My Emphasis on Goals and Treatment Planning
What Do Our Clients Really Want from Their Therapy?
Sometimes people come into therapy with vague, unclear goals such as, ‘I just want to feel better.’ I always ask my clients, what will your goal for therapy look like and feel like, what will you be doing or not doing differently, who will you be or not be hanging out with, how might your feel in your body, your posture, etc.? I always make sure that I get a concrete picture of how they want to be different through our therapy together, even if that conversation takes a little time. I set out their goals on the front page of their file so that if we ever got off track I can re-orient us to where we were headed. When a certain goal is met, we are able to compare how they feel now and what they are doing differently in their life to their original description of how they wanted to change. We can then move on to the next goal or add a new one, or even end therapy!
Knowing what your clients’ goals are is very important for me to know as I consult to you about your work with your clients. In addition to developing a clear definition of your clients’ goals I will also make suggestions for how to prioritize them so you and they know what to work on first, then second, etc. Sometime it is tricky to figure out which goal to work on first if the client is experiencing acute symptoms related to a relatively recent event yet also has a negative core belief that is influencing his or her current behavior.
Each of the following elements of Phase One connect directly to your client’s goals for change:
1) Assessment and Conceptualization of the Problem(s)
The more you understand about your client’s background and current situation, the better you can help them to develop a clear plan of action. I can provide you with AIP-oriented forms to utilize with your clients, including a basic assessment form that covers negative and positive beliefs, a case conceptualization form that makes you look deeper into how not only their memories but their attachment background relate to the current symptoms, and a treatment plan form that lists the target memory sequences as well as plan for the preparation phase. You can use these forms to discuss and expand the issues which bring them to therapy, then together as a treatment team determine what aspects of their present and past experience are relevant to therapy now. The assessment process goes both ways – it allows them to check you out, ask you questions and build their comfort and trust in you as their therapist. Your Assessment continues throughout your work together so you can revise treatment plans and goals as needed.
2) Creating Lasting Change
In this element, you identify together with your client(s) their most distressing symptoms or problems and design the techniques and approach that will help them to overcome this. Your clients’ goals are directly related to the kind of treatment plan you co-create with your client. I recommend a simple treatment plan which outlines the priorities for goals, treatment and approaches which offer the most promise. This plan will always include changing the negative beliefs to positive beliefs for each goal, even if they might change over time. Giving your client a copy of the treatment plan is therapeutic in itself – the client sees that their therapist views them as important enough to be taken seriously by organizing their treatment. At the very least the client might think that their therapist knows what they’re doing (and that has to be worth something).
3) Stabilization and Learning Regulation Skills
Your history taking and assessment will yield valuable information about what kind of resources and stabilization your client will need to reprocess their traumatic memories that are related to their symptoms and emotional issues. If your client wants to work on a recent trauma (even if they have other issues from their more distant past) then their preparation phase might be fairly brief before their work on the recent event begins. If your client has agreed to a more extensive treatment plan, for example, one that relates to their goal of not having to please everyone in their life, then it might make sense to work on resource development and increasing their ability to tolerate certain emotions.
When Therapeutic Goals are Achieved
When you have clearly laid out with each client a clear and concrete picture of what desirable changes will look and feel like during the Assessment Phase, you will both recognize when these have been achieved in their therapy. That is what therapy is all about, and there is nothing more satisfying to both you and your clients than to accomplish the goals you have worked hard to achieve!