Getting Started in Therapy: Setting Treatment Goals

At some point during my first session with a client, I’ll ask him/her “why did you come to see me today” or “what would you like to get out of therapy.” In other words, I’m trying to figure out what our treatment goals will be. This is important for two reasons: 1) Depending on your treatment goals, I can determine whether or not I will be able to help you. 2) Once we know our goals, we can start to brainstorm the steps to achieve those goals. Without a destination, we can’t start planning our journey. Once we have our destination and our routes planned out, it will also be easier for us to recognize if we start veering off course or not making progress.

Too often I hear the responses, “I want to be happier” or “I don’t want to feel anxious anymore” to my question about treatment goals. These responses highlight people’s tendency to label certain emotions as positive/good (eg happy, excited, joyful) and others as negative/bad (eg sad, angry, anxious, depressed). The natural consequence to that of course is to eliminate the negative and pursue only the positive. The problem with this mindset is forgetting that all emotions, positive or negative, have a purpose and to be human is to experience a broad spectrum of emotions, so to get rid of one particular emotion or all the negative ones is akin to cutting off an arm or leg. As a clinician, I like to categorize emotions as those that make us comfortable and those that make us uncomfortable, rather than good versus bad or positive versus negative. Just because feeling anxious makes us uncomfortable, doesn’t necessarily make it bad and mean we have to get rid of it. If you read the previous blog (and tried to not think of a green polka-dotted elephant), you will also realize that it is impossible to not feel anxious, sad, or whatever “negative” emotion you’re trying to push away. We cannot isolate any one emotion to get rid of. That is to say, to numb out one emotion is to numb out all of them.

So what do I do when I hear those common responses? We change them into S.M.A.R.T. goals:

  • Specific – What has to happen for me to feel happier or less anxious?
  • Measurable – How will I know that I am making progress towards my goal?
  • Achievable – How will I know when I’m “happier”, What kinds of things will I stop doing or do more when I am not anxious anymore?
  • Realistic – Is this within my control? Are there aspects of my goals that are within or out of my control?
  • Timely – What changes do I want to make or see in the next week? month? year?

Another quick exercise for you to try:  How would you change those two treatment goals that you see above in bold?
Possible solutions:

  • “I want to manage my anxiety so that I can attend social functions without experiencing a panic attack.”
  • “I will know my depression is better when I am able to go shopping and cook dinner three times a week.”

Sometimes it takes an entire session to develop treatment goals, but it is so necessary.