Weiste, Niska, Valkeapää & Stevanovic (2022).
Weiste, E., Niska, M. Valkeapää,T. & Stevanovic, M. (2022). Goal setting in mental health rehabilitation: Reference to competence and interest as resources for negotiating goals. Journal of Psychosocial Rehabilitation and Mental Health, 9, 409–424.
Involving clients in decision making and planning for recovery is a deliberate and essential process in therapy. Research evidence to date shows the importance of personally meaningful goals in sustaining motivation and supporting recovery. This paper shows how these goals are negotiated and talked into being between clients and practitioners.
Weiste and her colleagues emphasise the importance of deontic rights in goal setting, that is “the power to determine what will be done” (p.410). The data in this paper comes from a Clubhouse in Finland; the Clubhouse model is a not-for-profit community-based rehabilitation site that promotes belonging, relationships and skill development for returning to employment. The data here are six recorded discussions between clients and social workers as they wrote down goals for a period of several months. 32 goals were identified for analysis of how this goal-setting was constructed in the conversation.
Typically, staff proposed goals which were initially rejected by clients: not necessarily outright rejection but received with minimal acknowledgement or commitment.
“In these accounts [i.e. reasons to support the stated goal], [staff] highlighted clients’ potential in terms of either (1) competence (the client should pursue the goal because they are capable of achieving it) or (2) interest (the client should pursue the goal because they are interested in it). When, in their following turns of talk, clients resisted staff members’ proposals, they invoked the opposite factor: when staff members produced an account of clients’ competence, clients appealed to their lack of interest. When staff members accounted for the rehabilitant’s interest, clients rejected the proposal by appealing to their lack of competence. In this way, clients were able to reject staff members’ goal-proposals without disagreeing with their rationalizations. However, goal-decisions were best reached when staff members focused the talk on the characteristics of a desired activity, rather than on the characteristics of a client. In so doing, they invited clients to specify what would need to change regarding the activity, thereby involving them in the goal-setting activity.”
Where clients resist by claiming a lack of interest, they hold the epistemic authority i.e. they are the ones who know best what interests them or not. Where clients claim a lack of ability, (e.g “I’m really interested in the meetings but I am so tense that I don’t really dare say anything”) staff might counter by re-stating the client’s competence, yet to little effect.
What proved most productive in these interactions was focusing on the activities (i.e. elements of the goal itself) rather than the competence or interest of the client (e.g. “what if we put something about work assignments”). Focusing on the characteristics of the activity rather than the characteristics of the client was most effective in jointly establishing goals for recovery. This collaboration is necessary because ownership of goals is integral to their achievement.