Conclusion

This conclusion draws together the main themes of Working with goals in counselling and psychotherapy and revisits complex reasons people choose to engage in therapy. It explores the debate around the use, and usefulness, of goals in therapy. It sees the question ‘What do you want?’ as central to the therapeutic endeavour; but sees this a deceptively simple question that draws on complex psychological processes and requires great therapeutic skills to help clients answer. The chapter argues that therapeutic goals are about how therapists can help clients start in therapy, how therapists can remain flexible and open to changes in the directions that therapy may take, and how therapists can be as helpful as possible in joining clients on their journeys. The chapter concludes that the best kind of therapy is the one that best fits the goals, wants, needs, preferences, and context of the client.

From problems to goals

The goal of this chapter, ‘From problems to goals: identifying ‘good’ goals in psychotherapy and counselling’, is to outline what makes a ‘good’ goal for therapy. Much of the discussion in this chapter is influenced by the theory underpinning rational emotive behaviour therapy (REBT). It is argued that negotiating goals make most sense when a clear understanding has been arrived at concerning the psychological state of the client. Distinctions are made among the psychological states of disturbance, dissatisfaction, and development. It is proposed that goals can be negotiated with respect to each psychological state, and these processes are illustrated with clinical examples. Various problems with respect to goals are identified and discussed.

Using goals in therapy

The chapter ‘Using goals in therapy: the perspective of people with lived experience’ explores clients’ views of the benefits, issues, and challenges of using goals in therapy. The chapter is written by and provides the authentic voice of people with lived experience of therapy that work to improve mental health services. It discusses the importance of using goals in therapy, how using goals can help clients to feel in control of the therapeutic process and enable them to feel heard, validated, and involved in their care. It also explores the key difficulties and challenges of using goals in therapy from the perspective of clients and provides suggestions on how therapists can avoid or overcome these.

Philosophical, conceptual, and ethical perspectives on working with goals in therapy

This chapter explores the underlying assumptions that inform goal-oriented therapy, with the aim of examining the relevance of different critical perspectives on contemporary theory and research into therapeutic goals. An appreciation of what it means to talk about goals requires thinking about some of the basic questions around human experience and existence, including the nature of free will, time, causality, and explanation; and the ways in which realities are constructed through language and conversation. The chapter also discusses important ethical and moral dilemmas associated with processes through which goals are co-created within relationships characterized by differences in power and authority, and the forms of research and inquiry that might yield practical knowledge of relevance to clinical practice in this area.

Introduction

This introduction to Working with goals in counselling and psychotherapy outlines the key concepts, debates, and scope for the book. Goals can be defined as ‘subjectively desirable states of affairs that the individual intends to attain through action’. They are closely associated to such phenomena as strivings, desires, purposes, and personal strivings. Goal-oriented therapy can be understood as including goal-setting, goal-monitoring, goal-discussion, and goal-based formulations; as well as attempts to achieve goal-agreement. Recent developments in policy, research, and practice have supported the use of goals in therapy. Goals can help focus therapeutic work, empower clients, and are consistent with many clients’ therapy preferences. However, when applied in rigid ways, there is also the risk that they may increase clients’ feelings of self-judgement, and reduce the depth of the work. The aim of this book is to explore these issues and to detail an effective goal-oriented practice.

Goal-oriented practice

This chapter focuses on the application of goals and goal-setting in goal-oriented practice. It sets out goal-oriented practice as a therapeutic ‘stance’ and not a therapy model, and sets the clinical context for goal-oriented practice. The chapter explores how service systems and structures can support goal-oriented practice. Goal-oriented practice is defined as any therapeutic encounter that works towards helping the person move towards what they want to get from therapy. A ‘goal’ is considered shorthand for ‘what I want to be different if therapy is successful’. Its emphasis is on co-producing explicit goals for therapy that can then be revisited and tracked throughout an intervention. Therapists need to be realistic and pragmatic about the goals that are achievable in therapy and be cognizant to the complexity and adversity in the real-world contexts in which many of our clients strive to reach their goals.

The psychology of goals

This chapter, ‘The psychology of goals: a practice-friendly review’, examines psychological evidence and theory on goals and goal processes, and draws out implications for clinical practice. Research indicates that psychological wellbeing is associated with the actualization of goals: having important goals in one’s life, believing that they are attainable, progressing towards them (at an appropriate pace), and achieving them. These processes, however, are mediated by several significant goal dimensions, such as how important the goals are, whether the goals are ‘approach’ or ‘avoidance’, and the extent to which the goals are conscious. Goals can be conceptualized as existing in a hierarchical framework, with ‘higher order’ goals achieved through ‘lower order’ goals. Here, wellbeing is also associated with lower levels of goal conflict, and more effective means of goal-actualization. This conceptual framework can be used to facilitate the process of formulation in therapy, and to inform therapeutic practice.

Goal-oriented practice across therapies

This chapter explores goal-oriented practice across therapies: cognitive behaviour therapy (CBT), psychoanalytic psychotherapy, psychoanalytic child psychotherapy, interpersonal psychotherapy (IPT), humanistic and existential therapies, systemic family therapy, and online therapy. Each section gives an overview of the approach and sets out ways that goals are conceptualized, negotiated, and embedded. Examples are given to illustrate how goals are used. Differences are found across these approaches in the methods used to negotiate goals, and the extent that these are made explicit and embedded in the work. Greater similarities are found in the use of goals in CBT and IPT, compared with the less directive modalities of humanistic, psychodynamic, and systemic psychotherapies. Differences are also found within modalities (e.g. psychoanalytic psychotherapy for adults versus psychoanalytic child psychotherapy). However, the chapter demonstrates the many similarities in the use of goals as a common factor across these different therapeutic approaches.

Measuring outcomes using goals

Goal-based outcome measures are increasingly seen as important tools when working with counselling and psychotherapy clients. The aim of this chapter is to identify and review different measures used with children and adults, outline the considerations around their psychometric properties, and explore the benefits and challenges of goal setting and tracking. A range of goal-based measures is available for clients. The flexible and personalized approach of goal-based measures means that they can be used across healthcare settings and appointments, as well as contribute to collaborative working. Incorporating multiple stakeholder views and issues around client capacity have been suggested as barriers to the use of goal-based measures with certain populations or situations. However, with appropriate clinician training and a flexible approach to goal-setting and monitoring, measuring outcomes using goals should become central to the counselling and psychotherapy process for all.

Goals and psychotherapy research

This chapter, ‘Goals and psychotherapy research’, examines goals in psychotherapy as they relate to clinical outcomes by surveying the extant research. Following a brief discussion of the importance of goals for personal development, the chapter focuses on research concerning the collaborative relationship between client and psychotherapist in goal-setting and effecting psychotherapy tasks to meet therapy goals, with particular emphasis on the client-therapist collaborative-outcome relationship. Next, the chapter reviews goal-psychotherapy outcome research for both adult and child/adolescent clients. The research presented is interpreted using clinical examples. The chapter closes with conclusions gleaned from the research reviewed followed by suggestions for practitioners.