3 - Goal Setting and Identifying Barriers
1. Introduction
Goal setting is an important part of psychologically informed mental health care. It helps turn a broad concern such as “I want to feel better” or “I need to get my life back on track” into a manageable plan that is meaningful to the person receiving support.
Effective goals provide direction, help the person recognise progress and allow the wider clinical team to understand what support may be needed. However, goal setting should never become an exercise in telling someone what they ought to achieve. Goals are most useful when they are developed collaboratively, reflect the person’s own priorities and take account of their current circumstances, strengths and readiness for change.
People experiencing mental health difficulties may encounter barriers that make change harder. These can include low motivation, anxiety, executive functioning differences, family pressures, financial difficulties, physical illness, social isolation or limited access to services. What appears to be a lack of engagement may therefore reflect an unrecognised barrier rather than unwillingness.
The case worker’s role is to help the person clarify what matters to them, translate this into realistic steps, notice barriers and communicate relevant concerns to the multidisciplinary team. Case workers are not expected to diagnose the cause of a barrier or independently alter a clinical treatment plan. Their contribution is to listen, explore, support, record, report and escalate appropriately.
This lesson builds on previous learning about recovery-focused care, active listening, motivational interviewing and collaborative working. It also prepares learners for reviewing progress and treatment goals in future appointments.
2. Learning Outcomes
By the end of this lesson, learners should be able to:
Explain the purpose of collaborative goal setting in mental health care.
Support a person to develop meaningful, specific and achievable goals.
Distinguish between long-term aspirations, treatment goals and practical action steps.
Identify personal, psychological, social, environmental and service-related barriers to progress.
Respond to barriers using a curious, strengths-based and non-judgemental approach.
Recognise when difficulties affecting progress must be reported or escalated to a senior clinician.
3. The Lecture
What Is a Goal?
A goal describes something that a person would like to achieve, change, maintain or work towards. In mental health care, goals may relate to symptoms, daily functioning, relationships, education, employment, physical health, independence or quality of life.
Examples might include:
Attending school more consistently.
Developing a more regular sleep routine.
Leaving the house twice each week.
Managing appointments more independently.
Reducing alcohol or substance use.
Reconnecting with a friend or family member.
Taking medication as agreed.
Learning strategies for managing anxiety.
Returning to an enjoyable activity.
Feeling more confident communicating with professionals.
A goal does not always involve making a dramatic change. For someone who is acutely unwell, maintaining basic routines or preventing further deterioration may be a significant and appropriate goal. For another person, the priority may be exploring possible changes rather than taking immediate action.
Goals should therefore be judged in relation to the person’s circumstances rather than against what other people might be expected to achieve.
Why Goal Setting Matters
Mental health difficulties can create a sense of uncertainty, helplessness or loss of control. A clear goal can provide direction and help make recovery feel more manageable.
Goal setting can:
Focus appointments on what matters to the person.
Break overwhelming problems into smaller steps.
Strengthen motivation and hope.
Support collaborative decision-making.
Identify the type of practical or clinical support required.
Provide a way of recognising progress.
Help the team review whether an intervention is useful.
Increase the person’s sense of ownership and autonomy.
The process of identifying a goal can be therapeutic in itself. It encourages the person to think beyond the immediate problem and consider what they would like life to look like.
However, poorly chosen goals can have the opposite effect. Goals that are imposed, unrealistic or too vague may leave the person feeling judged or unsuccessful. The quality of the conversation is therefore more important than simply completing a goal-setting form.
Person-Centred Goal Setting
A person-centred goal reflects the priorities of the person receiving support. It should not simply reflect what professionals, relatives or services would prefer.
A clinician may be concerned about sleep, medication or appointment attendance, while the person may be most concerned about loneliness or difficulties returning to work. Both perspectives can be discussed, but the professional should not assume that their priority is automatically the person’s priority.
Useful questions include:
“What would you most like to be different?”
“What is having the greatest effect on your life at the moment?”
“If things improved slightly, what would you notice first?”
“What would make the biggest practical difference to you?”
“What feels realistic between now and our next appointment?”
“Is there anything you would like to maintain rather than change?”
“What has helped you make changes in the past?”
“Who or what could support you with this?”
Some people may not initially know what their goals are. They may feel overwhelmed, have difficulty imagining the future or be attending because somebody else referred them. The case worker should not pressure them into selecting a goal immediately. Exploring their values, daily routines and current difficulties may help an appropriate goal emerge.
The Person’s Goal and the Service’s Goal
A common mistake is to confuse a service outcome with a personal goal.
For example, “improve engagement with the service” may be important to the clinical team, but it does not explain why engagement would matter to the person. A more person-centred goal might be, “Attend appointments so that I can get support with managing panic attacks and return to college.”
Similarly, “be compliant with medication” is not respectful or sufficiently collaborative. A more appropriate goal might be, “Make an informed decision about medication and, if I choose to take it, develop a routine that helps me remember it.”
Professionals may still need to discuss important clinical matters, even when these are not the person’s immediate priority. This should be done openly and respectfully. For example:
“I understand that returning to work is your main priority. The team is also concerned about how little you have been sleeping because this could affect your mental health. Would it be all right if we discuss both?”
This approach acknowledges the person’s goal while remaining attentive to clinical risk.
Different Levels of Goals
It can be helpful to distinguish between aspirations, goals and action steps.
An aspiration is a broad hope for the future, such as:
“I want to feel confident again.”
A goal describes a more defined area of change, such as:
“I want to become more comfortable leaving the house.”
An action step is a specific activity that moves the person towards the goal, such as:
“On Tuesday afternoon, I will walk to the end of the street with my support worker.”
Broad aspirations are valuable because they tell us what matters to the person. However, they are often too large to guide immediate action. The case worker can help the person preserve the aspiration while identifying a smaller next step.
Developing Clear and Achievable Goals
The SMART framework can help make goals clearer. SMART goals are:
Specific: The goal describes what the person intends to do.
Measurable: There is a practical way of noticing whether it happened.
Achievable: The goal is possible within the person’s current circumstances.
Relevant: The goal matters to the person and connects with their priorities.
Time-related: There is an agreed period for attempting or reviewing it.
For example:
“Over the next two weeks, I will take a ten-minute walk after lunch on Mondays and Thursdays.”
This is clearer than:
“I will exercise more.”
SMART should be used as a guide rather than a rigid rule. Human change does not always happen in a neat or predictable way. A goal can be useful even if every element is not precisely measurable.
Overemphasising measurement can also make goals feel mechanical. “Speak to one friend before the next appointment” may be measurable, but the more important issue may be whether the person feels less isolated and what made contact possible.
Making Goals Manageable
A goal should be challenging enough to feel meaningful but not so demanding that it feels impossible.
When a goal is too large, ask:
“What would be the smallest first step?”
“Could we break that down?”
“What would make this feel more manageable?”
“How confident are you that you could do this?”
“Would you like to make the step smaller?”
A confidence scale can be helpful:
“On a scale from 0 to 10, how confident are you that you could do this before the next appointment?”
A low score does not mean the person is unmotivated. It may indicate that the step is too difficult, the timing is wrong or an important barrier has not yet been discussed.
If the person gives a confidence rating of three, the case worker might ask:
“What is making it a three rather than a higher number?”
or:
“What would need to change for it to feel like a five?”
The aim is not to persuade the person to claim greater confidence. It is to understand what would make action more possible.
Strengths-Based Goal Setting
Goal setting should not focus only on deficits or problems. The case worker should also explore the person’s abilities, interests, relationships, resources and previous successes.
Questions might include:
“When have you managed something similar before?”
“What helped on that occasion?”
“What are you already doing that is useful?”
“Who supports you?”
“What personal qualities could help you with this?”
“Are there particular times or situations when this feels easier?”
“What would someone who knows you well say you are good at?”
A person who has stopped attending college may still be completing work from home. Someone who struggles with appointments may nevertheless respond reliably to text messages. A young person who finds verbal communication difficult may express themselves clearly in writing.
These are not minor details. They can provide the foundation for a workable plan.
Understanding Barriers
A barrier is anything that makes progress towards a goal more difficult. Barriers may arise from several areas and often interact with one another.
Emotional and Psychological Barriers
These may include:
Anxiety or fear.
Low mood or loss of interest.
Low confidence.
Shame or fear of judgement.
Previous negative experiences.
Feeling overwhelmed.
Perfectionism.
Difficulty trusting others.
Uncertainty about whether change is wanted.
Fear of failure or of what might happen if circumstances change.
For example, someone may say that they want to return to work but repeatedly avoid completing an application. This should not automatically be interpreted as laziness. They may fear rejection, worry about explaining a gap in employment or feel uncertain about coping in a workplace.
Cognitive and Executive Functioning Barriers
Some people have difficulty with:
Remembering plans or appointments.
Starting tasks.
Organising materials.
Estimating time.
Prioritising.
Moving between activities.
Following several instructions at once.
Maintaining attention.
Breaking a task into steps.
These difficulties may be associated with ADHD, autism, learning disability, brain injury, mental illness, sleep problems, medication effects or other factors. Case workers should observe and report relevant patterns but should not independently diagnose their cause.
Practical support might include written reminders, visual prompts, shorter instructions, calendar alerts, checklists or dividing an activity into smaller steps.
Physical and Health-Related Barriers
Physical illness, pain, fatigue, sleep difficulties, mobility needs, sensory differences and medication side effects may all affect a person’s ability to complete agreed actions.
If a person is repeatedly unable to follow a plan, it is important to ask whether the plan takes sufficient account of their physical health and energy. A goal requiring early-morning activity may be unrealistic for someone experiencing severe insomnia or sedating medication effects.
New, severe or concerning physical symptoms should be reported according to the service’s clinical and emergency procedures.
Social and Practical Barriers
These can include:
Financial hardship.
Housing instability.
Caring responsibilities.
Transport difficulties.
Limited access to digital technology.
Language or communication needs.
Problems at school, college or work.
Social isolation.
Family conflict.
Domestic abuse.
Discrimination.
Lack of childcare.
Difficulty accessing community services.
A psychologically informed approach recognises that distress is influenced by the person’s environment. Encouragement alone will not overcome a practical barrier such as having no money for transport.
Cultural and Identity-Related Barriers
Beliefs about mental health, family expectations, stigma, previous experiences of discrimination and differences in communication style can influence whether a goal feels safe or acceptable.
The case worker should remain curious rather than making assumptions. For example:
“Is there anything about your background, beliefs or family situation that we should understand when thinking about this plan?”
Where language is a barrier, an appropriate interpreter should be considered in accordance with service policy. Family members should not automatically be used to interpret sensitive clinical information.
Service-Related Barriers
Sometimes the barrier comes from the service rather than the person. Examples include:
Inconvenient appointment times.
Inaccessible buildings.
Long waiting periods.
Unclear instructions.
Repeated changes of professional.
Communication that is difficult to understand.
Failure to make reasonable adjustments.
Lack of continuity.
A plan that does not reflect the person’s priorities.
Professionals should be willing to consider whether the service needs to change its approach. The person should not be labelled as “non-compliant” when the plan itself is inaccessible or unrealistic.
Exploring Barriers Without Judgement
The way a barrier is discussed matters. Questions such as “Why didn’t you do it?” can sound accusatory, even when this is not intended.
More helpful questions include:
“How did you get on with the plan?”
“What happened when you tried?”
“Was there anything that made it more difficult?”
“Did the step feel manageable at the time?”
“Was there anything we did not take into account?”
“What might make it easier next time?”
“Would you prefer to adjust the goal?”
The case worker should listen for both spoken and unspoken barriers. A person may say, “I forgot,” when they also felt anxious, confused or doubtful about the goal. Gentle exploration can help build a fuller understanding.
Readiness for Change
People differ in how ready they feel to make a particular change. Someone may:
Not currently see a need for change.
Be considering change but feel uncertain.
Be preparing to take action.
Be actively making changes.
Be working to maintain progress.
Have experienced a setback.
Ambivalence is normal. A person can genuinely want two opposing things at the same time. For example, they may want to reduce cannabis use while also relying on it to manage distress or sleep.
The case worker should not argue, lecture or attempt to force commitment. A motivational approach might involve asking:
“What do you like about the way things are now?”
“What are the less helpful parts?”
“What might be different if you made this change?”
“What concerns do you have about changing?”
“What would need to happen before you felt ready?”
The purpose is to help the person explore their own reasons for and against change.
When a Goal Belongs to Someone Else
In work with children, young people and families, different people may have different goals.
A parent may want fewer emotional outbursts. The young person may want adults to stop placing demands on them. School may prioritise attendance, while the clinician may be concerned about anxiety or risk.
The case worker should avoid automatically treating the adult’s goal as the young person’s goal. Each perspective should be heard and recorded appropriately.
A shared goal may sometimes be possible. For example:
“Develop a morning plan that helps the young person feel less overwhelmed and supports gradual engagement with education.”
At other times, separate goals may be needed. Differences of opinion are not necessarily a failure. They are clinically relevant information that may need to be discussed with the supervising clinician.
Adjustments for Neurodivergent People
Goal setting should be adapted to the individual. A neurodivergent person may benefit from:
Clear and literal language.
Written rather than exclusively verbal information.
Additional processing time.
One question or instruction at a time.
Predictable appointment structures.
Visual or electronic reminders.
Smaller action steps.
Consideration of sensory needs.
Support with task initiation.
Goals that respect the person’s neurotype rather than aiming to make them appear more neurotypical.
For example, “make better eye contact” is generally not an appropriate therapeutic goal. A more respectful goal may be, “Develop a way to show others when more processing time is needed.”
Similarly, a goal should not require a person to suppress harmless self-regulation strategies merely to appear more socially typical.
Responding When a Goal Is Not Achieved
An unmet goal is information, not proof of failure.
When a goal has not been completed, consider whether:
The goal was genuinely chosen by the person.
The step was too large.
The instructions were unclear.
The person forgot.
Their mental or physical health changed.
An unexpected practical problem arose.
The person felt anxious or unsafe.
The required support was not available.
The goal was no longer relevant.
The person’s priorities changed.
The service did not provide what had been agreed.
Possible responses include:
Making the step smaller.
Changing the timescale.
Providing a reminder or practical aid.
Identifying additional support.
Revising the goal.
Pausing the goal.
Asking the wider team to review the plan.
Repeating the same plan without understanding why it did not work is unlikely to be helpful.
Recording Goals and Barriers
Documentation should be clear, respectful and factual. It should distinguish between what the person said, what was observed and what was agreed.
A useful record may include:
The person’s stated priority.
The agreed goal.
The next action step.
Who is responsible for each action.
The intended timescale.
Identified barriers.
Strengths and available support.
Any reasonable adjustments.
The planned review date.
Information reported or escalated to the clinical team.
Avoid judgemental statements such as:
“He failed to engage and made excuses.”
A more factual record would be:
“He reported that he had not attended the community group because anxiety increased when he reached the entrance. He remained interested in attending but requested additional support for the first visit. This will be discussed with the supervising clinician.”
Good documentation allows the next professional to understand both what happened and why the plan may need adjustment.
The Boundaries of the Case Worker Role
A case worker may help the person:
Clarify priorities.
Break goals into smaller steps.
Identify strengths and barriers.
Develop reminders or practical routines.
Access agreed community resources.
Review what helped or hindered progress.
Communicate relevant information to the team.
A case worker should not independently:
Diagnose a mental health or neurodevelopmental condition.
Provide therapy beyond their training and agreed role.
Change medication or advise a person to stop medication.
Alter a clinical risk-management plan.
Promise resources or outcomes that have not been agreed.
Make safeguarding decisions without following service procedures.
Keep risk information secret from the clinical team.
If the barrier appears to relate to worsening mental health, medication effects, safeguarding, significant risk or a need outside the case worker’s competence, it must be reported to an appropriate senior clinician.
When to Escalate
Escalation is required when the person reports or demonstrates:
Suicidal thoughts, plans or intent.
Self-harm or increasing urges to self-harm.
Risk of harm to another person.
Abuse, exploitation or safeguarding concerns.
Severe deterioration in mental state.
Possible psychotic or manic symptoms.
Significant medication side effects.
Severe self-neglect.
Inability to meet essential needs.
Unexpected confusion or marked cognitive change.
Substance use creating immediate risk.
A barrier requiring clinical assessment or a change to the treatment plan.
Concerns outside the case worker’s competence or authority.
The correct response is to recognise the concern, record it accurately, report it promptly and escalate it according to the service’s procedures.
If there is an immediate danger to life or a medical emergency, emergency services should be contacted in accordance with local policy. The case worker should not delay urgent action while waiting for routine supervision.
Clinical Example
A young adult receiving support for depression agrees to apply for two jobs before the next appointment. At review, they have not completed either application. They say, “I just couldn’t be bothered.”
A judgemental interpretation might be that the person lacks motivation. A psychologically informed case worker explores further and learns that the person opened an application but became overwhelmed by the employment-history section. They felt ashamed about a period when they were too unwell to work and closed the form.
The original goal was too large and did not account for the emotional barrier. A revised plan might be:
“Before the next appointment, identify one suitable vacancy and draft the employment-history section with agreed support.”
The case worker should also report the continuing low motivation and shame to the supervising clinician, particularly if these symptoms are worsening or accompanied by hopelessness or risk.
This example demonstrates why understanding the barrier is often more useful than simply repeating the goal.
4. Clinical Perspective
Clinical Pearls
A good goal is not merely well written. It is a goal that the person understands, values and has a realistic chance of attempting.
The person’s confidence in a plan can be more informative than the professional’s confidence. If the person expects the plan to fail, explore why before finalising it.
A missed goal is a source of clinical information. It may reveal anxiety, executive functioning differences, low mood, practical hardship, ambivalence or problems with the plan.
Small steps are not insignificant. For someone who has been socially isolated, replying to one message may represent meaningful progress.
Goals may involve maintaining stability rather than achieving something new. Preventing relapse, continuing a routine or remaining connected to support can be appropriate outcomes.
Practical Tips for Everyday Practice
Use the person’s own words wherever possible. This helps preserve their meaning and makes the plan feel more collaborative.
Agree who will do what. “Contact the college” is unclear unless it is recorded whether the person, case worker, parent or another professional will make contact.
Check understanding. Ask the person to describe the plan in their own words rather than simply asking whether they understand.
Write the agreed step down or send it through an approved communication method. Memory and concentration difficulties are common in mental health settings.
Consider likely barriers before the appointment ends. Asking, “What might get in the way?” can prevent avoidable difficulties.
Review both progress and effort. A person may have made a significant attempt even when the intended outcome was not achieved.
Common Pitfalls and Misconceptions
One common pitfall is setting too many goals. A long list may create pressure and make it difficult to identify what matters most. One or two priorities are often more useful.
Another is choosing goals that are important to the professional but not meaningful to the person. This usually reduces engagement.
Goals should not be used as a test of whether someone deserves support. Difficulty completing an action may indicate that more support or a different approach is required.
Avoid assuming that every barrier is psychological. Transport, money, housing, accessibility and caring responsibilities may be central to the problem.
Do not interpret ambivalence as dishonesty or resistance. Mixed feelings are a normal part of change.
Do not repeatedly reduce every goal until it becomes meaningless. Small steps should still connect clearly with the person’s wider aim.
Advice for Newly Qualified Practitioners
You do not need to solve every barrier yourself. Your role may be to understand it clearly and bring it to the attention of the right professional.
Be cautious about making promises. You can agree to explore a resource or raise a request, but you should not guarantee that another service will accept a referral or provide a particular intervention.
Remain curious when someone does not complete an agreed action. The question is not, “How do I make them comply?” but, “What does this tell us about the person, the situation or the plan?”
Use supervision to discuss goals that feel stuck, repeated non-attendance, conflicting family priorities or situations in which you are uncertain about your role.
Situations Requiring Clinical Judgement or Escalation
A senior clinician should be involved when:
The person’s ability to make an informed decision is uncertain.
Family members strongly disagree about the goals or treatment plan.
The person’s stated goal appears to create a significant risk.
Failure to progress may reflect worsening mental illness.
The person wants to change or stop prescribed medication.
A safeguarding concern is identified.
The case worker is being asked to work beyond their competence.
The person requires a clinical intervention rather than practical support.
The existing plan no longer appears safe or appropriate.
Escalation is not a failure of case work. It is an essential part of safe multidisciplinary practice.
5. Summary
Goal setting helps translate broad concerns and hopes into meaningful, manageable action. Goals are most effective when they are developed collaboratively, expressed in the person’s own language and connected to what matters to them.
The SMART framework can help make a goal clearer, but it should be used flexibly. Goals should account for the person’s circumstances, strengths, readiness for change and support needs.
Barriers may be emotional, cognitive, physical, social, cultural, environmental or related to the way services are organised. Apparent non-engagement should be explored with curiosity rather than judgement.
When a goal is not achieved, the case worker should help identify what happened and consider whether the goal, action step, support or timescale needs to change. An unmet goal is useful information rather than evidence that the person has failed.
Case workers can support practical planning, identify barriers and communicate relevant information. They must report and escalate concerns involving risk, safeguarding, clinical deterioration, medication or needs outside their competence.
6. Further Reading
NICE Guideline NG197: Shared decision making – guidance on involving people in decisions about their care and supporting informed, collaborative choices.
NHS England: Personalised care and support planning – resources concerning personalised conversations, agreed outcomes and coordinated support.
NHS England: Personalised care and support planning – a brief summary guide – a concise introduction to person-centred planning.
Skills for Care: Person-centred and community-based working using strengths-based approaches – practical material on recognising strengths, relationships and community resources.
Miller, W. R. and Rollnick, S. Motivational Interviewing: Helping People Change and Grow. Guilford Press.
Slade, M. Personal Recovery and Mental Illness: A Guide for Mental Health Professionals. Cambridge University Press.
7. Knowledge Check
Question 1
Which statement best describes person-centred goal setting?
A. The professional selects the goal most likely to improve symptoms.
B. The person and professional develop a goal based on what matters to the person.
C. The family decides the goal because they know the person best.
D. The service selects the same goals for everyone with a particular diagnosis.
Correct answer: B
Explanation: Person-centred goal setting is collaborative and starts with the person’s priorities, values and circumstances. The professional contributes clinical knowledge and helps make the plan safe and achievable.
A is incorrect because professional priorities should not automatically replace the person’s preferences. C is incorrect because relatives can provide valuable perspectives but should not routinely make decisions on the person’s behalf. D is incorrect because people with the same diagnosis can have very different needs, strengths and goals.
Question 2
Which of the following is the clearest action step?
A. Improve wellbeing.
B. Become more confident.
C. Try harder to leave the house.
D. Walk to the local shop with a support worker on Wednesday afternoon.
Correct answer: D
Explanation: Option D describes a specific activity, identifies support and includes a time for completion. It can be reviewed without implying that the person has failed if difficulties arise.
A and B are broad aspirations rather than immediate action steps. C is vague and the phrase “try harder” may sound judgemental without explaining what action is expected.
Question 3
A person has not completed an agreed telephone call. What should the case worker do first?
A. Record that the person refused to engage.
B. Make the call without consulting the person.
C. Explore what happened and whether any barriers arose.
D. Discharge the person from support.
Correct answer: C
Explanation: The first step is to explore the situation with curiosity. The person may have forgotten, felt anxious, misunderstood the plan or encountered a practical difficulty.
A is incorrect because it makes an unsupported judgement. B may remove the person’s autonomy and may not address the actual barrier. D is disproportionate and should not occur simply because one action was not completed.
Question 4
A person rates their confidence in completing a goal as three out of ten. What is the most helpful response?
A. Tell them that they need to be more positive.
B. Finalise the goal because they have already agreed to it.
C. Explore what makes the goal difficult and how it could become more manageable.
D. Abandon all goal setting.
Correct answer: C
Explanation: A low confidence rating suggests that the action may be too difficult, poorly timed or affected by an unidentified barrier. Exploring this allows the plan to be revised collaboratively.
A dismisses the person’s concerns. B risks proceeding with an unrealistic plan. D is unnecessary because the goal may become achievable with a smaller step or additional support.
Question 5
Which example most clearly represents an executive functioning barrier?
A. The person cannot afford the bus fare.
B. The person forgets appointments and struggles to organise multistep tasks.
C. The person fears being judged by other people.
D. The appointment room is not wheelchair accessible.
Correct answer: B
Explanation: Remembering, organising, initiating and sequencing tasks are executive functions. Difficulties in these areas may require practical adjustments and should be reported where clinically relevant.
A is a financial and practical barrier. C is an emotional or psychological barrier. D is an environmental and service-accessibility barrier.
Question 6
A young person wants fewer demands at home, while their parent wants improved school attendance. What is the best initial approach?
A. Accept the parent’s goal because the parent is responsible for the child.
B. Accept the young person’s goal and exclude the parent.
C. Listen to both perspectives and explore whether shared or separate goals are needed.
D. Avoid goal setting until they agree completely.
Correct answer: C
Explanation: Both perspectives may contain important information. The case worker should listen to the young person and parent, explore the meaning behind each goal and involve the supervising clinician where necessary.
A does not adequately respect the young person’s views. B unnecessarily excludes a potentially important source of support. D is incorrect because useful work can continue even when people have different priorities.
Question 7
Which goal is most neuroaffirmative?
A. Maintain eye contact throughout every conversation.
B. Stop all repetitive movements in public.
C. Develop a way to tell others when additional processing time is needed.
D. Practise appearing interested even when overwhelmed.
Correct answer: C
Explanation: Option C supports communication and self-advocacy while respecting the person’s needs. It aims to improve the interaction rather than make the person appear more neurotypical.
A may create discomfort and is not necessary for effective listening. B seeks to suppress behaviour that may support self-regulation without establishing that it is harmful. D promotes masking, which may increase distress and exhaustion.
Question 8
A person says they want to reduce cannabis use but also believes it is the only thing that helps them sleep. What does this most likely demonstrate?
A. Ambivalence about change.
B. Deliberate non-compliance.
C. Lack of capacity.
D. Proof that treatment will not work.
Correct answer: A
Explanation: The person can see possible benefits of reducing cannabis while also fearing the loss of something they experience as helpful. These mixed feelings are an example of ambivalence and can be explored using motivational interviewing skills.
B is judgemental and does not recognise the conflict the person is experiencing. C cannot be concluded from ambivalence alone. D is unsupported because mixed feelings do not mean that change is impossible.
Question 9
Which situation should be escalated promptly to a senior clinician?
A. The person would prefer to walk on Thursday rather than Wednesday.
B. The person wants to make an action step slightly smaller.
C. The person reports increasing suicidal thoughts and has considered a method.
D. The person asks for a written reminder.
Correct answer: C
Explanation: Increasing suicidal thoughts and consideration of a method require prompt risk assessment and escalation according to service procedures. If there is an immediate danger, emergency action may be required.
A and B are ordinary adjustments that can usually be discussed collaboratively within the agreed role. D is a reasonable practical adjustment, provided approved communication processes are followed.
Question 10
Which is the most appropriate clinical record?
A. “She was lazy and failed to complete her goal again.”
B. “She was non-compliant with the treatment plan.”
C. “She did not attend the group because anxiety increased as she approached the building. She remains interested in attending and requested support with the first visit.”
D. “Goal not achieved. No further discussion required.”
Correct answer: C
Explanation: Option C records what happened, identifies the reported barrier and describes the person’s continuing interest and requested support. It is factual, respectful and clinically useful.
A uses judgemental language and presents an opinion as fact. B applies a label without explaining the circumstances. D records the outcome but omits information needed to understand the barrier and plan further support.
