Dr Gina Di Malta, CPsychol., Lecturer in Psychotherapy and Counselling, The Open University

Setting goals in therapeutic work is used across a range of psychotherapies. It is especially commonplace in therapies such as cognitive-behavioural therapy (CBT), where clients may be encouraged to set SMART goals (specific, measurable, achievable, realistic and time-limited). This approach to goals is particularly suited to short time-limited therapy.

However, working with therapeutic goals is also common in other approaches, and is integral to pluralistic therapy, where the aim is to orientate the therapeutic work around the client’s own wants and needs. And, here, the concept of goals is about more than just SMART-ness. Rather, it encompasses a client’s direction, wishes, hopes, and aspirations. Setting goals in these therapies can be a way of making the direction of the client explicit. This enables the therapist to align with the client’s direction and to develop empathy for where the client is going.

In 2019, with Professors Hanne Oddli and Mick Cooper, I conducted a ‘mixed methods’ study with 22 clients in pluralistic therapy (see paper here). Clients were asked about their experiences of goal-oriented work. Based on the results, I would suggest five guidelines for goal-oriented practices.

1. Decide whether to work with goals on a case-by-case basis

Findings from the study suggest that working with goals tends to be beneficial for most clients, but can also be unhelpful to some clients. Therefore, first and most importantly, client and therapist need to decide whether they want to set goals, and whether this is likely to be beneficial to them.

According to our study, working with goals may be most helpful where clients feel overwhelmed with problems and would find it useful to have their issues framed in terms of goals—with the possibility of making them more manageable. Setting goals also has the potential to enhance a client’s focus and motivation to work on their problem, as well as to increase their awareness of the problem.

On the contrary, goals work could be unhelpful where clients feel they do not understand or view the world in terms of goals. In such cases, working with goals can lead to a client feeling misunderstood by the therapist. Furthermore, goal-oriented practices can be unhelpful where clients are particularly sensitive to failures in goal attainment.

 2. Allow sufficient time to explore and set goals

The research suggests that clients can experience anxiety from being asked about their goals in a first session. Some clients may not know what they want at such an early stage, and may feel pressured to set goals which may turn out to be irrelevant—making the intervention counter-productive. Goals become clearer and more fully formulated as a client’s story unfolds.

Therefore, therapists may need to consider setting goals over a few sessions rather than in an initial session. Client and therapist can work with emerging shared meanings over this time to create important and meaningful therapeutic goals. This also ensures that the therapist and client have a clear and more complete understanding of what the goals are about.

Therapists can consider providing pre-therapy interventions to support clients in thinking about their goals. For instance, clients might be provided with information encouraging them to think about what they would like from the therapeutic process, and what they would consider achievable within the time available.

3. Work collaboratively and flexibly

Findings from this study show that clients have found flexibility and collaboration around goals work particularly helpful. This flexibility enabled clients to use goals in ways that were most useful to them. Some clients, for instance, found that goals were a point of reference or a common ground to enable exploration, while other clients found goals useful as a structure to guide the therapy. Furthermore, allowing flexibility around goals work also enabled therapists to tune in to what their clients most needed at different times in the therapy.

This also suggests that therapists need to take an active role in promoting collaboration by inviting clients to share their views, input their ideas, feedback on the process, and share their own expertise in to the goal-setting process. In addition, therapists need to take a flexible approach to goals work and be willing to ‘let goals go’or change track if other issues become more important. One central aspect linked with collaboration and flexibility is the regular reviewing of goals, with the possibility of establishing new goals when previous ones have been achieved or are no longer relevant.

4. Set ‘sub-goals’ and regularly monitor goals

Clients who liked the guidance that goal structure provided particularly appreciated setting ‘sub-goals’, and the therapist’s support in tracking goal progress. The therapist’s engagement in goal monitoring was linked to more client motivation to achieve their goals.

Therefore, a helpful goal-setting strategy may be one in which the therapist and client set sub-tasks or establish relatively small, achievable sub-goals. The monitoring of these sub-goals may be essential in goals work to keep track of progress and keep a sense of direction for the client, as well as knowing that this direction matters to both the therapist and client. Setting and tracking smaller sub-goals is more likely to support a client’s sense of progress and achievement.

5. Be aware that a lack of progress towards goals can demoralise clients

Being goal-oriented has the potential to be upsetting—or even crushing—for a person who suffers from depression. This is because a lack of progress or achievement can directly feed into depression schemas such as ‘not being good enough’ or ‘being worthless’.

Therapists therefore need to be sensitive when working with goals, and particularly attuned to their client’s meanings around ‘failures’ and setbacks. Such setbacks in goals work must be taken seriously, with a therapist being alongside their client and connecting with their meaning. Therapists can also put clients’ goal setbacks in perspective: being supportive and noticing achievements and progress in other areas of their client’s life.