Effective therapy entails collaborating together to set reasonable expectations for treatment. It’s not uncommon for clients to enter treatment not really knowing what will happen. Some clients come into their intake session sincerely hoping you can change the course of their life. Others come in and state that they “know” they need help, but they don’t know what to talk about.
To complicate matters, therapists don’t always know how to set the best goals with their clients either. This can be especially true if treatment is limited in terms of session frequency- or if the client presents with numerous issues that need addressing.
Goal-setting keeps both client and therapist on track to increase the likelihood of successful treatment outcomes. And in the age of managed care, proper goal-setting is essential for proper authorization when working with third-party payers.
An Overview of Goal Setting in Therapy
Successful treatment needs to adhere to overarching treatment goals. What are you hoping to help the client achieve? How will you align your therapeutic process to best support their mental health? And are you both on the same page with what you're actually addressing?
The first step is collaborating with clients to form your treatment plan. What's bringing them to therapy at this time? Do they feel they have realistic goals? What's causing them the most distress during their life? How are they hoping the counseling relationship will help them feel better?
Knowing these answers as early as the intake will help you structure your therapy sessions and develop achievable goals. Today, many providers favor smart goals for their treatment.
1. Invite the Client to Share What They Want to Be Changed
A client should always have permission to share their therapy goals freely. This discussion should start as early as the intake process. It's also important to assess how current distress impacts daily life and whether the client currently believes their goals for therapy are achievable.
Reviewing goals is both pragmatic and encouraging. In addition, when a client feels hopeful that you can help them meet their goals, they may be more invested in the therapy process.
Clients with acute levels of anxiety symptoms, depression, or low self-esteem may struggle to believe things can ever change. Negative self-talk makes it hard to manage difficult emotions or implement healthy coping techniques. It's your job to hold space for the client and believe that growth is possible.
2. Always Consider Imminent Crisis Issues Within The Treatment Plan
Stabilizing acute crises must always take precedence when it comes to managing therapeutic goals. It's exceedingly difficult to focus on overall life wellness or personal development when a client is facing potentially life-threatening situations.
Proper assessment is key in obtaining information about these crises, particularly when it comes to suicidal ideation, acute substance use, or severe mental health symptoms. Mental health support at this time may include wraparound treatment. Subsequently, the goals for therapy may include supporting clients with referrals to other providers.
A client may downplay or withhold their truth because they fear being judged. Maintaining a warm, empathic presence can't be overstated.
3. Review What’s Helped In The Past
Discuss what your client has done to try to work on these therapy goals in the past. What kind of self-care has been helpful? What normally gives them a sense of self-confidence? What healthier ways have they tried implementing to improve their mental health symptoms?
Don't just limit the conversation to what they've worked on in previous treatment episodes. Consider any steps they have personally taken toward trying to change.
Ask when life has felt different in the past. What were they doing? Who were they spending time with? How did they stay motivated in making progress toward their goals?
4. Contextualize Other Mental Health Conditions
Clients often come to treatment with a myriad of presenting issues. This can pose a challenge for even the most seasoned clinicians. What therapy goal do you start with when there are so many items to address?
It's important to remember that symptoms often overlap. When someone is seeking therapy, they need guidance in everyday life. This often includes goals focused on improving communication, strengthening self-esteem, and learning how to challenge negative thoughts.
5. Explore What Hasn’t Helped Before
In addition to exploring what has helped, you need to also pay equal attention to what the client feels hasn't benefited them. This may include certain support groups, therapeutic interventions, medications, or coping skills.
Be careful of automatically assuming these methods can't work right now. What didn't help in the past might speak to your client's level of motivation or support network. That said, you may encounter more pushback if you suggest these interventions without compassion.
6. Normalize Lapses and Regression
Providers must normalize the setbacks that often occur during the therapeutic process.
All change is hard, and many clients feel afraid or ashamed of their struggles. Some will come to therapy expecting fast progress and transformative change. The setbacks can be even more discouraging.
This is where it can be helpful to teach clients the benefits of practicing self-compassion. As they try to meet their actionable goals, they will encounter challenges along the way. It's essential for them to learn how to bounce back and stay on track.
7. Empower Autonomous Thinking
Fostering an unhealthy attachment to a therapist can be damaging to the relationship. It can also stunt a client's emotional growth.
Ultimately, clients need to learn how to carry what they learn in treatment out in the real world. They can and should rely on you for support, but the work becomes problematic when you become the sole source of support. Encourage your client to build positive relationships with people who can provide them with validation and guidance.
Reassess Goals Together
Setting goals for therapy keeps treatment on track. But the goal-setting process is never static. You should revisit the validity of these goals- and how your client is feeling toward their progress often.
