3.B.2
Setting goals: from crisis to quality of life
ASPPB's competency statement 3.B.2: Plan and implement treatments/interventions to meet the goals (e.g., positive change, symptom reduction, crisis stabilization, quality of life) of individuals, couples, families, groups, systems, or organizations
Treatment goals differ in kind and in level. Kinds include crisis stabilization, symptom reduction, positive change in skills or relationships, and quality of life; levels run from one person to a couple, family, group, organization or wider system. A plan orders goals by urgency, with safety first, and states them so progress can be seen. Goals agreed with the client relate to better outcomes, so setting them together is part of treatment, not paperwork.
Key ideas
- Crisis stabilization
- When safety is at risk, the first goal is to reduce immediate danger. The Safety Planning Intervention, a prioritized list of coping strategies and contacts, combined with follow-up calls, was associated with less suicidal behavior after emergency care (Stanley and colleagues, 2018).
- Symptom reduction
- Many plans target symptoms found in the assessment, such as depressed mood or panic frequency, measured with a standard scale before or during sessions so that change can guide treatment (Lewis and colleagues, 2019).
- Positive change and quality of life
- Goals can also concern skills, relationships, work and meaning. Symptom change and quality of life can diverge: CBT for health anxiety reduced symptoms markedly but had limited effect on quality of life (Axelsson and Hedman-Lagerlöf, 2019).
- Level of intervention
- The handbook names individuals, couples, families, groups, systems and organizations. The level shapes the goal: a family goal might be calmer evenings at home, an organizational goal a change in policy or practice (ASPPB, statement 3.B.2).
- Goal consensus
- Agreement on goals relates to outcome: r = .24 across 54 studies, with collaboration r = .29 across 53 studies; the authors advise seeking clients' input on goals throughout therapy (Tryon and colleagues, 2018).
Worked example
A 44-year-old restaurant owner is seen the day after an emergency visit for suicidal thoughts, which began when his business failed. He keeps a hunting rifle at home and sleeps about three hours a night. His wife came with him and wants to help but does not know how.
- Crisis stabilization comes first: assess current risk and write a safety plan with him, covering warning signs, coping steps, people to contact and professionals to call, and agree that the rifle will be stored outside the home for now.
- Bring in the couple level: with his consent, give his wife a defined part in the safety plan, such as knowing the warning signs and whom to call.
- Once he is safer, set symptom goals, such as longer sleep and lower scores on a standard depression measure, and agree how often they will be checked.
- Then add quality-of-life goals he names, such as deciding about work and rebuilding time with his children, so treatment aims beyond the end of the crisis.
Order goals by urgency, set each at the level that can change it, and agree every goal with the client.
Check yourself
A psychologist writes treatment goals from the assessment and hands the client a copy at the second session. What does research on goal consensus suggest?
Sources
- Stanley, Brown, Brenner and colleagues (2018), Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department, JAMA Psychiatry (PMID 29998307), Abstract; intervention and results
- Stanley and Brown (2012), Safety Planning Intervention: A brief intervention to mitigate suicide risk, Cognitive and Behavioral Practice, Steps of the safety plan, including making the environment safe
- Lewis, Boyd, Puspitasari and colleagues (2019), Implementing Measurement-Based Care in Behavioral Health: A Review, JAMA Psychiatry (PMID 30566197), Abstract; definition of measurement-based care
- Axelsson and Hedman-Lagerlöf (2019), Cognitive behavior therapy for health anxiety: systematic review and meta-analysis of clinical efficacy and health economic outcomes, Expert Review of Pharmacoeconomics and Outcomes Research (PMID 31859542), Abstract; quality of life
- Tryon, Birch and Verkuilen (2018), Meta-analyses of the relation of goal consensus and collaboration to psychotherapy outcome, Psychotherapy (PMID 30335451), Abstract; results and therapeutic practices
- ASPPB (2026), The integrated EPPP Candidate Handbook, Appendix F, Statement 3.B.2