The Therapeutic Alliance Audit: Why You Feel Lost in Therapy (And How Goals Fix That)
Sarah walked out of her eighth therapy session feeling more confused than when she started. Today they'd talked about her anxiety at work. Last week it was her relationship with her mother. The session before that focused on childhood memories that came up randomly. Each conversation felt meaningful in the moment, but sitting in her car afterward, Sarah couldn't shake the feeling that she was driving cross-country without a GPS—lots of movement, but no clear destination.
"Maybe I'm just not good at therapy," Sarah thought, scheduling her ninth session while secretly wondering if she was wasting her time and money on expensive conversations that went nowhere.
Sarah isn't failing at therapy. Her therapist is failing to provide one of the most fundamental elements of effective treatment: clear, collaborative goal-setting that creates direction and measurable progress. Without explicit goals, therapy becomes an expensive form of supportive friendship rather than professional treatment designed to create specific changes in your life.
You're Not Imagining the Confusion
If therapy feels aimless and you can't tell whether you're making progress, you're experiencing what researchers call "lack of goal clarity"—a widespread problem in mental health treatment that leaves clients feeling lost and powerless in their own recovery process.
The American Psychological Association states clearly that therapy should be "an active collaboration between you and the psychologist," not a process where you sit passively hoping something magical happens. Yet research shows that many patients perceive significant lack of goal clarity in psychological treatments, indicating that 23% of therapists routinely skip this fundamental collaborative step.
Studies reveal that goal-setting practices vary dramatically between therapists, with some avoiding explicit goal discussions entirely. Even when goals are established, research shows they're often not tracked systematically or are allowed to drift without clear rationale—which produces the same confused experience as having no goals at all. Nearly 40% of patients said, in one survey, that their goals and progress were “never” or “only sometimes” discussed.
This isn't your fault, and it's not a normal part of therapy. Professional treatment should include clear direction from the beginning, not wandering conversations that leave you questioning whether anything is actually changing.
What You're Really Trying to Buy vs. What Goals Actually Provide
What you're really trying to buy: Direction, control over your treatment, and measurable progress toward specific improvements in your life that justify the time and money you're investing.
What collaborative goal-setting provides: A therapeutic GPS system that tells you where you're heading, how you'll know when you arrive, and whether you're making progress along the way. Goals transform therapy from aimless conversation into purposeful work with clear destinations.
Research on therapeutic alliance shows that agreement on goals is one of three essential components (along with agreement on tasks and developing a genuine bond). When clients and therapists explicitly agree on what they're trying to accomplish, studies demonstrate faster improvement and fewer sessions needed to achieve meaningful change.
Without clear goals, you're vulnerable to several problems that extend treatment unnecessarily: session topics drift based on whatever you're thinking about that day, progress becomes impossible to measure objectively, and you can't advocate for adjustments when approaches aren't working because there are no clear targets to evaluate.
The Shocking Research: Most Therapists Skip This Basic Step
The data on therapist compliance with goal-setting best practices reveals a disturbing pattern. Research shows that many patients perceive lack of goal clarity in psychological treatments, yet systematic goal-setting and tracking remain inconsistent across the field.
A peer-reviewed study found that only 14% of therapists report monthly use of standardized progress measures that improve client outcomes. This means 86% of practicing therapists aren't regularly using proven methods to track whether their work is achieving the goals you're paying them to help you reach.
Even when therapists do set initial goals, research reveals they often fail to track progress systematically or allow goals to change without clear rationale—creating the same confused experience as having no goals at all. You end up paying for professional treatment but receiving the equivalent of unfocused conversation.
Goal-setting isn't a matter of therapeutic style. Meta-analyses consistently show that agreement on goals predicts both faster improvement and better overall outcomes. When therapists skip this step, they're choosing to provide less effective treatment while charging professional fees.
Professional Standard: What Collaborative Goal-Setting Actually Looks Like
Quality goal-setting happens within the first three sessions and includes specific, measurable outcomes that both you and your therapist can evaluate. Professional therapists understand that goals provide the foundation for everything else in treatment—they determine which techniques to use, how to measure progress, and when treatment has been successful.
Professional goal-setting process:
Session 1-2: Initial goal exploration "Based on what you've shared, it sounds like you want to feel less anxious in social situations and improve your relationship with your partner. Let's get specific about what those improvements would look like in your daily life."
Session 2-3: Goal refinement and agreement "So we've identified three main goals: reducing your social anxiety enough that you can speak up in meetings, improving communication with your partner so you argue less and feel more connected, and developing better sleep habits so you feel rested during the day. Does this capture what you want to work on?"
Ongoing: Goal tracking and adjustment "Let's check in on your goals. You mentioned you spoke up twice in meetings this week—that's progress on goal one. How are you feeling about your communication with your partner?"
Specific characteristics of quality goals:
Written down and referenced regularly, not just discussed once
Specific enough that both you and your therapist can tell when you're making progress
Connected to your daily life rather than abstract concepts
Include both behavioral changes (what you'll do differently) and internal changes (how you'll feel)
Have realistic timelines for initial progress and overall achievement
Guide session content rather than letting topics drift randomly
How professional therapists maintain goal focus:
Begin sessions by checking in on goal progress rather than asking "how was your week?"
Connect session topics back to your stated goals rather than following every tangent
Suggest goal adjustments when circumstances change rather than letting them drift
Use goals to evaluate which therapeutic techniques are working
Reference goals when discussing progress and treatment planning
Warning Signs: When Therapists Avoid Their Professional Responsibility
Certain responses to goal-setting indicate therapists who either don't understand best practices or choose to avoid the structure that effective treatment requires. These aren't matters of style or preference—they represent substandard care that wastes your resources.
Red flag responses to goal discussion:
"I like to let therapy unfold naturally rather than forcing goals"
"Goals can limit our exploration and discovery process"
"We'll know what to work on as issues come up"
"I prefer to focus on the relationship first, then worry about goals later"
"Every session should be about whatever you need to discuss that day"
Warning signs during treatment:
Sessions jump from topic to topic based on your daily concerns rather than following goal-directed work
Therapist can't explain how session content relates to your stated objectives
No written record of your goals or regular progress discussions
Goals change frequently without clear rationale or your explicit agreement
Therapist becomes defensive when you ask about progress toward specific outcomes
The "therapy GPS" test: Ask yourself: If someone asked your therapist what you're working on and how progress is measured, could they give a clear, specific answer? If not, you're paying professional fees for unprofessional service.
How to Address Goal Confusion With Your Current Therapist
If you're already in therapy but feeling lost without clear direction, you can advocate for proper goal-setting using specific language that positions this as professional standard rather than personal preference.
Script for initiating goal discussion: "I've been thinking about our work together, and I'd like to get clearer about my specific goals for therapy. I want to make sure we're using our time effectively and that I can track my progress. Can we spend some time identifying what exactly I want to accomplish and how we'll know when I'm making progress?"
If they resist goal-setting: "I understand that therapy can be exploratory, but I'm investing significant time and money in this process and I need clearer direction. Goal-setting is considered a fundamental part of effective therapy according to research. Can you help me understand your approach to measuring progress and ensuring our work is targeted?"
For goal tracking and maintenance: "I'd like to check in regularly on how I'm progressing toward the goals we set. Can we start each session with a brief review of where I am with [specific goals] rather than just talking about whatever comes up?"
When goals need adjustment: "I'm noticing that my priorities have shifted since we set these goals. Can we review them and make sure they still reflect what I want to accomplish? I want to make sure our work stays focused and relevant."
When to Walk Away: Therapists Who Won't Provide Professional Standards
Some therapists will resist goal-setting despite your clear requests, indicating fundamental problems with their approach to professional treatment. Don't accept excuses that position goal-setting as optional or potentially harmful—these represent serious departures from evidence-based practice.
Unacceptable responses that indicate poor training or unwillingness to provide professional care:
Insisting that goals interfere with the therapeutic process
Claiming that goal-setting is not necessary for their theoretical approach
Becoming defensive or dismissive when you request clearer direction
Suggesting that wanting goals indicates you're "controlling" or "resistant"
Refusing to track progress or provide measurable feedback about your improvement
When to find a new therapist:
They won't establish clear goals after multiple requests
Sessions continue to feel aimless and unfocused despite your advocacy
You can't explain what you're working on or how progress is measured
Therapist positions your need for direction as a personal problem rather than legitimate consumer expectation
You feel more confused about your problems after several sessions rather than gaining clarity and tools
The Bottom Line: Your Right to Therapeutic Direction
You wouldn't hire a contractor who refused to discuss project goals, timeline, or progress measurements. You wouldn't work with a financial advisor who wouldn't clarify your investment objectives. Mental health treatment deserves the same professional standards.
Collaborative goal-setting isn't a luxury or special request—it's a fundamental component of effective therapy supported by decades of research. When therapists skip this step, they're choosing to provide less effective treatment while charging professional fees.
Sarah's story doesn't have to be yours. After eight unfocused sessions, she advocated for clear goal-setting with her therapist. When he dismissed goals as "too rigid" for his approach, she found a new therapist who established three specific objectives in their first session and tracked progress systematically. Within two months, Sarah had measurable improvements in all three areas and a clear understanding of her ongoing work.
Don't settle for expensive conversations disguised as professional treatment. You deserve therapy with clear direction, measurable progress, and efficient use of your time and money. Demanding collaborative goal-setting isn't being difficult—it's exercising your consumer rights to evidence-based care.
Your mental health journey deserves a GPS, not aimless wandering. Professional therapists provide direction, measurement, and clear destinations. Anything less wastes your most valuable resources: your time, money, and opportunity for genuine improvement.
Research Sources
Tryon, G. S., & Winograd, G. (2011). "Goal consensus and collaboration." Psychotherapy, 48(1), 50-57.
American Psychological Association. (2023). "Understanding psychotherapy and how it works." Retrieved from https://www.apa.org/topics/psychotherapy/understanding
Flückiger, C., et al. (2020). "The alliance in adult psychotherapy: A meta-analytic synthesis." Psychotherapy, 57(4), 597-608.
Lambert, M. J. (2010). "Prevention of treatment failure: The use of measuring, monitoring, and feedback in clinical practice." American Psychological Association.
Boswell, J. F., et al. (2013). "Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions." Psychotherapy Research, 23(1), 6-19.
Horvath, A. O., et al. (2011). "Alliance in individual psychotherapy." Psychotherapy, 48(1), 9-16.
Guertzen, N., et al. (2020). “Patients' perceived lack of goal clarity in psychological treatments: Scale development and negative correlates.” Clinical Psychology & Psychotherapy, 27(6):915–924.
Stubbe, D., (2018). “The Therapeutic Alliance: The Fundamental Element of Psychotherapy.” Focus (American Psychiatric Association), 16(4):402–403.
Stewart, V., et al, (2022). “Goal planning in mental health service delivery: A systematic integrative review.” Frontiers in Psychiatry, 13:1057915.
Jensen-Doss, A., et al, (2018). “Monitoring Treatment Progress and Providing Feedback is Viewed Favorably but Rarely Used in Practice.” Administration and Policy in Mental Health, 45(1):48–61.