Goal Setting in Mental Health Rehabilitation: References to Competence and Interest as Resources for Negotiating Goals

Abstract

Goal setting is at the heart of mental health rehabilitation, but its joint negotiation by clinicians and clients has proven to be a challenging endeavor. This paper investigates goal setting decision-making in the context of Clubhouse Communities: non-profit organizations designed to pave the way for the recovery of individuals diagnosed with mental illnesses. Using the method of conversation analysis, we demonstrate how clinicians make and account for proposals to involve clients in the discussion as more equal partners. In these accounts, clinicians highlight the client’s potential in terms of either competence or interest. Clients, in turn, resist clinicians’ proposals by invoking the opposing factor: when clinicians highlight clients’ competence, clients appeal to their lack of interest and vice versa. In this way, clients are able to reject clinicians’ goal-proposals without disagreeing with the rationalizations of their competence or interest. By contrast, jointly formulated decisions are best reached when clinicians focus the talk on the characteristics of the desired activity rather than on the characteristics of the client. In so doing, clients are able to claim personal ownership of the goal.