One of Raoul’s initial goals was to be less anxious. This is a good general goal. Let’s see how Raoul’s therapist uses Questions to Develop Helpful Goals.
Therapist: Being less anxious is a good general goal, and a good place to start. I think it would be helpful if you could be a bit more specific or concrete.
Raoul: What do you mean?
Take a moment and think about how you could you use Question 1 to make Raoul’s goals more specific.
Therapist: I think it would be helpful to think of some specific ways that we could know you were on your way to achieving your goal. For example, are there any particular situations where you would like to be less anxious? (Question 1)
Raoul: I guess at work, I am just really stressed.
Raoul’s goals are starting to be more focused, but we still do not have specific, measurable goals. How
could you use Question 2 to make Raoul’s goals more specific?
Therapist: If you were less anxious about work, I am wondering what you would be doing differently?
(Question 2)
Raoul: Mainly I wouldn’t procrastinate over my big projects.
Raoul is starting to be more specific. Take a moment to think about how you could use what he just said and turn it into a goal.
Therapist: Might one goal be to stop procrastinating on your big projects?
Because Raoul did not explicitly state this as a goal, his therapist used the term “might” when she turned Raoul’s words into a goal. Using “might” permits Raoul to disagree with his therapist.
Raoul: Definitely.
Raoul has made the goal more specific, but it would still be hard to measure. How could you use Question 2 to make Raoul’s goals more measurable?
Therapist: If you stopped procrastinating, what would you like to do differently? (Question 2)
Raoul: I would stop avoiding my colleagues on the project, get down to work, and talk to my boss about the project.
Therapist: It sounds like some of your goals might be to stop avoiding your colleagues, talk to your boss about the project, and get down to work.
Raoul: Yeah, those would be good goals. I am not sure that I want to talk to my boss, but it would be good to start the project.
Therapist: It seems that a first goal might be to contact your colleagues and start work on the project, and then a longer-term goal might be to talk to your boss. Does that sound right?
The therapist realized that talking to the boss might not be Raoul’s goal at the moment. The therapist wondered whether breaking the goals down into immediate and longer-term goals was more in line with what Raoul wanted.
Raoul: (looking a bit more energetic) Yes, I think that would be very helpful.
Therapist: Those are good goals. Let’s write down the goals we have talked about so far and then see whether there are any other ones. When you think about what we just talked about—how would you write out the goals?
Notice that the therapist gives Raoul positive reinforcement for developing good goals.
The therapist and Raoul continue to explore his general goal “be less anxious at work.” They develop the following list of specific goals:
Raoul’s Goals:
• Cope better at work, particularly concentrate on my work and get my projects done on time.
• Socialize with people at work the way I used to. This includes talking to people, having lunch in the lunchroom, going out for lunch, and chatting in the hallways.
• Not get anxious every time the boss talks to me.
• Start to like work again.
You will notice that some of Raoul’s goals are very specific and measurable, for example, “get my projects done on time.” Some of the goals are still fairly general, for example, “start to like work again.”
The therapist thought they had made a good start and did not want to push developing specific goals too much, as they were just forming a relationship. The specific goals could be used immediately to give direction to therapy, and the more general goals could be worked on later in therapy.
YOUR TURN!
Help Suzanne Make Her Goals More Specific
Imagine that you have just introduced goal setting to Suzanne. Try to help Suzanne set specific goals that can be measured.
Suzanne: Well, to start, my main goal is to be less depressed.
Look at the three possible responses below and pick the one that will help Suzanne develop a more specific goal:
1. I am so glad you are willing to work on your depression. What could you do to be less depressed?
2. I hear how down you are feeling. You have a lot going on in your life. I am impressed that you came for help. It is an important first step.
3. That sounds like an excellent goal. It is pretty broad. If you were less depressed, how do you think your life would be different?
Response #3 is the most likely to help Suzanne develop a specific goal and to start thinking about what she would like to be different in her life. Response #1 starts to problem solve. This is too early in therapy. Response #2 is a supportive comment, but it does not help Suzanne become more specific.
Therapist: That sounds like an excellent goal. It is pretty broad. If you were less depressed, how do you think your life would be different?
Suzanne: Well, I would go out more for sure and not just want to stay home all the time.
Ask yourself whether “go out more and not want to stay home all the time” is specific enough. Look at the three possible responses below and pick the one you think will help Suzanne be more specific.
1. I hear you would like to go out more. Did you used to go out more? What are some of the things that are in the way of you going out more now?
2. If you were to go out more, what are some of the things that you would like to do?
3. I hear you would like to go out more. Can you tell me more about that?
Response #2 is most likely to focus the client on identifying specific activities she would be doing.
Response #1 starts a problem-solving process without being clear what “going out more” refers to.
Response #3 is too vague. You might get helpful information, but Suzanne may also talk about being depressed in a general manner.
Therapist: If you were to go out more, what are some of the things that you would like to do?
Suzanne: Well, for sure taking my kids to some of their activities, probably seeing friends, maybe going out with my husband.
Suzanne and her therapist continue to explore her goals and what might be some good indicators that she is on the path to feeling less depressed. Here are the goals that Suzanne and her therapist developed:
Suzanne’s Goals:
• Fit into the new school. Try to make friends with the other teachers and join some of the extracurricular activities.
• Not be so overwhelmed, but feel I am managing more; better morning and afternoon routine.
• Not yell at the kids so much and play with the kids more.
• Have good times with my husband and not be so angry all of the time.
• Reconnect with my friends.
• Enjoy my husband and children, start to do some fun things with them.
• Have more energy, not be tired all of the time. (As part of this goal Suzanne agreed to look at lifestyle issues. Depending on the client, this might include smoking, alcohol consump- tion, exercise, diet, and sleep hygiene.)
When you look at Suzanne’s goals, you will see that some are still very vague, such as “have more energy”; however, some are concrete and specific. You’ll also notice that some of the goals are stated in the negative and involve what Suzanne wants to stop doing, for example, not be angry all of the time, and some are positive goals, or what she wants to do. If your client has a negative goal, it is important to balance it with a positive goal.
Exercise 3.1: Miriam Wants a Better Marriage
Practice using Questions to Develop Helpful Goals.
Agenda Item #3 : Which Goal Do I Focus on First?
The third stage in goal setting involves choosing where to begin. The therapist can simply say,
“Let’s look over your goals and pick one to start with.” Frequently a client’s goals are interrelated, in which case it will be possible to work on more than one goal during a therapy session. For example, many of Raoul’s goals are related to work. You want to start with goals that are doable and where there is a good chance of success. When therapy helps clients make changes in their lives, clients become more committed to therapy and more hopeful that their lives can improve.
When Suzanne and her therapist looked at her goals, Suzanne’s first priority was to fit into her new school and try to make some friends among the other teachers. Her second goal was to do some fun things with her children and husband. Suzanne’s therapist thought these were good places to start and that it might be possible to address both goals early on in therapy.
Video 3.1: Set Specific Goals
Homework: Practice CBT
Before moving on to the next chapter, take some time to try the homework.
Apply What You Learned to Clinical Examples
Complete the following exercise.
Exercise 3.1: Miriam Wants a Better Marriage
Apply What You Learned to Your Own Life
Before practicing this week’s skills with your clients, let’s start with focusing on your own goals.
Homework Assignment #1
Set Goals for Yourself
Step 1: Take a moment to think about what you hoped to learn when you started reading this book. How did you hope to change your therapy practice? Now think about how you would like your life to be different. Identify one goal for yourself in relation to learning CBT and one goal in relation to your personal life.
Step 2: Try to make your goals more specific and measurable by using Questions to Develop Helpful Goals. For each goal, see whether you can identify a measurable indicator that would put you on the road to accomplishing your goal.
Step 3: Complete the following table.