20 commandments 17: Thou shalt listen well to the client’s aspirations for their life and give support to achieve them

One of the most annoying aspects of mental health ‘treatment as usual’ is the ease with which workers seem prepared to ‘write off’ their service-users’ dreams and aspirations as ‘unrealistic’ or ‘unachievable’. This is a natural by-product of the ‘us and them’ mindset that sees all workers as somehow more likely to achieve than all service-users.

It takes very little thought to understand just how ridiculous this assumption is but unfortunately that’s also what many workers apply to this question – very little thought.

Another outcome of this ‘us and them’ mindset is the likelihood that all workers, even the least successful will see their service-users as less able than they are themselves. So if the service-user’s aspirations are beyond what the worker can achieve themselves (or thinks they could achieve themselves) then it is automatically defined as ‘impossible’ by the worker. That isn’t a very high bar to set before we begin undermining the potential of our service-users to outgrow our service and do well in their lives, whatever ‘doing well’ might mean to them.

The antidote to this involves understanding that many (if not most) service-users naturally should outgrow our services if we help them to. Our task is to help them with the achievements that fall within our job description – not to impose limits upon what they can do once they leave us. So we take large objectives and reduce them down to the ‘task in hand’. What do we need to do at this stage of your development. Let’s work on that?

For example, if your client wants to be a brain surgeon we can have no idea whether or not they might achieve that goal. But we can be clear that the first step might be to get some O Levels and before they can commit to that they need to get a wake/sleep routine that will help them to study properly. So we work on that. What happens after they leave our service is, quite frankly, none of our business.

The process of setting goals and objectives need not be complex but it must be collaborative and the more precise each goal is along the journey of recovery the more likely it is to succeed.

Each goal should stretch the service-user a little but must also be achievable. Success breeds success.

It’s also extremely important to understand that goals and aspirations change. Even if you believe that the goal is unattainable that’s not your business. You work on what is appropriate for now. If the client isn’t destined to become a brain surgeon that will become apparent later, (perhaps when they begin to apply for medical school). But the goal is what motivates them for now – just as your early goals motivated you in the past, even though you long since changed direction and took a different path.

It is no more our place to rob our service-users of their aspirations and dreams than it would have been anyone else’s to rob us of ours in years gone by.

Unrealistic goals are always reducable:

Brain surgeon
↓

 Doctor
↓

      Medical school
↓

        University
↓

   Night school/access course
↓

          Routine
↓

      Sleep pattern

↓

     Deal with drug/alcohol use

↓

Change social situation

Based on the work of ‘Margreeth H.’   

www.20commandments.blogspot.com