Bridge the Gap Between Goal and Attainment

As Schut and Stam point out, goal setting “may be a powerful management tool, but setting goals is a delicate process.”5 Specific guidelines to assist clinicians in establishing goals are limited, although the need for such guidelines is well documented.^6,9 It is hypothesized that the most effective goals are grown from the ability of the clinician to establish a therapeutic relationship with the client, pursue individualized and client-centered objectives, and honor and support self-efficacy. Although some clients may come to therapy quite focused with specific goals, others are ambivalent about therapy or have limited insight into their needs. Motivational interviewing principles can help guide the goal-setting process by honoring client autonomy in light of clinical feedback and recommendations and by supporting a client’s willingness to put forth effort to make a change.

Motivational Interviewing

Motivational interviewing is a client-centered counseling style that is directed at discovering and enhancing a client’s intrinsic motivation for change. It is not a standardized technique to learn, but rather a directive method of interaction based on a spirit of collaboration, evocation, and respect for client autonomy. The relationship between the clinician and the client is considered a partnership rather than a more hierarchical relationship in which the clinician acts as an expert and the client acts as the recipient. The clinician using motivational interviewing principles structures the conversation to elicit and promote the client’s own motivational statements for a desired change or goal. These statements are known as “change talk.” The clinician selectively reinforces the client’s intent to change by reflecting upon and affirming the client’s change talk. This is done through the use of open-ended questions, affirmations, reflective listening, and summarization (OARS).¹⁰ (See Table 2, above.)

Use of each OARS component is carefully interwoven throughout the conversation to guide and emphasize the client’s reasons, needs, and desires to work on specific objectives.

Open-ended questions allow the clinician to gain a great deal of knowledge in a short time. An open-ended question invites the client to share what he or she feels is important and may help to establish a therapeutic relationship. To gain insight about a client’s perspective of his or her situation, a clinician may ask such questions as, “How has your arthritis pain affected your work?” or “What bothers you most about the stiffness in your fingers and wrists?” Such questions shape the conversation while allowing the client autonomy to address his or her concerns directly.