My Emphasis on Goals and Treatment Planning

Sometimes people come into therapy with vague, unclear goals such as, ‘I just want to feel better.’ I always asked 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 made sure that I got a concrete picture of how they wanted to be different through our therapy together, even if it took a little time. I set out their goals on the front page of their file so that if we ever got off track I could re-orient us to where we were headed. When a certain goal was met, we were able to compare how they felt and what they were doing differently in their life to their original description of how they wanted to change. We would then move on to the next goal or add a new one, or even end therapy!

Knowing what your clients’ goals are 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 

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 and graphic tool that makes sense of the memories related to the current symptoms, and a treatment plan form that sets 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 comfort and trust. 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) the 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 (preferably given to the client) which outlines the priorities for goals, treatment and approaches which offer the most promise. This plan would 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 (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!