What are goals? Definition Goals are internal representations of desired states (Austin & Vancouver, 1996, p. 338)

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1 Goals in Counselling and Psychotherapy Mick Cooper Professor of Counselling Psychology University of Roehampton, London What are goals? Definition Goals are internal representations of desired states (Austin & Vancouver, 1996, p. 338) Consist of: cognitive representation Commitment/ affect 1

2 Being as goaloriented Teleological philosophy Everything begins with the future. - Martin Heidegger Telos= end Logos = reason Teleological philosophy Man, first of all, is the being who hurls himself towards a future and who is conscious of imagining himself as being in the future. - Jean-Paul Sartre 2

3 Teleological philosophy As human beings, we are not caused to do things. Rather, we do things for reasons: to achieve the goals/futures/purposes that we set for ourselves. Hence, to understand human beings we need to understand our goals and thewaysinwhichwerelatetothem. Goals and affect Teleological psychology He [or she] who has a why to live can bear with almost any how Nietzsche 3

4 Research suggests that people feel better when they attain, progress towards, perceive as attainable, and are orientated towards goals (in general) Presence Absence Perceived attainability of goals Hope, optimism, control, order, excitement, expectation Orientation to goals Meaning, purpose, sense of direction, orientation, order Progress/velocity towards goals Accomplishment, excitement, self-belief, expectation, control Hopelessness, futility Meaninglessness, disorientation, chaos, directionlessness, despair Frustration, failure, despair, disillusionment, lack of self-belief, anger Attainment of goals Satisfaction, accomplishment, fulfilment; experiencing of desired state per se Dissatisfaction, failure, sadness, loss, frustration, envy, anger When emotions, themselves, are goals may create range of vicious or virtuous cycles I m not as happy as I should be Disappointment Frustration The nature of goals 4

5 What kinds of goals do clients have? Percentage of clients with goal Assertiveness Connectedness/intimacy Current relationship Other relationships Parenthood Loneliness and grief Fears or anxiety Depressive symptoms Specific life domains/stress Eating behaviours Coping w ith somatic problems Substance use/addiction Obsessive-compulsive Sexuality Sleep Coping w ith trauma Suicidality and self-injury Interpersonal goals: 74.5% Coping with specific problems/symptoms: 60.3% Attitude tow ards self Desires and w ishes Responsibility/self-control Emotion regulation Personal growth: 45.9% Well-being Relaxation/composure Exercise and activity Past, present, future Meaning of life Well-being/functioning: 13.4% Existential issues: 11.1% Holtforth and Grawe, 2002 Goals can be viewed as existing in a hierarchical structure. For example Happiness Autonomy Relatedness Competence Physical pleasure Good friendships Loving partner Basic principles Equifinality: each goal can be attained by several different means Multifinality:any one means can attain a range of goals 5

6 Multifinalmeans can create synergies between goals Happiness Autonomy Relatedness Competence Physical pleasure Good friendships Loving partner Become massage therapist But subgoals/means to attain higher order goals can also be in conflict Happiness Autonomy Relatedness Competence Physical pleasure Separate from partner Live with partner Greater goal conflict is associated with greater psychological distress Are your client s goals synergetic or in conflict? 6

7 Intrinsic vs Extrinsic goals Goals may be for intrinsic selffulfilment (e.g., being in love) or to impress/comply with others (e.g., winning X-Factor) Cf. ideal vs ought goals (Higgins); learning vs. performance goals Ju5tm3l1554on Deviantart.com Wellbeing association with attainment of intrinsic, not extrinsic goals Are your clients goals intrinsic or extrinsic? Approach vs Avoidance goals Goals may be desire for something (e.g., intimacy) or to get away from something (e.g., emotional hurt) (Elliot) Robin Green, Flickr 7

8 Wellbeing tends to be associated with presence of approach, rather than avoidance, goals Are your clients goals approach or avoidance? Conscious vs Unconscious goals Research indicates that goals can operate at unconscious level For instance, subliminal exposure to cooperative words led to more cooperation in task (Bargh et al.,2001) Conscious vs Unconscious goals Active goals are the unit of control over higher mental processes, not the self or individual person, and active goals singlemindedly pursue their agenda independently of whether doing so is in the overall good of the individual person (Bargh& Huang, 2009, p.127) 8

9 Dominance of unconscious goals may be related to greater distress Is you client aware or unaware of their dominant goals? Goals also need Implementation intentions to be successful: if-then plans to fulfil the goal Does your client have concrete plans for how they will attain their goals? Psychological research also indicate that goals are most likely to be effective when they are: Relatively challenging Specific Committed to by the person Important to the person Have clear rationale Close by, achievable Supported by feedback 9

10 Value and limits of goal-setting in therapy Reason for setting goals 1.Can help clients be more conscious of their goals, and therefore more able to develop and sustain plans for their attainment 2.Can help clients to elicit/establish more salutogenic goals: i.e., synergetic, intrinsic, approach, linked to highest order desires Most clients do want to set goals in therapy And good evidence that agreement between client and therapist on goals is related to good outcomes (Tryon and Winograd, 2011) 10

11 Reasons not to set goals Some clients do not want it May make therapy feel more pressurised, task-oriented Client may need/want space to allow things to emerge Basic principles 1. Clients should not be required to set goals 2. Goals can normally be established in a first, or assessment, session 3. But, goal-setting is a process across therapy, and not a one-off event 4. Clients should be allowed to add to, remove and modify goals as appropriate 5. Goals should be determined by clients, in dialogue with their therapists Goal-elicitation questions Do you have a sense of what you want from our work together? What do you hope to get out of therapy? So I wonder what s brought you here? What kind of things would you like to change in your life? What do you see as the goals for this therapeutic work? Where would you like to be by the end of therapy? IF YOU WERE TO SAY JUST ONE WORD ABOUT WHAT YOU WANTED FROM THIS THERAPY, WHAT WOULD IT BE? What would have to be minimally different in your life for you to consider our work together a success? (Duncan, et al., 2004: 69) 11

12 Structured methods Existential attribution (Wong, 1998): Asking Why? questions to track back to clients highest level goals FAST-FORWARDING FORWARDING (WONG, 1998): ASKING CLIENTS TO DEPICT LIKELY FUTURE SCENARIOS GIVEN A PARTICULAR CHOICE, AND DESCRIBING HOW THAT MIGHT FEEL Magical thinking (Wong, 1998): Asking questions that help clients transcend their current circumstances: e.g., If you could be whoever you wanted right now, what would it be? The movies exercise (Schulenberget al., 2008). Asking clients to develop a film of their life, describing future and past Clients may not be able to identify goals immediately: Often an open, on-going dialogue is required Mick: Where would you like to move forward to? Saskia: I don t know what to ask, I mean, obviously, 20 sessions is not a long time. Um I don t really know, I don t want to hope for too much. Em It s hard to say. Mick: What are the main things that you d like, perhaps, to be a bit different? Saskia: Well certainly the relationship things a big thing because, you know, I m 22 now and I haven t been with anyone for a long time [Client talks about her desire for a stable relationship.] Mick: So getting somewhere maybe to the point where you re closer to being in a relationship sounds like a good place--maybe a good place to get to. Saskia: And maybe, also, I dunno, there s always this problem of, um understandably I think there is this problem of jealousy and envy. [Mick: Uh huh] And it s all about comparison and, er, setting myself up for a failure [Saskiagoes on to talk about her tendency to compare herself against others, and how she would like to stop doing this.] So, to say--to ask me where I would like to be--i dunno, healthier, anyway--i know that s very vague and general. Mick: Physically, do you mean, or? Saskia: Both ways, both ways [Saskiatalks about her current lack of exercise. Mick and Saskiathen go on to talk about whether she would like to be in employment. Saskiasays that she would like to be doing some work as a teaching assistant.] Mick: So if you were like, two of three years down the line, and you had a life that was working with children, and you were in a relationship, that would feel good? Saskia: Aw, that would be awesome. If therapists do not think that clients goals will be of benefit to them, this can be brought into the dialogue 02:24 12

13 The Goals Form The Goals Form The Goals Form can act as a record of clients goals and goal progress; and also serve as an individualised outcome measure for service- and clientlevel evaluation (See Using the Goals Form 1. Client and therapist discuss the client s goals for therapy (normally at assessment) 2. Wording is agreed a written down on the Goals Form 3. Clients are asked to rate how much they feel each goal is currently achieved 4. Clients are asked which goals they would like to prioritise 5. The client s goals are transposed to an electronic copy of the form and copies of the personalised form is printed off 6. Clients are asked to rate their goals at the start of every session 7. Clients can add to, delete or modify their goals as the work progresses 13

14 Clients generally positive about the Goals Form (Cooper et al., 2015) Helpfulness ratings for measures (1 = very unhelpful, 5 = very helpful) Measure Mean (SD) Median Mode N PHQ (1.0) GAD (1.1) Goals Form 4.2 (1.2) HAT 3.9 (1.2) SRS 3.7 (1.1) WAI-SF 3.1 (1.0) ANS 3.6 (0.9) TPF-A 3.8 (1.2) TPF 3.5 (1.0) Clients generally positive about the Goals Form (Cooper, 2014, Michael et al., 2015) 1. Helped clients articulate what they wanted to work on [Completing the Goals Form was helpful] in the sense of, actually, you know, going through What is it that I want to achieve, what is it that is making my life difficult, and I want to improve?.definitely very useful, to crystallise and put things down. [I]t was--- good to be able to have a look and see-- Yes, this is exactly what I m aiming at. Clients generally positive about the Goals Form (Cooper, 2014, Michael et al., 2015) 2. Gave focus to the therapy I m a very scatty mind because I was very depressed I couldn t concentrate and then it s helpful to have something in black and white on paper because then you knew this is what you were working at. I really liked the goals, for example, I really liked that element of it, and knowing that you have this--and focusing your thoughts and saying, Ok, What do I need to do to achieve that and that and that? I think, probably, this task [of completing the Goals Form] was probably one of the most helpful [aspects of therapy] 14

15 Clients generally positive about the Goals Form (Cooper, 2014, Michael et al., 2015) 3. Gave a sense of overall progression I could see that I was gradually getting better and we talked about that as well which gave me a sense of encouragement. [Y]ou could see: Were you on target? Were you making progress? Goals on the Goals Form should be Concise:Not more than one sentence long Single goals Absolute :Not relative (e.g., less depressed ), as difficult to rate from week to week Ideally, goals on the Goals Form should be Synergetic: or at least not in conflict Intrinsic Approach goals Achievable (i.e., supportable by specific plans) 15

16 Research also suggests goals should be Relatively challenging Specific Important/rele vant/committed to by the person Supported by ongoing feedback: i.e., keep measuring regularly Goal-based outcome measure (young people) 16