How to set realistic goals with a client

I am graduate SLP student. I have been learning in my stuttering class that in therapy, we must remain realistic when setting goals with our clients. We cannot promise that we will eliminate a stutter, but we can work towards eliminating the struggles that may come with the stutter. I can imagine that this may be discouraging for clients to learn that they may never be 100% fluent. What is your advice for effectively delivering this message to clients so that they will not be discouraged, and instead encourage and empower them to work towards the goals of eliminating struggles?

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How to set realistic goals with a client — 3 Comments

  1. Good question. I am honest with clients that there is no guarantee regarding outcome. However, I temper this by saying, truthfully, that while we do not know what the outcome will be for any individual, that recovery is certainly possible and that whatever their goal, I want them to focus on the small steps that lead to success, whatever their definition of success looks like.

    All the best as you continue your studies!

    Lynne Shields

  2. Hi!
    Thank you for Your question!
    I find the response from Lynne very relevant. I just want to add a few more things: In clinic we usually recognize multiple factors which may influence a PWS’s therapy goals. Often the goals are mainly based on the principles of coping in real world settings, at least when older children, adolescents and adults who stutter are concerned. One way to deal with the issue about setting goals, is to let the PWSs express their expectations and goals more explicitly and in detail. For example a dialogue might be as follows; Ok I hear that you want to stop Stuttering (reduce Stuttering/be more fluent in talking etc.), but tell me; if this goal is becoming a reality -how will this change become implemented into your life/communication? Some responses might be ‘I want to be more social’, or ‘I want to be more active in talking at work’ ‘I don’t want to struggle so much or use so much energy’, ‘I want to feel more confident at school’, ‘I want to talk more with my children’ and so on. Then I think it is easier to continue the dialogues with the persons to settle mutually agreed goals to therapy.

    Just another way to deal with the question in clinic is to refer to Your previous clinical practice (when you have more experiences:-)) or refer to information from what we know from Research. I also sometimes refer to adults I know and who are hardly Stuttering any more (those cases are more rare). I think it is very important to let the person keep his or her hope and readiness for a change. I also quite often experience that the person change his or her goal/wishes (from ‘to get rid of the stuttering’ to ‘I accept Stuttering as long as it doesn’t prevent me from speaking or achieving what I want to do in life’) during the treatment process.

    I do hope that you understand my ‘Norwegian-English’:-) All the best wishes from
    Hilda Sønsterud

  3. Hi. I like to use an approach taken from Solution-Focused Brief Therapy when goal-setting with clients. I might begin by asking them what they hope to get from our meeting today or from our work together. People do come up with all sorts of responses, but it’s not unusual to hear responses such as “I want to stop stuttering” or “I want to speak more fluently”. I then go on to ask them what will be different in their lives when they have “stopped stuttering” or when they are “speaking more fluently” (or whatever it was that they said) – what will they be doing in their daily lives that they are not doing now or what will they be doing that they are doing now. This often develops into a very interesting conversation, where individuals begin to talk about activities they would like to engage in more or emotions they would like to address. Solution-Focused Brief Therapy provides lots of guidance as to how to develop such conversations in a structured manner (I must admit to being a particular fan of Kidge Burns’ book: “Focus on Solutions: A Health Professional’s Guide), and it can be a constructive way to shift the focus of the conversation whilst empowering clients and harnessing their enthusiasm for change.

    When adult clients ask me directly about the potential for “cure”, I adopt a similar approach to that described by Lynne. I explain that research indicates that, for people who have stuttered for more than four years, the likelihood of stuttering resolving is lower. I go on to explain that I do not know what the outcome will be for that particular individual, but that the research also indicates that stuttering does vary over time, and that change in both the physical experience of stuttering and the way it might be impacting on the individual’s feelings and activities is possible. I share my hope that we will be able to effect positive change through our work together.

    Thank you for your question and for your engagement with the online conference.

    Best wishes,
    Kirsten Howells