Working with Goals in Psychotherapy
What are the advantages, and disadvantages, of using goal setting with clients? Are goals energising and empowering – or can they be dehumanising, and distract us from deeper needs? The answer lies with the individual, as Professor Mick Cooper talks us through the good, the bad, and the better of goal-oriented practice
Is it helpful for psychotherapists and counsellors to talk to their clients about goals for therapy, to set them, and to monitor their progress? For some of us, it’s part of our everyday practice. For others, its anathematic to our very concept of mental health. So what does the latest theory and research say?
On the plus side…
1. Goal setting provides clients with an opportunity to think about what is most important to them. For instance, one client stated: “Even though I knew they were the things I wanted, it was all jumbled up in my head so to actually write [the goals] down on paper… made it a bit easier”.
2. Goal setting can energise clients, stimulating them to progress from thinking about what they want to do to planning and action.
3. By monitoring – and witnessing – progress towards their goals, clients may experience enhanced feelings of achievement and confidence, supporting further progress towards goals.
4. Goal setting and goal monitoring may also enhance persistence in goal-directed behaviours: extending effort over time.
5. Goal-oriented practices may engender hope and positive expectations in clients: because a positive image is called to mind, and a potentially overwhelming problem is broken down into achievable steps.
6. Goal setting and monitoring may focus effort: providing a “target” and directing attention to specific future possibilities.
7. Some clients may feel that having goals creates a safer, more predictable structure for therapy. One client stated: “I quite like knowing what I’m in for”.
8. Goal-oriented practices may help clients feel more empowered, as it positions them as choice-making, intelligible beings, who have the potential to act upon their worlds. Closely related to this, goal-oriented practices may send a message to clients that their individual perspectives and desires are valued.
9. Goal-oriented practices can help to ensure that clients and therapists have a shared understanding of the goals of the therapeutic work – a factor which is known to correlate with positive therapeutic outcome.
10. Perhaps most importantly, most clients do want goals to be set for therapy: around 70 per cent in one recent survey.
11. Finally, discussing and eliciting clients’ goals for therapy may have an important ethical dimension: helping to ensure that the therapy is aligned with what the client – rather than the therapist – actually wants.
And on the minus side…
1. Most obviously, clients may not know what their goals are – around 40 per cent in a recent study. One client said, “It’s nice that I was asked my opinion on something…
but it kind of put me in the spotlight a bit and I was just there, like… ‘I don’t know, whatever you think is best’”.
2. The goals that clients articulate (if at all) will only, ever, be their conscious, “self-attributed” ones; and these may bear little relationship to their implicit motives. So goal-oriented practices could actually divert clients away from their deeper needs and wants.
3. Goal-oriented practices may leave clients feeling judged and pressurised: that they have failed themselves or their therapists if they are not showing “good” goal progress.
4. Goal-oriented practices may be experienced by clients as emphasising attainment, striving, and doing over a more “authentic” state of being.
5. Some clients may feel that their problems, or their way of being in the world, cannot be articulated in goal-related terms; or that to think about them in these terms diminishes and dehumanises them.
A ‘pluralistic’ approach to goal-oriented practices
So goal-oriented practices have the potential to be both helpful and unhelpful, and a key factor may be how they are done. Goals that are allowed to emerge flexibly, through therapist-client collaboration, may be most helpful. Goals that are ‘pinned down’, early on in therapy, with little discussion, exploration, or follow-up dialogue, may be least facilitative.
Clients should never be pressurised to set goals too early on in therapy, and should be reassured that it is ‘OK’ if they don’t have clear goals at the start.
Research also suggests that clients may benefit more from goal-oriented practices when therapists help them to set appropriate goals: for instance, realistic, manageable, and specific.
Ultimately, however, as we say in the pluralistic field, different clients, at different points in time, may want and need very different things. Goals may be particularly useful for clients who have a sense of what they want, but need the motivation and focus to move into planning and action. Clients who are just developing an awareness of their own needs may benefit less from goal-oriented practices. These practices may also be most helpful to clients who value structure and focus, and least helpful to those who just want to ‘be’.
Integrating counselling and psychotherapy: Directionality, synergy, and social change (Sage, 2019), by Mick Cooper, has recently been published and includes extensive discussion and illustration of goal-oriented practices. Mick will be running a workshop on working with goals in counselling and psychotherapy at the Jury Inn Brighton on Oct 19 2019.