Reading: A change plan the client owns
Goals, options, supports and a specific first step, chosen by the client.
Reading: A change plan the client owns
What you’ll learn
- Help a client set their own short-term, specific goals.
- Respond when the client’s goals differ from yours.
- Build a change plan with options, support and a first step.
In preparation, the client is committed to change and deciding what to do. Your job shifts from evoking reasons to helping them build a plan, while still listening for ambivalence, which can return at any point.
Clarify the client’s goals
Help the client set goals that address the concerns they raised earlier, and make them as realistic and specific as possible. Early goals should be short-term and measurable, so the client can see progress and feel hopeful. Think of the goal as the vision and the steps as the tasks that get them there. An open question gets it started: “What do you think is the first step toward this goal?”
When goals differ
Sometimes the client chooses a goal you or your agency wouldn’t. A goal, by definition, is something the client is ready, willing and able to work toward. You can’t push your hopes onto them, and trying to can become an ethical problem. You have options:
- Negotiate. Be open about your concerns and your hopes, find goals you can both agree on, and start with what the client feels is most urgent.
- Approximate. Agree on a goal that’s a step in the right direction, such as working on cocaine use first, even if you hope for more eventually.
- Revisit. Agree to check how the goal is working and adjust it together.
Offer a menu of options
Rather than one recommendation, offer several options, with permission, and let the client choose. Talk through how much help they want, such as mutual-help groups like AA, NA, SMART Recovery or Women for Sobriety, intensive outpatient treatment, or residential care. Choose a short-term plan with a start date, and discuss who will support them.
Write it down
A worksheet helps the client think through the details. Fill it in together, in the client’s words.
- 1. The most important reasons I want to make this change are:
- 2. My main goals for myself in making this change are:
- 3. I plan to do these things to reach my goals (and when):
- 4. The first steps I plan to take are:
- 5. Other people could help me in these ways:
- 6. Possible obstacles, and how I could handle them:
- 7. I will know my plan is working when I see:
Then summarize the plan back to the client and ask whether you got it right. Saying a plan out loud, and telling other people about it, strengthens commitment. At the next session, ask how it went, and change what isn’t working.
You’ve decided to stop drinking on weeknights. What do you think would help most?
Not keeping beer in the fridge, I guess. And maybe going to the gym after work instead of straight home.
Two ideas: no beer at home, and the gym after work. When would you start?
Monday.
So starting Monday, no beer in the house and the gym after work. Who could back you up on this?
The ideas come from the client. The counselor reflects them, asks for a when, and moves to support, so the plan ends up specific and owned by the client.
This plan sounds overly ambitious. Respond without overruling it.
ClientI want to quit everything, all at once, starting tomorrow.
Show a model answer
“You’re ready for a big change, and you want to start right away. That takes real determination. What would the first week look like?” Exploring the details lets the client test the plan. If it still seems unrealistic, you can share a concern with permission.
Key takeaways
- Goals belong to the client. Make early ones short-term, specific and measurable.
- When goals differ, negotiate, approximate or agree to revisit, rather than overruling.
- Offer a menu, write the plan in the client’s words, and summarize it back.
Adapted from SAMHSA, TIP 35: Enhancing Motivation for Change in Substance Use Disorder Treatment (2019), chapter 6. Public domain. Open TIP 35, chapter 6: change goals and plans