Session Planning and Goal Setting
Effective therapy sessions begin with a clear understanding of the goals to be achieved during that particular session. Creating session goals is like charting a map for therapy, and this map can change as we go along. The formation of session goals can occur at various points in the therapeutic journey, including:
1. At the end of a Session: A good time to reflect on what you achieved with the client and what you plan to work on next is at the end of a session, particularly while you are doing your case notes. Always include 'plans' in your session notes, as this is when your memory is the most fresh on what happened during the session and what would be beneficial to achieve next. However, there are times when your plan for the next session hinges on the client's reports during that session. For example, you may need to wait to hear about the outcome of their homework practice. Or you may need to hear their reports about the impact of the session you just had, which can determine if you have successfully addressed the current goals and any subsequent goals which may emerge. In such cases, your plans for the upcoming session can be left open to be decided upon at the session's commencement.
2. Before the Next Session: Before you meet with the client for the next session, it's a good practice to take a moment to study your notes and reflect. Review the plans you made at the end of the previous session. This review ensures that each session builds upon the progress and intentions established earlier and helps maintain continuity and a clear sense of direction in the therapeutic process.
3. During the Session: Understanding the client’s dominant thoughts and emotions during the time between therapy sessions holds much valuable insights. At the start of each session, it's imperative to explore the dominant thoughts, emotions, and dreams since the previous meeting. This information can help you form goals for the session, or readjust your previous goals. Below are a few factors to consider:
Thoughts and Emotions: Start by inquiring about the client's prevalent thoughts and emotions during this interval. Ask if they've noticed what occupied their minds most since the last session. If the client is uncertain, prompt them to recollect their mental and emotional states during moments of solitude or mundane activities, such as bedtime or routine tasks like sweeping or brushing teeth. These moments often unveil unfiltered thoughts and emotions.
Dreams: Additionally, inquire about any dreams the client remembers from this period. Dreams can serve as gateways to the unconscious, providing glimpses of underlying emotions, concerns, or questions that may not surface during regular conversations. Explore the dream's content, the emotions it aroused, and any thoughts or insights that emerged during or after the dream.
Exploring Dominant Thoughts and Emotions: The period between therapy sessions is crucial, offering insights into the client's mental landscape. Start by asking the client about their dominant thoughts and emotions since the last session. Inquire about the content of their inner world and any recurring themes or concerns that have occupied their mind. Encourage them to recall moments when they were alone or engaged in less mentally engaging activities, as these moments often reveal unfiltered thoughts and emotions.
- **Uncovering Dreams:** Dreams can serve as windows into the unconscious, offering glimpses of underlying emotions, concerns, or questions that might not come up in everyday conversation. Ask the client about any dreams they recall since the previous session. Dive into the dream's content, the emotions it stirred, and any thoughts or insights that emerged during or after the dream."
Psychological Trends and Goal Setting:
As you delve into these discussions, you may notice trends in your client's thoughts, emotions, and dreams. These trends typically fall into three categories:
1. Consistent Dominance: In some cases, a particular trend may have consistently dominated the client's thoughts, emotions, and dreams, persisting over multiple sessions. If this trend appears unyielding and resists change, it's crucial to conduct a "case conference" with yourself. Reevaluate whether you've correctly identified and targeted core beliefs or emotions. Sometimes, minor adjustments to your approach may be sufficient. In other instances, a more substantial redirection in treatment goals may be necessary. External circumstances may also influence the client's reluctance to engage in inner healing processes, lengthening the therapy process. In such cases, your role involves patient education and encouragement, demonstrating how inner shifts can enhance their coping in challenging external environments.
2. Emerging Trends: Clients may experience shifts in the dominant trends of their thoughts, emotions, and dreams. Unless these shifts align with significant external changes in their circumstances, they often indicate the need to address new layers of trauma or unresolved issues. This transformation can occur because previous sessions successfully shifted a dominant core belief or emotion, allowing secondary concerns to surface. Think of psychological healing like peeling an onion—one layer at a time. However, when a new trend emerges, it may not necessarily result from successfully healing the previous layer. It could signify that you've inadvertently brought another layer to the surface prematurely. This could overwhelm the client, leading to heightened agitation, restlessness, and inattention, and a constant oscillation between the new dominant trend and the unresolved issues. When this occurs, it's essential to help the client understand the dynamics at play, prioritize what to address first, and potentially explore both trends simultaneously if they inform each other.
3. Chaotic Trends: Some clients present with a complex web of emotions and thoughts, lacking a clear point of focus. Sessions with these clients may feel like navigating a labyrinth, as their thoughts constantly shift from one topic to another. If your client struggles to concentrate on any specific activity or therapeutic goal, this trend may be present. Addressing any area may prove challenging, as the client's attention easily wanders, and staying focused can be a struggle. When confronted with such complexity, it's vital to maintain patience and flexibility in your approach.
As you navigate these client trends, remember that therapy isn't always linear. It's a dynamic process that adapts to the client's evolving needs and experiences. By acknowledging and understanding these trends, you can tailor your therapeutic interventions to best serve your client's progress and well-being.