 Hi everyone and welcome to today's presentation on goal setting. Over the next 45 minutes to an hour, we're going to identify the purpose of setting goals, learn about smart goals and how to set them, explore ways to help clients identify their own goals, learn how to help clients increase and maintain motivation and identify the six most common pitfalls in goal setting and how to prevent them. One of the things that I've noticed over the past 20-some odd years working in community mental health is a lot of my clinicians, a lot of my supervisees had difficulties setting goals, treatment plans and documenting the goals on paper. They knew how they wanted to get their client from point A to point B, or at least generally what they wanted to achieve out of treatment, but breaking it down to articulatable incremental goals was a little bit more difficult, so that's what we're going to focus on in the first part. And then we're going to explore ways to teach our clients how to do this because of course part of therapy is helping clients learn how to set and achieve their own goals in the future. Goal setting is an integral part of treatment and it's something we do every day. I mean you get up in the morning and you're like you figure out well I want to well maybe I'm not that you want to. You need to go to work today. So you need to get to work, which means you've got to get up, get showered, get dressed, find your car keys, drive in. Those are all incremental steps to getting to work. Now we don't think about that on a typical day-to-day basis specifically what we're doing as we're doing it. It's sort of automatic, but it's something that somewhere along the way we develop this routine in order to get ready for work. There are a lot of other things that we do throughout the day that you can break down into smaller goals. Yesterday I went home and I had three loads of laundry to do. Some of it had to be soaked, some of it had to be pretreated, some of it had to be taken out of the dryer, so there were a lot of steps leading up to it. So some of the activities you can have people do to get them used to setting goals would be to take some simple daily activities and say what is your process for getting to work? What is your process for getting clean clothes? What is your process for? And use simple things. Making a casserole is another one. Recipes are pre-printed for you, so you know there you go. But we want to help people not feel like it's this overwhelming, oh my gosh, complex thing. It's not. It's small goals that will go from knowledge to skills to abilities. Knowledge being you have to have the general knowledge, skills applying it in a controlled setting, learning how to do it like you learn when you're in shop class, you learn how to use power tools, and then abilities, taking it out into the real world, practicing it and kind of honing those skills. Ineffective goals have a negative impact on self-esteem. So if clients are regularly setting ineffective goals, then they may feel like they can't achieve anything. And that's that all or nothing thinking that we're talking about. Sometimes all of us are going to set goals that we don't achieve. And that's a learning experience. We can look back on it and go, okay, what did I miss? How did I not do this so well? But if you're regularly not meeting your goals, then at a certain point, people either may decide, well, what's the point in setting them if I'm never going to achieve them? Or they may just kind of sit back and go, what's the point in trying? Ineffective goals can make people mistakenly think they're helpless to change anything. So our smart goals, specific, measurable, achievable, realistic and time limited. I want you to think about the last goal that you set that was successful, as well as the last goal that you set that was unsuccessful, and the difference between the two of them. A lot of times we set goals that are not specific enough. We set goals like, I want to start my own business. Okay, well, that's lovely. It's a great goal. But that's kind of big and we don't know what kind of business you want to start. And there are a lot of other factors that we need to hammer around. Another goal people set is I want to be happy, or I want to lose weight, or I want to get in shape. And my question to them is, okay, how will we know when you have achieved that goal? We need to be more specific about what is it going to look like? Which takes us to measurable. Can we measure when you've met that goal? And we're going to talk about different ways to measure goals as we go through this presentation. Is it achievable? If you want to lose 60 pounds in 30 days, that's probably not achievable. If you want to get in shape for a marathon in six weeks, for most people, that's not achievable. So we want to look and see, is this something that you can do? Is it realistic that you could achieve it in that time frame and get it done? Is it something that you're going to be able to do? At this point in my life, I'm not 18 anymore, deciding that I want to be an astronaut, probably not achievable or realistic. So when we're looking at our goals, and obviously most of our clients aren't going to want to be astronauts, but we want to be clear with them that they need to set goals that are achievable for them, not for their Aunt Sally, not for their children, not for whomever else, but for them. What's realistic and achievable? And it has to be time limited. Most of our goals, we can break down into smaller sub-goals that can be achieved in a day or in a week. But we don't want to have these super long goals that we won't achieve for 10 years without having some sort of mark point or end point in between. Think about when you went to college or when you went to school. A lot of us went to school for a whole lot of years because we wanted to be in this profession. But first, we had to graduate high school. There was an end point there, time limited. Then we had to go into undergraduate. And if your school was like mine, at 100 hours, they were starting to get antsy and they wanted you out the door. They're like, you can't be a professional student. You got to either go to grad school or get out. So that was time limited. Most people got their bachelor's in a certain amount of time. Master's degree was the same way. It was time limited. You weren't going to stay there in Dilly Dally forever, partly just because it was too expensive. But you knew that you were going to achieve it. You knew when you started the program, if you followed this path that they laid out for you, which classes to take, which semester, you would be out in two years. So if you were in a particularly hard semester, you could think to yourself, all right, there's light at the end of the tunnel. This semester ends in nine weeks. And I'll be finished with this professor or I will be graduating from the master's program in this many years or in this many months. So I can make it through. I've made it through this far. These are the things that are important to consider when setting the goals. When goals are not specific, measurable, achievable, realistic and time limited, a lot of times people will falter because they will not know when they've achieved their goal or they'll be trying to reach something that's just not achievable. And then we want to look at motivation. And we're going to talk about that today too, because no matter how wonderful and amazing your treatment plans or your goals are, if you or your client are not motivated to achieve them, whoever's setting the goal, if the goal setter is not motivated, you're not going to get very far because motivation by its very definition is kind of wanting to get up and do something. So where do we start? Well, we ask why? Goals are the overarching reason a person begins to do something. Often the goals that our clients come into treatment with are, I want to be healthy, healthier, I want to be happier. I want to then we need to break these goals down into manageable, meaningful, observable objectives. How will you know when you have gotten happier? How will you know when you're happier? What's going to be different? It's important to try to phrase goals as adding a positive instead of removing a negative. So I want you to think for a second about punishing a behavior. If you have this little child, and this little child is just wound tight, and he goes over and he starts pushing somebody and you tell him you can't push that person. He says, okay. And he goes over and he starts moving chairs around you say, you can't move chairs around. He says, okay, so I can't push people can't move chairs around. Then he goes over and he starts writing on the board and you say you can't write on the board. And he says, okay, I can't write on the board. I can't move chairs around and I can't push people. You're not giving him anything to do instead. So this little child ultimately will run out of behaviors because you told him he can't do anything. And he's just going to be standing there going I got a whole lot of energy and I'm about to explode. So you need to give me something to do instead. When we talk about treatment for depression, for example, yes, people don't want to be depressed anymore. But if they're not depressed, what are they going to be instead? When we talk about treatment for addiction, they don't want to use substances anymore. That's awesome. If they're not going to do that those substances that behavior was serving a purpose. So how are they going to meet that need? How are they going to what are they going to do instead of using substances? So we want to add a positive and that's going to be sort of our ultimate goal statement. The problem statement is your I don't want to be depressed or I want to lose weight or whatever it is. The goal statement for that problem is I this is what it will look like I will add these behaviors or I will add this character to my person. One way to elicit goals is through the miracle question. And you got to be real careful how you ask this because when I first started in counseling and I think I used it early on in my first internship, I said, you know, if you woke up tomorrow and everything was better, what would be different? And, you know, of course, my client being a smart alec responded with, well, I would have won the lottery and I wouldn't be here anymore and went on this litany of things that were just not achievable or realistic. So figuring out how to ask the miracle question in a way that is meaningful for the client. If you woke up tomorrow and your depression was gone, what would be different in your life? And you could even walk them through some of the different dimensions. Emotionally, how would you feel differently? Mentally, what would be different? Would you be able to think more clearly? Would you be able to make more decisions? Would you be more creative? Physically, how would you feel differently? Socially, well, how would your relationships change if you weren't depressed? Spiritually, environmentally, occupational, you can list all kinds of different areas, but you want people to really start thinking about what is this going to look like? Because this is their goal. This is where they want to go. But it also is what we're going to base our motivation on. If they don't want any of those changes, then they're not going to be motivated to do the work to make those changes. When we ask them this miracle question, if you woke up tomorrow and your problem was resolved, what would be different? People may say things like, I would be able to sleep through the night. So back in our clinical minds, we're going, okay, so that tells me right now this person is not sleeping through the night. That's a problem we may need to address. So this will give you some insight into the foundation of this particular person's symptoms and their definition of the problem. So their overall goal for treatment, they come in, they go, doc, I'm depressed. What do I do? How will you know when the problem's resolved? Specific. We want to really have them hammer down and tell us specifically what it looks like. I won't feel as hopeless and helpless. Well, okay, great. What does that look like? How do you, how will you know that you don't feel as hopeless and helpless? I won't dread getting out of bed. Okay, that's another thing that we can look at. That we can, that's a yes or no. Did I dread it? Did I not dread it? We're going to talk about measuring some of these sort of vague emotional concepts when we get down to measurement. Mentally, I won't be so foggy headed and we'll be able to concentrate. We know with depression, there's difficulty concentrating, lack of motivation. We've talked in other courses about changes in neurotransmitters that cause this. So make sense to me that this person is hoping that this will go away when they start to feel more energetic and they start to feel less depressed. Physically, I'll have more energy and lose some weight. So as a clinician, I'm hearing you feel fatigued all the time, which is normal for depression, but you also are probably not moving as much, not getting as much exercise and maybe eating to cope with emotions. So this may be something we need to look at as part of the treatment plan. And socially, I'll enjoy spending time with friends. Well, that's good. Tell me about your time with friends right now. What does that look like? Why don't you enjoy it or what makes you say you don't enjoy it? Help me understand what your life looks like right now and how you want it to look different when we get finished with treatment specifically. So the sub goals, we talked about depression. They need to learn about depression in general. What is depression? What causes depression? Then they need to learn about their specific symptoms, causes and triggers of the problem. And this is true for just about any issue. If you are buying a house, you learn about the process of house buying in general. And then you learn about what you need to do to buy a house specifically based on your locale, your credit, your income and all that other stuff. So you learn the general and then you learn the specific. And then we want to talk about ways to identify and address specific symptoms, causes and triggers for the person. So they've said, okay, I'm depressed. I'm not having problems with excessive feelings of guilt. That's not one of my symptoms. Okay. Well, then obviously we're not going to focus on that. But what are your symptoms, causes and triggers? Let's talk about that. What are your symptoms? What do you think causes these symptoms? And by learning about depression, they'll be able to say, well, my nutrition is not so great. I haven't been sleeping well. I've got a lot of stress in my life. They can start identifying things that might be causing it. And then we can explore that in treatment. And we also want to talk about triggers. There are causes, but then there are things that trigger an exacerbation of the depressive episode. So I want to talk about that. What triggers your depression? For me, when I watch those, I'll be at the gym and I'll be on the treadmill or something and one of those ASPCA commercials will come on. And I can't even watch the TV. I'm like, oh no. I couldn't even make it through the introduction to the book of Marley and Me, let alone watch the movie. So I'm a big sap and I know that certain things will trigger me to feel depressed. Half people identify what that is for them because not everybody looks at those ASPCA commercials and their heart hurts. Then we want to identify ways to address those triggers. And some of the triggers will be addressable. And some of them they're going to have to learn how to cope with. Maybe one of their triggers for their depression is the fact that they are in a financial hardship position right now. Well, we can't make that go away. It's not like the commercial where you can just avert your eyes. They've got to figure out how to deal with it. So then we need to talk in treatment about, okay, how can we make a plan to deal with this and help you cope with it so it doesn't make your depression worse and it doesn't keep you stuck. On the last slide, we asked emotionally how would you feel differently? I want dread getting out of bed each day. That's a negative. We're taking away the dread. Reframed as a positive, I'll be happy to wake up and face the day. Well, that's great. But we've got to figure out first what's causing the dread. Why do you dread going to work? Do you hate your coworkers? Do you hate the drive in? Do you find your job tedious? What is it that causes you dread? And then let's figure out how to deal with it. You never knew treatment planning could be quite so intricate. Anyhow, I will have more energy. So we have the person learn about causes of fatigue and low energy. And they probably learned a lot about that when they were learning about depression. But they learn about causes of fatigue and low energy and identify potential causes for their fatigue and low energy. Because what wears you out may not wear me out. What wears me out certainly doesn't wear my kids out. I wish I had their energy. We need to help the client identify what it is specific to them. We can't just put them into a group and go, okay, everybody needs to have this information and this cookie cutter plan will fit everyone. It's not the way it works. So I told you we would talk later about how to measure some of these things that are a little bit more abstract. Frequency is a number of events over time. So the number of crying episodes per day or per week, the number of eating episodes not due to hunger per day or per week, number of glasses of water consumed per day, or the number of times the person wakes up during the night. So you kind of get the idea of what we're talking about. It's a number. And it's over a period of time that stays constant. We can also look at duration. How long did you sleep? So we can look at frequency. How many times did you wake up? And how long were you in bed? And then we can start talking about how long you actually slept. Exercise, you know, somebody may exercise three times a week, but exercising three times a week for 30 minutes each time is different than exercising three times a week for 90 minutes each time. So if somebody's trying to increase their fitness level, they may increase the duration of their exercise or the frequency. Same thing with the crying episodes, the frequency, you know, they may cry three times a week or they may cry every single day. But if they go from crying for an hour each time to crying for two or three minutes, that's a significant improvement. And we see this some with people who are dealing with grief issues. As the grief starts to subside a little bit, and that's overly simplified, but the episodes of sadness will start to dissipate some. And we want to focus on that. Clients will come in and go, Yeah, I'm still crying every day. Alright, let's talk about how much and what is the intensity and this is go down here. Likert scales can be useful, but there are a couple of crucial things to remember. If you give people a five point Likert scale, one on a scale of one to five rated, most of the time people are going to pick one three or five. And three is going to be your most common answer, right in the middle. The most effective Likert scales are four point Likert scales. So there is no middle number. And they're anchored. Not only do you have a number, but you have a word or a face or a description of some sort. So the person can go, Yeah, that's where I'm at. A little bit, very little, a little bit, a little bit more than a little and a lot don't mean anything to me. But that's me. I tend to be a little bit more picky. Try to give people some meaningful anchors for their Likert scale so they can identify really how they're feeling for you. But the intensity of the crying episode, you know, was it mild, moderate, intense, or overwhelming or excruciating, you know, four would be I cried so hard I threw up. One would be I had tears kind of coming out of my eyes. You want to work out with the client what that means or what that looks like for them for each point on the Likert scale. Sleep, you can't really measure intensity of sleep. So that's one you're not probably going to look at but depression and anger and all of those dysphoric moods and even the euphoric moods. How did you feel? How was your depression? Was it mild, moderate, intense, or just excruciating? You didn't feel like you could go on. Same thing with anger. When I was in residential and we had clients that were on suicide watch, every hour they would have to come in report to a clinician and tell them on a scale of one to four where they were in terms of their suicidality. Was it not at all there all the way to, you know, I'm really contemplating killing myself. And that gave us an idea of what we needed to do to most effectively intervene with the client and we knew that it could change. It also taught the client how to monitor themselves and stay mindful of their own emotional state on a pretty regular basis. So Likert scales are great, anchor them, make them four-point. Other things to measure intensity would be, you know, maybe the number of calories per binge if you're working with somebody who's binge eating. Intensity is almost always measured by Likert scales, unless you're doing some sort of fitness or nutrition type work. So the measurable part, the main issue is depression. I can't go on. Number two, level number two, I'm okay. Number three is pretty good. You know, I'm optimistic that things are going to get better. And number four is I'm awesome. Today is a great day. A lot of times when you're talking about emotions, those faces that you see little emoticons work really well. Have clients find the faces that they think fit for their particular anchor. I won't dread getting out of bed each day. So we want to look at the cause of the dread. The cause of the dread is my job. Okay, so you hate your job. On a scale of one to four, same anchors, how much are you dreading your job? How much do you hate your job today? And then let's talk about why what's going on that's making it better or worse. I will have more energy. The person identifies that one of the causes of their low energy is poor sleep. So they may record the number of hours they sleep, the number of awakenings they have and the quality of their sleep. You know how you wake up some mornings and you feel refreshed and other mornings you wake up and you're like, did anybody get the name of that truck that hit me? Yeah. So let them kind of create their own narrative for how they're going to record it. But you want to be able to compare days, not apples and oranges. So you need to have apples and apples over a week, two weeks a month. So people can see improvement or patterns. And then you can look at those patterns and say what makes it better and what makes it worse. So one thing you can do in group or even if you have a staff meeting and your staff is struggling with writing treatment plans, write each of the following, each of the following on a piece of paper. So you'll have what four pieces of paper, lose weight, get in shape, feel better about myself and be happier. You know, we hear those kind of goals a lot, whether it be somebody setting New Year's resolutions, or it's somebody that is in our in our office for treatment. But those are pretty vague, non specific. There's no time limit, you know. I don't know what you're going to call it success here. So we want to identify at least two ways for each goal that tells the person he or she has achieved the goal. So if you brainstorm ahead of time, you might have some suggestions for people. How will you know when you have lost the weight that you want to lose or you have achieved your goal weight? How will you know when you're in shape? How will you know when you feel better about yourself? What is what does that look like? And how would you measure each of those? Rome wasn't built in a day, neither were people's problems, neither were their strengths. We want to help people understand that they are not going to change overnight, but they are going to see small changes every day. You know, it may be incremental, which is why we keep charts, why we keep logs. They need to be patient with themselves and be realistic about what they're expecting. If they've been using drugs for 20 years, they can't expect to achieve true recovery in 28 days. They can get clean and they can start on the road for recovery. If they have been clinically depressed for, you know, a while, in two or three days, they are not going to be undepressed or happy or whatever you want to call it. They're going to start feeling better, but what does it look like when they've achieved their goal? They're starting it. Another way you can look at it, you can tell them they're starting at a one right now. They want to get to a 10. So the steps along the way to get to that 10, what do we need to do if we're walking up the stairs? Build on prior strengths. So we want to ask them in the past when you have had depressive episodes, what's helped in the past when you've tried to lose weight, what's helped? We want to focus on something the client is motivated to change. If a client comes into you and says, my boss said, I have to come here and talk to you because I've got anger management issues. And, you know, of course the question is, so do you feel you have anger management issues? No. Well, the anger management is probably not going to be an effective goal. Now that may be implied in what we end up coming up with as a goal, but we need to understand, let's take a look at why your boss thinks you've got anger management issues, what precipitated those events, and how can we intervene. Another thing that I used to do with my involuntary clients is I'd say, you know, you're stuck with me for the next 12 weeks. Whether or not you think you have got an addiction problem, the court says you're with me for 12 weeks. So what can we do in that 12 weeks that is beneficial to you because you're getting this treatment paid for might as well take advantage. What can I help you with? Anything that I would help them with is probably going to reduce their stress and help them not relapse, help them not reoffend. And that was always my goal. But I focused on what was it that they wanted to change? We also need to set these time limited goals. Most of us can handle weekly goals. Some people, if they're in intensive outpatient treatment or doing something that's really intense, they may need daily goals. That's fine. You know, what can you accomplish today? Let's have a check in at the end of the day. If somebody's in crisis, and when I worked at the suicide intervention hotline, we would have people call in every hour. You know, let's see if we can help you make it through this hour. Some people who are recovering from addictions are in the same boat. They start feeling like they're going to relapse. And it's take it minute by minute, hour by hour, not, well, let's see if you can get through tonight, call me in the morning. That's, that's too long of a goal for them. One of the ways to identify how long they can make it is to ask them, how long can you make it? How long can you do this goal before you think you can not tolerate it anymore, or you think you need to stop and check in? So the hook, we need to make sure we identify who is responsible for doing what, when, where, why, and how. Now, this may not all be on the treatment plan, but it's something we're going to discuss with the clients. If I'm going to give them a book to read, it's not just because I don't want to talk about all that stuff with them. It's because I want them to have the opportunity to read the book, formulate their own ideas, and then we can come back and discuss it. Why is very important? Too often, I see clinicians barking out assignments, barking out activities, you will do this. Without any explanation is, what's my rationale? Why am I having you do this? A lot of times clients are afraid to ask why, because they're, you know, they feel like they should know, or they're just supposed to blindly follow. I want to empower clients to ask why, because the only way they're going to learn how to set their own goals and achieve their own goals is to ask why. And I think that's the most important thing to learn how to set their own goals and achieve their own goals without us in the future, is if they understand the why's and the how's, and then the who, what, when, and where, you know, depends on the goal. So who is your client? This is the person that's going to do most of the work. Sometimes you will give them handouts or things or they will have to come to group with you. What are they responsible for doing, when, and where? If you give them a book, you can't just say, here, read this, you need to give them a book and say, here, read chapter one, and we will talk about it next week. That's measurable, time-limited, specific. Tell them why they are doing it. Why did you choose that specific book or that specific, specific activity, and what do you hope they're going to get out it? Which takes us to, how is it helping them meet their ultimate goal? So the main issue, you know, this is an example from 8.1 to 9.5 of 2016. Sally's going to learn about the overall problem of depression by reading one chapter of XYZ book and the handouts provided by Dr. Snipes each week for five weeks. So that's very specific. What she's going to do, why she's going to do it, she's going to learn about the overall problem of depression, that I'm going to give her handouts, etc. Sally will learn about her symptoms, causes, and triggers by taking notes on what sounds like her as she reads through the book and handouts about depression. She will process those notes in counseling with Dr. Snipes each week. Sally will identify ways to address her specific symptoms, causes, triggers by completing the my symptoms and my triggers worksheet provided by Dr. Snipes. And then each morning and evening, Sally will rate on a scale of one to four her happiness and explain her response. Why did she rate it a one, a two, a three, or a four? And these logs will be discussed with Dr. Snipes each session. So all of these are very specific. I can say yes or no, the client did or did not do these things. And Sally can say yes or no, she did or did not do those things. But part of goal setting means changing a behavior. They're doing something and they don't want to do it anymore. Or they're feeling some way and they don't want to feel that anymore, which means they have to learn something. Part of the learning process involves improving motivation. Because right now they keep doing the same thing. A, because it's all they know how to do with the tools they have at the present time. If they had options, they've probably exhausted those. So we want to talk about why should you do this? Why should you try again? We need to improve motivation and help them learn that there are other options. And effective change means presenting the information in a form in which the person most easily learns. So for example, I am not an auditory learner. If you gave me eight hours worth of lectures and said, go listen to these and come back and we'll talk about it. I think I'd pull my hair out. I do not like listening to auditory things. I am a reader. Now I can read and listen at the same time, but I process things a lot better visually. So present the information visually to people who are visual learners. And obviously people have multiple learning styles. There's three parts to the learning process. Cognition, how people get the knowledge in their mind. Seeing, hearing, or doing. And generally it's a combination of two or all three. But there's one that's prominent. If you have a choice to learn a skill or a tool or something, how would you do it? And your knee jerk reaction is going to be what your primary learning style is. Then conceptualization, how people process the information. Now that you have it in your head, how do you make sense of it and store it? You know, you've got to box it up somewhere, relate it to things you know, make it make sense to you. So you have it in your mind, you have it all boxed up and you're holding this box in your head and you're going, does this matter to me enough to make room and storage? And this is where a lot of people kind of fall down because they don't have the why do I care? And when I read, for example, when I read a book, when I read lecture notes, I'll read through parts of it and then I'll stop and I'll go, what does this mean to me? Why do I care about this? How could I use this to help somebody in the future? Because that's my affective dimension. I do things so I can improve my skills. We need to make the information matter. When I was in undergraduate and I had to take the history of Greek archaeology, you know, I learned that stuff long enough to pass the test and I couldn't identify any of it now to save my life because it didn't matter to me. It was something I had to do to get my degree. This is important for just about anything, not just goal setting. But when you ask your kids to do something, you know, they hear it and they conceptualize it. However they do, it's either this is a pain or oh, goody, I get to do something to help. Probably this is a pain. But then you have to help them understand why it matters to them. Why do you care to remember this information? So our learning styles, active and reflective is when you process information. Some people are have the ability to process information as they go along and they're just they're uh-huh uh-huh through a lecture and oh, I've got it and the teacher will ask a sample question and they'll have the answer. I'm sitting back in the back. I'm just kind of taking it all in going yeah, this will make sense after class. I take all the information in and I process it and then I have that aha light bulb moment when everybody's quiet. I never did well in active processing. If I read the chapter ahead of time, then I was, you know, I'd already had time to reflect on it and I could participate. So if you're going to have some sort of participate participatory group, try to give people a heads up, give them the written information ahead of time so they can prepare if they happen to be reflective learners. Then we already talked about methods for receiving information are hearing, seeing or doing. Most people do really well either hearing or seeing and then taking that information and manipulating it, applying it to scenarios or practicing. Another way people conceptualize information is factual or emotional. Is it the logical thing or is it what makes you feel well, feel good. In order to make that affective dimension come out, we need to make it meaningful to them. So if people find things that are statistics based, more meaningful, then that's what I'm going to give them. If they find things that are emotionally charged, more meaningful, then that's what I'm going to give them. Do they pay attention to the big picture or the little bitty facts, the little bitty details? I'm a big picture kind of person. And how do they do they like to learn? And I always ask people the puzzle question. When you do a puzzle, do you start just dump it out, put the box on the floor and just start trying to put pieces together? Or do you tack up that box so you can have a guide to go by and then you put together the frame and then you start filling it in. My son is a parts to hole, so he can put the box down and he just wants to see how it fits together and he will be surprised when it is finished. Me, I want to have something to go off of. I like going from the hole and breaking it down into its little parts, first the frame, and then we do the flower over in the corner. And that's how I think and that's how I deal with information. So when we're talking with clients about depression, we can either start talking about basic things, talking maybe about Maslow's hierarchy or we can talk about depression in general and break it down from there. Motivation, the problems that the clients select have to be changeable. If they don't like the fact that they're 5'4", they can't change that. They can't be taller. There are a lot of things they can change. Motivation on these any problem is going to be variable. There are some days you're going to get up and you're going to be like, woohoo, I get to work on my goal. And there are other days you're going to get up and go, oh, really? Again, think about going to the gym. You set that New Year's resolution, you're going to go to the gym the first few days, you're excited, you're going about the fourth day you start getting sore and you wake up and you're like, yeah, how much does this behavior change really mean to me? So the components of motivation are emotional. I want to do this because intellectual, I need to do this because social, either everybody else is doing it or this will improve my relationships because or I made a commitment to other people so I need to do it. Or for me, it's ego. If I'm going to go, I'm not going to go and be on the machine for 10 minutes and then be off and be like, well, that was good. I'm going to be there for an hour. If I'm going to go, I'm going to do it. Physical, yeah, my own issues. Physical motivation. Why do you want to do it? To feel better, to get more energy, to sleep better. And situational motivation. Sometimes there are situations that get you more motivated and when we talk about exercise, I cannot exercise in my living room. I am just not motivated. I feel stupid standing there. I can go to the gym and I can be there all day long. I am much more motivated there. When we talk about depression, what situational factors are in play that encourage people to do the things that will help them get undepressed, like get out of bed? What are the situational factors? So maybe getting up and opening the blinds. You know, it's not nearly as pleasant to lay in bed when the blinds are wide open and everybody's looking at you and it's bright and you can't sleep. So changing the situational motivation. We've talked about decisional balance exercises. They're good always. We want to talk about the benefits of changing the behavior, the drawbacks to changing the behavior, the benefits to staying the same. Just not doing anything. And the drawbacks to staying the same. And I've put the cues in there, if you will, to remind you to look at the emotional, mental, physical, social, financial, and occupational consequences and others you can add on there for each change, desire to change or desire not to change. That really helps people hone in and look at it more completely. If you just say, what are the benefits to this? They may identify three, but if you really force them to think in each of these areas, they're going to identify at least six. So, you know, score. This can be useful in addressing what used to be called resistance because it can help us understand why a client's not motivated to change. Because clearly their old behavior is working for them better than what we're proposing. So why is that? And this helps us understand that. Maintaining motivation. List 10 reasons you want to make this change and review them daily. Create a collage of all the reasons you want to make this change. Keep a journal each day of how things change positively for you as you make this change. Make a list of disputes for your most frequent cop outs. And tell three people about your goal. Give people this option. They can look and choose what they want to do in order to maintain their motivation. They don't need to do all five. Intellectual motivation. List 10 reasons you need to do this. Keep written information available that highlights the benefits of whatever you're doing. Have clients research how this change will benefit them. Have them learn how improving their nutrition or improving their sleep will help their depression. List 10 reasons you know you can and set an end date for each objective. So this is intellectual. This is your planning side. This is your cognitive rational side we're appealing to. Socially identify three social supports that understand or are willing to learn about whatever issue you're dealing with in this goal. Buddy up. Encourage people with similar goals to support each other in and out of group or class. Now this can be kind of dicey especially in substance abuse treatment. Some places say that clients should never associate outside of group when in reality they're going to all the same meetings. So your agency will have policies for how that works but outside of group but while they're at the facility is also you know an option for talking socializing when they're on their breaks between groups. And plan weekly fun social activities with friends, children, and or pets. You know you got to have fun. It can't be all work and no play. You don't want to have your nose to the grindstone on this goal all the time without lifting your head up and looking around and going gee I'm starting to feel better. Let's you know enjoy a day or so. Environmental motivation means creating a positive environment because the way things look on the outside often reflect how the person feels on the inside. Right now I walked out of the house today and I was looking around and I was like oh my gosh it looked like a hurricane hit. We had sort of a little trauma yesterday in our family and I was not in the mood to clean. I was not in the mood to go around and pick up stuff. So the way things look on the outside reflected the fact that I was using all my energy to deal with stuff that was going on on the inside. Clients are the same way. So if they create an environment that generally is welcoming and clean and smells good is going to improve their mood. Sometimes they're not going to have the energy to clean the whole house. Have them create a little section maybe a corner that is their serenity corner. A little place that they can go that they know they can keep clean. Eliminate sensory stimuli that trigger the bad whatever they're trying to change that trigger their depression trigger their cravings trigger their addiction. The Bob Marley posters for example they got to go I'm sorry you may love them but if that reminds you that you want to smoke weed we probably need to get rid of them. There are other things that may remind people of things that are depressing pictures pictures of loved ones that have passed. Now eventually they'll probably put those back up but in the short term it may be useful to move them to a less obvious place in the house where they don't look at them every single day and get themselves into a state. Physical motivation keep a daily check-in sheet of how you feel physically pain lethargy fatigue irritability you know we as clinicians can make easy check sheets for people using that Likert scale on a one to four it's easy peasy people don't have to write a whole diary out but if we can get an idea of what's going on physically and mentally with them then we can start by helping them identify those patterns. Use money you would have spent on your addiction to take care of yourself obviously this is specific to people recovering from addictions so you know instead of spending six hundred dollars a month on coke you're spending six hundred dollars a month on fitness center memberships hot tubs spa days whatever in general have people identify five obstacles to accomplishing their goal what motivations they're related to and three solutions for each so they know what their obstacles are or what they have been in the past have them identify those and come up with three solutions because one solution may not work but out of three you're generally going to come up with at least one that helps and then look at prior relapses when you've tried to change this behavior in the past whether it's depression addiction anxiety what caused the relapse what made it worse again what was the motivation for each you know what led you to this place and what are some alternative behaviors so that doesn't happen again and finally pitfalls failing to consider why you do or do not engage in certain behaviors we're so worried about whatever the behavior is overeating depression anxiety eliminating it we fail to consider what function it's serving and if you take away a behavior if you take away a coping behavior or a reactive behavior that's serving a function if you don't replace it with something else then it's going to come back you know it's there for a reason now it may be a you know misguided reason because of cognitive distortions irrational thoughts whatever but you know take anxiety for example if a person is feeling anxious they feel like there's a threat so we need to examine why do they feel like there's a threat and how do we address that setting goals that are too big you know when somebody comes in and they have bipolar and they have been diagnosed with poly substance abuse and they're going through all kinds of other stuff in their life expecting to be living a quote normal life in 90 days probably not going to happen you know let's look at what we can't accomplish in 90 days we can help you at clean we can help you find a place to live and we can get you stabilized on meds that we can do setting goals that are too hard if somebody wants to train for a marathon more power to them but if they want to train for a marathon in six weeks that's probably not going to happen unless they've already been running so they need to be realistic setting too many goals if you try to do too many things at once you're going to end up doing a lot of things halfway think about when you're at work and you have 16 different things that you're supposed to be working on and your head's spinning this is how our clients feel if we set too many goals so we want to encourage them to focus their goals to one two maybe three but generally when they set those first three goals those first three goals mushroom out into 15 sub goals which mushroom out so we don't we want to help them see let's get into it let's start working on one or two goals and then if you're feeling good and you've got extra energy we can always add another one setting goals without sufficient rewards just the satisfaction of doing it is great but some days that is not going to feel like enough so what is it that is keeping you going what are the rewards what is the benefit of achieving this goal for you have clients write that down have clients make a collage have clients figure out what those rewards are and interestingly setting goals that are too specific if they want to do something um for example if I want to get my one mile run time down to six minutes and 59 seconds that is a very specific goal and that might not be achievable in a specific time frame that I have said or might not be achievable at all for me so understanding that it's important to have a little bit of wiggle room the ability to adjust goals and it doesn't mean you failed it just means that you've got to step back and readjust to focus on priorities remember when we talked about acceptance and commitment therapy having clients continually ask themselves is whatever I'm doing right now moving you further toward what is important to me and who is important to me or is whatever I'm doing right now or feeling right now moving me away from whatever or whomever is important to me prioritizing goals I generally suggest people use Maslow's hierarchy help them get biologically stable you know address any medical issues nutrition sleep that kind of stuff chronic pain before they start focusing on a lot of the cognitive stuff but most times I find that clients want to start focusing on some of the cognitive distortions or irrational thinking or however they phrase it in addition to the physical stuff so that often ends up as our you know our first two goals learning about the depression and learning about health and wellness so good goals use positive language address the reasons for not changing as well as changing are meaningful to the patient are smart and use the ksa progression knowledge skills and abilities knowledge in general the knowledge specific to the patient skills in general like rebt the abc's of rebt skills in general how does that apply with my client how do I help my client apply that well formed goals guide effective treatment and making goals smart help clients improve self-esteem and self-efficacy and see incremental improvements if they can see over the course of a week that they're crying you know half as much as they were at the beginning of the week how awesome is that yeah they're still crying but it's less and which means that they're probably going to be able to kick this and it gives them a sense of control and resilience