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Physically Ill But Needing to Find Goals or Lose Therapy

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From Canada: Until 7yrs ago when I was 50, most of my life revolved around my work, full time child emergency child protection social worker, part time private therapist, three volunteer jobs, all night shifts.

I have no family other than an elderly father on the other side of the country or friends. My dog died two years ago. My cat is very ill. Now due to a variety of reasons, and the cost of medications I’m in poverty. Very depressed.

Already, I have been hospitalized for suicidal reasons, for months, severe ME (fibromyalgia), chronic fatigue, a.m. Cortisol at 23 nmol/L, multiple lytic lesions including on the skull, BMI 15.8.

Now my therapist is suggesting I find short/long term goals (SMART goals at that). If I don’t produce these without his assistance, I no longer have any access to psychiatric assistance (social medicine).

I have only one goal, suicide. I only have the final step to complete. I was hoping to be able to wait until my Dad died as we (my father and I), had agreed upon, but now I’m not sure. I need to come up with some SMART goals in the meantime to get me through at least a year of therapy. Yes, I’ve looked into the ACT info. Help please. No goals, motivation, dreams, or inspiration.

Physically Ill But Needing to Find Goals or Lose Therapy

Answered by on -


I’m very, very sorry that your life has had such a downturn in the past few years. I’m sure it feels relentless. I’m sure it’s discouraging. But you are an intelligent, educated woman. You are also a therapist so you have a skill set you can bring to bear on your own problems. Do consider what you would say to a client like yourself who has had terrible luck and is on the edge of giving up. I trust that you would find whatever core of resilience is present and build from there.

If you were working with me, we would take a hard look at how your physical illness is contributing to how you are feeling mentally. Those diagnoses need to be addressed for you to have the energy to keep on keepin’ on. Your therapy can help support your efforts to take care of yourself despite how bad you feel.

Have you been honest with your therapist? It seems to me that your only goal is to get well enough to have goals — which is a worthy goal.

SMART goals are simply a formula to help people think about what is possible and achievable. Don’t let a format get in the way of good thinking. If coming up with goals is what is required to keep your therapy, I’m sure you are creative and intelligent enough to come up with something.

How about:
S: I want to gather more information about my various medical diagnoses and to develop a treatment plan. Over the next 6 months, I will make and attend appointments with a neurologist for the skull lesions as well as specialists who can give me more information about chronic fatigue and fibromyalgia. I will also see a nutritionist.
M: I will make a record of appointments and findings and will write about my concerns and reflections to discuss in therapy.
A: In order to stay on track, I will need the support of my therapist. But I do think it is a realistic goal.
R: The result of this goal is a more complete understanding of my condition and a focused direction for treatments.
T: By December 1, I will accomplish this information gathering and will have worked with my therapist to develop a comprehensive treatment plan.

That’s just an example, not a recommendation. I hope you can come up with something that feels right for you.

Meanwhile, I suggest you consider getting into group therapy in addition to the individual therapy. You need more support. If the idea of joining anything is daunting, at least consider joining one of the forums here at PsychCentral. People from all over the world provide each other with information and support.

I wish you well.
Dr. Marie

Physically Ill But Needing to Find Goals or Lose Therapy

Therapists live, online right now, from BetterHelp:

Dr. Marie Hartwell-Walker

Dr. Marie is licensed as both a psychologist and marriage and family counselor. She specializes in couples and family therapy and parent education. Follow her on Facebook or Twitter.

APA Reference
Hartwell-Walker, D. (2018). Physically Ill But Needing to Find Goals or Lose Therapy. Psych Central. Retrieved on November 30, 2020, from
Scientifically Reviewed
Last updated: 8 May 2018 (Originally: 21 Jun 2017)
Last reviewed: By a member of our scientific advisory board on 8 May 2018
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