The difficult work of psychotherapy is made easier when patients can see the relationship between what they are asked to do (whether that is to reveal their inner thoughts, approach unpleasant emotions, or complete homework) and what they hope to get out of the therapy. This relationship between mutual goals and what the patient is asked to do is the essence of what is meant by the working alliance.
Many therapists don’t set goals with patients. Some assume the goals are implicit and need not be stated overtly. If therapists don’t set goals, it’s often because they and their patients understand that the goal is to find love, work engagingly, enjoy life, or feel their lives have meaning. Dr Michael Karson, a professor of psychology at the University of Denver, prefers to make these goals explicit, even if they never come up again. He suggests that some therapists, "don’t set goals because they don’t like the idea of subjecting their work to measurable criteria. The latter can signal failure or a time to stop (when goals are achieved), which can be aversive for therapists."
Recent developments in the field of therapy have reacted to the image of the know-it-all doctor pontificating about the patient’s life and psyche. Now you often see therapists who think they can keep from imposing their own values on patients, which leads them to doing it unconsciously. The result is a generation of therapists who think they are not allowed to co-create the goals of the therapy with the patient. Karson says, "I think it is important to ask patients what they would like to be doing with their time and energy if they weren’t anxious or depressed. This approach allows therapists to decide if they are on board with their patients’ goals, and it articulates an outcome that can inspire the patient. It also sets the stage for psychology to enter the picture when therapists direct attention to patients’ efforts to do these things directly. For example, patients say they would socialize more if they weren’t depressed. Often, it is the case that not socializing is causing the depression rather than the depression causing isolation, but even if that is not the case, it is useful to wonder what step the patient would take if he or she were to socialize. Then, the therapist can focus on what keeps the patient from taking that step."
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Source material from Psychology Today