Setting Goals and Developing Treatment Plans in Therapy

Seated mental health practitioner makes notes as seated person with half-smile describes concernsThe purpose of most therapies is to heal, or alleviate, symptoms of a concerning issue or condition. Medical professions create treatment plans that outline the professional’s approach and interventions used to achieve a certain goal. In mental health therapy, this is generally created collaboratively with input from both the person in therapy and the therapist. In some cases, it may be wise to include input from other professionals, such as a primary care physician, psychiatrist, or school counselor, perhaps even parents or caregivers.

When it comes to creating a treatment plan for a physical condition, it is often a bit more straightforward because such conditions tend to be visible or otherwise apparent. For example, the goal of a fractured wrist would be to heal the wrist. The treatment plan would perhaps consist of wearing a cast for several weeks, taking medication as prescribed, and resting.

I have found that some people have a difficult time setting goals for their counseling treatment plans because healing an emotional condition can be more complex. It can be hard to know where to start. It is even common for people to have difficulty explaining why they are seeking counseling in the first place.

Why Now?

Everyone has struggles in their lives, and everyone has the ability to cope with stress. You would not have made it to this point in life without some helpful strategies and problem-solving for difficult times.

Asking yourself what is happening now for you, or in your life, that is compelling you to seek counseling is an important first step. One common reason may be that your usual coping strategies aren’t working as well as they used to. Perhaps there is a lot of change occurring in your life, and things feel out of your control. You may be noticing an impact on your thinking, feeling, or relationships that you’re not satisfied with. Try to dig deep and describe what is happening that’s making you consider counseling at this specific time.

Get Behaviorally Specific

Contrary to some people’s perceptions, therapists can’t “fix” everything—and what does get resolved happens largely as a result of the work the person in therapy does outside of session, using tools and strategies learned in therapy.

Your therapist will ask you to describe your symptoms. It is helpful to use common language rather than “psychobabble” so both you and your therapist are clear on what you are describing. For example, you may self-describe as having depression, meaning you feel sad most of the time. However, your therapist may interpret this as you having been diagnosed in the past with a condition called major depression, which is used to describe a specific set of symptoms. However, your feeling sad most of the time may be related to a recent breakup, which may be normative and not a symptom of a depressive condition.

Through proper and thorough assessment, your therapist should be able to make an accurate diagnosis to describe your symptoms accurately. Being behaviorally specific also allows you and your therapist to be clear on what you actually want to address and change with the help of counseling.

Let Yourself Dream

Contrary to some people’s perceptions, therapists can’t “fix” everything—and what does get resolved happens largely as a result of the work the person in therapy does outside of session, using tools and strategies learned in therapy. Therapists don’t possess a magic wand.

However, as part of the goal-setting process, imagine a magic wand that could change your life overnight does exist. Allowing yourself to imagine using this wand, and noticing what would be different, can help you and your therapist clarify what areas of your life you’d like to change.

Be Realistic

When setting goals, make sure they are realistic. Setting a goal for feeling happy 100% of the time is unrealistic because we all experience a variety of moods throughout the day. It is reasonable to expect you will have difficult days that may be filled with uncomfortable emotions, as well as happier days. Rewording the idea of being happier into a more realistic goal may mean focusing on how you can create more happiness in your life—perhaps by learning how to manage or cope with difficult emotions, or making some other change.

Be Kind and Patient

Therapy is hard work! It can feel horribly uncomfortable and exhausting to go through the process of examining and talking about the difficult things we experience.

Much in the same way you need to feel fatigue in your muscles to build strength, the same is true for mental health therapy. Be sure to take care of yourself and be kind along the way. If you knew what to do already, you wouldn’t ask for help. And the truth is no therapist has all the answers. Simply showing up, making the effort, and being honest along the way are some of the key ingredients to successful therapy.

© Copyright 2016 All rights reserved. Permission to publish granted by Mallory Grimste, LCSW, Topic Expert

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • alicia

    December 7th, 2016 at 9:38 AM

    I am very much a dreamer, have all sorts of lofty goals and aspirations but I think that my biggest problem with that for me specifically is that I tend to want to move in leaps and bounds when I need to get a little more reality focused. Slow and steady usually does win the race but it can be hard for me to slow down enough to remember that at times

  • Mallory Grimste, LCSW

    December 13th, 2016 at 9:51 AM

    Alicia I am so with you. I often fall into Shiny Object Syndrome (wanting to give my attention to anything new, fun and interesting). I find having a solid plan helps keep me on track!

  • Erik

    December 7th, 2016 at 2:55 PM

    I don’t think that most people go in to therapy thinking that this is going to be about setting goals for themselves.
    I believe that most people think that it is more like you go in and tell someone what is going on with you and then they give you some magic to “fix” that.
    really I don’t think that most understand that this is something that is like a job, hard work, but very rewarding once you go through it and see all the benefits you can get from it as a result of that deep work that you end up doing.

  • Mallory Grimste, LCSW

    December 13th, 2016 at 9:53 AM

    Excellent points Erik! I find this to be very true. I do believe that sometimes processing in sessions can be highly beneficial but just like with anything if you want effective and efficient change, you can’t just “talk the talk.” Having some ideas on what you’re working on helps with getting to the action part.

  • lizz

    December 8th, 2016 at 10:30 AM

    I did not get along too well with my first therapist mainly because it felt like she was leaving me to do all the tough stuff and I did not yet realize that duh, this is my job to do, not hers. I think that I went into it with the expectation that she would do it all and I would just listen and then be all better.

    I see that now looking back that I placed way more on her and not my own fair share, that was why that did not work out.

  • Mallory Grimste, LCSW

    December 13th, 2016 at 9:55 AM

    Lizz I’m so happy to hear you are doing the work! It can be totally uncomfortable to own the fact we are each individually responsible for our outcomes. It sounds like even though you didn’t get along with your first therapist, those sessions stuck with you helped lay the groundwork for future progress. Congrats for sticking with it even through the tough times!

  • Corinna

    December 9th, 2016 at 11:12 AM

    So my thought is that maybe a therapist should sit down with you on the very first visit and talk to you about what your goals are for being there and the things that have to be done to accomplish those goals. Maybe that could help to avoid some of the misunderstandings that could be there when one goes into therapy. They could just tell you straight out the things that they think that you two should work on together and how they feel you could best meet your own expectations. Maybe this is how it works I don’t know, but that would keep there from being any questions right off the bat.

  • Mallory Grimste, LCSW

    December 13th, 2016 at 9:57 AM

    Corinna I completely agree! I can’t speak for all therapists, but in my own practice I make sure that at the end of the initial assessment I’m asking for what it is they want to be different by the time we’re done with therapy. Some therapists do the full treatment planning in that first assessment but I like to wait for the second meeting so people have time to digest all the info we talked about in our first meeting. I fully agree it is important to be clear from the beginning what the goals will be and how to get there.

  • Anne

    December 11th, 2016 at 10:13 AM

    When at all possible I too think that it is a great idea to get other professionals involved. You might not think about something that has been going on but they will and this might be the key to unlocking any of the other things that could be going on.

    Sometimes it really does take a village to set all things right again.

  • Mallory Grimste, LCSW

    December 13th, 2016 at 9:59 AM

    Anne- I totally agree with you! I’m actually in the middle of writing my next blog for Good Therapy about this very topic! It can be very difficult for people to allow their therapist to talk with others because they fear their confidentiality will be violated, or that providers will be gossiping about them. However, most of the time it’s about sharing helpful information to support the person getting the help. I’m all about transparency either way and believe in letting the client know what has been discussed with others so they are aware as well.

  • candace

    December 12th, 2016 at 2:50 PM

    If someone says why now, then I would reply why not now?

  • Mallory Grimste, LCSW

    December 13th, 2016 at 10:00 AM

    I love this Candace! Excellent dialectically thinking (I’m a Dialectical Behavior Therapy/DBT nerd….)

  • jt

    December 13th, 2016 at 12:17 PM

    Great point candace!

  • Alisha

    December 14th, 2016 at 2:21 PM

    I for one am always worried when I don’t think that someone is listening to me especially if I am with a doctor. When I am with someone who tries to finish my words for me, that makes me very uncomfortable. So I think that to work with a therapist who I felt really got where I was coming from, that would be a big deal to me, and if they just kind of let me create that on my own with just a little bit of guidance from them, I think that I could get even more out of that experience

  • Mallory Grimste, LCSW

    December 16th, 2016 at 8:15 AM

    I am so with you Alisha! I believe therapy should be driven by the person coming to the sessions. After all, you are living your life all those other hours and days of the week. My belief is that my job as a therapist is to provide the space and guidance for you to work through what you need to make therapy a success. As a DBT-informed therapist, I am also trained in specific skills that may help that process, but overall it’s your process- not mine.

  • garnet

    December 15th, 2016 at 10:50 AM

    This is always the hardest part, getting started.

  • Alex

    August 20th, 2017 at 5:40 PM

    Not sure if this is even active anymore, but thank you for this article. I went into therapy after a relationship ended, dealing with severe anxiety, and depression that I couldn’t drag myself out of. Now that time has healed some of the stress from the breakup, the depression has significantly lessened, and my anxiety feels somewhat calmer, I don’t know what my goals for therapy are. And when my therapist asks me, I freeze up. There are many things I would like to work on, but…I also think, having zero friends, I really just enjoy having someone to talk to as well. I’m having a hard time figuring out what my goals are/need to be. Difficulty communicating verbally is something else that we work on so relaying what I’m feeling and wanting is very difficult. I’m trying to figure it out. It was nice, though, to know that it’s difficult for others as well. Thank you for the insight.

  • Mallory Grimste, LCSW

    August 25th, 2017 at 11:54 AM

    Yes Alex figuring out how to articulate and ask for what we want to work on in therapy is super difficult! Sometimes one of the very first goals you can have can be just that- figuring that piece out. The things you mention sound like great goals to focus on in treatment as well. Best wishes to you in your process!

  • Julie

    March 14th, 2018 at 11:03 PM

    I’ve been in therapy now for a while. I always have a difficult time setting goals. My therapist warns me before our next appointment that I will have to set goals. Between our appointment, I am highly anxious, depressed and just get teary eyed as I have no clue what to use for goals. The insurance company requires this like quarterly. Most of the time my therapist has to help with this and if she doesn’t (like a previous therapist), therapy will end, which makes me all the more anxious and depressed. How can I come up with just even some simple goals as even the thought of trying to come up with goals is overwhelming to me.

  • Mallory Grimste - Teen Therapist

    March 15th, 2018 at 7:41 AM

    Julie – First I want to *thank* you for being so vulnerable and honest about your experience as I’m sure it applies to many. Goals are generally meant to be a guideline- not an “end all, be all” for the sessions. While managed care and researchers *love* goals because it makes it easy to “track” how the therapy is going- it doesn’t always work well in individual day-to-day or week-to-week life. One simple way to set a goal that will satisfy their needs, and help guide you and the therapist may be to start with how you are feeling now and how you want to feel when therapy is over. Have you tried to use a 0-10 scale? I will sometimes offer my clients the wording of “I am feeling # on a 0-10 scale of depressed where 0 is not at all and 10 is the most. I want to feel # on that scale by (insert date of next review). I will attend and participate in therapy sessions as scheduled.” I hope this helps to get you started. Also- be sure to talk with your therapist about how anxious this feels for you- there may a goal in there, too ;-)

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