It’s classic existentialism: grad school and figuring out the basics of being a semi-competent therapist is extremely difficult. The more clear you are on why this is worth accomplishing, the easier it will be for you to get through the difficult days. I encourage you to take some time to clarify your principles and how they translate into your career goals.

Try a values clarification exercise (also good for clients). We often initially set naive goals, but now that you have at least some initial experience, I wonder if you already notice some room for your goals to evolve. 

You are responsible for your own learning. If there's something you need: ask yourself what you're doing to correct that. Be suspicious to feelings of blame towards others in this context.

Motivation means ‘to provide motive’. Ask yourself: why is this difficult task worth accomplishing? Versus “I just wasn’t feeling motivated last week”. By the latter phrase, people seem to mean they weren’t experiencing the sudden, inexplicable strike of wild and fleeting inspiration. It’s usually a thoughtless excuse that they (perilously) accept, and then they give up on the behaviour in question.

Client goals

Goals in therapy should be based in what the client cares about changing, and we can help clients adjust or add to goals to make them realistic and forward moving. A helpful way to reflect on this is to consider the difference between a big meaningful ‘goal’ and the ‘means’ to get there—it’s good practice to have both. 

Scott Miller often talks about this when cases aren’t going smoothly, and it gives clients more avenues to positive outcomes. A related image he uses for course correcting therapy is the metaphor of a stool, the components of which keep clients engaged, the 3 legs: role, goal, means, which are all connected via the top of the stool: client preference. I’m mostly drawing on Scott’s excellent work for this whole ‘client’ section, as well as some existentialism and SFT.

'Goal' is what you want
'Means' is how you are going to get there 
'Role' is how can I help with this​

I typically wait until after I’ve been invited to help (as described in first sessions), and sometimes it’s as simple as me asking “is there anything about this whole situation that you’d like to be different?”. This serves as a bridge toward responsibility taking. I ensure we’re focusing on what they can control, not other people or things that merely happen nearby them. Ideally I’ll get the client trying to convince me why the hard work of change is worth doing (aka motivation), and mixed in there somewhere we’ve begun considering the means to achieve their goals. 

After I get the invitation to help the client, I ask questions such as:

• Suppose you felt/experienced less of [the issue], what would that give you an opportunity to do more of?

• What would you be doing differently?

• What might people who know you well be surprised to see you doing? 

Better goals are positively stated, concrete, obtainable, able to easily detect their presence, something you can move toward (“SMART”) — negative goals are elusive, abstract, and you can always fail tomorrow (e.g., addictions: “I haven’t used yet!”)​. It can be useful to separate goals from problems (instead of whipping the horse bloody, get off and design an engine for current and future use.

​​Often I’m giving or modifying a metaphor or image that captures a person’s experience while also providing a constructive path forward. This becomes our aim of counselling and then we figure out the means to achieve it.

When clients share poorly stated ‘goals’ like they want to drink less alcohol, wake up earlier, communicate better, I say: “okay, let’s say it takes work but after a few months we accomplish all this. Why is that work worth doing? What will it allow for in your life?” I’m trying to get at their real goal or motivation, and drinking less or exercising is simply a means to that end.​

An example of a reasonable goal and rationale: since my behaviour while drinking alienated my wife and children, I want to rebuild trust with my kids now because I’ve realized how important family is to me. To even have a chance at that, I need to be sober and working on my health. Help me do and learn x, y, and z (means) so I can move toward that reconnection.

Much of the time, the goals clients come up with on their own are functional enough and they progress. But when therapy isn’t working (you’ve got to measure this), we need ways to investigate it such as considering the role, goal, and means in therapy. It’s often helpful to have more refined language to reflect on and discuss a nuanced situation like therapy, which this ‘stool’ imagery can provide.

Questions that help when therapy is off track:​

• "What do we need to do differently today that we haven't been getting to in previous sessions?" 

• “What am I missing?”

• ​“I feel like I’m missing something here, that something needs to be said but hasn’t been”

• ​“Is there something you keep hoping I’ll ask about? Or that you want to learn?”​

• “I really want to help you, but first we need to figure out where we’re going”​

• “What do you want more of?”​​

• Reflect on whether you’re hearing the story about the goal versus the actual goal: if I keep thinking “So what? What is it you want to be different?” then we haven’t found the goal​

Common mistakes​:

• Vague goals

• Accepting means as a goal

• Strange roles that are often unspoken: implicitly agree they can just come here and vent without working on a goal​

• Insisting the client accepts the therapist's of change​ or meaning

• Working harder than your client

• In response to clients ‘playing the victim’, you becoming their motivator

​Bad goals in Therapy

• ​“I don’t want to be depressed”

• “I want to work on myself”

• ​“I want to replace my problem drinking with exercise" isn’t great phrasing​

• “I need to practice more self-care”

• “I want to make peace with the trauma from my childhood”
  Fortunately these generally contain the seed of a useful idea, and we can become increasingly skilled at getting there.

When therapy feels weird or like it isn’t progressing, quality of client goals should be one of your first considerations. Ask yourself what the goal is (i.e., do you actually have one) versus what did the client say they want (i.e., you’re not listening to the client). Consider staying away from the word ‘goal’ in session. Instead you can ask about ‘big, blue sky thinking”, “what do you want to be different here” and so on.

Everyone has a different idea about this language and that’s ok. What matters is understanding the ideas behind a goal and how that relates to how this client thinks about change (and how goals relate to values, meaning making, tasks, competing priorities/principles, etc). The more you can see how this connects into the rest of the ideas at play in a course of therapy, the more clearly you can guide people. 

You find very quickly that precision of language matters a lot in therapy, so while I oftentimes explore different methods of a goal discussion, I do return to the ones I find most efficient and effective. As I often suggest to clients considering change, it’s good to run experiments.

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