When I get started with work in the morning, I usually check my email, deal with emerging issues, requests, etc., and then move on to plan what I’d like to get done that day. I might have meetings to attend, students to supervise, classes to teach, committee work to do, and so forth. Amidst all of this stuff, I’m usually working on a couple of things over the long-run. I might be working on revising my readings, assignments, exams, and presentation materials for the next time I teach a particular class; writing an article or a book chapter; organizing and coordinating a research project, or working on a report of some kind. These activities represent longer-term goals that I can’t really accomplish in a day; I work on them slowly over time. The emails, meetings, etc., are more like short-term goals – things I have to address on a day-to-day basis. If I decided to only do the short-term stuff, my work life would be chaotic, just attending to one thing (or putting out one fire) after another. On the other hand, if I were to only work on longer-term goal and projects, all of the short-term stuff would fall by the wayside, I’d have hundreds (probably thousands) of unanswered emails, and I wouldn’t be available to help students, clients, or others who need my support in the moment.
If you’re in DBT, you might find that you need to balance short and long-term work in therapy as well. Clients in DBT usually bring in something called a “diary card” on which they document how they felt, whether and how much they practiced DBT skills, and what they have done over the course of the week. The main things they document are important targets for treatment. If you’re someone who would like to reduce self-harm or drug use, for example, you’d put that on your diary card. If you’re working on increasing your exercise or healthy eating, you could put that down and document it as well. Each session, you and your therapist review the diary card and figure out what to focus on that day. Usually your therapist will prioritize (in this order) anything that could threaten your life (e.g., self-harm, suicidal behaviour), interfere with therapy (e.g., not showing up, showing up late, not doing homework, etc.), or hamper your quality of life (e.g., depression, anxiety problems, substance use, eating disorder challenges, avoidance of activities or people). If, however, you were to only discuss stuff that shows up on your diary card each week, you’d probably be missing out on time to address longer-term goals.
Longer-term goals in therapy usually relate to your vision of a life worth living – a life where you’re doing what is important to you, feel a greater sense of peace, fulfillment, and freedom, and are able to cope with the stresses of everyday life while maintaining some sense of equanimity. A life worth living is different for different people. For some, this might involve improving relationships, becoming closer with family members and loved ones, meeting and connecting with new friends, getting around barriers to closeness in relationships (e.g., difficulty expressing emotions), and so forth. For others, life worth living goals could involve working toward gainful employment, increased health, fitness, and wellbeing, contributing to society, or helping others.
You can’t really accomplish these types of goals in one session. It takes time and consistent work. That is why it’s important to balance out the focus on the week-to-week stuff that shows up on your diary card with carving out time to address long-term, life worth living goals. For example, you might spend maybe 20-25 minutes on some high priority stuff from your diary card but then work with your therapist on longer-term, life worth living goals for the remaining time. If you’re finding yourself just addressing week-to-week stuff but not making progress on your longer-term goals, it could be useful to bring this up with your therapist. See if you can work together to make time for both. Moreover, if you start to chip away at your longer-term goals and feel happier with the state of your life, you might also find that the shorter-term problems, such as harmful coping methods, are easier to avoid as well. ~Alexander L. Chapman, Ph.D., R.Psych.