Goals in Mind: A Randomised Controlled Evaluation of the Effectiveness of Tracking Goals in Counselling

In recent years, there has been a rapid rise in the use of outcome and feedback measures in the counselling and psychotherapy field. In part, this is because evidence suggests that the systematic collection and integration of client feedback improves outcome across client populations, professional discipline, and model used. In a meta-analysis of five trials comparing use of a routine feedback protocol with treatment as usual (TAU) for adults receiving individual psychotherapy, there were significant gains for feedback groups over TAU, especially for clients identified as at risk for premature dropout or negative outcomes (Lambert, 2010). In a review of studies using the Partners for Change Outcome Monitoring system, clients using brief outcome measures at each session were 3.5 times more likely to experience reliable change and had half the odds of deterioration than those in TAU (Duncan, 2010, 2011; Lambert & Shimokawa, 2011; Murphy & Duncan, 2010). Currently, three randomized, controlled trials indicate improved outcomes using this system (Anker, Duncan, & Sparks, 2009; Reese, Norsworthy, & Rowlands, 2009; Reese, Toland, Slone, & Norsworthy, 2010). Based on the overall strength of current evidence, Lambert and Shimokawa (2011, p. 72) recommended that 'clinicians seriously consider making formal methods of collecting client feedback a routine part of their daily practice'.

At present, most psychological measurement is conducted using nomothetic scales. These are based on questions chosen by professional experts and consisting of checklists of symptoms (e.g., CORE-OM, PHQ-9). These questions are selected to be acceptable to large populations. However, given the diversity of problems presenting to mental health care services, a more personalised approach to psychological measurement might seem appropriate. Such an approach would shift the emphasis of measurement away from predefined, professionally-driven criteria, replacing it with a focus on those criteria given importance by the individual client. Individualised measures are questionnaires that include questions which can be generated by clients alone or in collaboration with the practitioner. This results in clients creating their own tailor-made questionnaire which only contains items that have meaning for them. Items are rated for intensity in a similar procedure to that of standardised measures.

The advantages of using individualised measures have been highlighted in a number of studies (e.g., Ashworth et al., 2005). Client-generated measures are evidenced to be user-friendly as individuals themselves identify areas of personal concern. Clinical improvement therefore, is evaluated according to topics of relevance to the individuals concerned. Research indicates that the fact that people themselves identify their own personal problems or goals which are meaningful to them and which reflect their individual needs, leads to more engagement in therapy (Turner-Stokes, 2011). Also, individualised measures are flexible and take into account the client's idiosyncratic variables such as personality, socioeconomic status and cultural background (Sales & Alves, 2012).

However, to date, the most commonly used personalised measures, such as the Personal Questionnaire (Elliott et al., 2015) and the PSYCHLOPS (Ashworth et al., 2005), focus on clients' difficulties rather than their goals. Research suggests that this may be problematic: there is evidence to suggest that focusing on positive goals to approach, rather than negative problems to avoid, may be associated with better psychological health and attainment of goals (Elliot & Church, 2002; Elliot & Friedman, 2007).

Hence, the aim of this study is to evaluate the benefits, to both the process and outcomes of therapy, of using a personalised goal form: the Goals Form. The Goals Form (Appendix 2.1) is an individualised outcome measure used to assess attainment of personal objectives for therapy. It was used as part of an initial open-label trial of pluralistic therapy (Cooper et al., 2015), and invites clients, in collaboration with their therapist, to identify up to seven goals for therapy typically at a first assessment session and then to rate them on a 1 7 Likert scale, with 1 being not at all achieved and 7 being completely achieved (Cooper, 2014). The agreed goals are then typed onto a digital copy of the form and printed off, such that the client is able to rate the same goals at regular intervals, ideally every session. Over the course of therapy, clients may choose to delete, add or modify goals, and the electronic copy of the Goals Form is revised accordingly. The Goals Form has shown satisfactory levels of internal reliability, and convergent validity against CORE-10, GAD-7 and PHQ-9. It is also sensitive to change in clinical populations (Cooper, 2014; Michael, Cooper, & Fugard, 2015).