Patients Resolve to Pursue Small Steps Toward Big Goals

Feeling any buyer's remorse about those New Year's resolutions you invested in emotionally last month? An alcohol and drug counselor at the Mountainside treatment facility in Canaan, Conn., says most of her patients can sympathize, having learned from painful experience about the pitfalls of setting often unrealistic personal goals.

So when Mountainside primary clinician Jana Wu, LCSW, LADC, asks patients in her facilitated groups if they commonly make New Year's resolutions, she's usually met with a resounding “no.” She tells Addiction Professional that she'll often hear comments such as, “I have tried, and I used again.”

For both the treatment population and the general public, the way in which resolutions are articulated often doesn't account for the small steps it will take to reach the bigger goal, she believes. Wu, who works with patients at numerous levels of care in Mountainside's continuum, therefore prefers to steer the end-of-year conversation to questions such as: What worked for you this past year? How did you get there? Who helped you?

That last question becomes critically important for patients who have struggled with setting goals on their own and will acknowledge, “I need other people. I need community,” Wu says.

Signs of progress

Wu refers to the steps that she'd prefer to see patients take as “small committed actions to move toward your values.” Many patients in the past have become demoralized by trying so hard to achieve the bigger goals, and they are not alone. Research in the general public has suggested that a high percentage of New Year's resolutions don't survive into February.

At the end of the year, Wu will focus the discussion to the positive, reviewing with patients the accomplishments they have been able to make. In recovery maintenance groups, progress might entail having sustained a month of sobriety, or being part of a recovery community that doesn't judge. For some male patients, progress might involve having communicated better with loved ones now that they are on a recovery path. For some women, it might involve improved self-care, being able to say “no” without guilt.

With treatment becoming more patient-centered in general, Wu says the process of setting goals is evolving as a more collaborative venture. A patient in an abstinence-focused program might state a goal of “making better choices” rather than achieving abstinence, and it becomes the clinician's job to determine how to help the person within the confines of the counselor's role, she says.

Goal setting can become a dynamic process in group, she says, as some patients' personal goals will tend to shift during treatment as they observe how others are faring with theirs.

Setting a goal also can be daunting for family members of patients, given how this has led to frustration in the past. Wu says she encourages family members to think in terms of their “hope,” both for their loved one and, importantly, for themselves.