Goal Setting and Collaborative Contracting|Unit IV: Middle Stage / Working Phase of Counselling| BASP638 ~ Dr. Manju Antil | Counseling Psychologist | Psychotherapist

1. Historical Background

The concept of the working phase of counselling evolved from early psychoanalytic practice, where the middle phase was considered the period of working through unconscious conflicts (Freud, 1914). With the emergence of humanistic approaches (Rogers, 1951), emphasis shifted toward client autonomy, collaboration, and goal clarity.

Later, behavioral and cognitive-behavioral therapies formalized goal setting as a core therapeutic component, linking goals with measurable outcomes (Beck, 1976). In contemporary practice, the APA’s evidence-based framework integrates goal setting with ethical practice and client values, while the DSM provides a standardized diagnostic system that informs treatment planning and goal formulation (APA, 2022).

Thus, modern goal setting and collaborative contracting represent a synthesis of:

Psychodynamic insight,
Humanistic collaboration,
Behavioral measurability,
Diagnostic clarity.

2. Meaning of the Middle Stage / Working Phase

The middle stage, or working phase, is the most active and change-oriented phase of counselling and psychotherapy. It follows the initial stage (intake, rapport, assessment, formulation) and precedes the termination phase.

This phase focuses on:

Implementing therapeutic strategies
Achieving agreed-upon goals
Modifying maladaptive thoughts, emotions, and behaviors
Enhancing coping and functioning

3. Meaning of Goal Setting

Goal setting is the systematic and collaborative process of defining clear, realistic, and therapeutically relevant objectives that the client aims to achieve during counselling.

According to the APA, goals should be

Client-centered
Evidence-based
Culturally responsive
Ethically sound
(APA, 2017)

4. Meaning of Collaborative Contracting

Collaborative contracting refers to a mutual agreement between the clinician (psychologist or psychiatrist) and the client regarding:

Therapeutic goals
Roles and responsibilities
Methods and techniques
Duration and structure of therapy

It reflects a partnership model rather than a directive or authoritarian approach.

5. Nature of Goal Setting and Collaborative Contracting

The nature of this process is

a) Collaborative

Goals are jointly formulated, respecting client autonomy and professional expertise.

b) Dynamic and Flexible

Goals are reviewed and modified based on progress and emerging clinical information.

c) Evidence-Based

Goals are informed by scientific research, clinical judgment, and client preferences.

d) Ethical

Consistent with APA ethical principles of beneficence, autonomy, and non-maleficence.

e) Contextual

Sensitive to developmental stage, cultural background, and psychosocial realities.

6. DSM Perspective

From the DSM-5-TR perspective (APA, 2022):

Goal setting is informed by symptom clusters, severity, and functional impairment.
DSM diagnosis assists in:
- Identifying treatment targets
- Planning intervention intensity
- Monitoring symptom reduction
Diagnosis at this stage is provisional, not absolute.

🔹 The DSM answers, “What pattern of symptoms is present?”
🔹 Therapy addresses “How can change be facilitated?”

7. APA Perspective

According to the APA’s Guidelines for Evidence-Based Practice (APA, 2017):

Goal setting must integrate:
1. Best available research evidence
2. Clinical expertise
3. Client characteristics, values, and preferences
Collaborative contracting supports:
- Informed consent
- Transparency
- Shared responsibility
- Strong therapeutic alliance

8. Types of Therapeutic Goals

Symptom-focused goals
Reduction of anxiety, depressive symptoms, and panic attacks
Functional goals
Improvement in academic, occupational, or interpersonal functioning
Process goals
Increased insight, emotional regulation, therapy engagement
Preventive goals
Relapse prevention and coping skill development

9. Clinical Case Examples

Case 1: Goal Setting (DSM-Informed)

A 28-year-old woman presents with persistent worry, restlessness, and sleep disturbance.

DSM-based understanding: Provisional anxiety disorder
Goals:
- Short-term: Reduce physiological arousal using relaxation techniques.
- Long-term: Modify maladaptive worry patterns and improve functioning.

Case 2: Collaborative Contracting

A 35-year-old male with alcohol-related problems agrees to:

Weekly counseling sessions
Monitoring drinking behavior
Developing alternative coping strategies
Reviewing progress after six sessions

This shared contract enhances accountability and adherence.

10. Role of Psychologist and Psychiatrist

The clinician:

Integrates DSM diagnosis with individualized formulation
Translates assessment into realistic therapeutic goals
Ensures ethical compliance (APA Code of Ethics)
Coordinates psychotherapy and pharmacotherapy when required
Continuously evaluates progress

11. Challenges in the Working Phase

Client resistance or ambivalence
Unrealistic expectations
Comorbid conditions
External pressures from family or institutions

Clinical judgment, empathy, and flexibility are essential.

Conclusion

The middle stage, or working phase, of counselling is the core therapeutic phase where meaningful psychological change occurs. Goal setting and collaborative contracting

provide structure, direction, and ethical grounding to this phase. While the DSM offers diagnostic clarity and treatment targets, the APA framework ensures person-centered, culturally sensitive, and evidence-based practice. Their integration allows psychiatrists and psychologists to deliver effective, ethical, and outcome-oriented mental health care.