Patients' Perceived Lack of Goal Clarity in Psychological Treatments: Scale Development and Negative Correlates

Naline Geurtzen*, Ger P.J. Keijsers, Johan C. Karremans, Bea G. Tiemens, Giel J.M. Hutschemaekers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Goal setting in psychological treatments may have favorable effects on patients' motivation and treatment outcomes. Therefore, it seems important to detect when patients do not perceive clear treatment goals. The current study presents a questionnaire measuring patients' perceived lack of goal clarity. The cross-sectional study consisted of 742 adult outpatients with diverse mental disorders. Patients completed the perceived lack of goal clarity questionnaire, and additional items measuring goal setting and evaluation, therapeutic alliance, symptom levels, patients' dependency on their treatment, and their expected and needed number of future treatment sessions. Exploratory factor analysis and reliability analyses resulted in an unidimensional and reliable questionnaire (9 items, α = .85). Additional findings showed that 23% of the treatments lacked initial goal setting according to the patients. Also, perceived lack of goal clarity was lower when treatment goals were established explicitly at the start of treatment, were formulated together with the therapist, were discussed regularly during treatment, and treatment progress was monitored regularly. Moreover, patients reporting their goals as unclear also reported a poorer quality of the therapeutic alliance, higher symptom levels, increased need for future sessions, but also lower levels of care dependency. These findings underscore the importance of perceived goal clarity in psychological treatments, although the relation with actual goal setting remains uncertain.

Original languageEnglish
Pages (from-to)915-924
Number of pages10
JournalClinical Psychology & Psychotherapy
Issue number6
Early online date22 May 2020
Publication statusPublished - Nov 2020


  • FAIL
  • care dependency
  • goal clarity
  • symptom severity
  • therapeutic alliance
  • treatment goals


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