A program to assist people with severe mental illness in formulating realistic life goals - Formulating Realistic Life Goals

Posted by Justin | July 31, 2007 .

A review by Spencer, Davidson, & White (1997) indicated several clinical approaches for helping individuals develop hope for the future. These approaches include goal setting, goal attainment, examination of change in an individual’s occupational configurations over time, and qualitative interviews about life history. It was reported that rehabilitation professionals used purposeful activities to help individuals develop goals during the recovery process (Howard & Howard, 1997).

A longitudinal study (Harding & Zahniser, 1994) demonstrated that people with serious mental illness can recover as evidenced by their successful employment and meaningful lives. A case study by Stern and Drummond (1991) illustrated that individuals with persistent schizophrenia changed from being `unwilling to be discharged’ to `willing’ when appropriate strategy was used. Steams (1998) measured the change in hope of 13 individuals with mental illness after receiving a three-month Lowa rehabilitation program. Significant differences in pre and post measures of the Herth Hope Scale were noted.

To date, hospital-based treatment protocol to help individuals with mental illness in setting realistic life goals has been scant. Bauer & McBride (1996) developed a five-session psycho-educational program designed to help in-patients with affective disorder develop life goals, improve their social and occupational functioning and improve self-management skills. The program however, was not suitable for individuals with persistent schizophrenia as individuals with this disorder are usually detached from reality and have poorer prognosis than individuals with affective disorder. Structured protocol to assist the development of life goal for individuals with severe mental illness has rarely been documented. A clinical protocol (Goal Attainment Program, GAP) (Ng, 1999) was therefore designed and piloted to in-patients with severe mental illness in Hong Kong (a Special Administrative Region of China). This paper aims at describing the theoretical framework and reporting the findings of the pilot study regarding the effectiveness of the GAP.

Framework of the Four-stage Cyclic Model of Goal Attainment

The framework for planning the Goal Attainment Program was based on the Mezirow (1981) learning cycle (adult learning theory) and a planning model for change (Rantz and Miller, 1987). Mezirow’s adult learning theory (1981) provides a framework to guide individual mentoring processes which was found useful in integrating Chinese scholars into Canadian culture (Morales-Mann & Higuchi, 1995). The adult learning theory was used as guideline for the program in this study because it emphasizes self-examination and relates one’s experience to others. It is consistent with the approach of life history review during counseling sessions. The adult learning theory also encourages building competence and confidence in new ways of acting, which is one of the objectives for the Goal Attainment Program. As in-patients with severe mental illness have often adopted a maladaptive passive life pattern, encouraging them to view life with a new perspective may facilitate change. Finally, the reintegration into society as the final step of adult learning theory matches the ultimate goal of the Goal Attainment Program.