Defining problems and goals
When maintaining processes get in the way
I suspect I’m not the only trainee who has ever had the disconcerting experience of ‘barking up the wrong problem/goal tree’ with a client.
Clients often present with an undifferentiated thicket of problems, which we help them to track back to the main ‘trunk’ problem. However, an additional complication is that the processes maintaining the problem may in themselves come into operation when defining what the problem really is!
And the client therefore sets herself a misguided goal because it doesn’t actually address the ‘right’ problem… An example may make this clearer. One of my clients recently described a perfectly reasonable (although vague) goal around her difficult relationship with her parents:
‘I want to get closer to my parents.’
We spent a few minutes in session operationalising this goal, so that it evolved into:
‘I’d like to visit my parents for a weekend every six weeks. I’ll structure our time together by gardening with my Dad and cooking with my Mum.’ (These are activities that she genuinely enjoys).
This is beginning to look like a SMART goal. However, having worked with her generalised anxiety, low self-esteem, self-critical thinking, perfectionistic standards and tendency to ruminate, I wondered whether this goal might possibly be addressing the ‘wrong’ problem. We explored my hunch through Socratic methods and discovered that what she actually wanted was to:
‘Give myself an easier time about feeling ambivalent towards my parents.’
We returned to her formulation of GAD and low self-esteem. This helped us to see that her distress was being maintained by ‘worrying’ how her relationship with her parents was falling short of perfect and that she was to blame. Once she was able to recognise that she was engaged in the behaviour/process of ‘worrying’ and to use the Worry Tree to ‘forget’ this worry, she was able to operationalise her goal as:
‘I want to stop worrying about my relationship with my parents.’
This is clearly a very different goal from the original one! And it’s based on a very different identification of what her current problem truly is with regards to her parents i.e. the problem is her worrying about the relationship, rather than the relationship itself.
So is there a way of reliably recognising the ‘wrong problem, wrong goal’ issue? I think the answer is to go back to the formulation and maintaining processes.
• Reflect - what maintaining processes do people with this underlying diagnosis characteristically present with?
• Defining the problem - ask yourself if it’s possible that these might be operating and ‘getting in the way’ of defining what the problem actually is
• Setting the goal - does the goal have a whiff of ‘should or must’ about it? This may indicate that a habitual thinking error is operating, such as unrealistic expectations, perfectionism, self criticism or black and white thinking
• Check out your hunch by Socratic methods, asking questions that relate the problem and goal to the client’s formulation
• Regularly review previously set goals – as the client learns and practices CBT skills, their goals may fundamentally change
Summary points
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Be aware that the client’s maintaining processes can themselves get in the way of the client identifying her ‘real’ problem. This can then lead to setting the ‘wrong’ goal
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Beware the goals that are built on potential thinking errors
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Regularly review previously set goals – they may have been attained, modified or fundamentally changed