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(p. 139) From problems to goals: Identifying ‘good’ goals in psychotherapy and counselling 

(p. 139) From problems to goals: Identifying ‘good’ goals in psychotherapy and counselling
Chapter:
(p. 139) From problems to goals: Identifying ‘good’ goals in psychotherapy and counselling
Author(s):

Windy Dryden

DOI:
10.1093/med-psych/9780198793687.003.0007
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Subscriber: null; date: 10 December 2018

Overview

The goals of this chapter are:

  • to outline what makes a ‘good’ goal in psychotherapy and counselling;

  • to argue that negotiating goals make most sense when a clear understanding has been arrived at concerning the psychological state of the client. Distinctions will be made among the psychological states of disturbance, dissatisfaction, and development. Goals can be negotiated with respect to each psychological state;

  • to identify and discuss various problems with respect to goals.

Alvin Mahrer (1967) edited one of the most seminal publications on goals in the field of psychotherapy where each contributor, a well-known figure in the field at that time, addressed the question, ‘What are the goals of psychotherapy?’. In his concluding chapter, Mahrer reviewed what his contributors had to say on this issue and argued that two broad goals of psychotherapy could be identified from what they had written. These goals were the alleviation of suffering and the promotion of growth or development. It is important to note that the first of these goals refers to the absence of a psychological state (i.e. suffering), whereas the second refers to the presence of a state (i.e. growth or development). Thus, right from the outset, there was confusion concerning what constitutes a good goal in psychotherapy and counselling. Is it the absence of a negative psychological state, the presence of a positive psychological, state or both? Interestingly, this confusion also appears when clients are asked to nominate their therapeutic goals. In the present chapter, I will consider this issue and several others as I set out to achieve my primary chapter goal: to outline what makes a ‘good’ goal so that therapists can work effectively with goals in psychotherapy and counselling. Let me be clear at the outset that much of what I have to say is influenced by the theory underpinning rational emotive behaviour therapy (REBT). In my view, this theory has much to offer the subject of goals in psychotherapy and counselling and helps clarify a number of the issues that I will discuss in this chapter. When reading this chapter, please bear in mind that good goals are collaboratively negotiated between you and your client rather than unilaterally set and the more they are owned by the client, the more they are likely to be pursued and achieved (Law & Jacob, 2015).

Problems and goals

Let me begin with a very common scenario. A person seeks therapy from you because they have one or more psychological problems and want help with this problem or problems. The first step is for you to understand and help the client to understand the problem(s) for which they are seeking help.

Focus on the target problem

Let’s suppose that you and your client decide to target one of your client’s problems for therapeutic help. When this happens this problem is known as the ‘target problem’.

When the target problem is assessed, if possible, you need to understand both a specific example of the target problem and its general nature.

AC-based problem focus.

Once a target problem has been selected and put in its general and specific context, then you need to engage with the client in the process of understanding the nature of the problem. In doing this here, I will use the ‘A’ and ‘C’ components of REBT’s ‘ABC’ framework. ‘A’ stands for activating event and is divided into the Actual situation and what the person is most disturbed about—here known as the Adversity. ‘C’ (Consequences) stands for the emotional, behavioural, and cognitive responses to the adversity at ‘A’. ‘B’ stands for Beliefs.

An example appears in the following box. (p. 140)

(p. 141) Focus on goals

After you have helped yourself and your client to understand the ‘A’ (Actual situation and Adversity) and ‘C’ (Consequences) components of their target problem, you are in a good position to set a goal with respect to that problem.

Here are some examples of questions that you might ask to initiate this process:

  • ‘What would you take away from therapy that would give you a sense that you could effectively deal with the issue?’

  • ‘Instead of responding to the situation or adversity with [name the client’s current problematic response], how would you like to be able to deal with it?’

  • ‘Instead of responding to the situation or adversity with [name the client’s current problematic response], what would an acceptable constructive response be for you?’

The importance of negotiating a goal in response to the adversity rather than in response to the actual situation

Often when people discuss their problems in therapy they talk about their disturbed responses to the actual situations that they find problematic. Thus, as (p. 142) discussed in the Case example below, when one client first told me what he wanted to focus on in therapy, he said that he was anxious about giving presentations. When we looked further we found out what it was about giving presentations that made him most anxious: he thought that his Board of Directors would think that he was not up to the job. In the ABC framework, giving presentations was my client’s Actual situation and thinking that his Board of Directors would think he was not up to the job was his Adversity.

If clients tend to identify actual situations when they nominate their target problem, they do the same when discussing their goal unless guided to set a goal with respect to their adversity. You will probably have to give them a rationale for providing such guidance, which they need to accept before you both proceed. Thus, you might ask them: ‘Do you think it will be more useful if I help you to deal more productively with giving presentations or with the possibility that your Board of Directors may not think that you are up to the job, given the fact that the latter is what you are most anxious about?’, or ‘Do you think I can help you best with giving presentations if you are anxious about your Board of Directors thinking that you may not be up to the job or concerned, but not anxious about this?’.

The importance of assuming temporarily that your client’s adversity is accurate

When your client comes to therapy struggling in the face of an adversity, therapy provides them with an opportunity to deal constructively with that adversity. In some forms of therapy, the emphasis is on helping clients to see that their inferred adversities at ‘A’s are distorted (e.g. ‘my boss wants to see me because he wants to tell me off’), and that the thrust will be on helping them by questioning these distorted inferences. Although this stance is often useful, it does not help your client to deal constructively with adversity from their frame of reference. In addition, it is not inconceivable that they may encounter situations in which their inferences turn out to be correct. Thus, while my client may at times distort reality by assuming that people think negatively of him if he reveals gaps in his knowledge during a presentation, this may happen and, as such, it is important that you help him deal with this eventuality, assuming that he sees the sense of doing so. In encouraging your client to deal with the adversity from his frame of reference and thus to set goals for dealing with it constructively, it is useful to encourage your client to assume temporarily that he is accurate in inferring the presence of the adversity. The best time for a client to stand back and consider the accuracy or otherwise of his adversity inference is when he is not in a disturbed frame of mind about this inference, that is when he has achieved his goal of dealing constructively with the adversity. Thus, the client who thinks that her boss wants to see her (p. 143) to criticize her is better placed to consider the accuracy of this inference when she is concerned, but not anxious, about this inference, than when she is anxious about it.

Helping your client to construct healthy responses to the adversity as goals

Once your client understands the importance of negotiating a goal with respect to facing their adversity, then your next task is to help them to construct healthy responses to that adversity. These will serve as their goals with respect to their target problem. In my view, the best way to do this is to take the AC components that you identified when working to understand the problem. The ‘A’ components were the situation in which the problem occurred (the Actual situation) and what the client was most disturbed about (the Adversity). When negotiating a goal with the client, it is important to keep these ‘A’ components the same. Otherwise the client will not be helped to deal with their adversity constructively. The ‘C’ components are the emotional, behavioural, and cognitive responses to the adversity. In helping a client to construct healthy responses, ideally you need to help them identify alternative healthy responses to each of the unhealthy responses in the three response categories listed above, that is emotional, behavioural, and cognitive.

Healthy emotional responses as goals

When a person has a problem with an adversity, they usually experience a negative emotion. I call this negative emotion unhealthy when it leads the person to get stuck, is associated with a variety of unconstructive behavioural and cognitive responses, and discourages the person from facing up to and dealing constructively with the adversity. When the person responds constructively to the adversity they also experience a negative emotion. Why? Because the ‘A’ is negative and it is healthy to feel negative when something negative happens. I call this negative emotion healthy when it leads the person to get unstuck, is associated with a variety of constructive behavioural and cognitive responses and encourages the person to face up to and deal constructively with the adversity.

Negotiating a healthy emotional response to an adversity can often be quite difficult with a client as people generally think that such a response involves the diminution or absence of an unhealthy negative emotion rather than the presence of a healthy negative one. Also, in the English language we do not have terms that clearly denote healthy negative emotions in a way that clearly differentiate them from unhealthy negative emotions. Consequently, it is important that you negotiate with your client terms for both the unhealthy negative emotion that they experience in their target problem and their healthy negative emotion which they will experience if they reach their goal.

(p. 144) Healthy behavioural responses

Perhaps the easiest healthy responses to construct are behavioural in nature. As I will discuss below, it is important, if possible, to help the person nominate the presence of a healthy behaviour rather than the absence of an unhealthy behaviour.

Healthy cognitive responses

When constructing healthy cognitive responses to the adversity, that is responses that accompany emotions at ‘C’ rather than those that mediate (at ‘B’) responses to the adversity at ‘A’, a useful rule of thumb is as follows. Healthy cognitive responses are balanced and incorporate negative, neutral, and positive features of ‘A’ (e.g. ‘Possibly being the laughing stock of the company and getting sacked, but more likely being helped to improve my performance and to rectify gaps in my knowledge’), whereas unhealthy cognitive responses are highly distorted and skewed to the negative (e.g. ‘Being the laughing stock of the company and getting sacked’).

Problems and goals: case example

Here is a case that I saw where my client’s general target problem was ‘I get anxious whenever I have to give a talk in public’, and the specific example was ‘I have to give a talk to the Board of Directors on Monday and I am anxious’. Below, is how I helped my client to understand the specific example of his target problem and then to set goals with respect to this target problem. I will provide explanatory commentary at various salient points.

Understanding the problem.

Client: I am anxious about giving a talk to the Board of Directors on Monday.

WD (as therapist): What’s threatening to you about giving the talk?

[Here I use my knowledge that when a person is anxious it is because they are inferring the presence of something threatening to their personal domain at ‘A’.]

Client: I may reveal gaps in my knowledge and they may think that I am not up to the job.

WD: Are you most anxious about revealing gaps in your knowledge or the Directors thinking you are not up to the job?

Client: The latter.

[I now have the actual situation and the adversity and can go on to explore the other ‘C’ aspects of the problem that accompany anxiety]

WD: What will you do or feel like doing before the talk and also during the talk when you are anxious?

[Having gotten the emotional component C (i.e. anxiety), I assess for the presence of the behavioural components of ‘C’.]

Client: Beforehand, I will do a lot of preparation and rehearsal and during the talk, I will avoid looking at the Directors and just concentrate on my PowerPoint slides

WD: And when you are anxious what do you tend to think?

[Now I am assessing for the presence of the cognitive components of ‘C’.]

Client: I think that I will be the laughing stock of the company and that they will sack me.

Here is a summary of the client’s problem.

(p. 145) Note that the ‘B’ section (which stands for beliefs) is not yet known. This section is assessed once the target problem and the goal with respect to that target problem have been identified and agreed. As such, it lies outside the scope of this chapter.

Negotiating goals

WD: So you are anxious about giving the talk on Monday and what you are most anxious about is that the Directors will think that you are not up to the job if you reveal gaps in your knowledge. Is that right?

Client: Pretty much.

WD: What would you like to achieve in discussing this problem with me?

Client: I would like to be able to be confident about giving the presentation.

[Here the client has nominated a positive psychological state with respect to his goal. However, note that he has not specified a goal concerning how to deal with (p. 146) the situation where the Directors might think that he is not up to the job. At the moment he would feel anxious about this possibility and he thinks that confidence is a good goal alternative to feeling anxious. So I have to do something tricky here: to work with the client’s stated goal—to feel confident about giving the presentation—and to help him set a goal concerning the prospect that the Directors may think that he is not up to the job.]

Thus, it is important to help clients set goals in the face of adversity before helping them to reach their stated goals when these goals make no reference to the adversity in question. In the above example, I proceed thus:

WD: OK, so you would like to feel confident about giving presentations and I will certainly help you to do that. However, given that you feel anxious about the prospect of the Directors thinking that you are not up to the job, do you think that it would be wise if I first helped you to deal better emotionally about them thinking that?

Client: But if I feel confident, then I will do a good job and then they won’t think that I am not up to the job.

[Here, the client points out that if the adversity does not occur, he will have nothing to be anxious about. However, the grim reality is that I do not have the time to help the client develop the confidence that he is seeking. Such confidence will develop once the client has given several talks while dealing with the adversity of negative judgement in more productive ways. Thus, it is possible that the client will reveal gaps in his knowledge and it is possible that the Directors, or at least some of them, will think that he is not up to the job. So I need to help the client deal with the adversity given that I cannot help him avoid the adversity.]

WD: That’s true and if I could help you develop the confidence that you want before Monday, I would, but how likely is it that you are going to go from being anxious to feeling confidence in one jump?

Client: Not very likely.

WD: And even if you had the confidence that you seek, does that mean that you would not reveal gaps in your knowledge or that the Directors would not think that you were not up to the job?

Client: No, I guess not.

WD: So given that, would you like me to help you deal more productively with the possibility that you may reveal gaps in your knowledge and that the Directors, or at least some of them, may think you are not up to the job?

Client: Yes, that makes sense.

WD: So, I need to help you to experience an emotion which is negative given that for you the Directors thinking that you are not up to the job is negative, but one that helps you do the best job possible. Does that make sense?

(p. 147) Client: Yes, it does.

WD: What emotion about the Directors thinking you are not up to the job would be negative in tone, would help you do the best job you could do?

Client: To be less anxious than I am currently?

[Here the client comes up with a common response—he is in fact wanting to experience the same disturbed emotion, but with less intensity. REBT theory discriminates between an unhealthy negative emotion, like anxiety, and a healthy negative emotion, like concern. While unhealthy negative emotions have behavioural and cognitive referents that are unconstructive and tend to interfere with the person dealing effectively with the adversity in question (see the client’s ‘C’ responses above), their healthy negative emotion counterparts have behavioural and cognitive referents that are constructive and tend to help the person deal effectively with the same adversity. My job is to help the client understand this difference and implement it in constructing a goal, in this case, concern rather than anxiety.]

WD: Actually, I may be able to do better than that. What if I could help you experience an emotion that was negative in tone, given that the Directors thinking you are not up to the job is negative, but one that has none of the unproductive behaviours and thinking associated with anxiety, one that helps you prepare sensibly, but not overprepare, one that leads to productive rehearsal, but not unproductive over-rehearsal and one that leads you to be more balanced in your thinking about the consequences of the Directors possibly thinking you are not up to the job, would you be interested in such an emotion?

Client: Yes, definitely. What is it?

WD: It is un-anxious concern. Shall I help you to develop this emotion and its associated behaviours and thinking?

Client: Yes, please.

The interested reader is directed to Dryden (2012) for more information concerning developing emotional goals together with their associated behavioural and thinking components.

AC-based goal focus

I mentioned above that the A (actual situation and adversity) and C (emotional, behavioural and cognitive consequences) components of the ABC framework drive the therapist’s focus on the client’s target problem. They also drive the therapist’s focus on the client’s goal with respect to that target problem. In doing so, the therapist ensures that the client sets a goal with respect to the adversity at ‘A’ rather than bypassing the ‘A’. The therapist, in the above example, shows how to respond when the client tries to factor out the adversity in their goal-setting.

If the above therapist had used the AC components of the ABC framework in a formal way by putting their formulation with the above client’s goal in written form it would be as follows:

(p. 148) Note again that the ‘B’ section is not yet known. As, before this section is assessed once the target problem and the goal with respect to that target problem have been identified and agreed. Also note that the ‘A’ features are the same in both the problem and the goal (i.e. actual situation: Giving a talk to my Board of Directors, and adversity: The Directors thinking that I am not up to the job). This shows the importance that a good ‘goal’ is one that helps your client deal effectively with the problematic situation and what the person finds particularly aversive about the situation that makes it a problem for them. Given this, in addition to negotiating goals which are developmental or growthful in nature and which tend to bypass the adversity, it is important to help clients set goals that deal with this adversity. Generally speaking, if you attempt to help clients pursue their development or growth goals before helping them deal with adversity goals, the presence of the adversity will interfere with the work that you both plan to do in helping achieve the development goals.

Negotiating goals appropriate to your client’s psychological state

So far in this chapter, I have stressed the importance of helping clients to set goals with respect to the adversities that they are actually facing, think they are facing, or predict that they will face.

(p. 149) Negotiating ‘addressing disturbance’ goals

My message has been that when clients are psychologically disturbed about these adversities, it is important to help them address this disturbance and to set goals which acknowledge that it is healthy to feel badly (but not disturbed) about the adversity and, indeed, doing so helps them face and deal with the adversity. REBT theory calls the emotional components of such disturbance ‘unhealthy negative emotions’ with the emotional components of their healthy emotional counterparts being referred to as ‘healthy negative emotions’. Another way of looking at this is that while unhealthy negative emotions represent ‘disturbance’, healthy negative emotions represent ‘dissatisfaction’, realistic negative psychological states that are free from disturbance. I have already made the point that we do not have an agreed language for healthy negative emotions, but with this in mind Table 7.1 outlines common adversities, the unhealthy negative emotions or disturbance for which people seek help and the healthy negative emotions or dissatisfaction that form realistic emotional goals in the face of adversity. (p. 150)

Table 7.1 Common adversities, unhealthy negative emotions, or disturbance (Problems), and healthy negative emotions or dissatisfaction (Goals)

Adversity

Unhealthy negative emotions (disturbance): problem

Healthy negative emotions (dissatisfaction): goal

  • Threat

Anxiety

Concern

  • Loss

  • Failure

  • Undeserved plight (self or other)

Depression

Sadness

  • Moral code violation

  • Hurting others

Guilt

Remorse

  • Falling very short of ideal

  • Others negatively evaluate self

Shame

Disappointment

  • Self more invested in relationship than is the other

Hurt

Sorrow

  • Rule violation

  • Threat to self-esteem

  • Frustration

Unhealthy anger

Healthy anger

  • Other poses threat to one’s relationship

Unhealthy jealousy

Healthy jealousy

  • Other has something that self prizes but does not have

Unhealthy envy

Healthy envy

I often sum up this position with clients by saying that I can help them feel badly about the adversities that they face and when they object by saying that are already feeling badly, I point out that they are actually feeling disturbed about the adversity and that I can help them take away the disturbance, but I can’t help them take away their bad feelings, which are, as I point out a realistic and healthy responses to adversity!

I often find it valuable to ‘unpack’ the difference between an unhealthy negative emotion (disturbance) and a healthy negative emotion (dissatisfaction) by distinguishing between their behavioural and cognitive referents. As an example, Table 7.2 outlines the differences in this respect with respect to (p. 151) anxiety and concern. I refer the interested reader to Dryden (2012) for information on the differences between the eight unhealthy negative emotions and their healthy counterparts listed in Table 7.1. The important point to remember here is to encourage clients to consider negotiating healthy negative emotions and their behavioural and cognitive referents as goals in the face of adversity. (p. 152)

Table 7.2. Behavioural and cognitive referents that help clients to distinguish between anxiety and concern

Adversity

  • You are facing a threat to your personal domain

Emotion

Anxiety

Concern

Behaviour

  • You avoid the threat

  • You withdraw physically from the threat

  • You ward off the threat (e.g. by rituals or superstitious behaviour)

  • You try to neutralize the threat (e.g. by being nice to people of whom you are afraid)

  • You distract yourself from the threat by engaging in other activity

  • You keep checking on the current status of the threat hoping to find that it has disappeared or become benign

  • You seek reassurance from others that the threat is benign

  • You seek support from others so that if the threat happens they will handle it or be there to rescue you

  • You overprepare to minimize the threat happening or so that you are prepared to meet it (NB: It is the overpreparation that is the problem here)

  • You tranquillize your feelings so that you don’t think about the threat

  • You overcompensate for feeling vulnerable by seeking out an even greater threat to prove to yourself that you can cope

  • You face up to the threat without using any safety-seeking measures

  • You take constructive action to deal with the threat

  • You seek support from others to help you face up to the threat and then take constructive action by yourself rather than rely on them to handle it for you or to be there to rescue you

  • You prepare to meet the threat but do not overprepare

Subsequent thinking

  • Threat-exaggerated thinking

  • You overestimate the probability of the threat occurring

  • You underestimate your ability to cope with the threat

  • You ruminate about the threat

  • You create an even more negative threat in your mind

  • You magnify the negative consequences of the threat and minimize its positive consequences

  • You have more task-irrelevant thoughts than in concern

  • Safety-seeking thinking

  • You withdraw mentally from the threat

  • You try to persuade yourself that the threat is not imminent and that you are ‘imagining’ it

  • You think in ways designed to reassure yourself that the threat is benign or if not, that its consequences will be insignificant

  • You distract yourself from the threat, for example by focusing on mental scenes of safety and wellbeing

  • You overprepare mentally to minimize the threat happening or so that you are prepared to meet it (NB. Once again it is the overpreparation that is the problem here)

  • You picture yourself dealing with the threat in a masterful way

  • You overcompensate for your feeling of vulnerability by picturing yourself dealing effectively with an even bigger threat

  • You are realistic about the probability of the threat occurring

  • You view the threat realistically

  • You realistically appraise your ability to cope with the threat

  • You think about what to do concerning dealing with threat constructively rather than ruminate about the threat

  • You have more task-relevant thoughts than in anxiety

Once clients have achieved their ‘addressing disturbance’ goals and are now healthily dissatisfied about their adversities, they are now ready to set goals that address their dissatisfied psychological state.

Negotiating ‘addressing dissatisfaction’ goals

In thinking about helping clients to set ‘addressing dissatisfaction’ goals, it is useful to consider the Serenity prayer attributed to Reinhold Niebuhr: ‘God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference’ (Narcotics Anonymous, 1976). The following are relevant ‘addressing dissatisfaction’ goals.

Goals that relate to the probable existence of the adversity

In the case example that I gave (see above) the client was anxious about giving an upcoming public presentation to his Board of Directors because he predicted that he would reveal gaps in his knowledge and more importantly that the Directors would consider that he was not up to his job. I called this latter inference an ‘adversity’ because it was what my client was most anxious about in the situation. Once the client has achieved the dissatisfied psychological state of being concerned rather than being in the disturbed psychological state of being anxious, he is in a position to stand back and consider the accuracy of his prediction. While how the therapist does this falls outside of my brief, as it involves considering what therapeutic tasks can be used to achieve such goals, the end result is that the client should be in a position to come to a conclusion on the inference accuracy question. When I am working in this area, I am guided by the idea that the client’s judgement is best informed by the concept known in the field of perceptual psychology as the ‘best bet’ and in philosophy as the ‘inference to the best explanation’ (Lipton, 2004). Thus, I encourage the client to assume that an inference of adversity is probably true if it provides an explanation of the available data. If not, I encourage him to develop and accept as probably true an alternative inference. Quite often, the client’s inference of adversity does not fit the available data and can be rejected and when the client does this, their dissatisfaction disappears because they no longer think that the adversity exists.

Goals that seek to change the adversity (if it can be changed)

If the inference of adversity has been accepted as probably true (e.g. it is probably true that a client’s friend is angry with the client), then the client can be helped to set goals that are designed to change the adversity. Care has to be taken here, and there is an important distinction to be made between goals that represent the client’s enactment of behaviour designed to bring about change (p. 153) in the adversity that is in the client’s control (talking to his friend to help diffuse the friend’s anger towards the client) and the change or otherwise itself, which is not in the client’s direct control. You should encourage your client to set the former goal rather than the latter.

You should remember that behaviour designed to change an adversity is best carried out when your client is in a dissatisfied psychological state rather than in a disturbed psychological state.

Goals that seek to change the situation in which the adversity occurs (if it can be changed)

Earlier in the chapter I distinguished between an adversity (what your client is most disturbed about in a situation) and the situation in which the adversity occurs. For example, your client has not been invited to a work meeting (actual situation) and infers that this is because he is not liked at work (adversity). Similar considerations should be borne in mind when you come to help your client to set a goal designed to change the situation in which the adversity occurs, if it can be changed, as those when you worked to help your client set a goal designed to change the adversity. Once again, encourage your client to set the enactment of a change-directed behaviour as a goal rather than the effect of that behaviour. Thus, you can encourage your client to approach the person in charge of sending out invitations to the meeting with the purpose of getting an invitation.

Relevant goals when the adversity and/or situation cannot be changed

What can you do when the adversity and/or the situation in which it occurred cannot be changed or your client’s efforts to change them have not proven successful. Don’t forget, however, that your client is, at this point, in a dissatisfied rather than a disturbed psychological state of mind so if the worst comes to the worst you can help your client to live with the adversity and remain in a dissatisfied psychological state of mind when they cannot help but focus on the situation/adversity. However, you do have other options here. Thus, you can help the client to set the following goals:

  • to remain in the environment but to avoid the situation/adversity as much as possible;

  • to change the environment and move away from the situation/adversity as long as this does not impact negatively on your client’s life;

  • to develop mindfulness skills so your client does not dwell on the adversity;

  • to act in ways consistent with one’s values even though the situation/adversity continues to exist.

(p. 154) Negotiating ‘promoting development’ goals

Once you have helped your client achieve their ‘addressing disturbance’ goals and their ‘addressing dissatisfaction’ goals, you are now in a position to help them achieve goals that relate to their growth or development. Mackrill (2011) calls these ‘life goals’. These are goals that are designed to help your client get more out of their work, their relationships, and their life in general. The more specific these goals are, the more likely they are to be pursued and thus achieved, although it may that these goals are more likely to be process in nature, that is goals that involve the achievement and continuation of behaviour (e.g. to jog for an hour a day, six days a week) than to involve a definite endpoint. The way the field has developed, it is fair to say that addressing disturbance and dissatisfaction goals are deemed to be largely the province of psychotherapy and counselling (the focus of this text), while promoting development goals is deemed to be largely the province of coaching.

Addressing obstacles to effective goal-negotiation

When negotiating goals it is worth taking your time helping your client to set a realistic goal. In particular, there are a number of obstacles to negotiate while effectively negotiating such a goal and you will need to address these when you identify them. Below some of the most common obstacles are described, along with brief guidelines concerning how to respond if you encounter them in psychotherapy and counselling.

When your client sets a vague goal

Your client may set a vague goal and if so, it is important that you help them to make this goal as specific as possible. Examples of vague goals are: ‘I want to be happy’, ‘I want to get over my anxiety’, and ‘I want to get on with my life’. A commonly used acronym represents an antidote to vague goals. It is SMART. SMART goals are those that are: specific, measurable, attainable, realistic, and timely. It is useful to remember this acronym when helping clients to set goals that address disturbance and dissatisfaction and those that promote development.

When your client wants to change ‘A’

Often your client may wish to change the ‘A’, either the actual situation and/or the adversity rather than changing their unconstructive responses to the ‘A’ to those that are constructive. If this is the case and ‘A’ can be changed, help them to understand that the best chance they have to change ‘A’ is when they are in (p. 155) a healthy frame of mind to do so and this is achieved when their responses to this ‘A’ are constructive. So before they can change ‘A’, they need to change their disturbed responses at ‘C’.

When your client wants to change another person

When your client’s target problem is centred on their relationship to another person or group of people, then their goal may be to change the other(s). You need to help your client to see that this goal is inappropriate as others’ behaviour is not under the direct control of your client. However, attempts to influence others are under your client’s direct control and may lead to such behavioural change. As such, they are appropriate goals. In such cases, however, it is often important to help the client consider their responses when their influence attempts do not work. Helping clients to deal constructively with such failed attempts is often important in such cases. And of course, don’t forget that the best time for your client to influence another person for the better is when they are in a dissatisfied and not in a disturbed frame of mind. Thus, if your client is in a disturbed frame of mind and wishes to change another person, you are faced with two tasks. First, you need to provide your client with an acceptable rationale for negotiating an ‘addressing disturbance’ goal, and then you need to help him understand that it is important to set a goal that is within his control (i.e. his behaviour) rather than the outcome of his behaviour (which is outside his control).

When your client sets a goal based on experiencing less of the problematic response

Often when asked about their goals in relation to the adversity at ‘A’, clients say that want to feel less of the disturbed emotion that is featured in their target problem (e.g. less anxious). While many therapists may accept this as a legitimate goal, I do not for the following reason. REBT theory which underpins my approach to goal negotiation argues when a client holds a rigid belief they take a preference (e.g. for acceptance) and turn it into a rigid belief (e.g. ‘I want to be accepted, and therefore I have to be’). When they hold a flexible belief they take the same preference and keep it flexible by negating possible rigidity (e.g. I want to be accepted, but it is not necessary that I am). In both the rigid belief and the flexible belief the strength of the unhealthy negative emotion in the first case and of the healthy negative emotion in the second is determined by the strength of the preference when that preference is not met. The stronger the preference under these circumstances the stronger the negative emotion of both types. Based on this analysis, my goal is to help the person experience a (p. 156) healthy negative emotion of relative intensity to the unhealthy negative emotion rather than to encourage them to strive to experience an unhealthy negative emotion of decreased intensity.

When your client sets a goal based on experiencing the absence of the problematic response

You also need to be prepared when your client nominates the absence of the problem as their goal (e.g. ‘I don’t want to feel anxious when giving a talk’). When your client says this, it is important to help them see that it is not possible to live in a response vacuum and from there you can discuss the presence of a set of healthy responses to their adversity as their goal.

When your client sets as a goal a positive response to the actual situation and bypasses the adversity

Another situation that may well occur when you ask a client for their goal is that they may nominate a positive response to the actual situation while bypassing the adversity. For example, if my client in the case example had taken this tack he would have said something like, ‘I want to become confident at giving public presentations’. In doing so he would have bypassed his dealing with adversity, which was revealing gaps in his knowledge and being thought of as not up to doing his job. A good response to this client would be to ask him how he could become confident at giving public presentations as long as he was anxious about being judged negatively by his Board of Directors. By helping this client to deal with this issue first and set an appropriate goal with respect to his adversity, I would be helping him to take the next step and work towards increasing his confidence about his performance. Taking this approach is akin to a situation where your client wants to get to Windsor (confidence) from London (anxiety) by train, but the only way of doing so is to get to Slough (concern) and change trains there to Windsor (confidence), as there is no direct train from London (anxiety) to Windsor (confidence). Figure 7.1 depicts these two routes. (p. 157)

When a client wants to feel indifferent in the face of an adversity

Sometimes a client says that their goal is not to care about a particular adversity when, in reality, they do care about it. Indeed, their disturbed feelings indicate that they do care. My practice is to help my client understand what not caring or indifference means as follows:

WD: Now Albion Rovers are playing Brechin City on Saturday in the Scottish 1st Division. Do you care who wins?

Client: Not at all.

WD: That is what not caring means. Faced with a choice between two options you can’t choose between them because you literally don’t care what happens. Now when you say you want not to care if you get promoted do you mean that faced with the choice of getting promoted or not getting promoted you want me to help you to be indifferent about the outcome?

Client: I guess not.

WD: Because would you prefer to be promoted or not to be promoted.

Client: To be promoted.

WD: So rather than not care if you don’t get promoted, how about if I help you to care about it but not to be disturbed about it should it happen?

Client: Yes, that make sense.

I then helped the client to understand what the behavioural and cognitive referents of non-disturbed caring would be so that he could strive for this psychological state.

When a client nominates a goal that is dangerous or unrealistic

Sometimes a client nominates a goal that is in Law & Jacob’s (2015) terms ‘unacceptable’. What they mean is that the goal is either ‘dangerous (e.g. a person with anorexia wanting to set a goal to lose weight, or someone with depression wanting to be helped to end their life), or because a goal is unrealistic (e.g. someone with a physical disability wanting to be a professional footballer)’ (Law & Jacob, 2015: 16). As Law & Jacob (2015) go on to say, these goals should not be dismissed, but should be a prelude for discussion and careful re-negotiation. Helping the client to imagine responding to a friend who nominates such goals can be particularly helpful here in providing the client with sufficient distance to enable them to participate in their own goal re-negotiation with the therapist.

(p. 158) The importance of negotiating goals based on values

As a therapist, you will be aware of the limited time that you have with your clients, particularly if you work within a brief therapy framework and therefore you need to discover ways of increasing the chances that what clients achieve from the process endures. One way of doing this is to help the client to find an important value that might underpin their goal, as goals that are underpinned by values are more likely to be achieved than goals that aren’t (Eccles & Wigfield, 2002).

Points for reflection

  • If a client nominated a goal of indifference in the face of an adversity, how would you respond?

  • What is your view on the issue of clients wanting to feel less anxious in the face of threat?

  • What core values do you have as a person that would have a positive influence on your goal-setting in an area where you wish to make a change?

  • In your opinion as a therapist, what makes for a ‘good’ goal?

Further reading

Dryden, W. (2012). Dealing with emotional problems using rational—emotive cognitive behaviour therapy: A practitioner’s guide. Hove, East Sussex: Routledge.Find this resource:

    A text which clearly outlines the eight major problematic emotions for which people seek therapeutic help and their healthy negative emotional alternatives. Each healthy and unhealthy negative emotion is distinguished by associated behaviour and thinking. This information helps therapists encourage their clients to set healthy negative responses to adversity as ‘addressing disturbance’ goals.

    (p. 159) Law. D., & Jacob. J. (2015). Goals and goal based outcomes (GBOs): Some useful information. 3rd edition. London: CAMHS Press.Find this resource:

      A clearly written booklet on therapeutic goals and goal-based outcomes that will be useful for therapists from a range of orientations.

      Mackrill, T. (2011) Differentiating life goals and therapeutic goals: Expanding our understanding of the working alliance. British Journal of Guidance & Counselling, 39, 25–39.Find this resource:

      This paper makes an important distinction between clients’ life goals and their therapy goals. The paper explores five problematic life goals and how therapy goals may help to address them.

      Mahrer, A. (Ed.). (1967). The goals of psychotherapy. New York: Appleton-Century.Find this resource:

        This is a classic text on the subject of goals in therapy and clearly shows that experts consider that therapy is designed not only to address issues of psychological disturbance, but also to promote growth or development.

        References

        Dryden, W. (2012). Dealing with emotional problems using rational—emotive cognitive behaviour therapy: A practitioner’s guide. Hove, East Sussex: Routledge.Find this resource:

          Eccles, J.S., & Wigfield, A. (2002). Motivational beliefs, values and goals. Annual Review of Psychology, 53, 109–32.Find this resource:

          Law. D., & Jacob. J. (2015). Goals and goal based outcomes (GBOs): Some useful information. 3rd edition. London: CAMHS Press.Find this resource:

            Lipton, P. (2004). Inference to the best explanation. 2nd edition. Abingdon, Oxon: Routledge.Find this resource:

              Mackrill, T. (2011) Differentiating life goals and therapeutic goals: Expanding our understanding of the working alliance. British Journal of Guidance & Counselling, 39, 25–39.Find this resource:

              Mahrer, A. (Ed.). (1967). The goals of psychotherapy. New York: Appleton-Century.Find this resource:

                Narcotics Anonymous (1976). NA white booklet. Chatsworth, CA: Narcotics Anonymous World Services, Inc. (p. 160) Find this resource: