Goals seem to work best when they’re important to the person, and the person has sufficient confidence that they’re going to be achieved. But…’there is many a slip betwixt cup and lip’ – while the goal might be set, actually getting there depends on many things. I wonder whether we can inadvertently slip up when we’re working to help someone set goals by focusing on outcome goals rather than process actions.
Let me clarify. Outcome goals are things like ‘sleep for 8 hours a night’. That’s what the person wants to achieve – but sleep might be disrupted by a child crying, a storm outside, or even a partner snoring! Sometimes the goal isn’t achievable not for lack of trying but because external factors intervene.
Process actions, on the other hand, are the particular actions the person does in order to work towards the desired goal. Actions are things like going to bed at a regular hour, keeping the bed for sleep and sex NOT worrying, arguing or being awake. Actions are specific behaviours the person can do, and are able to be achieved provided the person actually does them. Actions should lead toward the outcome.
I started to mull over the difference between goals and actions after reading through some of the ACT therapy manuals. In ACT, it’s important to identify the ‘why’ a particular action is being taken. The underlying reasons for an action are like a compass – they are the values that are important to the person, and guide the direction in which the person lives life. They’re never ‘completed’ or ‘achieved’, they can’t be ticked off a list and then dropped. Values can be eroded when actions that used to fulfil them stop being carried out. This can lead to a life full of actions to reduce negative experiences, but that inadvertently get in the way of actions that embody other important values.
When I look at the Stages of Change model and motivational interviewing, an important aspect of readiness to take action is to identify how important the change is, and how confident the person is to make that change. Reviewing the importance of a change uncovers the values that the new behaviour is intended to fulfil. Without being really clear about why a new behaviour might be carried out can lead to weak engagement in the goal. Importance is the aspect that MI identifies should be strengthened and clarified before starting to increase confidence.
Coming back to actions or goals. If a goal is the end point and the outcome varies because of something unforeseen, then the chances of the person becoming confident that it’s worthwhile persevering will be quite low. After all, if my goal is to be first in a race, and I see that everyone else lining up for it has a personal best far better than mine, I’m not likely to want to even begin the race!
It’s important to distinguish between actions that the person can take, and be in control of, and goals that may not be achieved because of other things. And the actions must tie in with underlying values or the person isn’t likely to find them important, even if they are certain they can do them.
This suggests a couple of preliminary steps before developing action plans or goals in therapy.
- Establishing what is important, or the values that a person has might be a necessary first step in developing a therapy plan.
- Values often tie in with roles that the person fulfils, but roles might be undertaken for different reasons – so we can’t make assumptions about why an activity is important to someone simply on the basis of our reasons for doing a similar activity.
- Sometimes people don’t know why an action is important, and we might need to spend some time working through this with the person – and in the end, may not pursue that action at all!
- Once the important values are identified, finding out what that value might look like in this person’s life may help to define the actions the person can take to live.
- These actions, and working towards being able to carry out these actions then become the basis of therapy.
Actions can be specified, measured, counted, tied to place and time and person – and they’re about what this person chooses to do (or not do). Achieving them helps the person live what they value, even though this may look different from what we might do to live that value.
I wonder if, instead of developing ‘goals’, we started to use the words ‘action plans’. This might help us as therapists focus on things the person can do in the process of living a life aligned with personal values. And isn’t that what we’re really trying to do in our own lives?
I hope you’ve enjoyed this tour through some goal setting literature. If you want to keep reading, you can subscribe using the RSS feed above left, or you can bookmark and just visit. I write most days during the working week, love comments and respond to questions! Don’t forget you can introduce yourself via the ‘About’ page, and if you’re an occupational therapist, there is the private section just for you. Email me for the password via the ‘About’ page.