What exactly is your relationship with goals? Therapists either love them or hate them.
I happen to be planted firmly in the LOVE IT camp! And secretly (but not so secretly) I hope by the end of this you might be too.
Ok- so beyond needing to take a big ole’ deep breath as you type in all the information that maaayyy be a little dry into your electronic medical record there is definitely gold in goal setting. In both the process itself and how it seres as a guide for the entire therapy relationship.
Check out my four reasons I love setting therapy goals with clients:
1. Enhanced parent and child engagement and “by in”
Let’s face it - most young people aren’t requesting to come to therapy. Usually a parent, the school, or a physician has noticed difficulties with mental heath, big feelings, or change in behavior and recommend the child receive therapy. And as much as we know young people need the support of therapy we can also have empathy that they didn’t exactly sign up for this. If you have ever (willingly or not so willingly) committed to doing something you didn't want to do, you can definitely relate to the feelings of dread, anxiety, and even anger that come up when it’s time to actually do that thing.
Research has shown that collaborative goal setting is actually associated with higher levels of engagement and therapy retention. When we can join together with young people and figure out what they want to get out of the process they can take more ownership over their own therapy. And - likely will have some fun in the process!
2. Identify a clear baseline of symptoms
Having a clear baseline of symptoms and symptom profile when a client enters therapy is essential for knowing what to do next. A client’s exact symptoms (including the frequency, duration, and intensity) helps you clarify next steps in a client’s treatment. Grounding yourself in what the symptoms are and the intensity helps you make a plan about what type of therapy is going to be most effective for your client.
3. Clarify realistic expectations
Oftentimes parents and young people come to therapy with the hope of what their life will look like as a result of putting in the hard work of engaging in therapy. Sometimes that picture is realistic and achievable and...well...sometimes it isn’t. It is in the goal setting process that we can set realistic expectations for what therapy can do - and what it can’t. We can help parents understand that their children are not going to be compliant robots that always turn 100% of their homework in on time, never sass back, and always have a clean room. We can help young people understand that having big feelings like sadness or anxiety is a normal part of life and that therapy won’t erase completely the bad things that may have happened in their lives.
4. Help evaluate progress
Maybe it is just me, but how often do you hear parents or young people say “therapy isn’t working”? And sometimes that is true. Maybe the client needs a higher level of care, different service, or different type of therapy.
However, most often the thought that “therapy isn’t working” isn’t really true at all. Remember above when we got a great baseline of symptoms? Well, we can use this valuable piece of information from goal setting to help pain the picture of where the client was when they started therapy and compare that to today when they are sitting in front of you in your office. You can use this as a tool to highlight their strengths and progress towards their goals.
And these moments? Well, they just happen to be some of my favorite moments in therapy. When a client can acknowledge their growth and have pride in how far they have come!
Okay - now your turn! Do you have a love or hate relationship with setting therapy goals? What are your favorite (or least favorite) parts? Drop a comment below!
The relationship you have with a child is the number one factor for client change. Really! Research shows the relationship is even more powerful than any technique or theory! (Don’t cringe too much - all the schooling, degree, and extra training you have is really important too!)
The therapeutic relationship is also described as the “most important ingredient in successful therapy” by Athena Drews and Charles Schafer when talking about the therapeutic powers of play. It is the relationship that opens the door to make the other powers of play possible.
In short - if a client doesn’t trust you or think you are someone safe they can talk to, it doesn’t matter how skilled you are, how many trainings you have attended, or protocols you know. None of that will matter because the child won’t feel safe enough to engage.
Okay, so now that we know that rapport and the relationship are not only important but essential - what next? Here are four of my biggest tips to build and foster relationships with young people!
Get cued in to the child’s window of tolerance
Having a good read on the child’s nervous system and looking for cues of hyperarousal (fight/flight) or hypoarousal (dorsal vagal collapse / shutdown) is essential, especially in the early stages of therapy. If the child is going outside their window of tolerance it is your job as therapist to regulate your own nervous system and give the child safe and social cues to help them regulate. Paying attention the small cues of dysregulation can help you pull back from activities or topics before the client floods.
When the relationship is stronger a child’s window of tolerance may be wider for certain techniques, types of therapy, or activities. Pushing too far earlier on can be a significant detriment to the relationship and can damage rapport. Want more information on neuroscience and Play Therapy? Check out my training HERE!
Have a collaborative relationship
The child and family are experts in their reality and what it means to be living in their unique family system. They are also coming to you as a therapist because they are struggling.
Working together with the client and parent in collaboration as opposed to making goals or recommendations from the position of an expert can significantly increase buy in from both the child and the parent. Ask the child what their strengths are, what areas are a struggle, how they see their symptoms, and what they want to be different in their lives. AND hold their answers with care both in the way you set treatment plan goals and how you work towards those goals in therapy.
Be open to feedback
In my first session with families I let them know that the relationship is the number one factor for therapeutic change (see above). I welcome them to give me feedback on my approach and style and have openness that there might be something about my approach that doesn’t fit well with them.
As therapists we need to be sensitive and curious about whether approaches, techniques, theories, or models are not a good fit for the client, or if they are struggling for some other reason. And sometimes….well, we find out that what we have to offer and our specific style of therapy is not a good match for the client. I mean we are human beings after all and one therapist is not the perfect fit for everyone!
In this case we put on our referral hat and figure out what therapist might be a better fit. All in all when we can be open with families about this from the beginning they feel more confident to speak up, which increases retention and engagement!
Repair Any Ruptures
Working with children is complex and multilayered. You are not only working with the child as an individual but also with parents and caregivers. In a climate where parents and children can often disagree about the symptoms that are the presenting concerns and factors impacting symptoms, your role as therapist to maintain rapport within the family system is difficult.
Sometimes you are put in a place to make parenting recommendations that are in the best interest of the child, but don’t often feel good to the child. Hopefully you can relate if you have ever made the recommendation that unrestricted media time and activities could have adverse effects on mental health!
And sometimes, well...you just mess up. You are human after all. I think we all have those moments where we wish we could re-play the tape and say or do something differently in our sessions. The best thing you can do for a therapeutic rupture in rapport is to repair it. Take ownership, apologize, explore the impact on the client, and work to fix it. And this process? Well some research has shown that it actually makes the therapeutic relationship stronger! Wheew - we can all feel a little bit better now!
These are my favorite strategies for building and keeping rapport with clients along with Carl Roger’s core conditions of genuineness, empathy and unconditional positive regard. Children have excellent detectors for grown ups who are not congruent!
Let me know your favorite ways to build rapport and relationship with the young people you see in the comments below!
Goal setting is one of my favorite things about the intake process. No, really!
When you can fully understand a client’s current level of symptoms when they start therapy, it is incredibly clear to see if they are improving in their mental wellness. And although there are external life stressors that may make it difficult for a client to progress, most of the time when you update goals you can see changes, improvement, and progress! Woo Hoo! High five!
This is also extremely helpful when you have parents or caregivers that don’t feel like their child has changed. Well….the initial treatment plan says that your child was tearful 2x per day and now they are having 2 crying episodes per week! Amazing news!
Sometimes parents (or children for that matter) don’t notice the micromovements of change that come during the therapy process and it might feel the same or normal to them but when you give them a clear picture to look back on it can make all the difference! It can allow them to give themselves credit and celebrate their successes!
Now, I am a firm believer that goals should be done collaboratively with the client, not just you typing away alone at your computer to wrap up the paperwork. For younger clients this might be heavily guided by their parent. However, for late elementary school students to teenagers they have the ability to think more about what they want from the therapy process.
And at the same time articulating goals to insurance standards for young people can be, well...tough. Does “I want to feel better” count for a quantifiable goal?
To help engage middle to older adolescent clients I developed a FREE interactive goal setting worksheet. Now updated with two font options!!!
This worksheet is an adaptation of the Wheel of Life activity developed by Paul J. Meyer for coaches to use with adult coaching clients. I adapted it to use with my middle school and teen clients to help them take personal responsibility and ownership for goal setting, which can be difficult at any age!
In this worksheet young people are encouraged to rate themselves on the 8 most common areas goals are typically set with young people and it also accesses the right brain visual centers which is a huge bonus!
Grab your FREE interactive goal setting worksheet HERE! (now updated with two font options!)
This worksheet assesses the 8 most common areas where I see young people struggling and needing to set goals. The first step is to fill out the self assessment sheet of how satisfied they are with each area on a scale of 1-10. Areas include things like peer and family relationships as well as self esteem.
Once all of these areas are rated the client colors from 0 -10 in each category their level of satisfaction. Any color that seems right! At the end you process the circle.
Sometimes I will use a wheel analogy and let young people know that in order for us to be operating as our best selves we want our wheel to be as full as realistically possible and a wheel that could roll down the street. Nobody will have all 10s, but sometimes it is difficult to live life as what I call a “whole happy person” if there are several areas where you are at a 1 or a 2. That leads to a stuck wheel!
Client goals in therapy should be targeted at helping increase client’s abilities to live their life in a way that feels good to them (and keep their wheel rolling)! By filling out the goal setting worksheet you can get clearer on what brought your client to therapy and what areas of their life they want to improve!
Grab your copy to use in assessment sessions HERE! Now updated with two font options!
I'm Ann Meehan, an LPCC, RPT-S, and EMDR Consultant. I help other therapists grow in their passions as play therapists, trauma therapists,and child and adolescent therapists.