How do you think about a client’s goals in therapy?
Are there other goals to pay attention to besides symptom relief?
Is there a way to measure the effectiveness of therapy based on a client’s progress towards their goal?
If any of these questions resonate to you then I hope you’ll find today’s post helpful. A client’s goals can be one of the most orienting parts of therapy. Whenever I am unclear about what is happening in a given therapy, I always go back to a client’s intake form to read the goals they listed for therapy. Doing this helps me to view what I find unclear with the following question in mind: “how might what is happening in the therapy now reflect a way the client is working towards one of their stated goals?”. The theory of therapy I work from – called Control-Mastery Theory – holds a lot of respect for the client’s goals. That is one of the reasons I find this approach so effective for survivors of narcissistic abuse. In today’s post – part 2 of a 6 part series – I’m going to discuss how Control-Mastery Theory thinks about client goals, how to infer and define goals with your clients and how to discern goals that will further a client’s development vs a goal that does not.
Today’s post is the first in a series on CMT and how you can learn to apply this theory in your own clinical work. It’s a 6-part series that covers these topics:
Part 1 Overview of Control-Mastery Theory
Part 2 The Client’s Goals
Part 3 The Client’s Pathogenic Beliefs
Part 4 The Client’s Key Traumas
Part 5 How Clients may Test Pathogenic Beliefs
Part 6 Five steps to case formulation
This series is about CMT in general. If you want to learn more about how to apply this form of therapy specifically to survivors of narcissistic abuse then check out my 3-hour online course on the topic.
My name is Jay Reid and I’m a licensed psychotherapist in California who specializes in the treatment of survivors of narcissistic abuse. I work from a form of therapy called Control-Mastery Theory which prizes the client’s efforts to overcome the trauma of narcissistic abuse and realize a fuller and richer quality of life for themselves. If this topic interests you then I encourage you to learn more by getting my free e-book on ‘Effective Therapy with Survivors of Narcissistic Abuse: The basics of Control-Mastery Theory’
An example of a goal in therapy
A client comes to therapy with a purpose. Something in their lives feels missing, unfulfilled, or distressing. Clients will typically state in the first few sessions what they hope to gain from therapy. You may even formalize this process and ask them in a form. From the perspective of Control-Mastery Theory, a client’s goals usually point to a developmental milestone they had to give up in order to adhere to a pathogenic belief that helped them avoid the danger of losing their relationship with a compromised parent. You can understand what I mean by ‘pathogenic belief’ by watching part 1 of this series.
Let’s continue with case example of Sarah that I used in part 1. As a reminder, Sarah had a depressed father who would only seem to feel better when she was home and trying to cheer him up. To prevent her father from falling into a consistent depression and being wholly unavailable to her she adopted the pathogenic belief that “If I don’t take responsibility for other’s emotional wellbeing then they will fall into depression”.
Sarah came to therapy complaining of constant anxiety, feeling stressed, and unable to rest. In learning about her history with her father, her therapist inferred her pathogenic belief and suspected that her symptoms of anxiety, vigilance and stress were a result of her having to pay more attention to others than herself. Sarah stated that her goal for therapy was to “feel less stressed.” In her first few sessions, she said that she was an avid swimmer when she was a teenager but did not feel like she could take time for herself these days engage in this activity.
Her therapist inferred that Sarah wanted to resume her developmental goal of taking responsibility for her own emotional well-being and freeing herself from the misplaced responsibility for others’ well-being. However, it is important to define a goal that is more measurable. A goal, for instance, is less effective when it is simply the opposite of a pathogenic belief as the therapist’s inference essentially was. Ideally a goal is concrete and can be observed. So, her therapist thought about what Sarah had said in the first few sessions and reasoned that if she were to resume swimming – or some form of exercise she enjoyed – that this would be observable and reflect that she was putting her own needs first and feeling less compelled to focus on the needs of others all the time.
This example is meant to capture the thought that goes into inferring a client’s goals. As you begin to understand the pathogenic beliefs held by the client and the kinds of traumas that led them to adopting those beliefs in the first place, it will become easier to infer the kind of life changes that might reflect the client has resumed pursuit of a developmental goal that had to be sacrificed to survive the earlier traumas.
What if the client has a goal that seems unhealthy?
An important rule of thumb when inferring a client’s goals is to be careful where you place your therapeutic allegiances. Sometimes a client may who believes that they must be perfect to be loveable can express goals in line with this pathogenic belief. If a client says, for example, that they want to be able to not make any mistakes at work ever then a therapist may do well to wonder if this goal reflects the client complying with a pathogenic belief rather than resuming their own development. There’s more to say on discerning the goal that will reflect the client’s resumed pursuit of their own developmental aims. If you’re interested in learning more I encourage you to check out my online course on Effective therapy with survivors of narcissistic abuse. This 3-hour course shows you how to apply the principles of CMT to the specific goals, pathogenic beliefs, and traumas of survivors of narcissistic abuse. Whereas this series is a more general treatment of CMT and how to apply it, the course focuses on survivors of narcissistic abuse much more extensively.
Jay Reid is a Licensed Professional Clinical Counselor (LPCC). If you are considering therapy for overcoming a childhood with one or more narcissistic parents please contact me for a free 15-minute phone consultation.