Life goals
People are motivated by goals; without goals, most become apathetic and have lower well-being. Short and medium-term goals are usually practical and easily defined. They include, for example, getting dressed in the morning for work and going on holiday with family in July, six months in the future. However, as many people discover when retiring or losing their job, the absence of any longer-term purpose in life can lead to low mood and worse well-being.
People generally require a sense of purpose to give meaning to their lives, and work often provides this. The instillation of purpose by work or taking responsibility for the home and family is usually considered a part of life; its crucial role in giving life meaning is not consciously recognised.
Researchers and philosophers have long understood the importance of purpose and goals in motivating people. Abraham Maslow was one, and he suggested that overarching goals could be categorised into five categories. Rehabilitation researchers have also appreciated the role of life goals in achieving better outcomes for patients. This page reviews life goals, their nature, roles, and use in rehabilitation.
Table of Contents
Introduction
People are motivated by goals; without goals, most become apathetic and have lower well-being. Short and medium-term goals are usually practical and easily defined. They include, for example, getting dressed in the morning for work and going on holiday with family in July, six months in the future. However, as many people discover when retiring or losing their job, the absence of any longer-term purpose in life can lead to low mood and worse well-being.
People generally require a sense of purpose to give meaning to their lives, and work often provides this. The instillation of purpose by work or taking responsibility for the home and family is usually considered a part of life; its crucial role in giving life meaning is not consciously recognised.
Researchers and philosophers have long understood the importance of purpose and goals in motivating people. Abraham Maslow was one, and he suggested that overarching goals could be categorised into five categories. Rehabilitation researchers have also appreciated the role of life goals in achieving better outcomes for patients. This page reviews life goals, their nature, roles, and use in rehabilitation.
The start - philosophy.
Humans look for meaning in everything, usually finding some meaning. The question, what is the meaning of life, has been discussed since people could think and communicate. However, although some of the discussion considers why humankind exists, most of the discussion concerns the meaning for the individual. What gives my life meaning? This is a perennial question.
Philosophers have investigated the question, and Thaddeus Metz has provided an overview. First, as applied to humanity, the meaning of life is distinguished from the meaning a person holds about their life. This page only considers the latter.
He then presents two supernatural factors that may give meaning. God-centred views hold that God has assigned the person with a purpose, chosen by God, and, for the person, satisfying God’s purpose gives meaning to their life. Generally, these ideas do not equate achieving God’s purpose with gaining a reward such as eternal life.
Soul-centred ideas focus on each person having an immortal, personal soul. In this context, the achievements in life are thought to determine the nature of the afterlife. One example is that God determines the nature of the afterlife and may do so by judging how well his purposes have been fulfilled. Soul-centred purposes do not require God; they generally assume that a better life leads to a better afterlife.
The naturalist approaches fall into two classes.
- The Subjective approach holds that the person alone determines what gives their life meaning and judges how well they have met those goals.
- The Objective approach holds that subjective determination requires further support and that some goals in three areas are intrinsically better. The three suggested areas of concern are:
- morality (goals that lead to morally good outcomes,
- enquiry, goals that seek after the truth, and
- creativity, goals that lead to beauty).
These two approaches are compatible with a belief in God or the existence of a soul. A third naturalist approach considers that belief in supernatural factors demeans the strength of naturalist approaches.
The last philosophical approach is nihilism – there is no meaning to life, in general, or for an individual. While this can be understood as a reasonable academic approach, it overlooks humans’ universal drive to find a purpose in life. A true nihilist’s meaning in their life might follow from a passion to convince others of the truth of their position!
From a clinical perspective, the naturalist approach is most relevant. It is neutral about a person’s supernatural beliefs, recognises their role in determining their meaning in life, and suggests three likely areas that could be used clinically and in research. In particular, the three areas put forward in the objective approach map well to aspects of self-actualisation in Maslow’s hierarchy of needs.
Purpose in life
Patrick Knight and Todd Kashdan defined purpose well in their paper, “Purpose in Life as a System That Creates and Sustains Health and Well-Being: An Integrative, Testable Theory.” They stated that purpose:
- Is a central and self-organising life aim
- Stimulates goals and alters behaviour
- Gives life meaning.
They compare purpose to a compass, giving life a sense of direction; following the direction is optional, but fulfilling purpose is associated with greater subjective well-being. They consider that purpose has three components:
- Scope, the extent to which it influences all activities or only a proportion,
- Strength, which determines the power of its influence on activities in different situations,
- Awareness reflects how well a person can articulate their purpose.
They suggest five elements, with each having a testable hypothesis. They are that purpose:
- Is associated with behavioural consistency. People whose purpose has a broad scope will act similarly and with similar intentions throughout their lives.
- Creates psychological flexibility, with the person able and willing to work around obstacles in their life.
- Increases efficiency in the person’s use of personal resources so they are less prone to illness and respond to stress better.
- Is associated with greater satisfaction with life and subjective well-being.
- Is related to greater cognitive control, with the person acknowledging their purpose.
Much evidence shows that living a purposeful life is associated with better health. Aliya Alimujiang and colleagues analysed data from 6985 people recruited aged over 50 years, investigating the association between the initially measured purposefulness and health 15 or more years later. They found higher levels of purpose in life were associated with lower all-cause mortality. Randy Cohen and colleagues found the same in a meta-analysis of ten prospective studies, including 136,256 people.
In a detailed discussion of Purposefulness as a critical factor in functioning, disability and health, Joshua Lee and colleagues suggest that purposefulness links a person with their narrative identity and experiences. They suggest that an active focus on the purpose someone has in their life, often increasing their awareness and helping them articulate their purpose, may help the rehabilitation process.
Maslow’s needs.
I have considered these in detail in a blog post. In summary, he suggested five areas of need:
- Physiological, which he termed basic, concerns persistent thirst, hunger, and similar needs driving behaviours.
- Safety concerns include having somewhere to live and sleep and sufficient resources to avoid being at significant risk from external events.
- Affiliation, which he termed love, means emotionally close relationships with one or a few other people, such as family.
- Esteem is another word for status as perceived by others and the person.
- Self-actualisation, which can be subdivided into three types:
- Cognitive, acquiring and using knowledge
- Moral: doing activities that are good
- Social, benefiting others or society.
This is a way of categorising needs; they are not specific needs attributable to any individual. The categorisation has evidence supporting its validity, not least its continued use and prominence over 80 years. The self-actualisation goals are also congruent with the objective naturalist goals mentioned above.
Maslow’s categorisation of needs extends well beyond the life goals developed on this page. Goals associated with life goals could be fitted into one of his categories, and life goals usually fit into the self-actualisation category. However, life goals overlook essential areas such as having somewhere safe to live and having close friends. Therefore, in clinical practice, one may always need to consider high-level, long-term goals outside the concept of meaningful goals.
Life goals
Life goals are concomitant with purpose; having a purpose implies a goal. Many terms are used for the same construct, such as meaningful goals, overarching or long-term goals, fundamental goals, and self-actualisation. The essential features are that they are:
- at the peak of the hierarchy of goals
- long-term.
- Usually related to abstract ideas and not specific, concrete matters
- Integral to the person, influencing all their activities albeit subtly.
Twenty years ago, Sivaraman Nair wrote Life Goals: the concept and its relevance to rehabilitation; this paper considered what life goals were, how they could be established, and how they fit into the rehabilitation process.
In 2017, a student, Neeltje Vermund and her colleagues undertook a qualitative study on general practitioners (family doctors) and senior hospital specialists in geriatrics, asking about goals in people with multiple diseases. Their data suggested goals fell into three groups that formed a hierarchy: those concerned with specific symptoms or impairments, functional goals, and fundamental goals. Fundamental goals “specify patient’s priorities in life, related to their values and core relationships.”
This and much other work shows that rehabilitation goals should form a hierarchy with lower-level and shorter-term goals linking to a person’s high-level goals; without a link, the person will not be committed to achieving the lower-level goals.
Following this, in 2020, Joost Dekker and his colleagues investigated setting meaningful goals in rehabilitation: rationale and a practical tool. Their work was based on an excellent, monumental review of the literature on making meaning in life by Crystal Park and some qualitative studies on patients who had had a stroke.
Joost Dekker et al. felt that fundamental goals had five aspects, interlinked but distinguishable:
- Core values: what is right and wrong
- Relationships with others, which may include animals
- Worldview on life and death, and suffering
- Identity: about one’s life and narrative
- Inner-posture: enduring what cannot be changed
Establishing life goals
Joost Dekker and colleagues developed a tool and method for establishing meaningful goals (life goals). They created a three-stage process. First, in a facilitated conversation with the person, one explores what their global meaning is. The five aspects of life goals are remembered and can be referred to to encourage thought and reflection. This is used to develop an overall meaningful rehabilitation goal. The third and final step is to set or adjust specific goals to align with the overall goal.
The process has been used, and Elsbeth Littooij and colleagues have assessed the experience of patients and staff. The process was emotionally challenging for some patients; clinicians did not report their emotional strain, but I suspect some clinicians found the discussion challenged them to consider their global meaning. It was reported by most people to be helpful and associated with a reported increase in satisfaction.
The process is resource-intensive and only applicable to patients who are able and willing to participate in the process. It is not feasible as a part of all rehabilitation.
A quicker way is to ask someone explicitly. Alternatively, for those who can read, patients and their families could be given information and a piece of paper with the five headings to help them consider the matter before having an abbreviated conversation with a team member.
In situations where a formal process is impractical, it remains essential to consider what a person’s life goals might be. When a person seems unwilling or unable to participate, a more focused effort to explore their life goals must be considered.
Life goals – synthesis.
This brief overview of an enormous and complex field of research demonstrates that rehabilitation ignores the topic of life goals at its peril. Many considerations will influence how much time and effort is devoted to life goals with individual patients. Still, in complex and challenging situations, some resources must be devoted to the topic. The two frameworks most likely to help are Maslow’s five domains of need and the five aspects of life goals suggested by Joost Dekker and colleagues.
Clinically, it is much easier to consider Maslow’s five areas of need for each patient because it can be brief, acting as an aide-memoire. If a detailed evaluation is needed, exploring the self-actualisation needs will require careful consideration of life goals.
Purpose, meaning, and life goals are all vital parts of anyone’s life. Their importance is maintained when the person is ill and adapting to their new situation. Therefore, life goals must be an essential feature of any rehabilitation theory. How they are incorporated into the service’s multiprofessional teamwork will vary greatly. Still, they must be discussed and not ignored by the team, for example, when developing service policies. Their use with a person must be proportional to the situation’s complexity.
Conclusion.
High-level needs or goals are the third foundation stone of the theory of rehabilitation. Many words are used to describe them, with life goals being one. They are closely related to Maslow’s needs, which is a way to classify general goals that may influence all behaviours and decisions. Maslow’s needs have the clinical advantage of being less intrusive to the patient and easier to use in practice. The top of his hierarchy is self-actualisation, closely related to fundamental beliefs or meaningful goals. The crucial message to take away is that the clinician and clinical team must always consider life goals. How much effort is devoted to exploring and discussing life goals with the patient is determined by feasibility, need, and resources. They must never be actively ignored; in challenging or complex cases, they should always be considered, but it is a matter of discretion in other situations.
