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Goal Setting in Therapy

Updated: Apr 23, 2023

Do you make this a part of your initial sessions? Here’s why you should and the best ways to implement goal setting!



Goal setting increases therapeutic engagement, reinforces collaboration and creates some structure for therapy. Initial therapy goals do not need to be specific; usually, broad goals are enough to get started. Goal setting gives our clients a sense of ownership over the therapy process. It also assists with enhancing motivation by identifying the most important things for our clients to work on.


I usually end my initial session by asking someone: "If we were to choose three things to focus on in therapy, what would they be?" or "What are three things you hope to get out of our time together?" If you are an early-career psychologist, goal setting may feel clumsy, or you may think that it should be you setting the goals. However, goal setting should be a collaborative process. Ideally, our clients will be responsible for setting the therapy goals, and we assist by managing their expectations of what is realistic and achievable. Therapy goals may look like this:


"I want to reduce my time spent worrying."

"I want to feel happier."

"I want my relationships to get better."

"I want to leave my house without feeling anxious."


Or they may look like this:


"I never want to feel sad again."

"I want to be worry-free."


Be mindful of goals like the latter that are black and white or extreme. This is where it will be helpful to collaborate with your clients and help them set realistic expectations for what they can achieve in therapy. For example, I would reframe a goal such as "I never want to feel sad again" to "I want to reduce the amount of time I spend feeling sad".


It is essential to prioritise your client's goals for therapy. There are only ever a couple of good reasons why you would not, and they include the following:


1. They are suicidal or at risk of harming themselves or others. Minimising the risk of harm to clients and others is always a top priority. It doesn't mean I will not assist these clients in setting therapy goals; it just means that I will focus on their risk in the first instance while trying to incorporate other broad goals, if appropriate.


2. They have a substance or alcohol use disorder. In this instance, clients are unlikely to achieve therapeutic gains without first addressing their addiction. I may use their broader goals to get them motivated to start with the treatment, but detox is always the priority.


Is your client struggling with identifying goals for treatment? Some clients won't know what they want from therapy or what they can achieve in the context of treatment. You can be more directive in this instance. Suppose your client struggles at the end of the initial session to identify what is most important for them to work on in therapy. In that case, offering some suggestions based on your clinical interview will be helpful. But always collaborate with your clients, don't dictate the goals. We want to ensure that even when we are more directive and offer suggestions, the therapy goals feel suitable for your clients. Check in with them: "How does that sound to you?" or "Does that seem like a good place to start?"


Therapy goals should be reviewed and updated as necessary. I often do this if and when therapy is not progressing and sporadically throughout therapy. This is also an efficient way of measuring therapy progress and ensuring you are still working towards the most important things for your clients. Sometimes, the goals that prompted therapy can change as their lives improve and they develop more profound insights into their values and aspirations.


Identifying goals for therapy should is an essential part of treatment. It enhances therapeutic engagement, provides direction for therapy based on what is most meaningful to the client, and gives us variables to measure to ensure therapy works for the client.





Amanda



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