Focus on therapy process, not specific goals

Goals? I loathe them: What to do instead

Here’s an insightful article from an Occupational Therapist:

Goals, targets or focus are useful, and the logic goes that unless you have them you won’t know where you’re going or when you’ve got there.

When I think about the purpose of therapy my focus is helping people to live the kind of life they value, doing the things they believe are important. My job is to help them develop skills and strategies to carry out the actions needed to live a life aligned with what they value

When I see them, their pain has interfered with doing the things they believe demonstrate “being a good parent” or “being reliable”.

Pain has moved in to their lives, and come and sat on their laps right in front of their face so that all they can see is pain.

If I ask someone in this state to “set goals” they laugh, rather sarcastically sometimes, and say they don’t have goals, they can’t think of anything and what’s the point anyway.

Indeed, being asked to set goals while constantly harassed by pain feels like an insult.  If we were in good enough conditions to set goals like normal people do, we wouldn’t be looking for help from the person asking the question in the first place.

Instead, I ask them “what would you be doing if your pain was less of a problem for you?”

The reason for this tactic is to help generate what Acceptance and Commitment therapists (ACT) call “creative hopelessness“

From Wikipedia: ACT is “an empirically-based psychological intervention that uses acceptance and mindfulness strategies mixed in different ways with commitment and behavior-change strategies, to increase psychological flexibility.”

For many people, the things they believe contribute to “being a good parent” far exceed what they can currently achieve. So they give up and get demoralised. They both have their pain AND they don’t manage the very things they most value.

But here’s the catch: often we hold very strong internal rules about how these things should be done so that unless we can do them exactly the way we think they should be done, we’re not satisfied

So I try to begin a process of developing flexibility – and using the values a person identifies as a compass rather than a checklist.

What’s important is less about the what a person does, and a whole lot more about why and how they do it.  When “being a good parent” becomes the direction we live (because we can never tick the box that says “being a good parent” is complete), then we focus on why and how we do it. Attention goes away from “but pain stops me”, and towards discovering all the ways “being a good parent” can be lived.

they begin to to take actions that bring them closer and closer to living the life they want to live.

 

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