What do you hope to be able to say is true as a result of engaging in counseling?
To provide a broad context for answering this question, please consider reading this entire page before beginning.
Treatment goals. Please open an email, address it to “anne@annegiles.com,” type “Treatment Goals” into the subject line, then copy and paste the following text into the body of the message. Please back over the underlines and fill in the blanks.
Try to use language that precisely expresses your own observations and insights. Try to use as little jargon as possible.
“I perceive my primary challenge to be __________. I am engaging in counseling founded in cognitive theory and the findings of neuroscience – all the while basking in the sun of self-kindness – to become more independently skillful at managing the interrelationship between events, feelings, thoughts, words/actions, relating to, and working with others.
In my own words, this is what I think the problem is and what I think would solve it: _____________________.
The primary feeling* I hope to be able to regulate is __________. The secondary feeling** I hope to be able to regulate is __________. The primary pattern of problematic thinking I hope to be able to challenge is __________. The primary behavior about which I hope to be able to make conscious choices is __________. I expect my relationships would work more smoothly if I were able to do this – __________ – and not do this – __________. Although I might wish it were different, I imagine if I accepted this reality – __________ – I might experience less distress.
I intend to gain more skill with __________, __________, and __________. Having more skills in these areas will help me achieve my primary goal of __________.
I will know I have made 50% progress towards my primary goal when I __________.
I will know I have made 75% progress towards this goal when I __________.
I will know I have exceeded 75% and thus reached a satisfying level of progress towards my primary goal when I have achieved _________%.
The evidence I have reached this level will be achievement of this milestone: __________.
I expect achieving this overall plan will take __________ weeks/months.
Specifically, I expect to achieve my primary goal by __________ (date).
My current level of progress towards my primary goal is __________%.
The primary actions I need to take to help myself achieve a further level of progress are __________, __________ , and __________ .
The specific steps I will take within the next 2 to 3 days will be to __________, __________ , and __________ .
When I have achieved this level – although I have the freedom and power to do this at any time if I am not progressing towards my goals at the rate I had hoped – I can conduct a cost-benefit analysis with rank ordering to decide whether to 1) discontinue counseling, 2) continue with my current counselor to a) deepen my gains for this treatment goal and/or b) establish a new goal, and/or 3) work with other counselors using other modalities to see what additional gains I might achieve.”
*Primary feelings are natural feelings that go along with being human and happen automatically without thought: mad, sad, glad, afraid, surprised, disgusted, alarmed (includes fight-flight-freeze response).
*Secondary feelings happen as a result of thoughts – often thoughts that are opinions, beliefs, or rules – that cause feelings of shame, guilt, humiliation, self-blame, mistaken other-blame, regret, rage, panic, despair, jealousy, righteousness, vengeance, and “ideations,” i.e. intrusive thoughts or fantasies of harm to self or others. Secondary feelings that result from thoughts cause suffering through 1) escalating natural feelings, 2) causing painful feelings, 3) creating a sense of “no escape,” which can result in feelings of rage, helplessness, and hopelessness, 4) increased reactivity vs. conscious choice, and 5) creating troubled interactions with others.
In my private practice, we update treatment goals every 3 months.
Once you have filled in the blanks, please send me this email. Thank you!
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Trauma timeline. If you have experienced significant traumas in your lifetime and are considering counseling for trauma, creating a trauma timeline may be useful. The directions are here.
Case history. If you think it might be helpful for you to write a case history, this explanation and outline might be useful. Adding a timeline of the major events in your life, from birth to present, may offer you and your care providers insights about what might be helpful next steps.
Case conceptualization. If you think it might be helpful for you to write a case conceptualization – a case history plus hypotheses as to how and why things are as they are – this example from Scott Branson, Ph.D. may be useful. For a comprehensive overview, this chapter from Collaborative Case Conceptualization may be of assistance.
“The true teacher defends his pupils against his own personal influence. He inspires self-trust. He guides their eyes from himself to the spirit that quickens him. He will have no disciples.”
– Amos Bronson Alcott, 1799-1888, educator, reformer“The ABC Worksheet is…the first of several worksheets that build on each other and are used across CPT [Cognitive Processing Therapy]; the ultimate aim of these worksheets is to have clients become their own cognitive therapists.”
– Resick et al., Cognitive Processing Therapy for PTSD: A Comprehensive Manual, 2016, page 111Becoming One’s Own Cognitive Therapist, this blog, 10/20/21
Last updated 7/4/23
This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.
