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Reading this beautifully observed description of two sessions with ‘Max’, in which the Goal-Based Outcomes Measure (GBOM, Law, 2009) is used to set and then review three treatment goals, two questions spring to mind. First, would one want to involve Max’s parents in this process? Second, does Max’s behaviour in the second reported session, so different from his rating of the goals, completely belie that rating and, if so, does it invalidate the exercise?
The question of involving parents in goal-setting is a complex one (Emanuel et al., 2013) and, of course, the therapist may well have been influenced by usual practice in his or her CAMHS. For Max’s parents, being asked to set goals, or rate Max’s, might have been difficult given their struggle with taking on the emotional impact of his disability on him. They have asked that the therapist ‘unlock the puzzle’ of Max’s unhappiness. That Max and his therapist can identify three goals in the third session, two of which clearly articulate things he is unhappy about, might be upsetting. Max
himself seems to have done well to be able to identify these goals so early on; prior to the referral, ‘he could give no reason for how he felt or behaved’. This case also demonstrates the importance of not privileging one rating over another: it seems as though his parents would have been at least as likely as he was to inflate the ratings. We do not know whether the goals and ratings were shared with his parents but I wonder whether this might have supported their own process of coming to terms with Max’s emotional life.
Prior to setting the goals, the therapist deals gracefully with Max’s attempts to demonstrate his physical potency, in which he seems repeatedly thwarted. I wonder whether he may have felt that his power and energy are running out, as well as his sessions, when he becomes preoccupied with dried-up markers. He clearly derives some satisfaction from the idea of the therapy continuing and as such seems energised by the