A Longitudinal Goal Setting Model for Addressing Complex Personal Problems in Mental Health

Abstract

Goal setting is critical to achieving desired changes in life. Many technologies support defining and tracking progress toward goals, but these are just some parts of the process of setting and achieving goals. People want to set goals that are more complex than the ones supported through technology. Additionally, people use goal-setting technologies longitudinally, yet the understanding of how people's goals evolve is still limited. We study the collaborative practices of mental health therapists and clients for longitudinally setting and working toward goals through semi-structured interviews with 11 clients and 7 therapists who practiced goal setting in their therapy sessions. Based on the results, we create the Longitudinal Goal Setting Model in mental health, a three-stage model. The model describes how clients and therapists select among multiple complex problems, simplify complex problems to specific goals, and adjust goals to help people address complex issues. Our findings show collaboration between clients and therapists can support transformative reflection practices that are difficult to achieve without the therapist, such as seeing problems through new perspectives, questioning and changing practices, or addressing avoided issues.

Approaches for tailoring between-session mental health therapy activities

“…Tailoring in mental health therapy emphasizes adjusting homework to client needs. That is, they should incorporate the client’s values, problems, and socio-cultural context [ 7 , 15 , 41 , 55 , 119 ]. The homework should be achievable between therapy sessions [ 119 ] and align with the coping strategies of the client [ 35 ].…”

“…To improve alignment, therapists work closely with their clients, often over multiple sessions, to identify their goals and suggest between-session activities for the client [ 12 , 15 , 40 , 41 , 55 ]. They employ their client’s values, long-term goals, underlying problems, and social relationships to tailor activities [ 7 , 15 , 33 , 55 , 119 ]. Without good tailoring, clients might encounter barriers such as low motivation to change or lack of understanding the relevance of therapy homework.…”

“…Tailoring behavioral activities can be difficult to achieve in the design of technology aimed at setting goals [ 7 ], providing behavioral recommendations and behavioral plans [ 10 , 33 ], and delivering motivational messages [ 20 , 69 ]. Tailoring of technologies is limited when they do not account for the contexts people experience — such as location (e.g., home vs. work) [ 93 ] and timing for engagement in desired behaviors [ 89 , 93 ] — people’s values [ 69 ], and how people engage in behaviors (e.g., being “on the go” and eating unhealthy food) [ 33 ].…”

“…Mental health is a particularly challenging domain for personalizing behavioral interventions to support people’s goals because the goals people set are holistic and span multiple aspects of their life (e.g. exercise, diet, relationships, and symptom management) [ 7 ]. People also might manage multiple such goals [ 7 ], prioritize different goals at different times [ 7 ], and experience a wide range of mental health symptoms (e.g., fatigue or sadness) [ 6 , 70 ] that can affect people’s motivation to work towards their goals [ 45 ].…”

“…exercise, diet, relationships, and symptom management) [ 7 ]. People also might manage multiple such goals [ 7 ], prioritize different goals at different times [ 7 ], and experience a wide range of mental health symptoms (e.g., fatigue or sadness) [ 6 , 70 ] that can affect people’s motivation to work towards their goals [ 45 ]. It is unclear which aspects of a person’s individual circumstance and life are most important to tailoring mental health support, and how providers decide how to adjust activities based on client needs.…”