Formulating Needs and Goals

Steve WoodLecturer

“Well, my main problem is that meeting people

makes me anxious.”

“In terms of your mental health, how would you describe your

main problem at the moment?”

“My main problem is my feelings of anxiety and images of making a fool of myself, accompanied by

sweating, muscle tension and nausea and an urge to run away whenever I have to meet unfamiliar

people. The anxiety and physical symptoms are quite severe and it occurs at least twice each week. This is affecting my employment, as I have to deal with personal enquiries by members of the public; I

have stopped going out socially and my friends have started not to invite me; and it is causing rows

between myself and my partner.”

Into something like this… You have helped the client convert this…

“So, your main problem is your feelings of anxiety and images of making a fool of yourself, accompanied by sweating, muscle tension and nausea and an urge to run away whenever you have to meet unfamiliar people.

What would have to change for that to no longer be a problem?”

“Well, if I didn’t have to meet unfamiliar people.”

“Okay, but you’ve told me that it’s an essential part of your job, and your job’s very important to you.”

“Yes, well, if I felt I was at least able to keep the sweating and nausea

under control.”

“So, you need to know a way of keeping those body symptoms under control when you have to meet unfamiliar people.

Does that sound right?”“I suppose so.”

“There are simple techniques you can learn to do that. Does it sound like something that we might be able to work on?”

“In terms of your mental health, how would you describe your

main problem at the moment?”

I worry about my heart.

You have helped the client convert this…

My problem is that I worry excessively about my physical health, particularly about my heart. Whenever I need to do

anything that involves exertion I start to worry that it will cause a heart attack. I constantly tune in to my heart, take my pulse, and read everything I can about heart attacks and how to avoid them. My body is constantly tense and I tend to get headaches,

which I put down to high blood pressure and this makes me worry even more, in case it’s damaging my heart. I never exert myself – never run for a bus, run with the children, try to avoid sex and so on. It’s getting so bad that some days I hardly get

out of the house. It’s affecting life at home, because I don’t do anything around the house; social life, as I avoid doing sport and other things I used to do; it’s causing rows with my partner and affecting my

relationship with the kids.

Use the steps of the skill to assist the client to reframe this problem as a need.

Into something like this…

So, your main problem is that you’re preoccupied with thoughts that exerting

yourself will bring on a heart attack and that these are leading to you constantly checking your pulse and

avoiding exertion.

What would need to change for that to no longer be a problem?

“In terms of your mental health, how would you describe your

main problem at the moment?”

I’m so depressed since I lost my job.

You have helped the client convert this…

My main problem is my low mood which has come on over the past 2 months since I lost my job. I’ve got no energy, get tired out easily, I’ve lost my appetite and can’t sleep. I find myself crying for no reason, and sometimes I’ve gone shopping and spent more than I could afford to try and cheer myself up. I’ve stopped seeing friends and lost interest in my hobbies.

Into something like this…

Use the steps of the skill to assist the client to reframe this problem as a need.

“So, your main problem is your low mood which has come on over the past 2

months since you lost your job. You’ve got no energy, get tired out easily, lost your appetite and can’t sleep. You find

yourself crying for no reason, and sometimes gone shopping and spent more than you could afford to try and

cheer yourself up. You’ve stopped seeing friends and lost interest in your hobbies.

“What would need to change for that to no longer be a

problem?”

In a family situation, this may be more complicated…

Consider the following example –

Jo, 22, finds it difficult to get out of bed in the morning.

Brian, Jo’s father, thinks Jo is lazy and that it would be much better if Jo went out and got a job.

Mary, Jo’s mother, is anxious about placing too many demands on Jo.

One morning, Jo is still in bed at 10am. Brian has been up since 8am and is about to take Mary to the supermarket. Just before they leave, Brian calls out “Isn’t it about time you were up? You said you were going job-hunting today.” Jo yells “You’re always on at me. Why don’t you leave me alone?”

Using the steps of the skill –

assist Brian to reframe this problem as a need.

Using the steps of the skill –

assist Mary to reframe this problem as a need.

Using the steps of the skill –

assist Jo to reframe this problem as a need.

Together, synthesise these needs so that you can offer the family something they can all sign up to work on.

Goal statements

Goal statements should:describe what the client would like to achieve in relation to the identified problemdescribe a behaviour that, when consistently implemented, would indicate a reduction in problem severitywhere possible, describe a positive change to be worked towards as opposed to simply stopping certain behavioursbe reflective of something that the client wishes to and can be realistically expected to achieve

indicate how frequently and for how long the behaviour would be sustained for.

Mark

Problem statementI am afraid that I will be attacked when out and as a consequence I stay in and do not mix with my friends.

Goal statementThree times a week I will visit the local shop to get milk and bread and I will stay and have a conversation with the shop assistant.

GOALS

“I want to feel better”

“I want to do

something useful with my time”

“I want more

friends”“I want a

relationship”

“I’d like to have more interests”

Here are some examples of vague, global goals

“I’d like to go out more”

GOALS

Use the steps of the skill to assist the client to convert the vague goals into good goal statements

GOALS

“I want to feel better”

GOALS

“I want a relationship”

GOALS

“I’d like to have more interests”

GOALS

“I’d like to go out more”

GOALS

“I want more

friends”

GOALS

“I want to do

something useful with my time”

Why avoidance DOESN’T Why avoidance DOESN’T WORK !WORK !

Anx

iety

0

2

4

6

8

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Time

HabituatioHabituation!!n!!

Facing Facing upup

leads leads toto

Breaking stressup

Shopping in Tesco Metro Monday afternoon

Shopping in local SPAR Monday afternoon

Shopping in local SPAR Saturday morning

Shopping in Tesco Metro Tuesday lunchtime

Shopping in Tesco Metro Friday teatime

Shopping in Tesco Extra Wednesday morning

Shopping in Tesco Extra Thursday teatime

Shopping in Tesco Extra

Saturday morning 8

7

6

5

4

3

2

1

Action plan

Taking my wife for a meal in a pub in the city

centre on a rugby international match day

8Use what you have learnt to assist this client to construct a programme of graded exposure to enable him to achieve his goal.