Can Therapy be Successful Without Goals and Objectives?
Can therapy exist without goals and agreements? Can success be achieved without the setting of concrete goals?
Michael Broda is a psychotherapist who works with people suffering from borderline personality disorder (BPD). He claims that, after several hospitalizations, these patients are generally more knowledgeable than professionals about specific therapy techniques for BPD.
However, when these techniques don’t work, therapists have to reach for more honest goals with their patients. For example, a simple non-suicide pact implies carrying out a therapeutic act without having first established specific objectives and agreements.
An inconceivable idea for psychology professionals?
Therapy isn’t a paid friendship. It’s a professional service. A service like any other. The client pays the agreed amount and the provider provides the professional service. These two things (and more) are included in informed consent.
There’s usually an agreed goal of the service, an end date, and, in many cases, also several agreed sessions. In fact, therapy focuses on a measurable goal of change. Therefore, there must be a measurable goal, no matter what the end condition is.
If there are no objectives or agreements, therapy is merely an informal relationship
Psychologists provide a service based on feelings and emotions. Although these aren’t always exactly clear, they can be identified to an extent.
A patient may enter therapy feeling extremely anxious and unable to perform their daily tasks. Although anxiety can’t be quantified exactly, a series of more or less approximate objectives can be established. As such, the individual progressively carries out relevant and important activities, spends less time being isolated, consumes fewer anxiolytics, etc.
On the other hand, friendships have no goals. Friends get together and just talk. They kill time together with no final objective beyond being together. It’s simply about each other’s company, not what they want from each other.
However, if a patient goes to therapy on a weekly basis and simply talks or vents their feelings, it isn’t therapy. Therapy requires a clear goal. In addition, therapy is temporary. It doesn’t continue with no end in sight.
Even for clients who’ve been in therapy for years, there are regular measurements of progress toward a specific goal, and these goals may change over time.
Without goals, there’s no real collaboration
Collaboration is central to building customer autonomy. Otherwise, without transparent collaboration, we’re left with an expert/client dichotomy.
The therapist is the psychological expert and the client is the expert on their life. The two meet in the middle and collaborate. The client is seen as a fundamental part of the therapy and not as the receiver of the therapy.
Not having a goal in therapy and simply wandering into the consulting room every week means the client develops a dependency on the therapist. Moreover, the relationship becomes one of weekly relief.
However, goals build autonomy and success. It’s important to meet goals in life. They’re essential for building trust, setting healthy boundaries, and encouraging courage and autonomy. But goals can’t be reached if they aren’t set.
The need to change the idea of objectives
Some patients can’t talk about goals and agreements with their therapist yet they need urgent psychological help. Michael Broda reports an experience with one of his patients:
“Working with borderline patients is not always one of the most engaging activities in my daily therapeutic work. Relationship tests are too frequent. The patient questions ideas like ‘Is the therapist really supporting me?’There are few opportunities to regulate the excessive emotions leading to self-punishment and self-injury, all of which generally make the work not easy to structure.
Traumas, experiences of sexual violence, hard drugs, recurrent fears, and panic attacks as well as innumerable love breaks characterize the biography of many patients. I told one of the patients with a more deteriorated mental state that I wanted to work with her on the condition that she didn’t attempt suicide until the next scheduled appointment or that she contact a therapist immediately if necessary.
She agreed to the no-suicide contract, but later told me that she thought nothing would happen to her if she ‘successfully’ broke it. She was surprised that I didn’t formulate more conditions, as she knew from previous stays at the clinic. From there, she just kept getting better. Establishing agreements in which patients are allowed to be as they want, without complying with anything and only paying attention to a specific point indicated by the therapist, can be the difference between life and death”.
Patients who ask for help, but don’t accept the need to assume goals or agreements
It’s not always mistrust or provocation that lies behind the reticence of a patient to carry out their own part in an intervention plan.
For instance, they may have been listening to what they should or shouldn’t do since they were little. Therefore, they don’t feel that doing something under the premise of “It’s for your own good” is worth it. These kinds of actions don’t play a significant part in their life history. In fact, they’re averse to them.
People don’t only attend therapy to change or let off steam. They also seek an intense emotional experience that activates their ability to return to the belief that life is worth living. This job requires, more than goals and agreements, a strong and healthy therapeutic relationship, as well as an existential dialogue about identity, the world, and the frustration that it sometimes generates.
In certain cases, instead of agreements, objectives, and commitments in therapy, some sessions can take place where nothing is agreed on. They won’t be any less professional for it. It simply means creating an environment of trust and work.
Sometimes, there are patients who need to gain some confidence and faith before wanting to start living their lives again. As a rule, they require an intervention plan that anticipates the main threats that their relationship with the therapist may suffer.It might interest you...