Speech pathologist perspectives on goal setting

In a study completed by Deborah Hersh and colleagues in 2012, thirty-four speech pathologists were interviewed to explore their perceptions of an aphasia rehabilitation goal. Interviewees viewed these goals in six main ways:

1. goals as desires;
2. SMART goals;
3. impairment or functional goals;
4. goals as steps;
5. goals as contracts; and
6. implicit goals.

The varying definitions provide insight into how different clinicians conceptualise aphasia therapy. The concepts of ‘SMART’ goals and goals as ‘desires’ are inherently different, almost contradictory, and as the author describes, represent an underlying difference in approaches to aphasia rehabilitation (Hersh, Worrall, et al., 2012).

The speech pathologist is in the difficult situation of having to attend to the desires and wishes of their client in a client-centred manner whilst also having to work in an efficient ‘SMART’ fashion, validating their efforts via improvements, often on objective scales. The two conflicting views parallel a longstanding tension between the impairment and social approaches to rehabilitation (Hersh, Worrall, et al., 2012).

Goals are increasingly expected to be collaborative, as clients demand more involvement in their care, have greater access to technology, and are generally better informed. This shift in client involvement requires the clinician to reflect on the appropriateness of their practice given the changing focus of care and their professional role from ‘technician’ to ‘partner or facilitator’. 

References

1. Hersh, D., Sherratt, S., Howe, T., Worrall, L., Davidson, B., & Ferguson, A. (2012). An analysis of the “goal” in aphasia rehabilitation. Aphasiology, 26(8), 971-984. doi: 10.1080/02687038.2012.684339