Why is goal setting important?
Evidence based-therapies such as those described in this blog seek to achieve measurable results that can be verified by clients themselves, as well as by external observers. If we were training people to throw darts we would want to know at the end of a few sessions how many darts the client can throw that hit the target, and how many of those throws achieved high-scores.
In the same way we want to know whether our clients are successful in improving their mental health than before their coming to therapy. To do that we spend time laying down some goals on the first session.
What is goal setting in psychotherapy?
Any of these can be useful goals to aim at:
- Symptom reduction. For example, the client’s anxiety episodes are fewer and less intense than they were before. Measurable changes in breathing, heart rate and nervous system activation can also be tracked.
- Changes in behaviour. For example, clients with depression are getting up earlier, are more active, and more engaged with other people than was evident at the first session.
- Reduction in subjective distress scores (SUDs). The client reports (using a scale of 0-10) that they are less angry, scared, anxious, frustrated, depressed, etc., since coming to therapy.
- Improved relationships. The client is more effective in communicating needs, handling conflict, and resolving disputes with partners. This particular goal can be verified by the client’s partners, family members and work colleagues.
- Reduction in alcohol and drug abuse. This is a relatively easy goal to monitor, given that it is possible to measure the intake of alcohol and drugs in milligrams (or millilitres) per day.
- Changes in thinking patterns. Clients demonstrate to the psychotherapist that they have acquired the ability to notice and defuse from distressing thoughts, and to identify and embrace new thoughts that promote effective action.
- Improvements in coping skills. The client is more effective at problem-solving, and handling stressful situations than before.
- Acquisition of life skills. Clients report that they are regularly and effectively using new skills that improve mental health: relaxation techniques, mindfulness, assertive communication, management of personal boundaries, and habit replacement.
Setting out the client’s goals.
The majority of clients, on coming to therapy for the first time, will state goals in terms of what they don’t want rather than what they do want. So their therapeutic goals might be to stop being anxious, to not be depressed anymore, or to be less stressed. This is understandable, and initial goal-setting can revolve around symptom-reduction and alleviating subjective distress.
However, mental health problems are not just related to clinical symptoms. Those symptoms typically have a history. For some people that history can go back a long way: to childhood conflict or adolescent rejection for example. Creating maladaptive patterns that persist into the present moment: insecurity; self-judgment, anxious avoidance, depressive withdrawal; or addiction – to name a few examples. Those patterns should ideally be replaced with new habits of thought, feeling, action and communication. Which entails coming up with goals related to specific changes for the better. Along the way reviewing old, dysfunctional reactions and changing the worries that underpin them.
Those same patterns of behaviour and thought are typically reactivated as life problems appear: work-place stress, failing relationships, financial hardship, child-care issues, illness and death, and so on. So worthwhile goals in therapy that lead to permanent improvements in mental health should equip the client with new ways to manage the problems of life. Which is where the acquisition of coping skills becomes important.
Finally, clients have to have a reason for change, a desire that will keep them motivated as they do the hard work in therapy. For that reason their goals must be linked to their personal values. Some of these values include:
- Success at work
- Loving relationships
- Effective parenting
- Financial security
- Spiritual progress
- Independence and self-reliance
- Community action
- Improved health
All these values relate to becoming a different person, replacing misery with happiness and self-fulfilment. Defining goals that mirror these values provide further evidence for success in psychotherapy. Hence the use of the solution-focused questions I ask all my clients when they have finished telling me about the things they don’t want to see happen anymore:
What will you be doing instead when you are no longer depressed, anxious, stressed?
What difference will that make to the quality of your life?
What new things will others notice about you when you are no longer troubled by these problems?
Setting specific life goals
As specific real-life issues come up for discussion in therapy it can be helpful to come up with assignments that enable clients to address these problems. For example, clients might specify a desire to improve a relationship, manage a financial problem, accomplish work-place deadlines, bond with their children, pursue a creative project, or improve fitness.
To complete an assignment related to any of these aims requires a well-defined goal.
There are a variety of goal-setting formats used by coaches and therapists which can be effective. One such approach is a SMART goal. Widely used on life-skills courses, and in business, SMART goals are an effective way to direct attention to the ingredients of successful action.
The mnemonic stands for: Specific, Measurable, Achievable, Relevant, Timed, actions. Where ‘relevant’ refers to the important value fulfilled by the goal.
Please feel free to copy and save the handout on the right.