Goals Form Guidance On Use

Mick Cooper, University of Roehampton

mick.cooper@roehampton.ac.uk

The Goals Form is a simple, personalised tool that can be used to set goals in counselling and psychotherapy, and to monitor clients’ progress towards them.

Therapy goals

Therapeutic goals can be understood as projected states of affair that clients hope to achieve through participating in therapy. It refers to what clients want to get out of therapy (e.g., ‘Not worry what others think about me’, ‘Have close relationships in my life’) rather than how they want therapy, itself, to be (e.g., ‘Feel valued by the therapist’, ‘Talk about my problems’). Goals may be specific (e.g., ‘I want to lose two stone’) or more amorphous (e.g., ‘I want to feel better about myself as a person’). It is the direction that clients want to travel in through the therapeutic process.
Some clients (and therapists) do not like the term ‘goals’. It may be perceived as being too ‘success-oriented’, too rigid, or too focused on outcomes rather than the process of change. Here, it is quite acceptable to use alternate terms for directions in life, such as ‘aims’, ‘wants’, or ‘hopes’. As always, the priority is to engage with clients in ways that are meaningful and helpful to them.

The value of goal setting and monitoring

Within the psychological literature, there is robust evidence that people—in general—are more likely to get to their goals if they set, and record their progress, towards them. Within the counselling and psychotherapy field, there is also some evidence that goal setting may have a positive effect on treatment outcomes, and that clients find this a helpful process—including through the use of the Goals Form. In one study, for instance, clients gave the Goals Form an average rating of 4.1 on a 1 (very unhelpful) to 5 (very helpful) scale. Additionally, a recent survey found that approximately 60% of laypeople would like specific goals to be set in therapy; with 20% not wanting this, and 20% not minding. There is also evidence that agreement between client and therapist on the goals of therapy is associated with positive outcomes.
Within the psychological field, goal setting and monitoring has been hypothesised to enhance outcomes through directing the individual’s attention to the identified goal, mobilizing effort, supporting persistence, and motivating people to develop strategies for their attainment. These effects have also been found in the mental health field; with evidence that it may also help to establish realistic expectations of therapy, facilitate insight, provide a safe and predictable structure for therapy, increase cooperation between therapists and clients, and support clients to see the progress that they are making. In addition, it has been argued that goal oriented practices may increase clients’ feelings of hope and empowerment, by “constructing” them as agentic, intelligible beings, with the potential to act upon their worlds. Goal oriented practices in psychotherapy may also have an ethical imperative. McLeod and Mackrill write:

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voidance of clarification around client goals could be regarded as an ethical breach, as it would make it impossible to know whether the direction and focus of therapy was congruent with the client’s views. That is, some kind of explicit checking-out of therapeutic goals is a necessary aspect of respect for client autonomy.

The limits of goal setting and monitoring

Clients may find it difficult to formulate goals, particularly at the start of therapy, and may feel ‘put on the spot’ by being asked to do so. Their self-identified goals may also not match their deeper wants and needs, or may become irrelevant over time. Consistent with this, research has suggested that explicit goal agreement is not necessarily present in the work of experienced, high alliance psychotherapists. This suggests that formal goal setting and monitoring may not be essential to establishing high levels of goal agreement. From a humanistic therapy standpoint, goal oriented practices have also been criticised for reinforcing clients’ ‘extrinsic’ desires—to achieve and ‘do’—rather than helping clients to ‘be’. In support of this, some clients may feel that they have failed if they do not progress towards their set goals; and others may feel that the concept of goals is too mechanistic or does not fit their way of being.
Goal setting and monitoring, then, may have the potential to be helpful to some clients; but it cannot be assumed that all clients, at all times, will benefit from this. The Goals Form provides a means of offering clients the opportunity to set and monitor their goals, but its value will always be dependent on the preferences and context of the individual client. Research also suggests that goal setting is most helpful when it is done in a collaborative, flexible and unhurried way, with the therapist guiding and supporting the client through the process.

Establishing goals

Therapy goals can normally be set in a first/assessment session. However, some clients may need longer to identify meaningful goals, such that initial goal setting may not be concluded until a second or third session.
Goals for therapy should be determined by clients, in collaboration with their therapists. The process should be a dialogic and iterative one. For instance, the client may give a rough idea of where they would like to get to, which the therapist then summarises, and the client then adds greater detail and nuance.
It should be explained to clients that any goals can be modified, removed, or added to as the work progresses.
Typically, therapists may start the goal setting process by inviting clients to describe what has brought them to therapy. This process should be given sufficient time (for instance, at least 20 minutes), and it is important that therapists develop a general, holistic sense of what their client’s current concerns are. Asking clients about their life circumstances—e.g., work, relationships and family—as well as some historical background, may help to deepen an understanding of where the client is ‘at’, and what they are wanting from therapy. Clients can also be asked more direct questions like:

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‘Where would you like to be by the end of our work together?’

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‘What would you like to get from therapy?’

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‘What are your goals/hopes/wants for the therapeutic process?’

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‘What would you like to change in your life?’

Based on the client’s narrative and their answers to the above questions, the therapist can begin to reflect/summarise what the client seems to be wanting from the therapeutic process. For instance, ‘It sounds like you want to feel more self-confidence, is that right?’ Therapist and client can then work together to agree specific wording for goals. Typically, clients will identify between two and five goals for therapy, though less or more is acceptable if clients show preferences in those directions. In agreeing goals for therapy, the following pointers should be borne in mind:

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Clarify. Try to establish a specific sense of what the goal is. For instance, if a client says they want to be ‘happier’, you can clarify what that actually means for them (e.g., ‘Feel more energy in the mornings’). However, it is important that the goal remains broad enough to be meaningful and important for the client.

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Concise. The wording of the goal should not be more than one sentence long (one or two lines of written text), so that it can fit on the Goals Form and can be easily assessed by the client. For instance, ‘Feel able to stand up to my father and tell him what I really think.’

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Single goals. Try to avoid having too many diverse goals within one goal. Ideally, each goal should represent one main thing, so it is better to separate out diverse goals. For example, ‘Feel vibrant’ (Goal 1), ‘Feel on top of things’ (Goal 2), rather than ‘Feel vibrant and on top of things’.

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‘Absolute’. Goals should be stated in ‘absolute’, rather than ‘relative’, terms. For example ‘feel happy’ rather than ‘feel happier’; ‘feel good about myself’ rather than ‘feel better about myself’. This is so that clients do not need to refer back to some reference point when rating.

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Approach goals. There is some evidence to suggest that it may be better to formulate goals in approach terms (something the client wants to achieve) rather than as avoidance goals (something the client wants to get away from). For example, ‘Feel happy and at ease’ rather than ‘Feel less sad and tense.’

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Intrinsic. Research suggests that clients do better when they progress towards personally desired outcomes (e.g., ‘Be closer to friends’), rather than the standards and expectations of others (e.g., ‘Lose weight to make my boyfriend happy.’)

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Achievable/realistic. There is some evidence that clients do better when their goals are achievable and realistic, rather than representing unattainably high standards. Larger goals can be broken down into smaller subgoals/substeps

Once wording is agreed, each goal can be written down on a blank Goals Form (by client or therapist).
For each goal, clients should then be asked to indicate how much they currently feel they have achieved it by circling a number from 1 (Not at all achieved) to 7 (Completely achieved). They can also be asked to indicate which of the goals they would most like to prioritise/start working on.

Although research indicates that most clients find it helpful to establish goals, some do not. It is therefore important to discuss with clients, before commencing a goal-setting process, whether they would like to establish goals and/or have them written down and rated on a weekly basis. There may also be times when it is inappropriate or unhelpful to focus on agreeing goals (for instance, if risks issues are present). Clinical issues should always take priority.

Transposing the goals onto a Goals Form

Once sessions are complete, therapists should type up, or, write down clients’ goals (without ratings) onto a blank copy of the Goals Form. They should then make some copies of this personalised master form for use in subsequent sessions.

Using the Goals Form

At the start of each session, clients should be presented with their personalised Goals Form, and asked to spend a few moments rating how close they now feel they are to achieving each of their goals.
Clients’ responses to the Goals Form may form the starting point for the therapeutic dialogue (for instance, if clients indicate that they have moved towards, or away from, particular goals; or if one goal shows much lower attainment than the others).
Note: clients should not be presented with a blank Goals Form at the start of each session and asked to re-articulate their goals.

Revising the Goals Form

At any point in the therapy, clients or therapists may suggest that the goals on the Goals Form should be revised to more accurately represent the client’s goals for therapy. This may involve the deletion of goals, the addition of goals, or the revision of the wording of goals. Particular times this may be most likely to happen are:

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When goals are achieved or no longer feel relevant to clients

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At review sessions

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Following completion of the Goals Form, for instance if clients note they are balking at particular goals or feels that something is missing.

The client and therapist should agree revisions to the Goals Form through dialogue. A new master Goals Form of the client’s revised personalised goals should then be produced by therapists and copies made before the subsequent session, and this should then be used for following sessions.
Clients are able to revise their goals as frequently as possible. However, for purposes of statistical analysis (and also, potentially, to maintain consistency in the therapeutic work), it is better if the goals stay relatively stable throughout the therapeutic work (e.g., each goal remains active for at least five sessions or so).

Scoring

Simple graphs can be made (for instance, on Excel) to plot changes in clients’ individual goals over time, and research suggests that many clients may find this a useful part of therapy. This is something that can be discussed with individual clients.
To calculate changes over the course of therapy, for service evaluation purposes, use the following procedure:

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For each client, calculate the mean score for the goals at first rating (the mean is the sum score for all of the goals divided by the number of goals). If a goal was established at the assessment meeting, this will be the assessment score; if it was established later on in the therapy, this will be the score at that time point. If goals are modified in any way, treat them as new goals.

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For each client, calculate the mean score for the goals at last rating. If a goal is active until the end of therapy, this will be the score in the final session. If it is deleted or modified prior to the end of therapy, this will be the last time it was rated.

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Calculate the mean first score across all clients, and the mean last score across all clients. The difference between these two scores indicates how much, on average, clients have changed in your service. For evaluation reporting purposes, you can plot these scores on a graph.

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Calculate an ‘effect size’ by dividing the mean amount of change by the ‘standard deviation’ of the first scores. An effect size is an indicator of the magnitude of change. An effect size of 0.2 is typically defined as ‘small’, 0.5 as ‘moderate’, and 0.8 as ‘large’. The standard deviation of the first scores can be calculated using the Excel command ‘stdev’. Example: Mean first score = 2.4, mean last score = 4.7, standard deviation of first scores = 1.5, Effect size = (4.7-2.4/1.5) = 1.53).

Troubleshooting

What happens if clients do not want to set goals?
As indicated above, prior to any goal setting, clients should be asked if they think they might find it helpful, or not, to set goals, and monitor their goal progress on a regular basis. If clients indicate that they do not want to do this, the Goals Form should not be used.

What happens if clients say they cannot think of any goals?
It is always worth asking this question in a range of different ways, as above. For instance, ‘Where would you like to get to by the end of therapy?’ or ‘What would you like from our work together?’ The assumption, here, is that clients are intelligible beings who have come to therapy for a reason, and that therapists can help them reflect on—and articulate—what those reasons are. However, if clients continue to indicate that they do not know what they want from the work, it may be best to leave this question and come back to it at a later date.

What happens if a goal become redundant?
A client can delete this goal from their Goals Form.

Should I comment on a client’s goal progress, as indicated on their Goals Form?
This may not be relevant each week, but client’s ratings of goal progress can certainly be drawn on in the therapeutic work: for instance, if a client is showing steady progress towards their goals, or is struggling to achieve a particular desired outcome.

Is it ok for clients to talk about things in sessions that are not related to their goals?
Of course. The Goals Form provides only a rough guide to what clients want to work on, and is not intended to cover every issue and eventuality. If clients come to therapy with pressing issues that are not represented on their Goals Form, it is entirely acceptable for them to make these the focus for the session. However, if they continue to remain focal to the therapeutic work, it may be appropriate to add to, or revise, the explicitly recorded goals.

Who should write the goals down?
The ideal is probably that this is done by the client, so that they have most ownership over the goals. However, it is fine if this is done by the therapist, provided that the client agrees to the wording of the goal.

Permission

The Goals Form is not copyrighted in any way and you are welcome to use the form without charge or formal permission. Please do let us know, however, about your experiences of using the form or any findings from its use. Also, if you revise the form or the procedure for its use in any way, please make this clear in any publications. Any publications or reports should also reference the original source for this form:

Cooper, M. (2014). Strathclyde pluralistic protocol. London: University of Strathclyde. See www.pluralistictherapy.com