Having too many goals can be as bad as having no goals. This is as true for therapists as for our clients, yet therapists may enter into a session with far too many goals to achieve in one sitting.
Trainees often struggle with first appointments, in which there is so much to do: establish a rapport, take a history, establish a diagnosis or formulation and agree a treatment plan. These would be the achievements of two, three or even more sessions but the impression given by many text books is that all of this must take place in the first session.
More experienced staff may feel the same pressures, but may also feel obliged by waiting lists and the need to demonstrate turnover to look for opportunities to discharge the case. Some may also feel that they must be on their guard against potential attempts at manipulation by the client.
So the list of goals for a session might be:
- rapport building
- information gathering
- establishing / testing diagnosis or formulation
- agreeing / following / evaluating treatment plan
- avoiding manipulation
- looking for opportunities to discharge / refer on
Any therapist with a list like this is likely to come away from most sessions feeling dissatisfied. Insoo Kim Berg & Yvonne Dolan (2001) propose asking clients:
what needs to happen that will tell you today's meeting has been useful?
While this is properly a question for the client, who should be the focus of the session, it is also a very useful question for the therapist:
if you achieve only one thing in this session, what do you want it to be?
For me, the one aim in any session is to ensure that the client will come back to see me (or some other element of the service) should they need to do so, whether now or in the future. All other targets follow naturally from this basic goal.
Berg IK & Dolan Y (2001) Tales of Solutions: a Collection of Hope-Inspiring Stories. WW Norton & Co: New York.