What does 2017 have in store for you? New Year is a common time to be looking at our lives, taking stock, and considering making change. We set intentions, make resolutions and plan goals. When I get client enquries in January I notice that this is the time when people seem most resolute about what they want - a fresh year, a fresh start. Or perhaps its more true to say that people are resolute about what they don't want, and they come to therapy to explore change and what can be done.
I came to psychotherapy from a career in coaching: first in sport, and then in life coaching. Like with therapy, people come to coaching because they want change. However, much of the time coaching clients do know what they want: they have a project in mind, a place they have set their sights on - and they want help clarifying that vision and working towards it. It is therefore common practice to set goals. As disciplines, coaching and psychotherapy have much in common - yet one of the distinctions often made is around goal setting.
On face value, goal setting can be seen to go against therapeutic principles of acceptance and 'being with what is' (especially for therapists like me who practice from what is known as a 'humanistic' frame). Many of the issues clients bring to me are rooted in a belief that they are not good enough as they are, and they need to 'be better', they need to improve. There is pain in their life, relationship, family or work situation and they have to do something. I hear this in their language - the 'shoulds'; and I see it in their body language - restlessness and dis-ease. I see the binds being set up - all because they believe that they are not good enough, that something is wrong with them. People in distress want to do something; and very often this doing is where they are going wrong, how they have ended up in the bind. People in distress set about trying to change their outside world rather than become more familiar with their internal world. Doing becomes habitual, we struggle to stay with our very being. This is illustrated with the case study of "John"...
John is a successful business man. He has a wife and two young children. He came to see me because his marriage was struggling - he and his wife often argued about his working hours. John couldn't understand his wife's complaint; after-all, he was working the long hours in order to provide for his family and to be able to afford to send his children to a good private school. His wife didn't see it that way, and wanted John to get home earlier from work so he could spend time with his children. John's solution was to plan activities for the family to do at the weekends - but these (often) extravagent plans just deepened the problem. Often John was too tired to enjoy them, and fuses got shorter; and the money being spent meant more pressure on John to work harder. I could see he was digging a deeper and deeper hole for himself. Doing less was hard for John. In fact 'doing' was deeply engrained in his identity - without 'doing' he didn't feel he existed. It was only in his doing that John got seen by his Father as a child (sport and school) and kept repeating in his career as a businessman. Yet his family life was calling him to learn how 'to be'. With time, I helped John unwind his need 'to do something'. In being he found the nourishment from his family that he had missed out on as a child.
So, is there a place for goal setting in counselling and psychotherapy? Mick Cooper - a Chartered Counselling Psychologist and an internationally recognised figure in humanistic and existential therapy - believes there is. You can watch Professor Cooper present on the topic here. Here are a few things that I appreciated the opportunity to reflect upon:
- The agency of human beings. Existential philosophers point to how we are born and then must make something of our lives: there is a call for self-determination - in effect they tell us life is in our hands and we must take responsibility for that. We could see 'goals' as outward expressions of our internal being.
- The need for hope. People come to therapy because of an experience of hopelessness. Goals might provide a life-line in setting up movement toward something that might be attainable. It follows that goals, and measurement toward them, might give clients a sense of progress and satisfaction.
- Building the therapeutic alliance. We often read that therapy is all about the relationship. Yet what makes the relationship successful is not just the sense of being listened to, understood or receiving empathy - it is the experience of having someone alongside and togetherness. Co-creating the work and path of therapy helps clients "buy-in", and arguably co-creating goals is a way to build an allegiance.
- Making explicit what is implicit. This functions on two levels. Firstly, it is arguable that therapists and clients are already setting up what is hoped for through change - why not speak to that process more explicitly? Secondly, therapists can help clients locate implicit needs and express these as explicit wants (with direction and intentionality). Arguably, this helps a client take responsibility for expressing their needs - in therapy and to others in their everyday life.
- Bringing out ambivalence. Clients will often express what they want; but then express the frustration that they don't follow through with what they want. Talking about goals may help clients identify inner conflicts. For example, "Sarah" told me she wanted to set up more genuine friendships. Yet as we explored her experience of friendships, we noted that she often hides vulnerabilty. If expressed in the terminology of goals, this could be one obstacle in the way of her desire for authenticity with others.
- Building contrast and motivation. Setting goals asks a client to look at where they are now compared to be where they want to be. Starting with that contrast in focus can be useful in working with any ambivalence. This is often a corner-stone of 'solution focused therapy'.
I imagine at least some of the points on this list appeal to you, whether a client or a therapist. Yet I also imagine the word 'goal' sticks in the throats of my colleagues - as it does with me. Is it simply semantics? Perhaps in part, but I think some of my reservations about goals in therapy remain because of how I see my clients and the cause of distress in their lives. I can see how setting explicit goals can give direction and purpose to the therapy; but I fear that the focus might become a 'thing', and might potentially distract the client and I from having a relationship, turning it instead in to a project, and somewhere to get to (and I wonder how people who wants goals might have an underlying complaint - not yet in their awareness - of not being met in their intimate relationships).
I believe that we much of the usefulness of goals depends on how we relate to them. In my work with athletes, I would encourage them to have goals - to plan them thoroughly in fact - but to then let them go and engage in the process instead. Too much focus on the goal leads to traps on the way to achieving them: and I think we, in the therapeutic context, must take heed of this. To borrow an idea from the Buddhist teachings, their is much to be gained by living a "middle-way" - to use goals to locate what we want, but not to become so fixated on them that we lose sight of what is going on right in front of us. Gestalt therapy believes that mental and emotional well-being come from bringing awareness to our experience: with awareness perhaps we can notice when healthy motivation tips toward a neurotic drive**.
Furthermore, I would encourage my therapist colleagues to consider whether goal setting is suitable for all presenting issues. We need to watch out for when too much future focus is rooted in a client believing they are broken and need 'fixing'. "I will be okay when...." and the danger of externalising what is an internalised "not okay-ness". A classic example is when clients come to us complaining about "work/life balance". Sometimes we get a sense of clients seeking an answer to a situation that actually calls for more flexibility than more structure: and we would serve them better by exploring the need for structure rather than helping them achieve it! Yet, for some a focus on goals can help people slow down BECAUSE of the structure - I think of people suffering with chronic fatigue syndrome. In my experience of working with these clients, setting goals helps helps: setting medium-sized goals for pacing as opposed to striving for 'stretch goals' (that take them over the edge).
Bringing all of this together, I think I am left with a dilemma: on one hand, goal setting might bring agency that speaks to the choice and responsibility at the root of all existential therapies; on the other hand, it sets up a potential trap of leaving clients playing out their belief that they are not good enough and need to do x,y,z to be okay. This dilemma doesn't feel like a problem. Rather we can point to the polarity and use the wish to set goals (and what that might tell us) in to awareness. It becomes the work.
**exercise is a classic example. Activity is good for our health, but fixating on fitness goals can hide a part of self that believes "I am not good enough, I need to look different to be loved"