Patients' perceived lack of goal clarity in psychological treatments: Scale development and negative correlates

Abstract

Goal setting in psychological treatments may have favourable effects on patients' motivation and treatment outcomes. Therefore, it seems important to detect when patients do not perceive clear treatment goals. The current study presents a questionnaire measuring patients' perceived lack of goal clarity. The cross-sectional study consisted of 742 adult outpatients with diverse mental disorders. Patients completed the perceived lack of goal clarity questionnaire, and additional items measuring goal setting and evaluation, therapeutic alliance, symptom levels, patients' dependency on their treatment, and their expected and needed number of future treatment sessions. Exploratory factor analysis and reliability analyses resulted in a unidimensional and reliable questionnaire (nine items, α = .85). Additional findings showed that 23% of the treatments lacked initial goal setting according to the patients. Also, perceived lack of goal clarity was lower when treatment goals were established explicitly at the start of treatment, were formulated together with the therapist, and were discussed regularly during treatment, and treatment progress was monitored regularly. Moreover, patients reporting their goals as unclear also reported a poorer quality of the therapeutic alliance, higher symptom levels, increased need for future sessions, but also lower levels of care dependency. These findings underscore the importance of perceived goal clarity in psychological treatments, although the relation with actual goal setting remains uncertain.

Agency via Awareness: A Unifying Meta-Process in Psychotherapy

“…For instance, we would hypothesize that patients' agency within the therapy context, as measured by the Therapeutic Agency Inventory (Huber et al, 2019), would be related to and preceded by their observerrated insight (Jennissen et al, 2018), emotional awareness (Høglend and Hagtvet, 2019), and reflective functioning levels (Fonagy and Target, 1996;Fonagy et al, 2016), as well as less frequent use of immature defenses (Perry, 1990). Likewise, we would hypothesize that increases in clients' awareness (Geurtzen et al, 2020) and internalization (Pelletier et al, 1997) of their own therapeutic goals would precede and predict increases in therapeutic gains as well as general self-efficacy (Schwarzer and Jerusalem, 1995)-a measure closely tied to our understanding of physical agency.…”

The use of goal‐based outcome measures in digital therapy with adults: What goals are set, and are they achieved?

“…Lack of structure, perhaps evidenced by a lower number of chat sessions, could explain why less progress is made towards self-set goals. Indeed, making explicit, collaborative goals, and discussing these regularly, is associated with lower levels of negative mental health symptoms in therapy (Geurtzen et al, 2020). Much work may be needed to ensure that digital therapeutic platforms promote structure around self-set, as well as collaboratively set, goals.…”

“…Setting and monitoring goals within therapy can enhance service‐user motivation, and increase the likelihood of favourable therapeutic outcomes (Geurtzen et al, 2020). Tangible “goals” within psychology were defined by Austin and Vancouver (1996) as “internal representations of desired states” (p. 338), with goal‐focused therapy centred on the devising of clear objectives.…”

“…In addition, another study found that depressed patients articulated goals that were less clear and coherent in the aim that they expressed (Dickson & Moberly, 2010). Higher clarity and tangibility of expressed goals are linked to better therapeutic outcomes, including reduced symptoms, and a lower need for further sessions (Geurtzen et al, 2020). When such goal clarity is achieved through collaborative dyadic goal setting with a therapist, these positive outcomes become even more likely (Tryon et al, 2018; Tryon & Winograd, 2011).…”

Guided Goal Setting in Therapy Towards Being Fully Functioning

“…Given a widespread acceptance that goals assist therapeutic processes, the research agenda has turned more recently to the way in which goal setting can best be managed. For example, the clarity of the goals set is regarded as important, with Geurtzen et al (2020) reporting that clients who said that their goals were unclear found the therapeutic alliance to be reduced, they reported their symptom levels to be higher, and had a greater need for future sessions. The process used to define goals is also seen as significant, with a collaborative approach being preferred: In their meta-analysis of studies of goal consensus and collaboration across therapeutic orientations, Tryon et al (2018) concluded that when therapists and their clients agree on psychotherapy goals and actively collaborate, they tend to have more positive treatment outcomes.…”