The power of setting achievable goals

​The power of setting achievable goals
 
As a mental health counselor I have long been acutely aware of the need to set achievable, measureable treatment goals. There are many factors which make this difficult. These include:
 

• The client/patient may be expecting immediate relief of the pain without believing that the actual work of healing will help long term or that they are capable to doing the work.
• One knows that behavioral changes are difficult to maintain over time especially which changing habits whether or not related to addiction.
• All involved – client/patient, clinician, and insurance provider – might expect goals to be achieved in an unrealistic amount of time or without accepting that relapse is ‘normal’.
• Although recognized as important, team work is not easily achieved because of various demands of schedules, transportation, access to internet, money or other factors.
• Clinician may get overwhelmed and discouraged and punish the client/patient for not achieving a goal over time. (Cardiologists have refused to continue to see patients who could not quit smoking cigarettes.  Physicians and addiction counselors often refuse to continue to treat a person who continuously relapses.  We, in the United States, live in a punishment oriented society.  Clinicians may blame patient/client rather than reexamining the treatment goal and method of treatment.

 
All of the above resulted in my interest being piqued by Seema Bansal’s Ted Talk entitled “How to fix a broken education system…without any more money.”    Ms.  Bansal was asked to explore solutions to grave education issues in many places in India.  For example, in India by age 11, 50% of students were so far behind grade level that they were dropping out.  The state of Haryana hired her to explore goals and a solutions.  The primary goal they set was that by 2020, 80% of students would be functioning at grade level.   She knew that to reach this goal it has to be affordable, sustainable long term and practical in areas which do not have fat budgets or sophisticated equipment.  The changes that she helped them implement was very basic and included such simple procedures as:
 

• Focusing on long term changes.   Just getting time-limited grants were not necessarily going to be helpful.  When grants end often there is not money to continue to put the changes into effect.
• Using what is available.  For example, if one knows hands on learning is more effective explore the environment to discover what is available.  In some environments sticks and stones were available to demonstrate math principles.
• Using communication systems which work and which allow individuals to help each other.  For example, using a smart phone app was a wonderful way for teachers in that state to communicate not only with administrators but with each other. Suddenly, teachers were helping each other solve problems.
• Insuring that the focus was allowing the teachers time to teach rather than focusing on building maintenance or related issues.

 
Although she does not, in this Ted talk, specifically talk much about the power of hope, we know that when individuals in any system are convinced that some situation is hopeless they quit trying. Hope is contagious.
 
Can we who are involved in other professions apply some of the same principles?  How would one apply them, for example, to working for/with clients/patients presenting with addiction issues (addiction to food, sex, alcohol, other drugs or other substances/behaviors)?   Suppose we consider the following:
 
Goal:

• Reduce the number of relapses by 50 percent over the next year.

 
Methods:

• Keep paperwork to a minimum.  Do not focus on trying to prevent fraud. More time and money will be wasted on attempting to prevent fraud that will be saved.  Trust professionals to do a good job.
• Set realistic goals for each patient and reward small success. Perhaps a realistic goal for some might be for their progressive illness to not progress.
• Never punish the patient/client for behavior which is symptomatic of their illness/presenting issues. (Never punish for any reason.)
• Use resources which are realistic.  For example, not all communities have 12 step meetings or other similar resources.  Meetings may be available on line via computers or smart phones.
• Use on line services –phone, email, text, letters – as a primary form of delivery or as an adjunct to face-to-face meetings.
• Use such resources as text messages to share daily, hopeful messages.  Use with clients/patients and help clients/patients set up group chat or communication system.
• Make it easy for clinicians to help each other.
• Insure that clinicians and patients/clients have an ownership in the system.
• Be open to learning at all levels.  Ask questions. For example, ask why it is that home schooling, often by teachers who are not trained or certified as teachers and using a variety of long distance learning tools, works so well.  Why is it that some para-professional counselors who are not licensed are so effective? Can we pay para-professionals who do a good job at the same rate we pay professionals which in the addition field is not much?  Do we care how folks got educated or proficient in their skills?

 
Of course, there are also some systemic changes which need to be made.  These changes are already taking place in a number of communities. One such change is sending people to treatment rather than sending them to jail/prison.
 
It seems simple to keep focused on what is not working, problem solving what might work, keeping systems simple and available, improving communication and treating everyone win the system with respect.  Yet, it is these simple pieces which often seem to elude us.
 
Written August 13, 2016