It can be difficult to know just what is “supposed” to happen in therapy.
The truth is that there are many different ways of doing therapy with a variety of different goals, and every therapist approaches things slightly differently.
Here’s how I think about creating goals:
When we start our work together, we will spend the first several sessions with me getting to know you and how you’d like to grow and change through therapy. Together, we will draft a “treatment plan.” Treatment plans are most often required by insurance companies to help justify coverage and they follow a pretty strict format based on reaching specific outcomes. In my practice, I see the treatment plan as a more flexible and organic document that we craft for us to make sure we are spending time on the things you want to work on in therapy. We will check in periodically about whether we’re following the “plan” and whether it needs to be revised.
The therapeutic outcomes you have in mind for therapy are individual to you. You might have a very specific goals like, “I will report less frequent symptoms of Generalized Anxiety Disorder as measured by the GAD-7 anxiety scale in six months time.” Your goals might also be more nebulous (but still just as valuable), such as “I will increase the social supports in my environment” or “my partner and I will improve at validating each other during conflict.”
Because this is your therapy, you get to decide what is most important to you to work on as well as how we will know if we’re meeting your goals.
At the same time, I have my own way of practicing therapy and a set of overarching goals about what “should” happen in therapy.
These goals are process goals. They’re goals about what I want to happen during the process of us working together rather than a specific outcome we are trying to produce.
The focus here is on the how instead of the what:
Moving out of the head and into the body. It’s one thing to have a cognitive insight about a pattern of behavior or to understand the research about a particular topic or diagnosis. It’s another thing to feel the sensations in your body shift and to notice the change in your mood or emotional state. Without attention to what is happening for you right now, we are missing an important part of how you process and make use of the valuable information your body is sending you. We’ll pay attention to shifts in your affect, demeanor, tone of voice, body posture, and manner of expression. This process of slowing down and paying attention in order to notice what is happening for you is a practice. We’ll do it in session together, and I’ll ask you to practice it outside of session, too.
Trying out something new. We’ll spend time together discovering the ways that you “do” you. How do you get your needs and wants met in life? Do you get stuck somewhere on the way to satisfaction of your desires? How and in what specific ways? We’ll pay attention to these patterns and put them in the context of your lived experiences and personal, familial, and cultural history. For example, if your habit is to state what you want and then immediately qualify it by saying it isn’t that important, we’ll get curious together about why you do this. Then, I might ask you to try telling someone else what you want and then saying it is important to you. The goal here isn’t to make you do things that aren’t authentic to you; the goal is a process goal of seeing what happens when you try something different. How did your body feel? Your emotions? How did others react? We’ll work together to find ways to experiment with new ways of doing that are novel for you. We’ll try them out in session. We’ll practice. We’ll non-judgmentally observe what happens when you try something “out of character” for you. We’ll be surprised together. Sometimes, you’ll take these new ways of doing outside of session (when you’re ready and you want to) to see if your life feels more satisfying and vital when you inhabit this new way of interacting with your environment.
Finding what works for you based on your own intrinsic measure. We’ll practice differentiating between what others have told you, what you’ve learned from your family, peers, or society, the unconscious habits you have just taken on over time, and your own conscious, agentive, intrinsic measure. By intrinsic measure, I mean your own felt, known, sensed, and intuited way of knowing that something is good for you. We’ll practice moving from “I should” to “I want to.” We’ll practice shifting from right/wrong to useful/not useful and from “I’m broken/damaged/messed up/bad” to “I have choices about how I show up in the world and how I want to be.” We’ll practice figuring your how you know what works well for you (and what doesn’t). This is your therapy and you get to decide. My job is to help you get to this place of intrinsic knowing.
We’ll build a relationship. Part of the process of therapy is learning to trust someone else with the most tender and vulnerable parts of yourself. We’ll work on this together and it will be a process, one where you have choice over what you share, how, and when. Sometimes, I will do or say things that don’t feel good or that make you wonder if you can trust me. That’s normal. We’ll practice working through those moments together. If we practice this well enough and can hang in there together as a team, we’ll develop a relationship that will support you in feeling comfortable enough to engage in the three process goals listed above each time we meet.