Therapy is a goal or solution-focused endeavor with the client as expert. Therapy is a goal or solution-focused endeavor with the client as expert.
This chapter is designed to help you understand and develop skills in forming well-defined goals.
We like to think that the therapy process is similar to creating a movie. We are assisting clients as the directors of their own solution movies. The clients simultaneously are both directors and the principal actresses or actors.
In chapter two, we mentioned an example of the East German bobsledders and how they rehearsed their run down the hill. Metaphorically, we want to take our clients through that type of process. We want to assist them in simulating the making of movies of themselves in the process of solving their problems, movies that are complete with soundtrack and internal dialogue. We want these movies to be of their creation that they can step into in order to experience themselves solving the problem or doing what they want in a positive sense.
In the succeeding chapters, you will find out how clients frequently tend to start describing their solutions in the subjunctive mood or the future tense. For example, they may say subjunctively, “If I were parenting the way I want to, I would be following through on what I have said.” Or, they may say in the future tense, “When I will be parenting the way I want to, I will be following through on what I am saying.” Within these two forms of speech, you can assume that clients are creating representations of themselves solving the problem. When their sentence mood changes from subjunctive to indicative and/or from future to present tense, you can guess the clients are likely to be stepping into their movies and rehearsing their solutions, or are reciting present experiences of solving the problem. An example is, “When I am following through, I am speaking calmly and telling the children the consequences of their behavior.” This movement from future tense and subjunctive mood to present tense is optimal. The movement to present tense comes about in conversation as we move from talking about some hypothetical solution to times in the present when clients are performing their goal somewhat already.
We use the words goal and solution in a unique way. Many of us commonly interchange these words with words such as end result, objective, or outcome. Our use of the words goal and solution connotes processes and movielike, not static things or finished results. An end result for our bobsledders would be a still picture of them as they cross the finish line or receive their medals. A process is more like movies of their going through the entire run. Perhaps, if it were not grammatically clumsy, we should use words such as “goaling” or “solving” to enhance the process connotation.
Keeping this movie metaphor in mind will help to facilitate your using the tools of this and the following chapters.
A solution-focused brief therapy is a consumer approach. We endeavor to help clients get what they want. Other models built on normative models of mental health or of a well-functioning family or marriage take an expert position and state what the goals should be. On the other hand, a solution-focused approach focuses exclusively on what the client states she or he wants to be doing.
Given that we focus on what the client wants rather than on what we think the client should want, client goals are critical. We have found not only that the notion of a goal is critical but that applying certain criteria in developing goals is also critical.
The criteria for a well-defined goal are as follows:
By this, we do not mean good or bad, moral or immoral, healthy or unhealthy. We do mean that the goal needs to be stated in a linguistically positive form, that is, in terms of what the client will be doing or thinking, rather than what they will not be doing or thinking. The reason for stating the goal in a linguistically positive way is that we want the client to be developing a representation of the goal in her or his mind and experience. This can be a visual representation, it can be words or sounds, it can be feelings or sensations. The representation will likely include some or all of these sensory modalities. The critical piece is that the representing has to be something rather than the absence of something.
We want a positive representation because to form a representation of something that is stated in the negative is impossible. Think about the previous statement for a moment. If we were to ask you in the next few seconds not to think of a piece of cake, you would more than likely picture a piece of cake in your mind and begin salivating. You might then do something to that picture such as try to make it disappear or cross an X over it in order to “not think of a piece of cake.” However, you will picture it before you do anything else.
In exactly the same way, should clients state that their goal is to not be depressed anymore, it would be impossible for them to make that representation. They will more than likely recall feeling depressed first, and then tell themselves that the feeling should not be felt or that the feeling is not necessary. Clients might also picture themselves being or acting depressed or repeating depressing comments to themselves. In fact, the more clients try to make themselves not depressed, the more likely they are to think about depression and, as a result, feel more depressed.
One of the major inadvertent drawbacks to problem-focused approaches is inherent self-reinforced affirmation of the problem. The clients are very often talking about the problem and making representations of the problem. The more the clients talk about the problem, the more they renew the same feelings and create further images of the problem.
This reinforcement of the problem is not what we want our clients to be doing. We do not want them to have to think about the problem first every time they want to think about achieving their goal. However, if clients begin to develop a representation of what they want to be doing, the representation can be very compelling in itself and act as a movie for where they want to go.
Returning to our story of the bobsledders, you will notice the considerable advantage for these athletes to have formed a representation of themselves successfully maneuvering the difficult course. They not only formed a representation of their goal but also became part of a positive representation of the goal and made the representation a rehearsal for the actual event.
When your client outlines a negative representation, the key word for you to use in evoking a positive representation is “instead.” For example, if the client says, “I do not want to withdraw from my husband,” your question to use is, “So what do you want to be doing instead?” This juxtaposition will evoke some description of what they will be doing or thinking differently in a positive form.
By this, we mean that the goal should be stated as if the description were movielike, a process, rather than a still picture. Nouns used as goals are static. Nouns represent still pictures; while better than a negative statement, stills are not nearly as compelling or effective as movies with sound tracks.
One good way to know that your clients are describing goals in a process way is when they use verbs with “-ing.” This ending indicates that they are sequencing actions, thoughts, or representations. The processing can be in the future tense or present tense.
For example, the client might say, “I will be listening to what my child has to say before I tell him what I want him to do.” The client might describe the exchange more conditionally by saying, “If I were handling this the way I want to, I would be listening to what my child has to say before I told him what I want him to do.” The client might also state the goal in the present tense as, “When I handle the relationship now the way I like to, I am listening to my child first, before I tell him what I want him to do.” All of these examples are process descriptions with “-ing” verb endings and suitable for defining the goal.
The word for you to use to evoke a process description is “how.” The client will more than likely give you either “-ing” descriptions or a sequence of actions. “What” questions usually evoke nouns and are not useful for process descriptions.
Process in the here and now means that the client can start the solution immediately or continue with solution actions. Many clients talk about what they want as if the goal were some object in the far future. For example, a client might say, “I want to make a decision whether to stay married or get a divorce.” The problem with this definition of behavior as a goal is that the goal is usually too far into the future, and too removed to feel any control over. The way the goal is stated as a “decision” takes the form of a noun, a static object, something removed from them. It is usually thought of as an event that is usually far into the future.
We want to define the goal in a process way as something they can be on track with, immediately. So we would ask, “So if you were on track to making a decision now, what would you be doing or doing differently?” Another way of saying this is, “As you leave this session and you are on a track to solving this, what will you be doing differently, or saying to yourself differently?” “… saying to yourself differently,” may invoke a different meaning. These questions bring the goal into a process form and can be substantially more immediate. The client might respond with, “I would be bringing up the topic of separation with my wife and talking with her about separation rather than avoiding the topic.”
As therapists, we do not think necessarily that we have to continue to see this client until she or he makes whatever decision that will eventually be made. We basically need to help the client more into the process and feel inherently convinced that she or he is on track to making a decision.
The problem with goals so far out in the future is that they are far away. Experientially, they can seem to be remote and, therefore, less under the client’s control. By bringing the goal into a process form right into the present, the client becomes more focused on things she or he can do right now or perhaps may be doing already.
In addition to those clients who want a completed action such as a decision, there are clients who state what they want as a difference of condition. For example, a client may state that she or he wants to be 50 pounds lighter. This is stated as a static state, that is also too far into the future. If such a weight loss were stated as the goal, we would want to bring the solution process right into the here and now. We would ask, “So if as you leave the office here today, you were on track to becoming lighter, what would you be doing differently?” This question brings the distant object of a 50-pound weight change into a process form in the here and now.
An answer such as, “I would be eating differently and going through my day differently, not so hectically,” would be a good start. The person is describing eating differently and going through the day differently. These are process words and have more potential for being done right now.
The more specific a description, the more compelling the description is for the client. The art of the therapist comes into play here as you use all your skills to help clients develop even more specifics about what they will be doing or thinking. What we mean by “doing and thinking” is the definition by clients of concrete behavior and what they would be saying to themselves or to other people. What clients say they will be saying to themselves provides the meaning or new meaning they will be using to describe the situation.
Keep in mind that if some clients do not immediately come up with specifics, they are not being resistant. If you consider for a moment that clients have probably been overfocused on the problem and on what they do not want, they probably have never thought, or only rarely thought, of what they do want. So clients may need some coaching and patience on your part in focusing on the positive—what they do want and, specifically, how they might be doing what they want or will be doing what they want.
The chief way to evoke specific answers is to be direct. For example, “Can you tell me more specifically how you will be listening more to your child? What will you be doing differently? What will your child notice specifically that will tell her (or him) that you are listening as opposed to not listening?”
This criterion is critical and should probably be starred. Many of our clients come in with complaints about how they want someone else to be different or how they want something to be different that they can do nothing about. If we engage with clients about goals of changing someone else or having someone else change, we will be participating in an endless and fruitless effort.
We want to help clients identify a goal that they can start and maintain by themselves even now in our office. The goal cannot be contingent on something or someone else changing or changing first. We may be able to help clients bring about some change in relationships with others even without the other person being in therapy, but we cannot join in the notion that someone else has to change first.
Clients who state their goal in terms of a change of condition not within their control or state their goals in terms of someone else changing first may be working under the assumption that these changes have to happen first in order for something else to happen that they want. The clients may view this type of change (something out of their control or a change in someone else) as a means or condition for something else that they ultimately want to happen. For example, in a cocaine case, a woman thought she had to first rid herself of the taste for cocaine in order to stop using it. She thought that she had to dislike the cocaine in order to stop using it. Ridding herself of the taste, however, was not within her control.
Clients often think that in order for “B” to happen, “A” has to happen first. Acting in accord with this assumption, they persist in trying to make “A” happen so that they can have “B.” However, if “A” is out of their control, they end up very frustrated.
For example, a man may believe that he needs to have more self-confidence in order to act more directly in asking someone else for a date. As he tries to make himself feel more confident as a first step or to remind himself that he has to be more confident, he, of course, is even more aware of the times when he does not feel confident. As he puts off talking with women until he feels more confident, he feels worse about his lack of confidence. He believes that “A”—more self-confidence—has to happen first before he can do anything toward what he wants, that is “B”—talking to women and getting a date. The problem is that trying to make himself feel more self-confident is out of his direct control. Ironically, the more he focuses on his lack of confidence as a condition for action, the less confident he feels and the less likely he is to ask someone out for a date.
Another example is a husband who thinks that a change by his wife is a condition for their having more intimacy. He thinks she should want to be spending more time together. He, therefore, tries to convince her that her desire for space is unrealistic and not loving. He tries to convince her that she should want to be together with him more because that is what married couples do who love each other. Ironically, the more he tries to convince her that she should want to be together, the less she feels like being with him. He continues to try to change his wife, a goal that is not within his control. He continues to focus on the means (the change in his wife’s attitude) rather than on the end, intimacy with his wife.
As clients persist in attempted solutions that fail, they continue to see ultimate goals (or ends of the means) as being further out of reach. When clients state a goal that is out of their control as a means to something they want, we help them reverse the assumption about the means to the end. Where clients think that “A” leads to “B,” or “A” has to happen first, we often suggest the opposite assumption, that “B” can lead to “A.” Very often, “B” involves some action or change of thinking on their part which is within their control.
Reversing the assumption and having the man mentioned above act as if he were confident or the husband act as if he were already more intimate provides each with options that are within his personal control.
As the man pretends to be confident, he takes actions that yield some of what he wants. He may approach a woman and engage in conversation. He may not get the date he is looking for and the conversation may not be all he wants, but he does have some experience for feedback about his next course of action. As he continues to take actions and to adjust his actions as needed, his self-confidence will more than likely change and/or he may discover that self-confidence is not so crucial as a means to talking with women.
As the husband focuses on the occasions when he now has close times with his wife and on what he does at those times, he notices that he is more relaxed and not so pushy with his wife. She perceives him as being more relaxed and tends to be more welcoming. With success at focusing on what he is enjoying with her and on having intimate times, he can give up his belief that she has to change first.
This criterion is a check on us, as therapists. We want to be sure that we are working toward a goal that the client wants, not what we want or what we think the client should want. Many of us have received training about what is good or normal or healthy. We find it easy to slip into thinking that a client has a variety of problems that the client is not talking about or is denying. So we start thinking about all the things that the client should be working on.
Many of us have been trained to “read between the lines” of what people are saying and to interpret what they really want, even if they do not consciously know it yet. Many of us have made interpretations like, “This child’s failing in school is really a cry for help about his family” or “This boy’s refusal to go to school is really a request for limits.” By making these assumptions or interpretations, we can easily attempt to define goals for clients rather than focusing on what clients say they want.
If children you think are crying for help by failing in school do not want help with school, do not try to convince them that they should want help in school. Ask them what they are coming in to see you about and write it down in their words.
When we find that sessions do not seem to be progressing, we usually discover that we are off track on the goal. Sometimes, we consult with each other. When we consult, our first question to the other is, “What does the client want?” Sometimes, the answer may be, “Well I think the client wants better communication skills.” The consultant of the two of us will ask again, “Is that what the client says he/she wants?” We usually discover then that we have assumed what the client wants or made the decision ourselves about what the client should want rather than making sure we have the client’s explicit statement. We have been pursuing action on some goal that the client has not defined as his or her want.
To make sure that you know what the goal is, write down in the client’s words what they say they want. It is not unusual for the final form of what clients say they want, to be quite different from their initial statement. Through conversation about and clarification of the goal in terms of criteria of a well-defined goal, the form of the goal may well change. Clients may realize through defining processes that they cannot change another person or may discover that the goal may be something other than what they initially stated. Just make sure that in the final form, the goal is what they say they want and in their words.
Below is a checklist for a well-defined goal. This is a useful tool for making sure the goal is continuing to be developed. Each statement of the client can be compared with the criteria. The key words will give you some hint about whether the statement meets the criteria or give you a shorthand clue of what to do. If the statement is not yet well-defined, use one of the questions provided on the right to help your client develop his or her “movie” according to that criterion.
CRITERIA |
KEY WORDS |
SAMPLE QUESTIONS |
1. In the positive |
“Instead” |
“What will you be doing instead?” |
2. In a process form |
“How” “-ing” |
“How will you be doing this?” |
3. In the here-and-now |
“On track” |
“As you leave here today, and you are on track, what will you be doing differently or saying differently to yourself?” |
4. As specific as possible |
“Specifically” |
“How specifically will you be doing this?” |
5. In the clients control |
“You” |
What will you be doing when that happens?” |
6. In the clients language |
Use the client’s words |
Figure 2. Criteria for Well-Defined Coal Worksheet
QUESTION:
What is the difference between goals and solutions?
We think of solutions as a type of goal, or solving as a type of “goaling.” In other words, the endeavor between therapist and client is goal-oriented. Within this larger frame, clients and therapists may sometimes frame the goal of the therapy as the construction of and solving of some problem. For other clients, who focus immediately upon what they want, the goal may never be mentioned in the context of problem or solution.
Within this model, we do not believe that problem information is needed in order to be helpful. A better title for this approach would be goal- or outcome-oriented therapy. However, most of our clients and most of us are working in situations where clients perceive the goal and function of therapy as solving problems.
The important thing to remember is that goals and solutions are processes. Even though the words, goal and solution, are nouns and it is easy for us to think that goals are some static thing or end result, we want to emphasize again and again that goals and solutions are movie-like, not finished results.
QUESTION:
What about issues the client has not mentioned but we know are a problem? What about deeper or unresolved issues?
Except for problems that are bound by law and ethics, such as abuse or the risk of danger to self or to others, we respect clients’ ability and responsibility to focus on what is a goal or problem for them. We trust that if a change is necessary for someone to obtain what they want the problem will come up on its own or be solved on its own. For example, if parents come in about their child’s school behavior, we trust that any marital problems that may exist will surface as we focus on how the parents are going to solve the school problem. We do not have to confront the parents head-on or label their difficulties as a marital problem. We trust that if the parents are going to solve their child’s school behavior together they will have to work out their differences either directly or indirectly. We also trust our assumption that small change leads to larger change and, therefore, the marital problem might solve itself.
We also do not make the distinction between surface and deeper issues. We take each problem, solution, or goal at face value with no one change dependent on another and no one problem as a sign of others.
1. Pick a difficulty that you are struggling with now. Ask yourself, “What do I want to be doing instead?” After you have begun that process, go through the checklist for a well-defined goal, one by one. Watch and listen for how your personal movie changes. If your solution does not meet the criteria, adjust your solution so that it does.
2. With a partner playing a client, ask him or her to tell you the goal in coming to see you. Keep the exercise framed in terms of goals rather than problems in order to make it easier to use the six criteria. Write down your partner’s responses and compare the goal statements with the criteria. Practice using “instead,” “how” questions, and “specifically” to focus the goal.
3. Go through your present case records and identify the client’s stated goal. Go through the worksheet for well-defined goals. Does the clients stated goal match the criteria? If not, ask yourself what questions you may need to ask in the next session. Make sure the goal is the client’s and not yours for the client.