Discussion in 'General Parenting' started by klmno, Oct 27, 2009.
Do tdocs establish these with CBT or is it primarily used for behavior mod?
The term is used for IEPs.
In what context have you seen it used?
In therapy- not regarding the IEP. I'm aware it's used for behavior mod and legal requirements for juveniles, but is it used in therapy (by regular tdocs) for CBT?
Not in my experience, klmno. I think its far too subjective because you're depending on the client to measure the goals, Know what I mean??
What a great question.
husband and I discuss this or things like it from time to time.
I think few psychologists would use something specific like a measurable goal.
That might be more like something a coach would do.
It saddens me that many therapists don't set true goals (doesn't have to be measurable...but at least goals).
Our daughter is seeing a mental health counselor and the style she is using (happens to be what I am familiar with/am studying) is different, interesting and beneficial for our daughter.
Our daughter's goals were determined in the first or second session.
They were healthy in nature. If you get right to it...most of us have healthy goals...to earn a living, make friends, be healthy, some a little more specific to the individual.
The therapist then uses them as a "base" to go forward.
When our daughter does things that are not going to help her achieve her healthy goals, then a discussion ensues about this.
The therapist uses many different traditional psychological theories...mostly CBT to go about helping our daughter see that her thinking and/or actions aren't in alignment with her goals.
So far (knock on wood) it has been a positive experience, much more so than traditional therapy simply exploring the past or behavior in general.
It is much more forward moving.
So, specific measurable goals are not set up, but goals in general are (in combination with- other things) and are used as a baseline in mental health counseling.
Have you asked the therapist in particular about his/her goals for your child? In my experience with 10+ tdocs over the years most have articulated to themselves some kind of goal for their client. It may be vague or specific depending on the problem.
Phobias for example lend themselves to very specific goals. Bipolar may be harder to give really specific goals but could still have general goals like reduced mood swings, reduced anxiety or dysfunctional behavior in response to mood swings. There may be an overall goal of reducing suicidal gestures or specific self-harm behaviors to rarely occuring with a specific level - say once a week instead of once a day - as an intermediate goal.
So I would just point blank ask the therapist what goals he/she has in mind for the client in question. I think it can be a very good question to ask, especially if you feel like therapy is not progressing or that there is a mismatch between your expectations and what is actually happening.
If the therapist has trouble articulating their goals for the client I would personally be strongly considering looking for a different therapist.
If the client is an adult or adolescent the therapist may decline to share much about their goals for the client out of a concern for confidentiality. In this case, I would suggest that you ask your psychiatrist to conference with the therapist to see if the psychiatrist feels the goals are appropriate. This assumes that you are happy with the care you are getting from the psychiatrist. So that could be a catch 22.
And the therapist may be unwilling to share much about the goals directly with the client depending on the nature of the goals.
I have specific goals that are considered measurable on my ...damn...cant remember what the sheet is called. It is based something like an IEP would be worded. Janet will increase or decrease XXX behaviors or whatever for XXX weeks.
Then it lists how the therapist is going to help me, what I am going to attempt to do for myself, how my family unit is going to help me, blah blah blah.
For example...say I am working on social anxiety.
Janet will attempt to engage in outside activities 2 times a week for the next 3 months. Therapist will meet with Janet one time a week at a social place each week. Janet will go out into the community at least one time each week that is not a doctor/therapy appointment. Family will engage Janet at least one time a month in leisure activities such as going to the park, out to eat, or somewhere fun in the area.
I remember Youngest having written treatment goals during many of her hospitalizations. We definitely discussed goals with her outpatient therapist as well, i.e., what were the goals of therapy in general. Some specific ones were part of the behavior contract we did. Whether she actually achieved them, is a different story ... many times they were just wishful thinking lol.
This is definitely going to be an interesting session with therapist Fri. morning. She had asked our goals for family therapy- I gave her two and difficult child gave her two. She wrote them all down and told me she couldn't help with my first goal- that was the extent of the first session. Second session, she blew my second one off and went straight to difficult child's about wanting more privileges, then said we needed to word things in a way that she could list measurable goals.
We had already had the discussion (she and I) about CBT being recommended by all previous tdocs for difficult child due to his underlying issues and that behavior contracts serve only to make him worse. Sttill, it appears to me that this is what she is establishing.
Even if I was willing to do it, which would not incllude letting a easy child minor do what he wants without a parent knowing where they are or what they are doing, difficult child is going to be on parole. The PO will set a curfew when difficult child is off house arrest. There are really too many unknowns right now for me to agree to any specific rule. difficult child knnows the standard stuff and the jist of it. (He knows because expectations were written at home when we set up a system for him to earn an allowance.) But, given his previous charges and actions and stuff he tends to do when he's unstable and restitution I am still paying, unless the therapist and legal authorities put it in writing that they will take legal and financial responsibility for anything difficult child does when oout alone/with friends, they can all forget me ever giving a blanket agreement to let him have a certain amount of hours with friends a week, or whatever. I need to know the friend, what their plans are, establish when he will be back, and have a good feeling that he is not acting impulsively. No blankeet agreements from me on that one until difficult child turns into a easy child and I cannot "list" a time frame for that.
K...I think there is going to be a sort of outline type thing as a Coverage of Rules so to speak.
First of all...he will have:
Those are the most important rules he has. They will say everything else he has to follow. They will list such things as:
Attend school regularly and maintain at least a C average.
Obey house rules.
Any mental health treatment they order.
Any physical health treatment they order.
Stand on your head and dance sideways on Fridays.
Now the school can make up their rules of course and you can make up your rules but the Parole rules are up to them. If they want to tell him that he has to eat Peas and Carrots...well then he has to eat Peas and Carrots.
He would have to eat Peas and Carrots in all places.
Or they could restrict him from Carrots in all places. No carrots until he is 18!
Of course I am being very simplified in all this but this is the way this goes.
Right- so if PO has already said "house arrest" for min of first 30 days and mentor, who we don't have a schedule for yet, then a curfew that we don't know yet, what good would it do for a therapist to get me to agree NOW for something like "2 hours with friends on Friday nights if difficult child behaves thru the week"? I think we should be spending this time covering other issues in therapy.
I agree with you.
Therapy now shouldnt have a darned thing to do with what is possibly going to be going on in 6 months. How on earth can you know what is going to be going on? That would be like me discussing in therapy how I am going to handle Billy getting married when he isnt even dating...lol. That problem is so low on my list of concerns it doesnt even register!
Why wouldn't the goals be psychologically oriented as opposed to things like earning privileges like going out with friends at night?
For example, establishing better control over anger as demonstrated by only raising his voice to family members once a day? or stopping the use of threats/bullying to get his way? or whatever is the outward manifestation of his lack of control and inability to conform to reasonable social expectations?
What about being able to conform to the terms of his parole? So it might be that his goal is to reduce behaviors that might lead to violating the terms of his parole like skipping school because he's bored or has been encouraged to do so by friends. Or that he seeks help when confronted with such temptations and isn't sure he can resist that tempation?
I'm not sure how to word or construct some of these things but it seems to me a good therapist should be able to do so.
Perhaps you should give the therapist a heads up about your expectations regarding the goals so she is not surprised at your next appointment if you have a fundamental disagreement about goals.
You don't have a signature line so it's a little hard to offer more specific advice based on your son's age or diagnosis, etc.
The other thing I would say is how much do you know about the tdocs level of experience working with troubled youth? Because I would want someone with a lot of depth of experience in that arena - as in 15+ years.
That's what I think rls- first, difficult child responds MUCH better when punishments are taken out of his "systems" put in place at school and home. Not that he doesn't get consequences when he does something wrong, but it works better when that is kept separate from any reward system. Next, the objective usually gets effort put into it when it is worded like "coping skills" and "problem solving".
Thirdly, underneath that are difficult child's issues regarding rejection/abondonment vs feeling accepted. He doesn't see that he has big issues in this area yet- but he does acknowledge to me that there are problems with how other kids "treat" him and that he has a hard time dealing with it. This is where CBT would be useful and why it has been recommended in the past. difficult child cannot see yet though that this stems from his father never wanting to meet him or be a part of his life. At least that is my analysis of it- but it's ok, I think, that difficult child can't really see that at this point.
The therapist involved right now is aware of these things but she has told me that since difficult child has done well there (incarcerated in Department of Juvenile Justice) that she doesn't see it as a problem. That just doesn't hold up with me for a few reasons. Anyway, she is a therapist at the Department of Juvenile Justice facility so it might be impossible to get her to view this as needing anything other than behavior mod. Maybe I will get lucky and the issue of difficult child getting more privileges with friends can lead to a conversation about his relationships (and lack thereof) with peers on Friday and just maybe she will start to see and address that issue.
Unfortunately, I've had enough dealings with tdocs working with difficult child that I'm not holding my breath. And it's much WORSE when it's a therapist being paid by the legal authorites after he's gotten into trouble. We'll see on Fri. though.
He's 14 yo by the way.
We have goals with tdocs. They include, difficult child taking medications, contacting us regularly, and handling herself in non-badgering, non-manipulaive, non theatening manner. Now we are on to doing more schoolwork. Next week we are up to 40 minutes. Staying in speinding limits.
Other goals I have include proscial goals, dinner with the family, outing with brother, palying with her pets, doing exercise,music, art.
She is not taling to tdocs directly and when she does it is very superfical.
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