One of the first things that I work on with clients is setting very specific goals in therapy. This is important because we need a roadmap for therapy. If we don't have a roadmap, we tend to go in circles! Goals help us stay focused and serve as important motivators for our work throughout counseling. They also help us evaluate our progress together.
Goals are something that shouldn't really change throughout the course of treatment. It can at times be tricky to come up with goals. Some of the things that I ask are what tangible things do you want to be different every day? Goals are the roadmap of therapy, and generally don't change much from session to session.
The goals should be very specific. So instead of saying "reduce eating disorder symptoms" we may say "eat three meals a day" or "spend less than 20% of my time thinking about weight, shape, or eating". Instead of saying “to feel less anxious” we may say “to spend less than 20% of my time worrying” or “to not let my anxiety get in the way of me doing what is most important to me.”
We also try to find ways to measure progress. I ask, what are some tangible signs that things are becoming different? How do we know that we are getting there? If the goal is to score in the normal range of depression symptoms, we check in on mood at the beginning of each session. So on a scale of 0 to 10, how happy do you feel? What would it take to shift it from a 6 to a 7? If the goal is to recover from an eating disorder, we check in on eating disorder behaviors that you may have engaged in during the past week.
We also set small goals from session to session. I like to call them "tiny goals." These are things that are specific, measurable, achievable, relevant, and time-bound (also known as SMART goals). I ask, what is the probability that you will do this on a scale of 0% to 100%? We need to set goals where you are 90% likely to do them. We usually go very slowly. If you are going through an eating disorder and only eating one meal, the goal may be to add a small snack, and eventually work up to a second meal. If you are severely depressed, it may be taking a shower three times a week. We then see how setting and meeting these goals changes things. How do you feel when you add a small snack? How do you feel when you take a shower?