Establishing goals with a client can sometimes be one of the most difficult parts of the relationship. When working at my internship site last year, I worked with folks who were working towards self-sufficiency. Even if we explained to them that counseling is part of the program during their intake process, they quickly forgot that they “signed up” for it. When we meet an individual for the first time, they may not understand the purpose of counseling, they may think we are doing something to them. We would hear statements such as: “I just need a job” or “I just need a little support until I can get back on my feet.” The troubling fact is that a large percentage of the individuals we served had been chronically homeless or close to homelessness for a significant portion of their lives. So, the purpose of counseling for that population is to help them create healthier patterns in many aspects of their lives so they can live in a new and better way. They don’t normally come to see us with open arms, so identifying goals in a collaborative fashion could, at times, be difficult.
I once worked with a client who had been in the program for about seven months. When we initially met, I asked her what she would like to work on? She replied that “she just needed someone to talk to.” After a few sessions, several themes came up geared toward things we could work on, but when I posed the formal question, “What would you like to get out of our time together? What goals do you have for our work together? Or even, what are your goals?” She again seemed unsure of what she would like to focus on. So instead, I started the goal process by pulling out things she mentioned. For instance, she was in a relationship with an addict and she presented with very co-dependent behaviors. While in session one day she mentioned something about wanting to feel better about making decisions on her own. I reframed it as, “it sounds like you would like to be more independent, how exciting! You have set a goal for yourself!” She smiled, and said “yes, I would like to be more independent, can you help me with that?” In my experience with this client, it seemed like the pressure of making a decision, or being tied to a specific commitment frightened her. When we just talked and I was able to reframe something she wanted in life, it was easier to digest for her. Some other techniques that have been incredibly helpful for me in focusing clients on goals have been art therapy and reality therapy (the miracle question). Corey (2009) describes his experience with his client Ruth and how the use of reality therapy worked to help her pinpoint what she wants in life. Some of the questions Corey (2009) poses that I find incredibly helpful are:
- If you were already the person you wish you were, what kind of person would you be?
- What would you be doing if you were living as you would want?
- Is what you are doing at this time taking you closer to or farther away from your goals?
The use of metaphors in art therapy has been instrumental in helping some of my clients get a better picture of what they want for their lives. It is so much easier to externalize and look at your problems from a different perspective. Few of us take the time to write down what we want in life, and fewer of us write down what is standing in our way. I don’t know, from where I sit in my chair, when I see these folks hold the image of what they want and put pen, or crayon, or paint to paper and identify what is holding them back, it is a pretty amazing thing. It’s like in a moment, without even realizing it, they have taken responsibility for their actions, it is in print, and now they can see it and begin their work. It is through this process that I am able to open up their thinking, get them to see something new and collaborate with them on some realistic ways to get what they truly want in life. The other cool thing is that even if they don’t necessarily get it all, I have a great visual that helps me understand my client in a deeper more meaningful way.
The message of the significance of the therapeutic relationship still rings in my ears from my schooling. I know that none of the work I have been able to do would have taken root, if I had not taken the time to establish a safe environment and work towards building our alliance. I have one client who kept missing appointments for family counseling and I tried to check in with her a few times to see what the roadblocks to attending family sessions were, I felt like I was getting nowhere. I also see her individually, so the next time we met, at the end of session as we were getting up to leave the room, I stopped and turned to her and said, “I hope you know that if have too much going on right now, and you just can’t find the time to come to the family sessions on the weekend, we could look at finding time during the week, or even postpone them for a while until you get to a better place, or even if you aren’t interested right now…please know that all you have to do is talk to me. My goal is to be helpful to you and your family.” She seemed to soften and said, no that’s not it, we do want to come, I have just been so busy…but thank you for telling me that, I really appreciate it. And the cooler thing is two days later we had a family session scheduled and they showed.
The power of the client-counselor relationship is reinforced throughout counseling history. From Adler, to Rogers, existential, gestalt and most theories going forward, the client-clinician relationship makes the difference for individuals. Rogers says it best as referenced by Seligman (2010), “Significant positive personality change does not occur except in a relationship.”
Thanks for this post. I’m in the middle of my first internship year and having trouble setting goals with some of my more impaired clients. Your comments about reframing especially stood out. I have a client in mind with whom I’m going to try this technique right away.
Thank you for your comment, and happy to be of help! It’s so interesting how a change in perspective can open your mind.