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patient distress. Even though some individuals death experiences, repeated rape, and neglect
are able to insightfully describe the problem, from her parents. The problem created trauma
others are only vaguely aware of nature of the symptoms (she did not meet all the criteria for
problem and focus solely on the symptoms. a PTSD diagnosis), feelings of low self-worth,
Areas that therapists consider in assessing the and a worldview that was inconsistent with her
problem are: faith.
• When did the problem begin?
• What keeps the problem from being resol- The Goal
ved? Only after determining the exact location of
• What attempts have been made at solving the client can a goal be established. As with the
the problem? therapeutic problem, the goal is a collaborati-
• Why have these attempts failed? ve effort between the patient and the therapist.
• What has the patient not considered? Believing that every person has the right to self-
• When is the problem not a problem (excep- determination, for a therapist to make this de-
tions to the problem)? cision on behalf on the patient is a disservice
• Who else is involved in the problem? to the one seeking help (Sanders, 2013). Thera-
peutic consent requires therapists to avoid im-
Following a thorough assessment, the therapist posing their own ideas of what is best onto the
and patient discuss the problem in detail and patient. This does not mean that we withhold
only then should the goal for counseling be de- our expertise or advisement as goals are deter-
termined. Determining both the problem and mined.
the goal should be a collaborative effort between There may be times when counselors do not
the therapist and patient. While the therapist fully disclose the intended goal. At times, tho-
brings knowledge and expertise to the counse- se seeking our help are not ready to discuss or
ling relationship, the patient is the expert on her even contemplate the full therapeutic picture.
or his self. Both are needed to provide the best For example, occasionally patients have unrea-
possible outcome. listic goals but are not able to recognize that
In using Jones’ forest metaphor, we would first the goal is either unobtainable or unhealthy for
locate the patient within the boundaries of the the patient. In these situations, some therapeu-
forest. We would need to identify exactly where tic work must be completed and then the goal
she is, what the area around her might look like should be revisited and adjusted.
and dangers that we would need to account for. In the case of Anna, she arrived at counseling
In the case of Anna, we might say that she was asking for a reduction in trauma symptoms.
reliving past traumas that was causing her great She also wanted help in healing her childhood
anxiety, sleeplessness, emotional turmoil, and memories and forgiving her brother so that
some confusion. We would also take into con- she could comfortably interact with him. She
sideration her supportive husband and child- further explained that because she was a Chri-
ren, strong faith in God, and environmental stian, God expected her to forgive her abusive
safety. We would also note that Anna’s brothers brother and forget the abuse so that she could
believed that she was the problem and should show Henry the love of Christ. Due to the fragi-
let the past go. After several sessions, the thera- le nature of the client, the therapist rightly cho-
pist would notice evidence of marked low self se to work with Anna on reducing her trauma
worth and self-denigrating self talk; including symptoms before she focused on the spiritual
her belief that she was “stupid”, “unlovable”, and concerns of forgiveness and challenged the wis-
“worthless” – beliefs that were in direct conflict dom of attempting to forget the violent nature
with how her husband, children, and friends of her brother – who continued to display ab-
viewed her and how she believed that God saw usive behaviors. Only after some work had been
her. For Anna, the therapeutic problem was done did the therapist revisit and then adjust
unresolved, multiple blow, childhood trauma the set goal.
stemming from significant physical abuse, near Knowing the goal of therapy gives direction to

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