Formulating Needs and Goals 2. Collaborative Goal Setting Steve Wood, Lecturer

Goals It is useful to think of goals in two ways – long-term short-term Long-term goals are what the person ultimately wants to achieve Short-term goals represent the steps the person needs to take on the way Goals should be SMART Specific Measurable Achievable Realistic Time-scaled

Goal statements Goal statements should: describe what the client would like to achieve in relation to the identified problem describe a behaviour that, when consistently implemented, would indicate a reduction in problem severity where possible, describe a positive change to be worked towards as opposed to simply stopping certain behaviours be reflective of something that the client wishes to and can be realistically expected to achieve indicate how frequently and for how long the behaviour would be sustained for.

Mark An example… Problem statement Reframed as a Need statement My main problem is my fear, accompanied by unpleasant physical sensations, that when I am out I will be attacked and the consequence that I stay in, do not do my shopping and do not mix with my friends. Reframed as a Need statement I need to overcome my fear of being attacked sufficiently to allow me to see to my everyday needs. Goal statement During the next week I will visit the local shop 3 times to get milk and bread and I will stay and have a conversation with the shop assistant.

Goal setting in graded exposure Education Collaboratively constructing a hierarchy Collaboratively constructing an action plan

Why avoidance DOESN’T WORK ! Facing up leads to Habituation!! 2 4 6 8 10 Anxiety “This slide will show you why Avoidance doesn’t work.” Explain the graph & relate the anxiety scale to students 0-10 ratings in their Daily Diary. Ask students to imagine a situation that is stressful for them personally, & that they would normally avoid – check that they all have one in mind. Then ask students to imagine their anxiety level starting off at 0, but that you then made them face that situation – ask what their anxiety level might rise to, & how suddenly – click – now say that you will allow them to escape the situation – ask what would happen to their anxiety level – click – now ask them to rate what would happen to their anxiety level if 2 hrs later you made them face the situation again – click – and if you allowed them to escape – click – and 2 hrs later you made them face it again – click. Suggest to students that their anxiety level continues to reach the same peak because they haven’t learned whether their STRESSFUL THOUGHT (link back) that’s DRIVING THEIR FEAR is TRUE OR UNTRUE – they haven’t tested it out. Get students to imagine the same scenario, but they stay in the situation – anxiety level peaks, remains high for a period of time, then (here link back to sympathetic/parasympathetic autonomic nervous system info from Session 2) will at some point start to drop. Ask students what they will have learned by staying in the situation – and what that might do to their original stressful thought driving the fear. Repeat, demonstrating the gradual decline in intensity and duration of anxiety level with repeated exposure. Emphasise that exposure has to be prolonged for long enough for the anxiety level to decline, and repeated a sufficient number of times for habituation to be achieved – explain the term “habituation”. Ask students if they have any questions. Ask students if they can now see the reason for Facing Up. Go on to next slide. Time

8 7 6 5 4 3 2 1 Shopping in Tesco Extra Saturday morning Shopping in Tesco Extra Thursday teatime 7 Shopping in Tesco Extra Wednesday morning 6 Shopping in Tesco Metro Friday teatime 5 Shopping in Tesco Metro Tuesday lunchtime 4 Shopping in Tesco Metro Monday afternoon 3 Shopping in local SPAR Saturday morning 2 Get students to imagine someone who avoids doing their shopping in supermarkets at busy times because they fear that they may start to panic while standing in the check-out queue. For this person, on a 0-8 scale, shopping in Tesco Extra on a Saturday morning might represent their maximum level of anxiety. Ask whether there would be drawbacks to tackling this fear by proceeding directly to doing their shopping in Tesco Extra on the next available Saturday morning. Get students to suggest an alternative approach. Reinforce their suggestions by the idea of a stepped hierarchy, and get students to make suggestions about intermediate tasks and where they might appear on the hierarchy. Plot these on flipchart or whiteboard, and use variations in students’ ideas about the relative difficulty of different steps to reinforce that this should be tailored to suit the individual’s unique problem. When ready, reveal the steps on the hierarchy, but emphasise that these are meant to illustrate one individual’s chosen approach. Use the hyperlink to the Action plan form to demonstrate the importance of goal planning to achieve each step and refer students to the guidelines in the manual about goal planning. Shopping in local SPAR Monday afternoon 1 Action plan

Taking my wife for a meal in a pub in the city centre on a rugby international match day 8 Use what you have learnt to assist this client to construct a programme of graded exposure to enable him to achieve his goal. Get students to imagine someone who avoids doing their shopping in supermarkets at busy times because they fear that they may start to panic while standing in the check-out queue. For this person, on a 0-8 scale, shopping in Tesco Extra on a Saturday morning might represent their maximum level of anxiety. Ask whether there would be drawbacks to tackling this fear by proceeding directly to doing their shopping in Tesco Extra on the next available Saturday morning. Get students to suggest an alternative approach. Reinforce their suggestions by the idea of a stepped hierarchy, and get students to make suggestions about intermediate tasks and where they might appear on the hierarchy. Plot these on flipchart or whiteboard, and use variations in students’ ideas about the relative difficulty of different steps to reinforce that this should be tailored to suit the individual’s unique problem. When ready, reveal the steps on the hierarchy, but emphasise that these are meant to illustrate one individual’s chosen approach. Use the hyperlink to the Action plan form to demonstrate the importance of goal planning to achieve each step and refer students to the guidelines in the manual about goal planning.

GOALS Here are some examples of vague, global goals “I want more friends” “I want to do something useful with my time” “I want to feel better” “I want a relationship” “I’d like to go out more” “I’d like to have more interests”

GOALS Use the steps of the skill to assist the client to convert the vague goals into good goal statements