Most people have heard of goal setting, have implemented it in their lives, or at least understand its value as a tool to help themselves stay focused and accountable for what they want in their life. But goal setting is twice as important for patients seeking therapy. Without knowing how to set goals and track them, therapy can become meandering and aimless, leaving clients unhappy and frustrated.
Setting therapy goals with patients, for both in-person and online therapists, helps them learn how to manage depression and anxiety as well as generally improve their outlook on their well-being. Think of it like a map clients can follow when they’re faced with challenges, feel stagnant in their accomplishments, or are stuck in one aspect of their life. Read on to learn goal-setting exercises that will help therapists offer patients actionable, concrete goals and goal-setting techniques so they can create behavioral changes that last.
Therapists work with all kinds of patients suffering from all types of mental health issues. Yet whether a patient is dealing with generalized anxiety disorder, major depression, post-traumatic stress disorder, eating disorders, bipolar, or beyond, it’s the job of the therapist to set expectations and treatment goals with clients. And not all therapists agree on what’s an appropriate goal during counseling, but there are definitely some commonalities.
As part of your practice, you should aim to:
Improve the client’s ability to establish and maintain relationships
Boost the patient’s coping abilities and effectiveness
Facilitate and push for lasting behavioral changes
Promote decision-making and increase client potential
Notice that these goals are more like guidelines rather than hard and fast rules. You want to help your patients make positive changes in their lives. It’s up to you to decide which goals to focus on first, and how to approach them. Not only that, but research shows therapy is more useful for the patient and the therapist when all parties involved have a set plan for what they’d like to accomplish. It also allows the therapist to track client growth and make necessary adjustments as they go through sessions.
In those first couple of sessions with a new patient, bring up the idea of setting goals. Ask them questions and figure out what they want to get out of the counseling process. What does the client think is stopping them from reaching these goals? What are their overall expectations of this therapy or of sessions? What motivates them to make changes?
Once you’ve both discussed, therapists will be able to prioritize and determine which goals are more likely to be met when and how. If goals are unrealistically low, it may be helpful to challenge the client, or start with that smaller goal and explain the idea is to reach this other goal. For example, a client with the goal of “successfully asking someone on a date” might actually want to reach the goal of “overcoming and managing a fear of rejection.”
Other clients might be resistant to setting any goals, as it could lead to failure. Or they may compare their lives and goals to other people. The goal-setting process helps patients move beyond their comfort zones and face the inner resistance they’re coming up against.
The merits of goal setting are obvious in many areas of life. From getting a promotion at work, to reaching a new relationship goal, to saving for a vacation, setting goals is somewhat necessary to achieve what we want. However, for behavioral and emotional change, it can get much harder to reach those goals.
A “standard” approach utilizes cognitive behavioral therapy as a starting point when working with new patients. It goes as such:
Identify the goal. This is deceptively simple, but often super challenging. What IS the goal? Many clients know they want a nebulous “new” thing (I want a new job), but they don’t know the specifics (I want to start my own business). Work with clients to fine-tune what the goal is and get super clear on what it is they actually want.
Choose a place to start. Clients have to understand exactly where they are right now, so they know how far they have to go in reaching that goal. A patient who is desperate to get married may need to hear that they have to open themselves up to new relationship experiences in order to find a suitable match.
Identify what it will take to reach that goal. If a client really wants to travel the world, for instance, knowing the basics of how to do this is helpful. They have to be honest with themselves – do they have the money to afford travel? Or the time, or necessary help like child care? Predicting every obstacle is impossible, but it’s probably a good idea to talk about strategies for overcoming some of the biggest possible pitfalls.
Take the first step. Breaking down the larger goal into smaller ones makes the big goal much more manageable, and keeps the client from feeling overwhelmed. After putting these steps in some kind of order, and going over all the potential obstacles they might face, it’s time for them to try that first small step. It’s a big achievement once a client starts taking those steps, and thus the job of the therapist to motivate the client toward those crucial first steps.
Collaborative goal setting and simplified goal setting tools can prove to be effective for all parties and have a positive effect on the patient. So what are some of the best therapist tools to approach setting goals beyond the basics?
This acronym stands for Goal, Reality, Options, and Way Forward.
Goal: Help the client to hone in on what they really want. Get super specific versus general. Instead of “eating better,” the goal is refined to become “I have the goal of improving my diet so that I am eating fresh fruits and vegetables every day, and I want to do this within the next three months.”
Reality: As the client works on those goals, it’s important to be realistic about reaching them. Discuss what’s happening in their present life, as well as any actions they’ve tried to take in the past to reach the goal. Have there been any results so far, or have they always struggled with reaching this goal? Perhaps adjustments need to be made to make the goal more realistic.
Options: Not everyone approaches the same goal in the same way. Reminding your patient there are options to achieving the goal is important. What other ways can they move forward? Going back to the healthy eating option, can they work with a nutritionist or dietitian to create an eating plan and be held accountable? In what other ways can they approach the goals, and are there specific pros and cons to doing things a certain way?
Way Forward. Ultimately, once the goal is achieved, how will the patient feel? Is it that they want to reach this goal for themselves, or for other reasons? What are those potential pitfalls, and can you plan in advance for them? In the same example, if they’re due to go on a vacation, how can they continue eating healthily when they’re not in their home or on their normal routine? And what can be done in a super small way in the next couple of days? Maybe someone looking to track their eating habits would benefit by buying a cheap notebook to list out their meals, or find it best to pull up a few easy, healthy recipes they can make this week.
Another popular acronym and therapeutic technique is building SMART goals. SMART stands for Specific, Measurable, Achievable, Realistic, and Time-bound. SMART goals help give clients direction while offering a plan for change, and work well for goals with a clearly defined focus.
Specific: Again, it’s about getting the client to state their goal in a few short sentences. Focus on the end state or the state of mind they’ll be in if they reach this goal.
Measurable: This is about not just measuring how to achieve the goal, but the meaning behind it. How does the patient define success? If this goal is to be successful, what does that look like? And why is it meaningful to achieve it?
Achievable: Is the goal action-oriented? Is it challenging but within reason? Gradually bring to mind how the goal can be achieved more and more so as not to discourage clients from reaching it in the first place.
Realistic: The focus, again, is on meaning and purpose. Everyone’s goals are different, but they shouldn’t compare themselves to others. What steps will need to be taken along the way to reach the goal, and how will the client feel during that time?
Time-bound: The timetable gives the goal relevance. It also serves as a motivating factor to have a countdown clock to reaching that goal. It needs enough time to be realistically achieved, but not so much that it gets lost.
The Average Perfect Day: For clients struggling to articulate their goals or ideal lifestyle, this exercise can help them recalibrate their ideas for what they hope to achieve. What is their perfect average day like? When do they wake up, what do they do next, and where do they go? What are the steps in their day? How do they spend that day? Who do they interact with? What about meals, routines, and so on? How do they relax at the end of the day? By focusing on a typical day, it helps clients see simple things within a vision of what they actually want instead of what they think they might want.
Someone You Admire: Another activity that helps take clients out of their comfort zone, this one asks them to imagine themselves as someone they look up to or respect. What are the qualities of this person? What do they possess? What does their education or career look like? What about their finances? What about their family, friends, and personal relationships? Are they in good health? What do they do for fun?
Areas of Life: Instead of focusing on a day or person, this is an activity for reassessment that encourages the client to create their ideal vision in each area of their life, such as career, health and wellness, personal life, social life, relationships, and so on. They may be fine financially, but feel the desire to get healthier. This allows them to put focus on setting goals for that area of their life, and come up with tangible steps towards getting healthier within their present means. It also allows everyone to see the bigger picture so that smaller, actionable steps can be set up.
The Worry Tree: For those in a negative spiral or suffering from depression and anxiety, the Worry Tree works to break down negative thinking. This can be especially effective for folks facing goal-setting resistance.
Going through a single thought, therapists work with the patient to discover:
What are you worried about? Stop and ask, what are you really worried about?
Stop and ask, what can you do about it, if anything, right now?
If you CAN do something, create an action plan. Do something immediately or schedule it for later, then let the worry go.
If you CANNOT do something, let the worry go and change the focus of your attention to live in the now.
Setting goals with your therapy clients is absolutely crucial to the process of counseling. And helping clients by encouraging them to hold themselves accountable will help. While it seems almost too simple to write out a goal, finding the motivation to create a goal that one can work towards, over time, in small steps, realistically, can actually be quite difficult.
Teaching clients the value of their own successes can go a long way towards reaching recovery. And remember, it’s a collaborative relationship. The more the client can focus on the goal and be open and honest about how they’re feeling, the more likely everyone will be able to track progress and see growth.
If you’re looking to start your own therapeutic practice and need help building from the ground up, contact us today, and our resource center can supply you with anything you need, from marketing for therapists to ideas for termination activities for therapists. No matter where your needs as a mental health professional lie, Advekit has you covered.