Doctor of Philosophy (Clinical Psychology)
School of Psychology - Faculty of Health & Behavioural Sciences
Clarke, Samantha, Recovery goals: goal quality, goal content and the impact of goal attainment on outcome for consumers with enduring mental illness, PhD (Clin/Psyc) thesis, School of Psychology, University of Wollongong, 2008. http://ro.uow.edu.au/theses/808
Personal goals are an important foundation of recovery from enduring mental illness (EMI), providing a sense of meaning, identity and hope. Recovery goals, within a case-management setting, are developed in collaboration between the person in recovery from EMI and the mental health worker. Goals are a fundamental component of most rehabilitation programs and models of recovery emphasise the importance of the goal striving process, yet minimal research has examined goal setting and striving within the mental health case-management context. This thesis aimed to progress recovery research related to goal striving. Four studies are presented that examine aspects of recovery goal setting for consumers with EMI.
Study 1 and 2 examined aspects of goal setting quality. Study 1 investigated the quality of goal setting within Australian mental health services. Mental health consumer files (N = 122) were reviewed and goal records were assessed for quality. Seventy four percent of files contained a goal record and on average goal records included 50% of goal setting principles likely to enhance goal progress. Goal setting quality was examined after mental health workers were trained in the Collaborative Recovery Model (CRM), which includes goal setting protocols drawn from previous evidence from goal research. Mental health consumers’ goal records (N = 78) both prior to and subsequent to the Collaborative Recovery Training Program (CRTP) were also reviewed. CRTP lead to an improvement in both the frequency and quality of goal setting and the use of a structured goal setting intervention also seemed to promote further goal quality.
To examine the relationship between goal quality and improvements in working alliance and treatment outcome, standardised residual gain scores for the Working Alliance Inventory (WAI-s) and mental health outcome measures were calculated and correlated with goal quality for 110 mental health consumers. Goal quality was also associated with the goal and task subscales of the consumer rated WAI-s, and there was a modest relationship between goal quality and improvements in symptom distress.
Study 2 also examined goal quality by surveying mental health workers (N = 83) on the clinical utility of the Collaborative Goal Technology (CGT) - a structured goal setting protocol. Workers reported they were more likely to use skills to develop meaningful and manageable goals when compared to the skills required to review goal progress. Technical skills of the CGT (calculating the Collaborative Goal Index and different levels of goal attainment) were employed least. Insufficient time was often reported as impeding correct use of the CGT and consumer factors (i.e., not being interested, too unstable) was the most frequently reported reason for mental health workers not attempting the CGT.
Study 3 examined the content of case-management goals set within recovery and investigated whether the content of goals differed depending on the stage of psychological recovery. One hundred and forty four mental health consumers’ CGT’s were reviewed. Physical health goals were reported significantly more frequently than any other types of goal and were rated as most important by 23% of consumers. Goals focused on employment and developing and maintaining relationships were often identified as most important, suggesting these types of goals are often a source of meaning and purpose for consumers within recovery. Significantly more health goals were set within the first stage of psychological recovery and health goals were also associated with poorer scores on the Recovery Assessment Scale - short. This suggests that in the early phases of recovery a focus on basic health needs is a priority and may signify the lack of longer term more meaningful goals at this time. Themes in the data suggest that people further along in their recovery set a greater range of goals. Relationship goals were typically set within the middle stages of recovery followed by employment goals toward the later stages of recovery. There was also significantly more approach goals set within the last two stages of recovery indicating that within these final stages, goals are more likely to be focused on moving towards desirable outcomes rather than avoiding negative outcomes.
Study 4 explored the relationship between case-management goal attainment and improvements in mental health outcome (N = 71). Path modelling indicated that when symptoms are perceived as less distressing consumers are better able to make progress towards their case-management goals, which in turn promotes aspects of recovery such as; hope, self-confidence, sense of purpose and positive identity. This highlights the importance of a recovery framework of casemanagement, placing a focus on both alleviation of symptoms and promoting striving towards personally meaningful goals in order to promote recovery from EMI.
The present research provides insight into the quality and content of goals set within recovery from mental illness for consumers with EMI and also provides support that goal attainment is associated with enhanced psychological recovery. Longitudinal research is required to assess the direction of the relationships found between treatment outcome and goal quality and goal attainment and, goal content and psychological recovery.