Using the goals and the goal-based outcome (GBO) tool to help shared decision-making
The process of shared decision-making is important all the way through any intervention with children, young people and families with mental health or emotional well-being issues. Even the things that may seem like small, almost insignificant, decisions to clinicians can feel like big deals to young people – so we should treat each decision with equal seriousness. There are some decisions that are clearly big to both and decisions about what to work on in therapy definitely fall into this category.
In the past therapy was seen as a ‘gift’ – something precious and valuable that young people should accept with good grace. With gifts, you got what you were given and you weren’t expected to have a say in what you got. We now, more helpfully, see therapy as a journey that a young person and therapist go on together. Like all journeys, we need to have an idea about where we want to get to, or at very least the general direction of travel. And like all journeys we take with someone, we need to have agreement on where we are heading to and how we might get there.
The goal-based outcome (GBO) tool is a simple clinical tool devised to help facilitate discussions with young people about what they might want to get from the effort it takes to engage in any therapeutic process. The tool is as simple as they come: a few boxes to write down what the therapist and young person have agreed to work on together in therapy. Some young people have a pretty clear idea where they want to get to and what they want; others might take a while to decide. It is fine and helpful for therapists to make suggestions on what they think might help, as long as these are presented as options and choices.
The tool is simple but to use it well requires a great deal of sophistication and the synthesis and application of good clinical research and practice. Put more simply, goal setting is good shared decision-making and good shared decision-making isn’t easy for either party. But it is worth the effort – getting goal setting right at the start gives young people a good experience of a therapist who is willing to listen and wanting to work with them; to hear where they want to go and travel with them to help them get on their way. Research suggests that good, collaborative goal setting leads to a better therapeutic relationship, which in turn leads to better clinical outcomes.
The GBO tool also has the numbers zero-to-ten next to the boxes to write in goals. The numbers allow the tracking of progress (or lack of it) towards reaching these goals. The numbers should lead to discussion about how things are going, and consequently, further discussion and shared decisions about how to proceed. If we manage to do this well we can journey a while together. If we don’t manage this well, we are likely to find there is soon a parting of the ways…..
Duncan Law is a Consultant Clinical Psychologist
For more information and ideas on using goals in therapy and to download free PDF versions of the goal-based outcome tool please visit www.goals-in-therapy.com