“What are your goals for therapy?”

Copyright © Donald Robertson, 2010.  All rights reserved.

Most modern therapists recognise that clients make better progress when their goals for treatment are well-defined.    Clients also tend to prefer knowing that they and the therapist both agree on the goals that they’re working toward, i.e., they’re “singing from the same hymn sheet.”  Sometimes it’s very quick and easy to arrive at satisfactory goal definitions, sometimes it can take several weeks, and sometimes goals are changed during the course of treatment.  Researchers have consistently found that a positive “working alliance” between therapist and client helps treatment succeed.  This is defined in terms of three characteristics,

1. A bond of trust between therapist and client, i.e., rapport and mutual understanding.
2. Agreement on the goals (the “what”) of therapy, i.e., what specific outcome you’re trying to achieve.
3. Agreement on the tasks (the “how”) of therapy, i.e., how you’re most likely to achieve those goals, including the right homework and therapy techniques.

We might also add, to this traditional list, the treatment rationale (the “why”), that links the tasks to the goals, i.e., why we believe the tasks and techniques that form the treatment plan should help to achieve the goal.  A simple example: If the goal is to fall asleep more quickly at night (overcoming insomnia), the tasks might involve learning relaxation skills and worry-management techniques, the rationale being that relaxing muscles more deeply at night and preventing worry tends to allow mental relaxation and sleep onset to happen naturally.  Of course, each individual is different so even therapy tasks and techniques that typically help clients with specific problems need to be approached with an “experimental” attitude, and modified if they don’t seem suited to the individual case.

The first step, however, is to clearly state your presenting problem or problems.  Ideally, you should be able to sum up your main problem in a couple of sentences, with the help of your therapist.  You may have several problems, but you’ll usually be advised to focus on one or two at a time.  Your therapist will help you to formulate your problems and goals but these questions may help you to reflect on things first.  Don’t worry about spending too much time on this, though, just make a few brief notes.  It’s more important that you understand the general idea…

Problem List

Therapy often begins by trying to develop a concise but comprehensive list of your problems.  Draw up a rough initial list of all the main problems that seem relevant to your therapy.  This usually contains anything from one item to about a dozen or more.  (If there seem to be more, consider subsuming your problems under a smaller number of more general headings.)  Once you have a satisfactory  list you need to prioritise things.  Consider the following questions with regard to your list, as a way of helping to choose priorities,

1. Are some of these problems different aspects of the same thing?  Can they be merged under a single heading?
2. Are some of these problems more fundamental than others?
3. Are some of these problems more severe or serious than others?
4. Are some of these problems going to be quicker and easier to resolve than others?
5. Are some of these problems more urgent or looming than others?

Problem Statement

Once you’ve chosen the first problem to focus on, it’s also useful to develop a more careful and detailed statement of it.  This should be as clear and specific as possible.  Consider the following questions as a rough guide to developing a clear written statement of your main problem.

1. Is your statement of the problem clear and unambiguous?
2. Why is this a problem?  What exactly is problematic about it?
3. Does your statement refer specifically to where and when the problem occurs and what triggers it?
4. Does your statement refer to your emotional and behavioural responses?
5. Does your statement refer to your thoughts or beliefs?
6. Have you mentioned the wider impact your problem has on your life?

Don’t worry if it’s difficult to come up with a “perfect” statement of your problem, just do your best to provide enough information to begin assessing your needs and planning treatment.

Behavioural Goal Statement

Once you’ve defined your main problem in the form of a clear and unambiguous statement.  It helps to develop one or more corresponding goals, which should also be phrased clearly and concisely.  Ideally, goals should focus on specific behavioural changes, i.e., what you should be able to do by the end of treatment if you’ve overcome your problem.  Again, consider the following questions as a rough guide in forming your goal statements. 

1. Is your goal realistic and achievable within a specific timeframe?
2. Is it within your power to control the outcome?
3. Will it be clear whether you have actually achieved the goal or not?
4. Will you be able to easily measure much progress you’re making toward your goal?
5. Is this really what you want to achieve?  Is it relevant to your problem statement?
6. What will the wider impact be on your life if you do achieve this goal? Why is it so important that you achieve this?

Again, don’t worry about getting this perfect, just do your best to come up with some rough ideas of specific goals for therapy.

Self-Rating Progress

Finally, once you have a clear statement of your main problems and goals, it helps to rate progress by putting a number on things.  Your therapist may ask you to rate your own progress at the start of every therapy session.  This will help both of you to track how you’re doing overall, and how you’re responding to different therapy strategies.  To do that you should rate both your problems and goals at the very outset, before you do anything else.  We use a scale from 0-8 to do this.  Rate your problem statement from 0-8, in terms of how upsetting it currently is, where 0 means not at all, and 8 means as distressing as you can possibly imagine.  Likewise, rate your behavioural goal from 0-8, in terms of how difficult it currently would be for you to achieve your goal, where 0 means that it’s easy and you could do it right away, and 8 means it’s very difficult indeed, virtually impossible.  Rating your level of distress in relation to the problem and your level of difficulty achieving your behavioural goal will make it much easier to track your progress during therapy and to know when you’re reaching the end of therapy.