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Table 1 Evidence synthesis of included studies (N = 7)

From: Goal setting with young people for anxiety and depression: What works for whom in therapeutic relationships? A literature review and insight analysis

References

Participants, study type and location

Findings

Strengths and limitations of study

Critical appraisal of study*

Bennett LR. Adolescent Depression: Meeting Therapeutic Challenges Through an Integrated Narrative Approach. J Child Adolesc Psychiatr Nurs. 2012;25(4):184–94

N = 1

Male

14 years old

Ethnicity: not reported

Collaborative goal setting influences therapeutic alliance via shared understanding of the difficulties, from the practitioner’s perspective. Goal setting is facilitative of good communication

Voice is given to the young person through the research, however, the study is primarily from the practitioner’s perspective

Credibility: some evidence (verbatim quotes)

Major depressive episode with anxiety

Single case example

Transferability: caution advised when applying to other contexts

Narrative case study

Emphasis on flexible working, via goals, to meet personal needs

Full demographics not reported

Dependability: not evidenced

Canada

 

Western high-income country

Confirmability: not evidenced

Berdondini L, Elliott R, Shearer J. Collaboration in Experiential Therapy. J Clin Psychol. 2012;68(2):159–67

N = 1

Male

20 years old

Ethnicity: European

Notes that there is no alliance without collaboration. Collaboration (goals and tasks) should be agreed with the client to ensure (1) Optimal working with their experiences; (2) Autonomy and acceptance of responsibility for own experiences/actions; (3) Completion of important therapeutic work

Voice is given to the young person through the research, however, the study is primarily from the practitioner’s perspective

Credibility: not evidenced

Social anxiety

Case showed that productive collaboration is not necessarily natural or spontaneous but requires efforts of both the young person and practitioner to take emotional/interpersonal risks by disclosure of a genuine manner

Single case example

Transferability: caution advised when applying to other contexts

Narrative case study

Full demographics not reported

Dependability: not evidenced

UK

Goals are a conduit for good communication and increase engagement

Western high-income country

Confirmability: not evidenced

Cirasola A, Midgley N, Fonagy P, Martin P, M Goodyer I, Reynolds S, et al. The factor structure of the Working Alliance Inventory short-form in youth psychotherapy: an empirical investigation. Psychother Res [Internet]. 2021;31(4):535–47

N = 465

11–17 years (M = 15.5)

Ethnicity: Majority White British (~ 74%)

Findings suggest that agreement on goals may be challenging in an age group who are often referred for therapy by others, and may not see difficulties “in” themselves, and developmental needs may interfere with the establishment of collaborative relationships with adults

Therapeutic alliance was rated over several time points

Credibility: good evidence

Depression

Focus of the study was young people’s ratings on a therapeutic alliance tool (WAI-S)

Transferability: caution advised when applying to other contexts

Randomised control trial assessing the effects of three therapeutic interventions in the treatment of adolescent depression

High levels of collaboration (goals and tasks) foster the development of a strong bond

Participants recruited from multiple settings

Dependability: some evidence

Unable to control for variance at the client or practitioner level

Confirmability: not evidenced

UK

Western high-income country

Diamond GM, Diamond GS, Liddle HA. The therapist–parent alliance in family‐based therapy for adolescents. J Clin Psychol. 2000;56(8):1037–50

N = 1

Male

15 years old

Ethnicity: White

Goal formulation is described as an important element of building therapeutic alliance. In the goal-formation phase, the practitioner aims to establish relationship building as the initial objective of therapy

Voice is given to the young person through the research, however, the study is primarily from the practitioner’s perspective

Credibility: some evidence (verbatim quotes)

Depression

Single case example

Transferability: caution advised when applying to other contexts

Narrative case study

Findings suggest that through specific goal setting, it is possible to increase disclosure, the sharing of vulnerable emotions, and mutual support between parent – young person – practitioner triads, during later conjoint conversations about difficult, relational themes

Western high-income country

Dependability: not evidenced

Israel

Goal setting with parents/carers can facilitate open communication with young people

Confirmability: not evidenced

Feltham A, Martin K, Walker L, Harris L. Using goals in therapy: The perspective of people with lived experience. In: M. Cooper & DL, editor. Working with goals in psychotherapy and counselling. Oxford: Oxford University Press; 2018. p. 73–85

“Young people” or “young adults” age not defined

Agreeing goals in therapy is of key importance to young people, for communication: to enable them to feel heard, and that practitioners are listening to them

Narrative review incorporating quotes and examples from young people/young adults with lived experience enables important voices to be centralised in this research

Credibility: some evidence (verbatim quotes)

Anxiety and depression are discussed as well as other difficulties

Transferability: caution advised when applying to other contexts

Narrative review of people with lived experience of mental health difficulties and therapeutic interventions

Low confidence or feelings of hopelessness and poor previous experiences of goal setting are limiting factors for prospective goal setting

Full demographics not reported

Dependability: not evidenced

UK

Western high-income country

Confirmability: some evidence

Law D, Wolpert M. Guide to using outcomes and feedback tools with children, young people and families. Formally known as the COOP document. London: CAMHS Press; 2014

“Young people” or “young adults” age not defined

Discusses the importance of building good therapeutic relationships, and cites goals as a central element of this. Provides quotes from young people based on their experiences of setting goals in therapy

Guidance for practitioners based on focus groups with practitioners and young people, incorporating quotes and examples from young people with lived experience enables important voices to be centralised in this research

Credibility: some evidence (verbatim quotes)

Anxiety and depression are discussed as well as other difficulties

Transferability: caution advised when applying to other contexts

Guidance document for practitioners for using feedback and outcome tools with children and young people in therapeutic settings

Reviewing progress towards goals too frequently in long-term therapy could give the young person the impression that the practitioner is more interested in gauging their own success, rather than being interested in them as a whole person

Full demographics not reported

Dependability: not evidenced

UK

Young people in long-term therapy may have difficulty engaging in goal setting. This is due to the potential of having experienced significant and repeated traumas which have impacted on their development

Western high-income country

Confirmability: not evidenced

Martin K. A critical realist study of shared decision-making in young people’s mental health inpatient units. 2019. Doctoral Thesis. UCL

N = 16

Female N = 10

Male N = 5

Gender fluid N = 1

15–17 years (M = 16.2)

Ethnicity:

Bangladeshi British N = 1

Black African N = 1

Black British N = 1

British Romanian N = 1

Latino N = 1

White British N = 10

White Other N = 1

Findings emphasise the importance of building good therapeutic alliances and this study cites goals as a central element of shared decision making. The findings include quotes from young people based on their experiences of setting goals within the inpatient setting

The focus on qualitative interviews with young people enables important voices to be centralised in this research

Credibility: some evidence (verbatim quotes)

Anxiety and depression and several other mental health difficulties

Sample recruited from two settings

Transferability: caution advised when applying to other contexts

Naturalistic study based in two inpatient mental health units

The importance of a collaborative way of setting goals was expressed as a key element of ensuring goals is an effective element of helping, such that the collaboration of the practitioner is key to ensure the young person is setting achievable goals. Goals are a facilitator of good communication and a shared understanding of ways forward

Primarily White British sample and study conducted in a Western high-income country

Dependability: good evidence

UK

Receiving feedback on progress towards goals is seen as a key motivator and provides validation that goals are meaningful and achievable

Confirmability: good evidence

  1. *Definitions drawn from Hannes K. Chapter 4: Critical appraisal of qualitative research. In: Noyes J, Booth A, Hannes K, Harden A, Harris J, Lewin S, Lockwood C (editors), Supplementary Guidance for Inclusion of Qualitative Research in Cochrane Systematic Reviews of Interventions. Version 1 (updated August 2011). Cochrane Collaboration Qualitative Methods Group, 2011. See Additional file 1: Appendix 2 for detailed definitions of the appraisal criteria