Participants’ lived experience of pursuing personal goals in the Illness Management and Recovery program

Abstract

Background:

The Illness Management and Recovery (IMR) program is designed to support people diagnosed with severe mental illness in developing tailored illness-management skills and to pursue personal goals. Although IMR is a goal-oriented program, little is know about the participants’ experience of goal-setting as part of IMR.

Aim:

To describe participants’ lived experience of personal goal-setting as part of the Illness Management and Recovery program (IMR).

Method:

A descriptive, phenomenological research design was employed with individual interviews.

Results:

IMR helped the participants break down their personal goals into manageable short-term goals. The main themes were as follows: ‘We were guided to set clearer and specific goals in IMR’, ‘We were encouraged to pursue our personal goals in IMR’ and ‘We were encouraged and supported to resume work on our goals when we stopped making progress’. The findings emphasise goal-setting in IMR as a means to instilling hope for the future and work on goals.

Conclusions:

The participants learned to identify, articulate and initiate work towards short- and long-term goals when guided by the instructor and supported by peers in the IMR group. Goal-setting is a useful method for breaking down personal recovery goals into a practical short-term goals and motivating participants to pursue them. The findings indicate goal-setting is an important part of the IMR-program, but suggest that flexibility in goal-setting is needed, especially in the time required to achieve personal goals.

Keywords

Illness Management and Recovery clinical and personal recovery personal goals severe mental illness

Introduction

The Illness Management and Recovery (IMR) program is a curriculum-based rehabilitation program designed for people with severe mental illness (SMI) (Gingerich & Mueser, 2011; Mueser et al., 2002). The core of the IMR-program is the pursuit of personal goals, which are broken down into smaller goals and steps towards those goals; consequently goalsetting is an integral part of the program (Moran et al., 2017; Shadmi et al., 2017). The pursuit of personal goals is considered an essential part of the recovery process as people discover or rediscover their strengths to grow beyond the mental illness and develop a new sense of identity (Mueser et al., 2006, 2013). Therefore, a major task of community mental health services is to help people pursue and achieve their personal goals (Tabak et al., 2015).

Although goal setting is a critical part of rehabilitation, research on this topic is according to a review from 2015 limited (Levack et al., 2015). Participants’ perspectives on collaboratively setting and working towards personal goals have been explored in community mental health settings (Biringer et al., 2017; Yarborough et al., 2016), which may inform mental health professionals about how to support them in pursuing their goals as they learn about emotional problems, reactions and behaviours (Biringer et al., 2017). Limited empirical research suggests that setting and pursing goals in the context of learning about illness management may help participants to monitor, alter or adopt illness management skills (Levack et al., 2015). In the IMR-program the pursuit of personal goals has been reported by the participants to be one of the most important parts of their recovery process (Roe et al., 2009; van Langen et al., 2016). Furthermore, mental health professionals can support people by helping them make progress towards their goals, recognising deviations from work on goals and facilitating refocus on them, tailoring support to periods of low expectation for recovery and believing in the possibility of every person to recover from mental illness (Yarborough et al., 2016).

Two prior qualitative studies on IMR have been conducted, focusing on how the experience of being in the program enhanced and maintained their recovery 1 year after completion (Roe et al., 2009; van Langen et al., 2016). However, these studies did not specifically explore participants’ lived experience with IMR in relation to the setting, pursuing and achieving of their personal goals. The present article provides an additional analysis of the lived experience of participants’ in an IMR program setting and pursuing personal recovery goals, based the qualitative study conducted by (Jensen et al., 2019). In the previous article personal goal setting was one theme among others related to the experience of participating in an IMR group. The importance of the theme called for a more detailed examination than the previous analyses allowed. Personal goalsetting in IMR has been rarely explored despite the theoretical and practical salience of the concept in the IMR-program, and in psychiatric rehabilitation in general. The aim of this article is to conduct a more in-depth investigation of participants’ lived experience of personal goal setting during their participation in the IMR program.

Method

Design

A descriptive, phenomenological research design inspired by Amedeo Giorgi was selected, aimed at describing the participants’ lived experiences of goal setting in IMR (Giorgi, 2009). The data collection study took place during the qualitative study by Jensen et al. (2019).

Participants

Data were collected at three sites: two social psychiatric residences and one community mental health center (CMHC) in Denmark. Variation in age, gender, years of receiving services at the CMHC and years living at a residential home was planned in the sampling strategy to capture a variety of perspectives on the experiences of participating in IMR (Malterud, 2012). The participants attended a minimum of 20 sessions of an IMR program. This qualitative study is inspired by the Danish IMR clinical trial aiming to gain a deeper understanding of the participants’ lived experience with recovery in relation to IMR. The sampling structure used in the IMR trial was enhanced in the qualitative study following the same criteria although the participants lived at the community residence were not involved in the trial of IMR by including individual participants in IMR who were living at a community residence who had not been part of the clinical trial of IMR (Dalum et al., 2018a).

The participants were adults diagnosed with a SMI who were receiving treatment at a CMHC or living at a community residential home, able to speak and understand Danish and able to provide written informed consent. Participants were excluded if they had a guardian or a forensic psychiatric arrangement as they are not allowed to participate in research studies in Denmark.

Setting

The CMCH offered a 9-month IMR-course to all people diagnosed with a SMI. Residents of the community homes attended IMR sessions at their facilities facilitated by IMR-instructors, who were psychologists or other experienced mental health professionals with a minimum of 3-day training in IMR. The 2006 version of the IMR-program was provided by two or three clinicians at weekly group sessions at the CMCH and the residential homes. Between the IMR sessions participants met with their case manager approximately weekly for consultation, practical advice or support.

Recruitment procedure

First author (SBJ) informed and supervised three staff members who were experienced IMR instructors about the purpose of the study and the sampling strategy. The IMR-instructors informed participants about the qualitative study after they had ended an IMR-course. If needed, participants from the community residence were supported by their social worker. Recruitment of participants ended approximately 3 months after they had ended the IMR course.

Goal setting in the IMR-program

The IMR-program was developed based on a review of 40 randomised clinical trials on illness-management programs for patients diagnosed with SMI (Mueser et al., 2006). The aim of IMR is for participants to learn about illness management by setting and pursuing personal goals as a short-term outcome to achieve long-term clinical and personal recovery (Mueser et al., 2006). The setting and pursuit of goals in IMR is intended to increase motivation for learning illness self-management as participants can evaluate whether improved illness self-management could help them attain their personal goals. The theoretical basis for the overall approach to illness management (i.e. addressing biological factors such as medication and substance use, building social support, enhancing coping) is based on the stress-vulnerability model and the transtheoretical model of change (Mueser et al., 2006). The IMR-instructor guides each person to explore which areas of their life they would like to improve. When specific areas of desired change have been identified, the goal-setting process is introduced, with long-term goals are broken down into short-terms goals and even shorter ‘steps’ towards those goals. IMR includes a personal IMR goal-tracking sheet that the instructor and the participant collaboratively update at each session.

Interview guide

To describe the participants’ lived experience of goal setting and the pursuit of goals, and their possible impact on illness self-management, an interview guide was created to address the research questions presented in Table 1. The guide, phrasing and follow-up questions were discussed with the advisory board in order to evaluate relevance and interview technique. The mean duration of the interviews was 44 minutes (range 38–75 minutes).

Table 1.

The interview guide.

Research questions	Questions posed in the interview
What are the main themes raised by participants about their experience of participating in IMR in relation to their recovery-process?	What motivated you to participate in IMR? By participating in IMR did you find something that helped you?
Experiences with goal setting	What is your experience with goalsetting? What was it like to set goals in the IMR-group? What is a personal goal?
Did their participation in IMR have an impact on their personal recovery process how and why?	Has your participation in IMR changed your view of yourself?
Which changes in relation to their recovery process did they experience during and after participating in IMR	I would like to talk to you if you have changed your view on your mental illness? Has your participation in the program changed your view of yourself? Have you explored new aspects of yourself by joining the IMR?

Data analysis

Individual semi-structured interviews based on an interview guide were conducted for the qualitative study by Jensen et al. (2019). In this analysis the questions about goal-setting (see Table 1 The interview guide) were elaborated by an additional analysis. The aim of this additional analysis was to describe the participants’ experiences of goal setting and working towards goals. Giorgi’s method for phenomenological analysis was applied following five analytic steps:

In step 1, the transcribed interview was administered as part of the former study by Jensen et al. (2019) (Giorgi, 2009). In step 2, the transcription was read as a whole and then reread with specific focus on personal goal setting. In step 3, all of the transcribed interviews were analysed. In order to be sure that each statement is given proper attention, each passage was broken into units. The coded meaning units were entered into the NVivo 11.0 software program. The preliminary meaning units were presented to an advisory board of people with lived experience to enhance bracketing the SBJ pre-understanding regarding personal goal setting in recovery after severe mental illness.

In step 4, The coded meaning units were transformed into condensed descriptions. In step 5, the condensed descriptions were organised into main themes supported by subthemes, and quotes were added to illustrate the participants’ lived experience of pursuing goals in the IMR group.

Ethical considerations

Participation in the study took place in accordance with the Declaration of Helsinki; thus, participation was voluntary, confidentiality was maintained, and personal information was used only for research purposes (Rickham, 1964). The participants were informed of these considerations both verbally and in writing, and the first author (SBJ) provided them with a written informed consent form. Participants could withdraw from the study at any time if they wanted. The study was approved by the National Committee on Health Research Ethics (H-15012362) and the Danish Data Protection Agency ((IMR) RHP-2011-09 I-Suite nr.01483).

Results

Participants had attended the IMR-program between February 2015 and July 2016 and were interviewed 1 to 3 months after completing the program. Interviews were carried out from November 2015 to April 2016. In total, 15 individual interviews were conducted; nine women and five men ages 30 to 72 years old. Seven participants were in IMR-groups taken place at the CMHC, where they had been receiving treatment for the past 2 to 7 years. Eight participants were in the IMR-group taken place at the residential home, where they had been living for the past 1 to 20 years. These residents had received treatment from either the CMHC or other local mental health practitioners.

Three themes were identified in the qualitative analysis exploring participants’ lived experiences with goal setting in the IMR program: Theme 1: ‘We were guided to set clearer and specific goals in IMR’; Theme 2: ‘We were encouraged to pursue our personal goals in IMR’; Theme 3: ‘We were encouraged and supported to resume work on our goals when we stopped making progress’ (see Table 2 Main themes of the qualitative findings on the participants’ experience with goal setting in IMR).

Table 2.

Main themes of the qualitative findings on the participants’ experience with goal setting in IMR.

Main themes	Subthemes	Excerpts of quotes
Theme 1: We were guided to set clearer and specific goals in IMR	We shared our past experiences of not achieving personal goals	Even pursuing a short-term goal was really difficult because you often gave up without even trying, or somewhere along the way. This is how I feel in many parts of my life (P5).
		‘Setting goals take a lot of confidence. . ..and you have to believe in yourself and that you can do it (P1)’.
		I have set a personal goal that interests me that I can begin to pursue. I don’t do much. . ..it’s just that symptoms change from day to day. There is no continuity in it (P6).
	In IMR, we focused on setting specific short-term goals towards a personal goal	The instructor kept asking questions that circled back to my actions during the week what I was working on – I truly liked that she (the instructor) came close to me, posing questions: What do you mean by that? How would you describe that? How would you handle that? These questions made me think because you couldn’t avoid them in the discussion (P4).
Theme 2: We were encouraged to pursue our personal goals in IMR	Pursuing short-term goals broke barriers	We started very early in IMR with instruction on how to set goals for ourselves – something that could lead us ahead somehow. For me, this meant starting to play the recorder again. Achieving this goal makes me feel warm inside; I feel great and happy (P9).
	In IMR, we saw small aspects of our everyday life change	We have an illness that increases the time needed to achieve our goals compared to that needed for people not diagnosed with a severe mental illness (P6).
Theme 3: We were encouraged and supported to resum work on our goals when we stopped making progress	We shared our experience of being stuck when working on short-term goals in the IMR-group.	Then, the instructor said; your goals are. . . And so we found the papers. How did you do? Well – I didn’t do anything. But I’ll try again next week I thought it was very nice to have a second chance (P11).
		When you get sick you cannot use the tools you have learned – you don’t think along those lines. Not even the tools you practice every day (P4).
	In IMR, we gained willpower	I organized my CDs and the ones I liked the most I placed in a box close to my sofa so I can hear the music I love, and I find inner peace in the evening. It may sound easy, but it has not been since I have not done it before (P6).

Theme 1: We were guided to set clearer and specific goals in IMR

The first main theme included two corresponding subthemes that described participants’ experience with goal setting. Subtheme 1 was ‘We shared our past experiences of not achieving personal goals’. Participants stated that establishing personal goals meant having aspirations for the future, which required trusting in their own abilities to act, as illustrated by one of the participants: ‘Setting goals take a lot of confidence. . ..and you have to believe in yourself and that you can do it (P1)’. However, this sometimes proved difficult to do, including the pursuit of short-term goals: ‘Even pursuing short-term goals was really difficult because you often gave up without even trying, or somewhere along the way. This is how I feel in many parts of my life’ (P5).

The participants described feeling sceptical about achieving their goals in the IMR group because they found the weekly follow through on goals burdensome and felt that the timeframe to achieve goals such as learning to cook a meal or adhering to a diabetes diet was often too short. In the participants’ experience, the first task of IMR, establishing simple, practical and easily measured steps towards a goal such as setting a routine schedule for shopping for groceries, was often hard to accomplish. One participant said: ‘We were committed to our goals, but we found it difficult to follow through on them’ (P1). Pursuing personal goals was described as difficult and involved dealing with many problems. One participant explained; ‘I have set a personal goal that interests me that I can begin to pursue. I don’t do much. . . it’s just that symptoms change from day to day. There is no continuity in it’ (P6). The participants emphasised that they needed to be in control of their symptoms in order to achieve their short-term goals.

Subtheme 2 was ‘In IMR, we focused on setting specific short-term goals towards a personal goal’. Participants reported that they were able to take steps towards their goals after discussions with the IMR instructors. They described how the instructors kept asking questions that brought them back to their goals and helped them identify short, manageable steps towards them. One participant said: The instructor kept asking questions that circled back to my actions during the week what I was working on – I truly liked that she (the instructor) came close to me, posing questions such as: ‘What do you mean by that? How would you describe that? How would you handle that?’ These questions made me think because you couldn’t avoid them in the discussion (P4). Participants who shared personal goals in IMR and established short-term goals for achieving them experienced the beginning of a process of accepting their illness and realising that new ways of living were possible. Participants described how taking small steps towards their goals involved exploring new ways of living, such as getting up every morning and eating regular meals during the day.

Theme 2: We were encouraged to pursue our personal goals in IMR

The second main theme contained two subthemes that describe the participants’ experiences with pursuing short-term goals. Subtheme 1 was ‘Pursuing short-term goals broke barriers’. The participants experienced changes in their expectations regarding their personal goals, as illustrated by one of the participants: ‘In the IMR program, my personal goals changed from being overwhelming to manageable short-term goals’ (P7).

Participants said that daily activities such as shopping were turned into short-term goals in the process of pursuing personal goals such as maintaining a healthy lifestyle and weight loss. The IMR-instructor inspired them to be creative in identifying skills that could help them make progress towards their goals. The participants described how personals goals could be related to reconnecting them with shared comment interests. One participant’s goal was to resume playing the recorder: ‘We started very early in IMR with instruction on how to set goals for ourselves – something that could lead us ahead somehow. For me, this meant starting to play the recorder again. Achieving this goal makes me feel warm inside; I feel great and happy’ (P9) The participants described being motivated by the other group members, as illustrated by one who said: ‘We were inspired by group members’ successes in using creative skills to achieve short-term goals’ (P15). The participants found that achieving short-term goals helped them think of other ways of achieving their longer-term personal goals.

Subtheme 2 was ‘In IMR, we saw small aspects of our everyday life change’. The participants stated that pursuing short-term goals did not come easily to them in their everyday life. They emphasised that preparing to pursue a personal goal meant accepting having to live with challenges related SMI, as described by one of the participants: ‘We have an illness that increases the time needed to achieve our goals compared to that needed for people not diagnosed with a severe mental illness’ (P6). Participants described how they began to see their small steps towards personal goals as making a difference in their everyday lives. According to the participants, such changes (e.g. clothing style, haircare, attentive on family members) had a positive impact on their communication with other people and on other everyday affairs.

Theme 3: We were encouraged and supported to resume work on our goals when we stopped making progress

The third main theme included two corresponding subthemes that describe the participants’ experience in the IMR-program of being helped to get back on track with working towards their goals. Subtheme 1 was ‘We shared our experience of being stuck when working on short-term goals in the IMR-group’. Participants said the group was an important place to get help them resuming working on their short-term goals. One participant described this experience in group after several IMR sessions in which she had not taken any steps towards her short-term goal: ‘Then, the instructor said: ‘Your goals are. . .’. And so we found the papers. ‘How did you do?’ ‘Well – I didn’t do anything. But I’ll try again next week’. I thought it was very nice to have a second chance’ (P11).

The participants said that their progress towards achieving their goals was evaluated at on a weekly basis because the program focused on goal achievement; however, one of the participants indicated that not enough attention was devoted to ensuring that changes that were made were maintained over time: ‘The evaluation neglected our need to discuss how to maintain short-term goals that we had achieved’ (P7). Some participants said it was important to focus on maintaining daily activities because they coped with symptoms such as paranoia or excessive thoughts and episodes of powerlessness that made it more difficult to focus on such activities. One participant said: ‘When you get sick you cannot use the tools you have learned – you don’t think along those lines. Not even the tools you practice every day’ (P4). Participants’ hope for identifying ways of achieving short-term goals grew when other group members empathised and shared their experiences with these issues in their everyday life.

Subtheme 2 was ‘In IMR, we gained willpower’. The participants found that the IMR instructors’ continual engagement and support was helpful in determining steps towards their short-term goals and increased their motivation to follow through on those goals. For example, one participant described how success in creating a comfortable home environment motivated her to work on other short-term goals: ‘I organized my CDs, and the ones I liked the most I placed in a box close to my sofa so I can hear the music I love, and I find inner peace in the evening. It may sound easy, but it was not since I had not done it before’ (P6). From the participants’ perspective, these experiences also increased their self-confidence, led to positive feelings and allowed pause for reflection. The participants found that the process of identifying steps towards short-term goals helped them maintain their determination to pursue personal goals such as living an independent life.

Discussion

The results of this additional analysis of data collected during the qualitative study by Jensen et al. (2019) [18] identified three themes illustrating the participants’ lived experience with goal setting in the IMR program. Theme 1 addressed how the IMR instructors’ guidance changed participants’ perceptions of their long-term aspirations or dreams; instead of seeing them as unattainable, they learned that progress towards their goals could be made by breaking them down into short-term goals and working on them. This instilled hope in the participants for the future. The experience of learning how to break personal goals into smaller ones is similar to the study by van Langen et al. (2016), who found that learning goal setting in IMR was one of the most important skills in participants’ recovery process, which also increased their motivation and positive thinking (van Langen et al., 2016). Overall, the findings in theme 1, together with the findings of the abovementioned studies, highlight the importance of the instructor’s guidance in helping participants set goals, and in instilling hope that they could be achieved.

Theme 2 addressed how participants were encouraged by the IMR instructor to pursue their individual short-term goals. The instructors’ recognition of participants’ efforts to pursue their short-term goals stimulated peer support among the IMR group members. Sharing their individual experiences in pursuing goals with peers made them feel more confident. Their successes in achieving short-term goals, often inspired by the group discussions, led them consider additional ways of achieving their personal goals. This experience is consistent the findings of van Langen et al. (2016), where the participants were encouraged to share information about living with SMI in the IMR group, which they found valuable in their recovery process (van Langen et al., 2016). This finding also corresponds to Biringer et al.’s (2017) finding that mental health professionals’ empathy for the challenges faced by the participants in their everyday lives is an important element of personal goal setting (Biringer et al., 2017). Overall, the findings in theme 2, together with those of the other studies, indicate that the IMR instructor’s understanding of participants’ everyday lives can stimulate peer support in the group.

Theme 3 addressed how the IMR instructor motivated and instilled hope when participants stopped making progress towards a goal, which corresponds to the findings in the studies of Roe et al. (2009) and van Langen et al. (2016). However, in the present study, some participants reported giving up when trying to achieve their short-term goals when they repeatedly got stuck trying to take steps towards them. Furthermore, some participants found that the weekly follow-up on goals neglected their struggle to maintain daily activities that were steps towards their short-term goals. From some of the participants’ perspectives, coping with persistent symptoms made it more difficult to focus on daily activities and maintain practical skills.

In line with this, Biringer et al. (2017) and Yarborough et al. (2016) found that mental health professionals need to be responsive to participants’ problems with taking steps towards short-term goals; therefore, the support has to be flexible as people in recovery move between successes and failures, including when they stop making progress (Biringer et al., 2017; Yarborough et al., 2016). These findings are also in line with the notion that every person with SMI has their own unique recovery process (Anthony, 1993). Therefore, a more flexible approach than the one used in the structured IMR group with the fixed 9 month timeframe may be preferable, since a person in recovery may need to repeat, postpone or pause work on a module to support their recovery process (Dalum et al., 2018a; Fardig et al., 2011; Levitt et al., 2009; Salyers et al., 2010, 2014).

Our findings showed that when participants were guided to set clear and specific goals, they went from feeling overwhelmed to feeling hopeful in the goal setting process. Applying the transtheoretical approach on our findings the changes reported by participants correspond with the progress from pre-contemplation stage; no intention to change behaviour, to contemplation stage; seriously considering a change but not having made a commitment to act (Krebs et al., 2018). Common for the contemplation stage is participants seriously considering changing behaviour Nevertheless, participants can be stuck at this stage for a long period without tailored support (Krebs et al., 2018). The participants in our study were encouraged and supported by IMR instructors to set specific goals which is a core element in the change from the precontemplation to contemplation stage. However, we found that the participants experienced time pressure when evaluating progress towards a short-term goal, which is a critical issue in the contemplation stage (Krebs et al., 2018). If instructors urge the person to change at this stage, they risk driving them away as there is a tendency for people to underrate the advantages of change and to overestimate the disadvantages, taking on a defensive position when pressured (Krebs et al., 2018). However, our findings showed some participants started taking small steps towards short-term-goals, corresponding to the preparation stage. At this stage the participants focus on identifying strategies and resources to help them effectively start to overcome problems, that is, persistent symptoms.

However, as some participants progressed to the next (‘action’) stage, they were unsuccessful in their attempts to achieve their goals. Some participants struggled to achieve or sustain their short-term goals. An explanation for this result could be that there was limited transfer of the knowledge and skills taught in IMR-course to their everyday lives (Illeris, (2009) . To ensure transfer, the content in the learning sessions needs to be practised or used in everyday life. The participants in the IMR may not have received enough support in working on their goals outside the group. The overall implementation of IMR in the Danish CHMC was good according to the IMR Fidelity Scale, but attention to the specific fidelity item of ‘Involving family and significant others’ was not high, which could have limited generalisation of IMR skills to outside the group and progress towards personal goals (Dalum et al., 2018b).

Altogether our present discussion suggests that participants’ personal goal setting is fundamentally aligned with Rose et al.’s (2017) finding on individuals’ experience choosing goals in rehabilitation in general (Rose et al., 2017). Furthermore, focusing on meaningful short-term goals and attention on personalised strategies reported by participants may have a positive impact on goal-pursuit, which corresponds with the findings of Rose et al. (2017). However, our study indicated that although participants learned how to structure the breaking down of personal goals into smaller short-term goals during IMR, they often stopped making progress towards their short-term goals, which is similar to people in rehabilitation in general (Levack et al., 2015; Rose et al., 2018). Additionally, we found that the frequent evaluation of progress towards short-term goals was experienced by some participants as time pressure, which felt critical and appeared to interfere with continued work on their goals. Participants are in risk of being misunderstood according to Rose et al. (2017) as some participants ask for support from clinicians in setting goals (Rose et al., 2017). Considering that some participants learned to set goals but stopped making progress towards them, we recommend future research to further explore how setting, pursuing and achieving personal goals might have an impact on the participants’ recovery process, for example, daily function, symptoms and social participations. In terms of potential contributions goal setting in IMR appears to help participants identify, articulate and initiate the pursuit of short-term goals when guided by IMR-instructors and supported by peers in the IMR group. Long-term support on personal goalsetting, from both the IMR instructors and other participants in the IMR group, might be able to build strong relationships and increase confidence in their ability to express opinions. The participants may need more assistance from the clinician in setting smaller and more achievable goals. Nevertheless, the present study shows that some participants stopped making progress and struggled to achieve their short-term goals, corresponding to the preparation stage in the transtheoretical model of change. Participants may in risk of being misunderstood by the clinicians as ‘passive’ or ‘unmotivated’. Some participants may want or need more help from clinicians in setting goals, and in modifying their goals. Some participants may want or need more help from clinicians in setting goals, and in breaking their goals down into smaller ones, and modify their plans to achieve goals when obstacles or lack of progress occurs. Sometimes clinicians may misunderstand this actively involved in goalsetting and follow-up. Participants in recovery from SMI may be in need of a more tailored and flexible approach to goal setting in order to support them in obtaining their recovery goals.

Methodological considerations

This article was based on a descriptive phenomenological study with data collected during another qualitative study by Jensen et al. (2019) involving individual interviews with participants after attending the IMR program (Jensen et al., 2019). The scope of the study was to explore the participants’ lived experience of participation in the IMR-program with a particular focus on goal setting as experience after attending IMR, in a given period of their live. Although some participants were encouraged and found the focus on identifying and pursuing personal goals in IMR to be positive and inspiring, others had difficulties making progress towards their short- and long-term goals or maintaining progress made towards their short-term goals.

Another consideration is the integration of IMR with the person’s clinical treatment (e.g. regular contact between IMR clinician and the team), which is recommended to facilitate the transfer of skills and support of increased knowledge, as is the involvement of significant others, who can play a role in prompting or helping participants use new skills. These factors in implementing the IMR-program may have had an impact on the participants’ lived experience, including some of the difficulties making progress towards goals. Furthermore, the results were based on an additional analysis of the qualitative study by Jensen et al. (2019), coding the data with particular focus on what participants had said about goal setting in a previous interview about their experiences of attending IMR courses.

Footnotes

Acknowledgements

The authors express their deep appreciation to directors, IMR instructors, clinicians, patients and residents at Residential Skovvænget and Residential Klintegården who agreed to participate in the study. Furthermore, special thanks to the IMR participants and staff and the administrator of the advisory board for supporting this study.

Contributions

All authors took part in designing, writing the manuscript and discussing the findings. SBJ performed the data collection and analysis.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The funders of the study: The TRYG Foundation, and Residential Skovvænget had no influence on the study design, data collection, data analysis, or writing of the article.

ORCID iD

Sofie B Jensen

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