Working with goals in psychotherapy and counselling
Abstract
Recent evidence suggests that working with goals in counselling and psychotherapy can support positive therapeutic change. Goals can empower clients and give them hope: helping them feel that they have the capacity to act towards achieving their desired futures. Goals can help focus, and direct, clients’ and therapists’ attention, building a better therapeutic alliance. Through negotiating and setting goals, clients can develop a deeper insight into what it is they really want in life: a crucial first step towards being able to get there.
Policy developments in both child and adult mental health services support the use of goals in therapy. Goal-setting and goal-tracking can help to ensure that therapy is personalised to the individual client: so that they are working towards objectives that are of genuine importance to them.
The historical developments of psychological therapies have led to differing cultures, psychologies, and philosophical assumptions and brought about varying attitudes and approaches to goals in therapeutic practice. Working with Goals in Counselling and Psychotherapy brings this range of attitudes and approaches together in one volume making it the definitive, critical guide for therapists of any orientation.
The book provides practical advice on how to help clients set, and work towards, personalised goals; the tools that are available to support these processes; and the theoretical and empirical foundations of this work. It is essential reading for all therapists interested in goals in counselling, psychotherapy and psychological therapies, and how they can be used to optimise therapeutic change.
... In goal-oriented practices, practitioners work collaboratively with clients to identify, develop and focus on objectives for the therapeutic work. For instance, the client and therapist may agree that the work should focus on helping the client overcome feelings of loss or readying the client for a new relationship (Cooper & Law, 2018). Goaloriented practices involve a continuous feedback loop of striving towards the desired endpoint, which may also act as a self-regulation strategy for clients (Harkin et al., 2016). ...
... Encouraging youth to write out their goals in their own words as opposed to just verbalizing them was noted as a mechanism to promote engagement, commitment, and increase focus (Cooper & Law, 2018;Matalí et al., 2020;McCarthy et al., 2010). Less often, authors described how to incorporate visual representations as part of goal-oriented practices. ...
Introduction
Goal‐oriented practices involve practitioners working collaboratively with clients to identify, develop and focus on objectives for the therapeutic work. It has been suggested that the key mechanism underpinning goal‐oriented practices with young people is the development of epistemic trust via the foundation of open communication, along with shared decision‐making: including young people in decisions about their care. However, goal‐oriented work in practice is variable in scope and content, with no research consensus on what it entails, the mechanisms of change and reported outcomes.
Method
This research aims to map the extent, range and nature of the evidence‐base for goal‐oriented practices, including gaps, through a synthesis of the available empirical evidence from the past 20 years. A scoping review of 9783 studies published from 2003 onwards was conducted.
Results
In total, 116 studies were identified for inclusion in the review, focusing on goal‐oriented practices specifically related to the mental health and wellbeing of children and young people aged 0–18 (including caregivers as relevant). Alongside presentation of the key elements of the included studies, three themes were developed relating to the features of mental health and wellbeing goal‐oriented practice in the contexts of the studies: Conceptual and Empirical Constructs of Goal‐Oriented Practices, Quality and Making ‘Good’ Goals, and The Socio‐Cultural Contexts of Goal‐Oriented Practice.
Conclusion
Several areas for future research are identified that will build on this evidence, and further understanding in this area. Work towards the development of best practice principles will move practice towards transparency in the understanding and delivery of goal‐oriented practices.
... The goal of the client-if clients choose the goal by themselves, their motivation is going to be higher than if they are pushed toward something [70]. ...
... The goal has a value for the client-if the goal is valuable for the client, the client feels some "passion" for it, and its achievement will bring some benefit, then there is also higher motivation to work at it [70][71][72]. A valuable goal contributes to the felt meaning of life and the client's well-being [72][73][74][75]. ...
Long-term unemployment, one of the challenges social workers face, produces a variety of non-monetary and social consequences. The helping professionals understand that interventions towards unemployed clients do not cover just the pure fact of their unemployment but that a holistic approach to the clients' living situations is needed. This paper aims to promote well-being while implementing solution-focused coaching in working with unemployed clients in social work practice. The Reteaming coaching model is supported by two detailed case studies describing three key areas covered in the Reteaming process. Working with clients in both cases contributed to various elements of the client's psychological well-being: positive emotions, engagement, relationships, meaning, and achievement. The Reteaming coaching model can be used effectively as a suitable structured approach, mainly used in strength-based social work.
... ") in his work (Wood, 2003). Current psychotherapy literature discusses focusing on goals or collaborative goal setting similarily (Cooper & Law, 2018). Focusing on the preferred future is also significant in terms of psychotherapy outcomes. ...
... For instance, Alfred Adler already incorporated a "preferred future" question (simply called "The Question", which reads: "What would you do if you were completely well?") in his work. Current psychotherapy literature discusses focusing on goals or collaborative goal setting in the same manner (Cooper & Law 2018;Miller & Rollnick 2012;Strong 2009). In some methods, there is an emphasis on discussing values (Harris 2019;LeJeune & Luoma 2020), life's meaning (Frankl 2006), preferred storylines (Béres 2014), the characteristics of a fully functioning individual (Renger & Macaskill 2021), or on contracting (Lapworth & Sills 2011). ...
The term “preferred future” refers to the outcomes a client hopes to achieve through psychotherapy. Collaborative goal setting is a crucial component of many psychotherapy approaches. This article describes the six ways to focus on a preferred future in solution-focused brief therapy: (1) common project, (2) Vision of a preferred future, (3) goal(s), (4) skill(s), (5) values, and (6) small signs of progress. All variants are briefly expounded upon with accompanied case examples. The second part of the article focuses on the transitions from problem descriptions to various forms of work related to a preferred future, and on the transitions among different methods of preferred future conversations. The primary purpose of this article is to broaden therapists’ strategies when working with preferred futures, enhancing their adaptability in managing these types of conversations with their clients.
... The underutilisation of goal-setting measures in our sample is consistent with previous studies (Cooper and Law 2018;Norcross 2011), despite strong evidence supporting the link between goal consensus and improved therapeutic outcomes (Tryon, Birch, and Verkuilen 2018). This indicates a critical need for greater awareness and training on the importance of goal setting in therapy. ...
Routine outcome monitoring (ROM) is one of the most important methodologies for evaluating client progress and improving the efficiency and quality of psychological assistance. Despite this, the culture of ROM use is struggling to establish itself in the Italian National Health System, shaping up as a sporadic and unevenly used practice. The main objective of the present study was to assess the frequency of use of different outcome monitoring measures and the attitudes toward ROM within psychological services of the Italian National Health System. The study involved 184 psychotherapist (75% female and 25% male) employed in the Italian Health System structures. Participants completed an anonymous questionnaire composed by Outcome monitoring use and Attitudes to ROM. The data reveal a general low‐frequency in ROM use, with the exception of the symptom monitoring measures. In our sample, the variables that significantly affect the level of ROM use are psychological capability and physical and social opportunity. The present study provides some empirical evidence to reflect on the importance of increasing the use of ROM within psychological services and to promote interventions to improve clinicians' positive attitudes toward ROM.
... Tools such as the Goal-Based Outcome tool (GBO) 29 , are considered effective measures of change during the course of therapy and provide useful information to facilitate clinical conversations. 27 The GBO allows young people to set up to three goals, tracking progress on a scale from zero to ten where 'ten' signifies goal achievement. Goals may change over the course of care, and it is important to balance this with the complexity of tracking progress over time. ...
There is an observed link between physical illness and mental health difficulties and an increased likelihood of mental health difficulties in young people with chronic health conditions. The main outcome focus in paediatric settings is on physical health outcomes and functioning. In terms of functioning, the focus is on quality of life, measures of emotional well-being and perceptions of personal change, which are likely to be multifaceted and vary between patients. To complement standardised and diagnostically based measures, goal-based outcome measurement may be considered. The aim of this paper is to build on previous research, to provide a reflective commentary based on the authors' clinical and research experience in the use and interpretation of goal-based outcomes, to address what using goal-based measures for outcome purposes in these settings means practically. Examples are provided to demonstrate the importance of considering meaningful outcomes of importance to young people and how professionals may presume that physical 'recovery' is the goal of treatment, but what recovery means to that young person may be very nuanced. Further key considerations and suggested phrasing are given to introduce and work with young people's goals.
... Empowering these clients to achieve the goals they have made for themselves may encourage healthy decision-making because it will a sense of control of factors impacting their choices in life. A focus on goal-setting and attainment is not new to counseling; for instance, Cooper and Law (2018) bring attention to the value of intense focus on client goal-setting as a therapeutic experience. Our findings bring added meaning to using goals as a way to build client autonomy that may lead to decreased alcohol consumption. ...
In the present study, we examined the ability of Self-Determination Theory’s causality orientations to predict alcohol use and abstinence self-efficacy. We also provided suggestions for counselors supporting client and student autonomy in clinical practice. Objectives: This study sought to answer the following questions: (a) Does a person’s causality orientation (autonomy, control, and impersonal) predict their alcohol use? (2) Does a person’s causality orientation (autonomy, control, and impersonal) predict their temptation to use drugs and alcohol? (3) Does a person’s causality orientation (autonomy, control, and impersonal) predict their confidence to use drugs and alcohol? Method: We utilized Amazon’s Mechanical Turk (MTurk), a crowdsourced online labor market approach to collect data from a community sample. Results: The results suggest heightened impersonal orientation was predictive of increased alcohol use and increased temptation to use while control orientation was also predictive of increased temptation. Higher autonomous orientation was predictive of increased confidence to not use while impersonal and controlled were not. Conclusion: This study’s findings underline the importance of SDT in substance use prevention, initiation, and treatment, and open the door to more empowering interventions. Through the intentional use of SDT, individuals may feel more empowered to set and achieve goals, feel a greater sense of control in their lives, strengthening their overall autonomy.
... 52 Furthermore, all CYP IAPT training programs place a strong emphasis on evidence-based practice within the context of service user involvement, shared decision making, 53 and goal-based work. 54 Lastly, although CWP and EMHP services are generally limited to 8 sessions of treatment, a key feature of these services is not the number of sessions per se, but the principle that intervention should be brief and time-limited. ...
The CYP IAPT program has played a leading role in workforce development in the Child and Adolescent Mental Health Service (CAMHS) in England since its inception in 2011. Despite promising evidence of CYP IAPT’s benefits, significant wait times for CAHMS have convinced policy makers that a new direction for CYP IAPT is required. Since 2017, the CYP IAPT program has changed its aim from workforce development to workforce expansion, with the project aiming to train 1700 new psychological practitioners by 2021. The CYP IAPT program now consists of three training streams (a) a low-intensity workforce, (b) a schools-based workforce, and (c) a high-intensity workforce based on the original CYP IAPT curriculum. The purpose of this paper is to outline the three CYP IAPT workforce streams. As will be reviewed, changes to CYP IAPT have occurred within the context of emerging ideas from dissemination science and government reviews that outline the shortcomings of traditional service models. Consequently, CYP IAPT practitioners are now increasingly being trained in the delivery of novel psychological interventions to address some of these shortcomings. A range of low-intensity interventions are being deployed by CYP IAPT practitioners to target mild-to-moderate anxiety, depression, and conduct. A recent meta-analysis indicates that low-intensity psychological interventions show promise for children and adolescents in efficacy trials. Nevertheless, further research is required to understand its effectiveness in real-world settings and to see if treatment effects are sustained over time. As such, this paper recommends that CYP IAPT services evaluate the long-term effectiveness of low-intensity work and subject their methods and findings to peer review.
... In particular, some counsellors, primarily from a person-centred background, perceived goal-oriented practices-therapeutic methods that involve the setting, discussion and monitoring of clients' goals (Cooper & Law, 2018;Di Malta, Oddli, & Cooper, 2019)-as unhelpfully mechanistic, outcome-oriented and evaluative. For those who did participate, ongoing delays in their implementation of procedures and their poor response to emails suggested further context-related barriers to engagement, including time constraints, complexity of study procedures and service leadership changes. ...
The establishment of counselling and psychotherapy as “evidence‐based” interventions is contingent on the effective implementation of randomised controlled trials (RCTs) in real‐world clinical settings. This paper identifies some of the pitfalls that led to the termination of a practical RCT in a community mental health setting. It reflects upon the significance of the lessons learned by drawing on similar challenges that are documented in the wider literature. Issues surrounding staff turnover, counsellor engagement and procedural clarity are discussed, as is the conflict between the time required for research procedures and counsellors’ clinical time constraints. In our recommendations, we recognise the decisive role of collaboration and counsellor motivation in research partnerships, and the significance of clinical relevance, communication, training and research co‐production in achieving them. Time commitment is identified as the pivotal challenge in the formation and maintenance of collaborative research, but one that also must be overcome for the advancement of the counselling and psychotherapy field.
El trabajo comienza con la revisión de la Formulación de Caso (FC) como acción social, en el sentido de una actividad cargada de intenciones y “no inocente” que, por tanto, requiere un cuidado especial respecto a los procesos que comprende. A continuación, se presenta brevemente el modelo de FC de la Terapia Focalizada en la Emoción (TFE) y se plantea el siguiente problema: la ausencia de un modelo explícito de lo que representa la mejor ejecución del proceso de co-construir un foco y acordar un proyecto terapéutico en TFE. Dicho problema es analizado mediante la revisión crítica de las dimensiones de la FC (proceso, producto y experiencia del cliente) así como su naturaleza como práctica de gestión del conocimiento en psicoterapia. A partir de ahí, se desarrollan los conceptos complementarios de “foco” y “proyecto terapéutico”, a fin de dotar de fundamento a una respuesta al problema planteado. Para responder, se parte de la consideración del proceso que se desea modelizar como una “macro-tarea terapéutica” orientada a la coordinación intersubjetiva entre cliente y terapeuta, y se conduce la fase inicial del Análisis de Tareas. En la sección de resultados se ofrece un modelo racional-hipotético del proceso de co-construir un foco y acordar un proyecto terapéutico en TFE, así como un manual de la tarea y la correspondiente escala de grados de resolución. Finalmente, se discuten los tres productos en términos de su valor general como recursos para la práctica integrativa en psicoterapia y el desarrollo competencial de los terapeutas.
This chapter outlines the critical components of a qualitative and quantitative standardized neuropsychological model leading to intervention that guides practitioners from assessment to intervention. The authors provide empirical and rational arguments for using clinical neuropsychology as a paradigm for client and case conceptualization when approaching evaluations and providing neuropsychological services. Eastern (qualitative) and western (quantitative) methods of neuropsychological assessment are discussed. Various approaches to evaluation such as the Lurian model are explored. Today qualitative assessment continues to be a viable method when looking at a neuropsychological assessment, and this chapter describes the processes involved in conducting qualitative assessments with children and adults. The authors explain the importance of differentiating health services based on an understanding of primary, secondary, and tertiary interventions. The importance of educating readers on the need for selecting research-driven, and thus evidence-based services for intervention, are explored. Moreover, the chapter provides a broad overview of differentiated assessments used at primary, secondary, and tertiary levels-- these assessments lead to evidence-based interventions in a comprehensive neuropsychological evaluation. Given the realization that all clients are unique, the importance of using a multicultural model to guide assessment is also described. Interventions are critical to the success of any assessment and, subsequently, must be standardized in a way that numerous professionals involved can perform their duties in a multifaceted and integrated manner. While not always acknowledged, all practitioners and educators practice according to a specific model and recent advances in understanding the neuroscientificbasis of behavior should serve as a primary model for how practitioners conceptualize clients.
The aim of this paper is to report our notes from the field on using movement toward goals at an aggregate level as an inference of service effectiveness. Analysis of routinely collected data from UK youth mental health services was conducted (N = 8,172, age M = 13.8, 67% female, 32% male) to explore the impact of including goal‐based outcome data in combined calculations of standardized measures based on the principles of reliable change (“measurable change”). Due to the broad nature of standardized measures, inferred validity becomes diluted in any team or service level aggregate analysis. To make inferences that are closer to the person's interpretation of their difficulties, we argue that Idiographic Patient Reported Outcome Measures (I‐PROMs) counterbalance these limitations. This is supported by our findings. The measurable change metric is the first step towards enabling national analysis of aggregated I‐PROMs. I‐PROMs, supplemented by standardized measures should be used to consider service evaluation.
Objective(s): Quantitative research on meaning in life in the context of psychotherapy is relatively limited. The current study aims to investigate the profiles of meaning of clients and their perception of the working alliance and initial symptomatology at the start of therapy.
Design: In a sample of 145 clients (62.1% female, mean age 34.77) who started person-centered psychotherapy, the relationship between meaning, search for meaning, symptomatology, and the working alliance was analysed. Assessment took place after the second session.
Results: Cluster analysis revealed four profiles: Low Presence High Search, High Presence Low Search, High Presence High Search, and Low Presence Low Search. These meaning profiles are distinguished in terms of symptomatology but not in terms of the working alliance perception. However, experience of meaning is significantly associated with the working alliance.
Conclusions:
Results show the relevance of meaning related questions for certain groups of clients at the start of therapy.
Objectives:
Goal-oriented practices are central to many contemporary psychotherapies. The aim of this study was to explore clients' experiences of this work.
Design:
Mixed methods, with a main qualitative part and a smaller quantitative component. Participants were 22 clients in integrative psychotherapy (15 females, 6 males, 1 "other"). Semistructured interviews after session 4 and at endpoint were analyzed thematically. On the basis of the identified themes, "goal attitude" scores were developed and their correlations with outcomes investigated.
Results:
Goal-oriented practices could help clients move from intention to action through increased awareness and focus, setting manageable tasks, and progress monitoring. However, they had the potential to hinder clients' awareness of their intentions, feel irrelevant, disorientating, or demotivating. Effectiveness hinged on client's management of their expectations, flexible working, and time. Positive attitudes toward goal-oriented practices were associated with improvement.
Conclusions:
Goal-oriented practices can enhance psychotherapeutic work but need to be individually tailored and implemented collaboratively.
ResearchGate has not been able to resolve any references for this publication.