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Do You Need to Have a Goal in Therapy?

Updated: Aug 24, 2020

Yes, there needs to be a goal (or goals) in therapy. OMG, yes. I discuss things like Bad Therapy on the podcast as well as in my Patreon podcast. But here I'll go through some main points in considering this question:

Therapy is not a paid friendship. It's a professional service. A service just like any other. The client pays the agreed upon amount; the provider gives the agreed upon professional service. These two things (and more) would be included in an informed consent. And there is an agreed upon goal of the service. Maybe an end date. Maybe a number of sessions. Either way, it ends when one of these conditions is met, but my focus is on a measurable change goal. And a measurable goal should be there no matter what the end condition is.

If I hire a plumber, it's for a set price for a set service and ends when my plumbing need is alleviated. The plumber doesn't just keep finding things to fix. Or wander around the house aimlessly. No. We agree ahead of time on what the plumber will do. They will work until the leak under the sink is fixed.

For therapists, we provide a service around something less obvious, but still measurable. Like until the feelings of anxiety have alleviated from a severity of 9/10 to 3/10. Or the nightmares have reduced to once a week versus nightly. Or the moments of noticeable "glimmers" with family members increases to 3x/day. Something like that, typically with a baseline and an identified stretch of time to see the change maintain as well (like for one month).

Friendships don't have goals. Or cut off points. Or a limited number of meetings. Friendship does not involve being paid. It's not a professional service. It's friendship. Friends can get together and just talk. They can kill time with no specific end goal in mind. It's about the company of the friend, not what you want out of the friend.

Therapy is different. There's something a client wants out of the therapist. Something that the client is not able to do alone at that point in their life. So they hire someone they perceive can help them get to the next step.

If you're coming in week after week and doing basic chit chat or venting, that's not therapy. Chit chat can have its place in building rapport with a client and oftentimes a session begins with chit chat. And there might be a week where the client tells me, "I just need to vent and for you to listen." But the heart of therapy is much more than this. Again, it's a service and not a friendship. We are supposed to provide something different that a friend or other support cannot. And part of that is having a clear goal to collaborate on.

I personally do not feel comfortable whatsoever with accepting money from someone to simply talk. Or chit chat. Or vent. That's something they can get elsewhere. If a therapist is taking payment from you week after week without a goal, then I don't know what they're doing. It seems they are charging you for talking with no end in sight. How do you know if this is helpful or not? How do you know if you're making progress? How is that being measured? Is the therapist a part of that discussion on progress? If they aren't discussing or measuring progress, what are they doing?

And I know, the client is still receiving co-regulation and simply connecting with another human being is important and helpful. But helpful towards what? What does my co-regulation have to do with the client unless they have a goal that they are working towards?

If you want co-regulation, that's what friends are for. You can get co-regulation in the form of friendly support. Or a mentor. Or a family member. Or a spiritual leader. But what if I don't have these things and just need someone to talk to? Then a goal of therapy is to increase your support network. Not for the therapist to be your support network.

Therapy is temporary! Not ongoing with no end in sight. Yes, some clients might be in therapy for years and years. This isn't a discussion on how long therapy should take. Only on whether there is a goal or not. Even for those clients in therapy for years, there should still be regular measuring of progress toward a specific goal.

Goals can change over time, by the way. The goal of the first few months of therapy might not be the same as the last few months. As one thing improves in therapy, then it might be time to change the goal to something else. But this needs to be a verbally discussed and then written agreement between client and therapist. Not meandering in and out of session, discussing whatever is the problem currently.

Not only should the goals be clearly discussed and agreed upon, but they should also be revisited regularly. I typically check in with my clients about their progress on goals every session. "How did the homework go?" "How's your progress on the overall goal?" "Do you feel like you're still making progress on the goal or do we need to re-discuss it?" Stuff like that.

I also regularly check in with them about myself as a service provider. Every session. "How did this session go for you?" "Did I do an okay job for you today?" "How was I as a listener for you?" "Is there anything I can do better for you next time?" Stuff like that.

A goal is something that is agreed upon and collaborated on. So getting feedback about myself as the provider involves the client in the collaborative aspect. They design the goal with me. They discuss what's working and not working with me. We change what needs to be changed as therapy progresses.

The collaboration is central to building autonomy for the client. Otherwise, without the transparent collaboration, we're left with an expert/client dichotomy. It's a strong power differential. When you collaborate, it begins to neutralize the impact of the power differential and eliminates the dichotomy. Therapists are the experts on psychology in the room. The client is the expert on their life in the room. The two meet in the middle and collaborate. The client is viewed as a fundamental part of therapy and not the recipient of therapy. Therapy is done with the client and not to the client. Without a goal, the collaboration is lost.

Not having a goal in therapy and simply meandering week after week builds dependence from the client to the therapist (although I also wonder about the therapist to the client as well). A relationship of weekly venting can emerge. One of a weekly reset. This weekly reset is helpful for the week maybe, but what about long term? What about that client's larger ability to gain more emotional independence?

If there is no larger goal being addressed, the client might be relying on the therapist for their weekly grounding. If the client has no one else in their life for support, this creates a significant problem. A therapist can't be offering only weekly venting. This is a guaranteed regular bill for a service that has no end in sight and may have also built dependency on the therapist. This is the exact opposite of what therapy is supposed to provide.

Goals build autonomy and success. Meeting goals is important in life; they are foundational in building confidence, healthy boundaries, bravery and autonomy. In feeling value in yourself and your capacity to meet challenges. But you cannot meet a goal if you have not set a goal. Same applies for therapy. To help clients build their autonomy and confidence, they need to experience feelings of success and pride in what they have achieved. To be able to see where they were and where they are.

When you begin treatment with a licensed therapist, creating a treatment plan is expected. It's taught to us in "therapy school" (as Mercedes would say) and is part of the basic structure of therapy.

Therapeers - if you don't set goals with your clients, what are you working on? Are you providing anything distinct from what others can give to your clients? How do you know? If you have some means of knowing that you're working on a goal... is your client aware of it also? Do they know that you have a goal for them? Has it been discussed with them? Have they signed off on it in writing? Does your informed consent say that goals aren't going to be developed if they're not?

I think at it's best, not having a treatment goal is an attempt to provide co-regulation, opportunities for venting and be a support for the client. At it's worst, it's a way to take advantage of someone's desperation and give them a weekly bill with no end in sight. And both of these can look the same way. How would you know the difference? We have to do better. We have to provide a unique collaborative experience and professional relationship for our clients that they cannot get elsewhere. And part of that is a goal for our time with our clients.

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3 comentários

beccyjoe stuart
beccyjoe stuart
19 de set. de 2021

Wow, thanks for this article. I have been working as a therapist for 4.5 years and I trained in a psychodynamic "open-ended" model. I believed it honoured the patient's experience, particularly those with early complex trauma. The theory of change in the model is that with a positive therapeutic alliance, the patient can work through their pain and develop a stronger sense of self, learn to regulate, build skills, etc. But lately I'm feeling very frustrated with the open-endedness, the lack of clear goals, the "meandering" nature of it, as you put it. It seems so simple and obvious, but if you are not doing therapy with the very clear understanding that the purpose is to not need therapy anymore,…

beccyjoe stuart
beccyjoe stuart
19 de set. de 2021
Respondendo a

Thank you Justin! - Yes I am seriously in the process of upping my therapy game. > A big part of this is social responsibility - here in Australia, there has been a massive demand for psychologists for some time (then throw a pandemic into the mix) and my waitlist is so long - I want to help more people, which I can't do if I'm stuck with the same people forever. I'm committed to giving the most people the most effective help in the shortest amount of time. Thanks for your reply. I look forward to reading more of your posts :) - Rebecca

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