High achievers tend to approach goal-setting the way they approach everything else: with high standards, high expectations, and a plan built for controlled conditions.
Life is messy and behavior change is one of the hardest endeavors.
The gap between how you set goals and how change occurs isn’t a discipline problem. Many self-help frameworks are designed for people with reliable bandwidth and a nervous system that isn’t already running at capacity — but that’s not most of the people I work with.
Where most people actually are:
In behavior change psychology, we use the Stages of Change model to understand where someone is in the change process — not where they think they should be.
- Precontemplation: Not yet considering change, possibly not fully aware it’s needed. Often these are folks who tell me they’ve been told they need help but they aren’t sure why.
- Contemplation: Aware, ambivalent, not yet moving. Often, these individuals oscillate between wanting to change but doubting the change is possible or worth the effort.
- Preparation: Beginning to organize toward action. In preparing to take action, we set up sustainable plans and strategize on how to leverage motivation and momentum.
- Action: Actively making the change.
- Maintenance: Sustaining it.
- Relapse: Lapses are to be expected. We identify how to keep a lapse from becoming a relapse.
Most of my clients come in at contemplation. They know something needs to shift. They’re not sure they’re ready. And part of my job is explaining that contemplation is legitimate clinical territory — moving through it thoughtfully is more useful than forcing action before the conditions support it.
What actually makes a goal work:
Specificity that accounts for your real week. “Exercise more” isn’t a goal. “Walk for fifteen minutes before morning rounds on the three days I don’t have 7am admissions” is a goal. The difference is that you’ve already thought through where it fits in your life.
Alignment with what you value, not what you’re supposed to value. Goals attached to external expectations — what a successful physician is supposed to do, what a partner-track attorney is supposed to model — are fragile under stress. Goals attached to things that matter to you have more traction.
Room for your life to happen. If the plan only works when nothing goes wrong, it won’t work.
Where therapy fits:
Therapy isn’t where you go when you’re ready to make changes. It’s where you go to figure out why change feels hard, what’s maintaining the patterns you want to shift, and whether the goals you’ve set are actually the right goals for where you are now.
If your goals haven’t been sticking, the answer probably isn’t to try harder.