GBO End of year review 2020

First of all, we hope all of you are managing to stay safe and well and, for those of you who are on holiday, we hope you have had a good break.  It has been an unprecedented year in all sorts of ways: some very difficult (COVID-19), challenging (Brexit), others terrifying (the climate emergency), and some more hopeful of a brighter future (Black Lives Matter). Personally, I remain optimistic and hope and expect 2021 will be a year of recovery and regeneration. I have no wish for things to return to ‘normal’ but I do wish for the world to emerge different and better. How we achieve this, is by listening to new and seldom heard voices who can shed light on new ways of being and new ways of thinking. 

This is needed in the world of mental health every bit as much as in every other aspect of our lives. This is where the GBO has a small, but significant part to play in the new recovery. For those of you who work with the GBO tool, you will know that it is primarily a tool to facilitate better collaborative working. It generates a discussion about what the aims of the work together might be, it gives focus to the joint work between therapist and client and, most importantly of all, it invites us to hear the voice of the other.  The numbers generated, in rating the tool, should always be seen as an invitation to a conversation, to help understand the other’s view of progress and facilitate a discussion to help continue the work together. The numbers are also a useful by-product, that can be used to build practice-based evidence to show which interventions work in real world settings. 

The GBO is a feedback tool that also has its uses as an outcome measure. An outcome measure that tracks progress on the thing most important to the client and not the things that (predominantly white, western, male) academics feel we should measure. Admittedly, such ideographic tools create some headaches for statisticians, but this is for us to work out how best to make sense of what is important, rather than to measure what is easy. Part of the new recovery will necessitate us doing things differently, doing what is right, even though it might be hard, rather than doing what is easy, because this is what we have always done.

It has been an unprecedented year in the life of the GBO. In the UK, the GBO remains one of the most popular tools across child mental health services, well-liked by practitioners and clients.  2020 saw it become an officially mandated metric in the NHS Digital’s dataset, after a protracted trial period. Thousands of new practitioners are being trained in using the tool as part of the NHS new workforce strategy. To complement the traditional paper-based versions of the tool, and to meet with the demand as most therapy services went on-line, an interactive PDF version of the GBO was developed. Alongside this there have been interesting developments in digital versions of the tool: with permission, it is been incorporated into the Anna Freud Centre’s POD system and there has been an interesting pilot using client generated avatars in Herefordshire and Worcestershire Health and Care NHS Trust (a paper should be published in early 2021). Also of course, there is the longstanding research collaboration with CORC and the usual string of papers including the use of the GBO in paediatric settings, and commissioned paper for a special edition of the Journal of Clinical Psychology. 

The GBO is licensed under Creative Commons, meaning it is free to use by anyone, anywhere, always. Its development is entirely self-funded and it remains assertively independent of any organisation or institution. This freedom of use, along with its utility, have led to a global uptick in interest and use of the tool. It has now been translated into 7 different languages and we hope to add more in 2021. We were particularly pleased to enlist help to translate the tool into Russian, following a visit in late 2019 to the XVI European Congress of Psychology in Moscow. This has led to an international reach like never before: in the past year, there has been interest in the tool and its philosophy, across five continents (see the map below). Despite the COVID crisis leading to many plans being postponed – notably a collaboration with Western Australia, many initiatives have gone ahead, despite the difficulties, including: collaborations in Norway with the excellent BUP and University of Northern Norway, the submission of a promising research proposal in Aahus, Denmark, and the finalising of an implementation focused research trial with CHEO in Ontario, Canada.  

Global interest in the GBO in 2020

So, what of 2021? We are excited that we will finally see the GBO take centre stage at the postponed, first, international CAPA conference hosted by our colleagues in Nova Scotia, Canada in May, albeit virtually. A new chapter is in progress on a book on Low Intensity Interventions in child mental health settings, (COVID permitting) there will be face-to-face workshops in Norway and Australia, and work continues on an Italian translation of Cooper & Law (eds) (2018) ‘Working with Goals in Psychotherapy & Counselling’ OUP.

We want to end with a big ‘thankyou’ to all of you who have shown interest in the GBO and recognise its value. We would love to hear from you about your experiences of using it, as practitioner or client, feel free to get in touch with us using the contact form below. We would love to hear your tips, ideas, struggles and successes. Also, if you can help with translations of the form, we would love to hear from you too – we would particularly like to make the tool freely available across Africa and India – if you can help with Swahili, Urdu, Hindi, Gujarati translations etc. get in touch.

Finally, we wish you all a safe, successful and happy 2021; we hope you are able to make progress towards the goal of a better and brighter new future for ALL. 

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.

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 

Guidance notes for using the goal-based outcome (GBO) tool

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.

The tool tracks what is arguably the most important thing to measure in any intervention: “Is this helping you make progress towards the things that you really want help with?” 

This full guidance can be downloaded here

Hard copies if the guidance will be available from later this month please follow http://www.goals-in-therapy.com to keep up to date with publication details.