Goals as red herrings
The first goals the clients state in session often end up not being the “real” reason they’re in therapy.
I want clients to show up as authentically as possible, and I don’t want to interrupt that. I do not even want to interrupt that by suggesting how they should be in therapy. Sometimes basic psycho-education is needed but I truly want the process undisturbed. I’m letting you know, they name their goals, if they want to.
I do bi-weekly consultation with a psychoanalyst that primarily has their clients free-associate in session, he sits away from them, and in the classic style, says very little. Sometimes a few words in some of his sessions. Or a sentence.
I’ve learned a great deal from this analyst so far. I’ve learned that clients say a bunch of things, and therapists, including myself at times, dive after each piece of material like they’re ancient relics or something, but sometimes they are not valuable thoughts. We all have all kinds of thoughts. I remember once he said something about my mind apparatus. He said little in this consultation. I don’t remember exactly what the hell he said about my “mind apparatus” but it made me feel quite seen. I love when weird therapy sentences make us feel seen.
Anyways,
I don’t chase every word and thought in sessions. I’ve gotten better at this. I’m actually quite fascinated by my own development as a therapist.
This has been particularly useful, in the first few sessions, where I often find the goals that clients set are not their actual goals for therapy.
Sometimes the goals the clients set are their genuine ones, in my anecdotal experience they’re more like secondary ones. Astonishingly and even more than slightly more than rarely, they sometimes are not even what the client actually desires.
Ogden in “Coming to Life in The Consulting Room” sort of lays out his thesis in the beginning for a patient’s goal being their “becoming to understand” First he quotes and summarizes Bion “We must denounce desires for results and even understanding. Memory of what we think we know. Both memory of what we think we know and desire for understanding of what has not occurred (and is consequently unknowable) are hindrances to the psychoanalyst intuition of the reality of what is occurring in the session” (Pg 18, Coming to life in the consulting room, mostly explaining Bion’s understanding of ontological analysis)
In his 1981 book The Practice of Multimodal Therapy, Lazarus warns that a client's initial complaint or goal is often just a "calling card." [1]
Basically, clients come in with a complaint that is neat or normal on session day, or in the first few. (you’ve already heard me vent about intake, that actually could have been 20 x longer but I digress)
What they’re coming in with is within their current access, their current memory, their ability to articulate safely. But often it’s a red herring. It’s important to explore the clients many issues and feelings. This doesn’t mean the goal is false, but it often isn’t central. And if Ogden is right in his thesis that therapy is about becoming, goals might genuinely be formed in the therapy later.
When I was an intern, I’d chase every piece of information like a very happy golden retriever playing fetch. Did I do horrendous therapy? I’m pretty sure no. Now, did I initially waste time? Absolutely.
Another interesting thing Ogden mentions is trying to “forget” everything the client has told you at the start of a new session. This can help you see the client brand new, consider their goals differently, and even shake off some of the counter-transference. Counter-transference can be an excellent window into the therapy. It is also sometimes so deeply distracting.
I find this “forgetting” helpful for clients who loop on goals they just don’t have the capacity to achieve yet- all of a sudden in session we uncover a new problem, a new goal, one they haven’t located. Maybe they have articulated this “goal” out-loud to someone for the first time.
My new favorite thing? It’s not when clients say “that was helpful” "or “great question” or change. It’s actually when a client says
“That is the first time I’ve ever said that aloud/out-loud.”
Because yes, this is what therapy is all about! They are thinking about themselves, their desires, and unlocking it in a very important way. They are getting to know themselves more deeply- and this includes locating goals and the real reasons they are in therapy, which might be initially unknown to them.
Winnicott, also discusses how people construct an entirely false self. Defensive mechanism to create a compliant sort of facade, devoid of spontaneity and authentic living. It is more than likely people come into therapy with this defense. One of the ways this false self is elaborated on is apparently by having their needs overridden by others. It almost sounds like a more elaborate description of “people-pleasing”
(a fake scenario obviously) A client could come in claiming that they no longer want to binge eat anymore. You could spend your time understanding why they binge eat, when they do it, how, is it related to this, is it related to that, are they struggling with their weight? blah blah blah. How neat.
Those are all well and good questions. frequency. severity. the basics.
However, after further digging you might discover that binge-eating is really the only spontaneous thing they ever do. It sounds more orgasmic, almost more sexual and uninhibited than like, all of their other behaviors, even their sex life. Yep.
Perhaps they are incredibly straight-edge and neat in every other area. In fact, you discover that they love binge-eating and they never want to end the behavior. The goal might still be yes, I suppose to stop binge-eating but another goal arises- how can we get this patient to live a more spontaneous and interesting life?
We’re trained to value goals. We want to help! Patients come in morose and might say little or a lot. We want to give them a salve to what ails them.
But human beings are deep. If we become religious and obsessed with the original map, we might stop looking at the client that is sitting right in front of us. and that is a sure way to set yourself up for a clinical detour.
What I cited here:
Coming to Life in The Consulting Room
Ogden who cited Bion’s work from 1967, apparently the words were said on page 137)
The Meta-cited work: In 1967, Bion published his seminal collection of papers titled Second Thoughts: Selected Papers on Psycho-Analysis
Winnicott, D. W. (1960). Ego distortion in terms of true and false self. In The maturational processes and the facilitating environment: Studies in the theory of emotional development (pp. 140–152). International Universities Press.
