A Qualitative Investigation of the Co-Construction of Therapeutic Goals in a CBT Framework

Abstract

Objective: To examine the discourses used by therapist-client dyads when co-constructing therapy goals in Cognitive Behavioural Therapy and how these discourses influence the process of goal-setting. Methods: Therapy tapes for five therapist-client dyads were examined and goal setting discourse were transcribed. From this, five representative excerpts were selected then analysed using a Discourse Analysis approach. Results: Discourses related to power, collaboration, expectations of the CBT model and positioning of therapist and client with regards to the task of goal setting were identified. The use of language as a tool for both creation of shared understanding and as a way of undertaking social action was also identified. There was an emphasis within the excerpts on the micro-process within therapy such as positioning, alliance building and showing a shared understanding of different topics, while narratives on what goals should be or look like informing the macro-process within the co-construction process and forming a wider narrative shaping the process undertaken by therapist and client. Conclusion: Ensuring that therapists have an awareness of the different discourses in use within goal setting and how they influence the process of goal co-construction is important in ensuring an effective goal setting process. Consideration of the different discourses in the goal setting process is not well represented in the research literature with the majority of research investigating the form and content of goals. Explicit discussion of therapy process in manuals of therapy and therapy teaching could be an important factor in ensuring effective goal setting. Future research could further investigate and how these may impact practice is important.