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New guidance notes on using the Goal-based outcomes (GBOs) out now

We have just published the latest guidance on using the goal-based outcome (GBO) tool.

It is free to download by clicking the link below

The goal-based outcomes (GBO) tool is a simple and effective method to measure progress and outcomes of an intervention.  It grew out of work with children, young people and their families in mental health and emotional well-being settings but can be used in any setting, that is change-focused and goal-oriented – including adult and physical health contexts. The GBO has been used extensively both in the UK and internationally.

The goal-based outcomes (GBO) tool is a tool to help facilitate collaborative goal-oriented conversations & to help track progress towards goalsand facilitate further collaborative goal-oriented conversations.

Copies of the GBO tool can be downloaded free by clicking the link below

For more information visit http://www.goals-in-therapy.com

Child friendly adaptations of the GBO by Livvy Hall, Great Ormond Street Hospital

Livvy Hall, a Clinical Psychology trainee has adapted the GBO into a more child friendly version. The adaptation was developed whilst Livvy was on placement at Great Ormond Street Hospital (GOSH).

This first adaptation is aimed at children aged 8 years old and under but may be helpful with older children to and those children who find visual cues more helpful than verbal instructions.

fig 1. Detail from the GOSH adaptation of the GBO for children aged 8 and under

PDF versions of the under 8s adaptation can be downloaded here

There is also a version aimed at 8 – 13 year olds

fig 2. Detail from the GOSH adaptation of the GBO for 8 – 13 year olds

PDF versions of the 8 – 13 adaptation can be downloaded here

The adaptations were made with permission from Duncan Law, the developer of the GBO. Like all the other GBO tools, the GOSH adaptations are licensed under ‘Creative Commons’ meaning it is free to download and use by anyone.

Understanding the difference between ‘vehicles’ and ‘destinations’ in goal-setting and goal-oriented practice

Duncan Law

January 2019

Goal-setting

A goal is simply what someone wants to change by engaging in an intervention. It is important to set collaboratively agreed goals with a client before setting out on the journey of therapy. Sometimes, when (or if) we ask someone what they want, they give us something that describes a processrather than an end pointof change.  Process goals can be fine and useful but they can lead to difficulties unless both practitioner and client are completely clear and agreed that they are working together on a process rather than working towards an end point of change.

‘Vehicles’ or ‘Destinations’

A simple travel analogy might help us understand the importance of this idea better: imagine for a moment we were travel agents and a client walked in to our shop.  We might ask them, “Where do you want to go on holiday?”.We would expect them to say something like: “Zanzibar”or “Blackpool”or “somewhere hot”or “somewhere I can ski”.  We would expect them to give us some kind of ‘destination’.  We would be very surprised and possibly puzzled if they answered the question: “Where do you want to go on holiday?”, with “on a train”or “by bike” or“fly”– i.e. they answered the question by describing the ‘vehicle’ and not the ‘destination’.   As travel agents we would reasonably ask, “….and where do you want the train / bike / plane to take you?”.This would give us the destination goal and we might them help the customer think about other vehicles that might get them to where they want to be. For example, if our travel customer who said they wanted to go ‘by bike’ paired this with their destination goal of ‘to New York’ we might want to understand their reasons for wanting to cycle to New York, but we might also help them consider other vehicles such as a plane or a boat that might get them there more effectively.  Once the destination and vehicle are agreed we can then help with some sub-goals: “Have you got a passport? Do you need any foreign currency? Do you have a suitcase? Etc…”

This process seems obvious if we use the analogy of travel and yet it seems more complex in clinical settings, but the process is the same.  When we ask clients some variation of, “what do you want to change?”,we might be given a ‘vehicle’ or process by the client: “I want my child to be diagnosed with ASD”or “I want CBT”or “I want to lose more weight”–  all these are processes or ‘vehicles’ that are important to the client, but in order to work together effectively, we need to understand what change the client hopes the diagnosis / CBT/ Weight loss will result in; we need to understand the destination or change they hope these processes (vehicles) will lead them too.

If we are presented with a process (vehicle), the question to ask, is some variation of, “…and what do you hope will be different if you get: the diagnosis / CBT / to lose more weight?”to which the answers might be: “I will understand my child better and can be a better parent / I’ll be less anxious / I will feel happier”.  Part of the task of setting goals is to make sure the task alliance is around a destination goal and not just the vehicle goal. 

Highly specialist services and goals 

The confusion around vehicles (processes) and destinations (change goals), is also driven by practitioners and services. This is more likely to occur in very specialised services where only one form of therapy is offered (only CBT or only psychodynamic psychotherapy etc.) or in diagnostic services that do not offer treatment themselves (e.g. ADHD assessment clinics or learning disability diagnosis services).   

If we return to out travel analogy: single therapy services and clinics are a bit like travel agent that are specialist in one form of transport or vehicle: a train company or an airline.  In these services the vehicle is ‘fixed’ by the context of the speciality of the services – you can go anywhere you like but it has to be by train / plane.  But even here it would be unimaginable not to ask the traveller: “where do you hope to get too on my train / plane?”.  And yet in clinical services we sometimes do forget to ask this fundamental question.  

Some clinical services are so specialised that they only offer one very specific thing e.g. autism spectrum disorder (ASD) assessment.  In travel terms this is like having a very high-tech train that only goes to one destination (a bit like the London to Paris Eurostar perhaps).  If someone booked a ticket on this service, even a seasoned travel agent might be excused for not asking, “where do you hope to get too by riding this train?”– the answer is so obvious the question is all but redundant.  This may be why in highly specialist services the client’s goals might not be asked about – if your service only does one highly specialised thing, then it may seem redundant to ask about a client’s hopes for the assessment. The question may seem redundant to the clinician but it is far from redundant for the client! The assessment process (vehicle) may be fixed and the destination (as for as the service is concerned) is also fixed (a positive or negative diagnosis) but for the client or family the diagnosis is only a stop-off on the way of a much longer journey. If we keep the bigger picture in mind, we are more likely to ask, “what are your hopes for this assessment?”,this opens up an opportunity to discuss the clients longer term destination goals – these might be surprising to the assessment service and might helpfully manage expectations of where a diagnosis on its own can take you. It can help focus aspects of the assessment and the subsequent report, to help the client with their onward journey.

Conclusion

It is important to avoid the potential traps of setting goals that confuse vehicles and destinations. Otherwise we may end up working with apparent goals that may be, just a statement of a process for reaching a goal but not a goal in itself. By reflecting on whether a stated goal really is a therapy goal that can be worked on collaboratively we are more likely to build a working alliance with the client and achieve a better outcome. 

More information on goals and goal-oriented practice can be found in:

Cooper, M. & Law, D. (eds) (2018) ‘Working with goals in psychotherapy and counselling’Oxford University Press

Cultural differences in goal-setting and GBO: please share your experiences

Goal-oriented practice and the use of the goal-based outcomes (GBO) tool has spread to a range of settings in physical and mental health in recent years.  It is used across Europe and in North America, Japan and Australasia and is being translated into different languages.  This spread means that the practice and the tools are increasingly being used across different cultures.  

We would like to hear from you about your personal and clinical experiences of using the GBO or goal-oriented practice with people across different cultures.

We are interested in things like:

  • What have you experienced in terms of different cultural attitudes to goal setting?
  • What ideas or techniques have you found helpful in explaining goals and the GBO?
  • What differences have you noticed in the sorts of goals that are set across different cultures?
  • What differences are there in peoples understanding of the concept of goals, goal-setting and rating goal progress?
  • What experiences have you had using the GBO with translators?

Please share your experiences via the ‘leave a reply’ link below or via the ‘contact’ page

Goal-Oriented Practice

Duncan Law

January 2019

Goal-oriented practice argues that the starting point of any intervention and the primary focus of therapy should be: “What do you want to change?”.  ‘What do you want to change?’, invites the client to share their hopes and wishes for the outcome of a therapeutic encounter: what they want to be different as a result of the effort and what resource they will need to invest in the therapy  – in short it asks for an expression of the client’s ‘goals’.  

Goal-orientated practice necessarily includes the need to understand the ‘problem’ through diagnosis or formulation, but it emphasises the primary purpose of therapy from being one of ‘understanding’ to being one of ‘change’.  This is not to play down the power of understanding as an intervention in creating shift, but in goal–orientated practice the emphasis is on the client’s wish for change and the therapy and therapist is guided by, and focused on, the change goal: “what I want to be different”.

In this sense goal-orientated practice is a therapeutic stance rather then a therapeutic model. Once a therapy goal has been collaboratively agreed it is possible to use any suitable intervention to reach it. Goal -orientated practice does not dictate any particular therapeutic model in which to reach the goal, but rather provides a focus, or a direction of travel, that the therapist and client have agreedto work on together to reach.  It works on the pluralistic principle that there are many potential vehicles that can take you towards the same destination. 

Goal-orientated practice is simply any therapeutic encounter that works towards helping a person move towards what they want to get out of the endeavour of a therapeutic intervention. A ‘goal’ is simply a shorthand for “what I want to be different if therapy is successful”.  Whatever phrase we choose to name ‘goals’, it is the concept behind the phrase: ‘goal -orientated practice’, that is of importance here. 

It might be argued that this is no different in purpose from pretty much all therapy.  The difference with goal -orientated practice is the degree to which the goals are made explicit, collaboratively agreed, perceived as jointly owned, and form a focus for change. In goal–orientated practice the goals of the client and the goals of the therapist are made explicit, and the therapy takes place where these goals overlap, are co-constricted and collaboratively agreed.

This blog is adapted from Law, D. (2018) ‘goal-oriented practice’ in Cooper and Law (eds) Working with goals in psychotherapy and counselling’OUP