Strategies used by experienced therapists to explore client goals in early sessions of psychotherapy

Abstract

The purpose of this study was to investigate the strategies used by highly experienced psychotherapists to explore client goals for psychotherapy during the first three sessions in treatments as usual. Transcripts from audio recordings of the initial three sessions of a sample of nine experienced therapists were analyzed using a modified constructivist grounded theory methodology. The transcripts revealed few therapist behaviors directed toward agreeing upon explicitly defined goals. Analysis of the data made it possible to identify two categories of goal-oriented activity: (1) ensuring that what happens in therapy is meaningful for the client and relevant to the attainment of the client's goals; and (2) being aware of complexity – the client's ambivalence and resistance to change. It is argued that the client–therapist dialogs examined in this study were characterized by processes regarding hope, motivation, and engagement rather than by explicit goal agreement. Implications for the concept of goal consensus and the working alliance are discussed.