8. Therapist & Client Goals - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Does the therapist's goals match up with the clients goals?  Carson's goal may have been for Vee to be fixed.  Vee's goal may have been to be heard finally.  Their goal as a couple was to stay together no matter what.  Does the therapist accept the client's goals?  Should the therapist accept the client's goals?  Who determines goals in therapy?  The therapist may have preferred processes for therapy that may not match client's expectations.  Client's expectations may be unrealistic or even counter-indicated to healthy relationships or for effective therapy.  Although disappointment in therapy may come from unreasonable expectations, the client may nevertheless harshly judge therapy and the therapist.  Benbenishty and Schul (1986) note that while clients may terminate therapy if they find the therapist does not fit their expectations or needs, therapists "may not be able to terminate the therapeutic relationship only because they experience a distressing gap between what they expect to happen and what they believe should happen in order for therapy to be successful.  Still, if the discrepancy is sufficiently large and persistent, the therapist's dissatisfaction and frustration could affect the therapeutic relationship.  This also may lead therapists to act in ways designed to reduce the discrepancy between preferences and expectations.  For instance, a therapist may try to socialize the client to behave in ways consonant with the therapist's preferences" (page 720).

The therapist may adapt in the process of therapy as they respond to client's needs.  There might be a bi-directional training between the therapist and clients suggesting or falling into mutually acceptable processes.  Subtle to overt cues and communications may direct each other to preferred or familiar interactive or therapeutic styles.  Or, frustrated or failed interactions may cause the therapist to experiment with different approaches.  The therapist may be able to work with fluid and adaptive therapeutic styles intentionally, if his or her theoretical philosophy incorporates matching client's style and expectations.  A multi-cultural approach or one that seeks to follow the cultural style of a specific client population may be recommended, especially if the client is not culturally familiar with common western therapy (page 721).  While the therapist often have preferred therapeutic processes and interventions, therapy may be ineffective if attempting to force the client to adhere to the therapist's preferences.  The client may be forced, intimidated, or coerced into interactions that are uncomfortable.  Therapy, especially good therapy is often uncomfortable.  Client consent for therapy assumes implicit acceptance that one will experience discomfort while exploring difficult issues, working through complex feelings or relationships, and revisiting old traumas.  On the other hand, consent does not give the therapist unfettered permission to manipulate the client and therapy in any manner whatsoever.  The therapist needs to remember that "whatever transpires in therapy is dependent not only on the therapists' preferences, but also on the clients' abilities and motives (page 725). The therapist has power or control in therapy only to the extent that the client gives them permission.  Pushing the client beyond the limits of permission or beyond abilities and motives may be ethically inappropriate and personally exploitive.  And almost certainly non-therapeutic.  Yet, stretching beyond personal limits is usually essential to growth, since staying within familiar but unhealthy boundaries often causes the life problems.  The art of therapy includes the therapist continually seeking and gaining permission to challenge or stress the client beyond comfort levels.  The good therapist facilitates therapeutic containers where the client is comfortable enough to risk being uncomfortable.  Therapeutic skills and judgment are essential so that client's ventures into discomfort are manageable and do not become overwhelming.  

The therapist often promotes or asserts goals that are meaningful for therapy and for the client's own good!  Sometimes, clinical instinct senses deeper goals or needs that the client is not aware of.  "…if a person did not get a good start in life and did not have good developmental opportunities in childhood (from the family), he or she could use other role models in adulthood as sources of support.  The therapist then can act as one of these role models and encourage the client to make new choices when interacting with his or her partner… this dynamic is analogous to creating a restorative experience in therapy with the couple.  This experience can develop a change in the couple's experience of attachment to one another because of the new experience.  In this case, the therapist is not an attachment figure per se, but a facilitator of partner as attachment figure while the couple puts their attachment to one another in context. …the emphasis is placed on redirecting the couple's focus from dependence on the therapist toward reliance on one another to get their needs met" (Peluso and Macintosh, 2007, page 257).

Many individuals present wanting to fight less in their couple or family relationships.  This is not the same as wanting to have more intimacy or unity.  The therapist may intuit the desire for intimacy or attachment is the core goal for the individual, couple, or family rather than some of the goals they otherwise assert in therapy.  Some individuals present overtly request that their partners or family members be redirected back or fixed into a role that is more familiar culturally.  Although it sounds like therapist arrogance, clients often need the therapist to better define the goals of therapy.  There will be situations when achieving the explicit and implicit goals of the individual, couple, or family collectively or specifically will lead to more dysfunction.  If they were good at selecting appropriate goals, then maybe they wouldn't have needed to come to therapy in the first place!  Sometimes, it is appropriate to make a translation of the goals presented by clients into therapeutic goals.  For example,

less arguing may be translated to feeling more respected;

less fighting may be translated to more effective fighting with resolution;

being on time may be translated to more awareness of communication needs;

more sex may be translated to more intimacy;

greater obedience may be translated to better defined roles.  

The therapeutic challenge is to present these translations in the terminology and spirit of the language, worldview, or culture of the clients.  The roles the therapist chooses may define or re-define the goals of therapy.  Other goals, some of which are more or less reasonable and therapeutically sound may include:

1. Elicit information to/facilitate awareness

2. Educate or to develop insight

3. Facilitating catharsis

4. Intervene/interrupt negative dynamics

5. Heal current and older injuries or trauma

6. Train… train what? Communication? Conflict resolution? How to fight?

7. Preach!

8. Reveal whatever needs to be revealed.  Sometimes, these are Secrets.  Sometimes, these are things just outside of conscious awareness.

9. Create a safe forum for communication or conflict; to reveal Secrets

10. Cross-cultural education/training

11. Make everyone happy (as opposed to one person being happy and the others feeling resentful, resigned, or defeated)

12. Verbalize rather than stifle anger.  Find appropriate expressions of anger.  Find underlying vulnerable feelings causing anger.

13. Activate anger!  Anger is often an empowering energy a member of a couple needs to take care of him or herself.

14. Promote niceness/avoid conflict (no no no no no!  Bad therapy!)

15. To Make a… The Decision

The relationship is often a two-person community that is positively or negatively affected by either member.  When individuals have an equal and balanced relationship, healing and fulfilling forums are formed for each person.  When involved individuals do not cooperate, get along, and work successfully together, they both end up hurt and dissatisfied.  Emotionally Focused Therapy conceptualizes the coupling process as "Couples who join together in order to meet each other's attachment needs create opportunities for healing and restorative relationship.  Again, when the relationship does not meet these needs, new hurts can trigger old trauma-based attachment behaviors that progressively distress the relationship" (Peluso and Macintosh, 2007, page 256).  Goals that serve the ultimate need of a healthy and loving relationship need to be retained and emphasized, while those that disserve collaboration and intimacy need to be identified and eliminated or minimized.

ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
phone: (510) 614-5641
fax: (510) 889-6553
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