The expanded goal bank is a list of possible general goals and explicit goals for psychological treatment in the WSIB Mental Health Programs. These goals help prompt thinking and discussion between the patient and treating psychologist.
Psychologists are encouraged to think about the ways work-related injury cause difficulties for the patient – whether it’s emotional symptoms or their ability to do daily activities – and identify related general goals for treatment. The explicit goals address the general treatment goals and are used to develop SMART goals. Both general and explicit goals should be recorded as treatment goals in the treatment progress report.
Since this is not a full list of goals, the treating psychologist may come up with other ideas to reduce symptoms, improve quality of life, and recover daily functioning.
Anger
General goal: Increase and practice anger management skills, and reduce angry behaviours
Explicit goals:
- Identify early warning signs that anger is increasing
- Learn and practice anger management skills
- Practice strategies and ways to cool down anger
- Reduce or stop unhelpful anger behaviours (e.g., yelling, name calling, destroying items)
- Practice skills to tolerate social situations that may arouse irritability or anger
- Identify triggers that increase anger response
- Practice more effective ways to express anger (see communication and assertiveness)
- Reduce frequency of anger outbursts
- Learn and practice ways to communicate anger verbally and effectively
- Live a whole day (or week) without an angry outburst
- Stay free of violent behaviour
Anxiety
General goal: Develop strategies to self-manage and reduce anxiety symptoms
Explicit goals:
- Recognize triggers and symptoms of panic attacks
- Identify early warning signs that anxiety is increasing
- Practice anxiety management skills to reduce frequency and intensity of panic symptoms
- Increase tolerance of social interactions/large groups of people
- Identify a list of feared/avoided situations, and create an exposure/desensitization hierarchy
- Gradually reduce avoidance of situations, people or activities
- Reduce avoidance or safety behaviours
- Identify source of anxiety or fear
- Self-manage worry by practicing worry appointments and worry postponement
- Identify top three situations that trigger anxiety, and prepare a coping plan
- Challenge unhelpful thinking with balanced thoughts
- Cope with worried or ruminative thinking by using thought distraction and redirection
- Chunk down tasks to smaller steps to prevent feeling overwhelmed
Behavioural problems or unhelpful habits
General goal: Reduce unhelpful behaviours and maintain positive behaviours
Explicit goals:
- Identify warning signs of maladaptive behaviours
- Identify/reduce unhelpful behavioural responses to triggers
- Reduce occurrence of maladaptive behaviours
- Replace maladaptive behaviours with new alternative behaviours
- Reduce controlling behaviours
- Improve behavioural self-control: practice skills to respond instead of react
- Reduce avoidance of triggers and gradually increase exposure to triggering situations/places/people
- Challenge avoidant behaviour or social withdrawal by re-engaging in activities
- Practice delay and distraction skills to tolerate emotional distress
- Practice self-soothing skills to tolerate emotional distress
- Be free of _____ behaviour
- Acknowledge and practice taking responsibility for own actions/behaviour
- Stop expressing threats to harm self and others
- Practice verbally expressing wants or needs instead of through behaviours
- Identify and share positive experiences or behaviours to feel proud of
Communication skills or assertiveness
General goal: Improve communication skills by learning and using effective communication strategies
Explicit goals:
- Practice appropriate boundary-setting in relationships
- Learn and practice assertiveness skills
- Use ‘I’ statements instead of ‘You’ when communicating with others
- Practice identifying needs
- Practice verbally expressing wants or needs instead of through behaviours
- Gradually practice effectively asking for something or saying no
- Be able to self-manage anger or anxiety in order to be able to communicate effectively
- Learn and practice how to speak clearly and effectively so others can understand
Grief and loss
General goal: Identify and resolve grief over loss(es)
Explicit goals:
- Discuss losses in therapy and put words to the feelings of grief
- Acknowledge and grieve changes in health status, body and/or physical functioning
- Grieve former work identity
- Identify and explore any ripple effects of learnings from the loss
- Explore sense of meaning, purpose and values
- Plan a way to acknowledge the anniversary of the loss
Harm to self or suicide/harm to others
General goal: Manage, reduce or be free of suicidal thoughts/attempts or self-harm behaviours. Reduce and be free of thoughts of harming others
Explicit goals:
- Develop a crisis and safety plan to get through thoughts of harm to self or others
- List people who can support you and help get through a moment of crisis
- Share and discuss your crisis plan with support people
- Create a list, and practice, coping skills to get through moments of high distress
- Remove means for harm from the home (e.g., weapons, knives, medication)
- Practice emotion management and distress tolerance skills
- Practice stress management and coping strategies
- Challenge unhelpful thinking
- Identify triggers to thoughts of harm to self or other
Health conditions(s)
General goal: Manage physical health conditions and cope with related stress
Explicit goals:
- Increase awareness of mind/body connection
- Identify how stress is connected to worsened symptoms
- Improve body image
- Identify what makes physical symptoms worse
- Improve ability to self-manage physical symptoms (e.g., pain, fatigue)
- Attend to symptoms only to determine the ‘how’ of effectively responding, and otherwise decrease symptom focus
- Practice distraction skills to tolerate physical symptoms
- Demonstrate understanding of hurt vs harm principles
- Reduce observable pain behaviours
- Identify ways body still functions well, even with any changes or losses
- Identify ways to stay active, even with symptoms (e.g., pain, fatigue)
- Pace activities to manage symptoms (e.g., pain, fatigue)
- Keep a journal of symptoms to identify triggers that worsen symptoms
- Create a plan to self-manage or reduce flare-ups of symptoms
- Identify and challenge unhelpful beliefs related to health and physical symptoms
- Increase functional tolerance in activities of daily living
- Identify and explore reactions to health condition and medication
- Identify and practice coping strategies to manage reactions to health condition
- Learn and practice assertiveness skills for interacting with health professionals
- Take medications as prescribed, consistently
- Report any concerns about medications to physician
- Attend all scheduled appointments regularly
Low emotional awareness
General goal: Learn to identify and effectively express feelings
Explicit goals:
- Understand the role of feelings in identifying needs and wants
- Create and keep a journal to identify feelings, wants and needs
- Be able to identify feelings as they happen
- Identify and practice healthy and effective ways to express emotions
- Practice expressing emotions verbally instead of through unhelpful behaviours
- Express feelings and needs in therapy sessions
Meaning, purpose and values
General goal: Improve sense of purpose and meaning in daily life, and live according to values
Explicit goals:
- Identify guiding values
- Identify and engage in volunteer work and/or other meaningful activities
- Engage in pleasurable/enjoyable activities
- Begin or return to volunteer activities
- Participate in meaningful roles (e.g., friend, parent, caregiver, worker)
- Start and maintain a regular gratitude journal
- Explore whether spirituality or a spiritual practice would improve sense of meaning and purpose
Mood or depression
General goal: Increase ability to manage moods, maintain stability of mood and improve overall mood
Explicit goals:
- Keep a log to notice triggers to mood fluctuations
- Challenge desire to withdrawal by re-engaging in activities
- Increase participation in previously enjoyable or pleasurable activities or outings
- Create a plan to structure daily activities
- Engage in daily activities as planned
- Pace activities to manage fatigue and exhaustion
- Learn and practice good sleep habits
- Learn and practice good self-care habits
- Learn and practice strategies to manage unhelpful thinking patterns
- Reduce thoughts of harm to self or others
- Use and practice crisis/safety plan to manage thoughts of harm
- Get through a day (or week) without crying spells
- Identify increases in positive feelings
- Identify supportive people and increase connection
Occupational or educational
General goal: Prepare to return to work, adjust work plan, or engage in retraining
Explicit goals:
- Consider volunteer opportunities – identify interests
- Engage in volunteering
- Let go of former work identity (if unable to return to pre-injury job)
- Engage in discussion regarding job search training
- Practice maintaining a daily routine/structure to simulate work schedule (e.g., up and dressed earlier; time concentrating on a task)
- Learn about the role of work engagement in positive mental health
- Actively engage in a work-related or vocational activity
- Apply learned strategies to improve coping with workplace situations and factors
- Practice and improve confidence in managing coworker questions
- Able to engage in return-to-work planning
- Able to manage emotions/tolerate return-to-work discussion
- Initiate contact with a trusted coworker
- Return to social interactions with colleagues
- Return to pre-injury job: modified or full work duties
- Provide consent for a referral to an occupational therapist
- Engage in work-related exposure therapy (imaginal/virtual, or in-person)
- Visit work site
- Create or update resume
- Attend meeting with employer and Return-to-Work Specialist
- Apply and incorporate coping strategies within return-to-work activity
- Identify any non-injury specific challenges or barriers to returning to work (e.g., organizational factors) and discuss with Return-to-Work Specialist
- Practice coping skills that would help in managing any non-injury specific challenges or barriers to returning to work (e.g., organizational factors)
Self-care and personal hygiene
General goal: Improve self-care skills, including personal hygiene and caring for the home
Explicit goals:
- Maintain a regular self-care routine (e.g., shower or bathe every day; get dressed every morning)
- Eat nutritious food regularly; establish daily routine to regularize eating
- Prepare meals
- Practice healthy sleep habits
- Engage in regular moderate physical activity
- Contribute to household chores regularly
- Practice self-nurturing behaviours regularly
- Create and practice a healthy habit plan
Self-esteem, self-worth and self-image
General goal: Develop balanced and healthy self-esteem, self-worth and self-image
Explicit goals:
- Challenge unhelpful negative attitudes toward self
- Discuss in therapy what contributes to a negative self-image
- Identify personal strengths, positive qualities and traits
- Make note of and share qualities or experiences that make you feel proud each day/week
- Improve confidence by building small levels of independence and self-reliance
- Improve body image
- Practice positive self-care habits
Sleep
General goal: Practice positive sleep habits to get restful sleep for seven to nine hours per night
Explicit goals:
- Keep a sleep log (time in bed, awake, total hours asleep)
- Create an evening routine to prepare for bed
- Learn and practice good sleep habits (cool, quiet and dark room, limit caffeine, no TV or computer time before bed, etc.)
- Develop and practice a sleep hygiene plan
- If not sleeping after 20 minutes, get out of bed until sleepy
- Limit bed to sleep and sex – stop doing wakeful activities in bed
- Practice deep breathing, relaxation or meditation daily
Social isolation
General goal: Improve social connections, establish and maintain healthy relationships, improve interpersonal skills
Explicit goals:
- Identify key relationships and increase level of connection
- Identify healthy relationships and/or seek out healthy relationships
- Engage more often with friends or family members
- Seek additional social support from _____
- Increase participation in social activities
- Expand social support (e.g., spend more time with friends/family; make a new friend)
- Connect with people around shared interests, values or activities
- Learn and practice interpersonal skills (e.g., active listening, empathy, assertiveness, communication skills, conflict management, effective emotional expression)
- Increase confidence in social situations
- Tolerate large groups of people
Stress, coping and emotional management
General goal: Improve ability to cope with life events and to manage stress; improve management of upsetting emotions and reduce emotional distress
Explicit goal:
- Understand the stress response (physical arousal, perception and self-talk)
- Identify personal physical symptoms of stress response and physical arousal (e.g., early warning signs stress level is increasing)
- Learn and use stress management techniques daily (breathing, relaxation, meditation, self-talk)
- Practice stress management techniques daily
- Exercise 20-30 minutes per day to reduce or manage physical stress response
- Practice healthy sleep habits
- Identify personal coping style, and practice ways to improve effective approach to stress management
- Identify stressors and create plan to manage stressors
- Identify activities or habits that help to reduce stress
- Increase use of problem-solving skills
- Practice focusing on the ‘how’ of problem-focused coping instead of the ‘why’
- Regain realistic sense of control in life: practice problem-focused coping to control the controllable and emotion-focused coping to tolerate what cannot be controlled
- Practice delay and distraction skills to tolerate emotional distress
- Practice self-soothing skills to tolerate emotional distress
- Manage agitation and restlessness
- Get through the day with less crying or angry outbursts
- Create and keep a journal for stress management
- Create a relapse prevention plan – how to maintain gains from therapy
- Reduce periods of feeling overwhelmed by emotions
- Increase ability to tolerate and regulate emotions
- Learn about, and practice, self-validation of feelings and reactions
- Accept feelings of guilt or remorse
- Challenge and reduce feelings of hopelessness
- Practice anger or anxiety management strategies
- Practice healthy sleep habits
- Discuss stress and emotions in therapy sessions
- Chunk down tasks to smaller steps to prevent feeling overwhelmed
- Identify and resolve remaining stress from injury or pre-injury job
Substance use/misuse or alcohol/drugs/medication addiction
General goal: Reduce substance use or stop substance use; take medications as prescribed
Explicit goals:
- Reduce substance use
- Create and maintain a log of amount and type of substance use
- Identify triggers to misusing substances (e.g., people, locations, events)
- Identify how substance use is affecting daily life
- Avoid triggering people/situations that increase risk of substance use
- Practice strategies and skills to reduce substance use (stress management, emotion management, change environment, distraction, etc.)
- Attend substance use or addiction recovery support group (e.g., Alcoholics Anonymous, Narcotics Anonymous)
- Create a relapse prevention plan
- Identify and practice relapse prevention skills
- Be free of substance misuse and/or abstinent for _______ (days/weeks/months)
Therapy motivation or participation
General goal: Participate in psychotherapy to increase likelihood of benefit/recovery
Explicit goals:
- Identify goals for therapy
- Share goals or make them publicly known
- Complete agreed-upon practice exercises between therapy appointments
- Identify obstacles that prevent goal achievement, and steps to overcome obstacles
- Discuss and resolve torn feelings or ambivalence; consider pros and cons of change
- Attend appointments regularly and on time
- Agree to stop therapy-interfering behaviour(s) ______________
Thinking, decision-making, concentration and memory
General goal: Reduce or manage negative thinking; establish balanced thinking patterns that fit with the facts of the world; improve decision-making skills; improve or manage difficulties with concentration or memory
Explicit goals:
- Identify and challenge unhelpful automatic thoughts or beliefs (e.g., about health/symptoms, self or others, etc.)
- Learn about ‘thinking mistakes’ (e.g., minimizing, catastrophizing) and improve awareness of unhelpful thinking habits
- Practice positive self-talk
- Reduce frequency, duration or intensity of worried/ruminative thinking
- Practice worry appointments and worry postponement
- Use a responsibility pie chart to establish realistic level of responsibility for issues or an event
- Challenge perceptions against how others see things and consider various interpretations of events
- Identify and practice strategies to manage memory loss
- Apply memory encoding strategies
- Use planning strategies to improve ability to perform sequenced or complex tasks
- Improve concentration through practice of gradually increasing the amount of time to concentrate on daily activities (e.g., reading, computer)
- Chunk down tasks to smaller, more manageable steps
- Write pro/con lists to consider options and help with decision-making
- Place a time-limit on making a decision
Trauma
General goals: Manage trauma-related symptoms; explore and resolve issues related to traumatic event(s)
Explicit goals:
- Learn about traumatic reactions, normalize symptoms, and learn about the recovery process
- Identify ways to establish a sense of personal safety
- Learn to identify and self-manage dissociative symptoms
- Learn and use grounding techniques
- Reduce frequency of dissociative symptoms/episodes
- Reduced frequency of flashbacks and/or improve tolerance
- Identify triggers to symptoms
- With therapist, create and practice self-management plan to respond to symptoms
- Create a plan with therapist to discuss the traumatic event
- Reduce avoidance of triggers, and gradually increase exposure to triggering situations/places/people
- Gradually tolerate exposure to previously avoided situations, people or activities
- Identify and work through stuck points related to trauma
- Identify and resolve remaining stress from injury or pre-injury job
- Where possible, identify any ripple effects of lessons or meaning/purpose after the traumatic event