DISABILITY AND REHABILITATION, 2004; VOL. 26, NO.
1, 18
REVIEW
Theoretical aspects of goal-setting and
motivation in rehabilitation
RICHARD J. SIEGERT* and WILLIAM J. TAYLOR
Rehabilitation Teaching and Research Unit, Department of Medicine, Wellington School of
Medicine and Health Sciences, University of Otago, Wellington South, New Zealand
Accepted for publication: September 2003
Disabil Rehabil Downloaded from informahealthcare.com by Linkopings University on 07/20/13
Abstract
Purpose: The purpose of this article is to provide rehabilita-
tion theorists and researchers with an introduction to some key
theories of goals and motivation from the eld of social
cognition and to argue for increased dialogue between the two
disciplines.
Method: The use of goals and goal-setting in rehabilitation is
briey surveyed and the somewhat ambivalent attitude toward
the concept of motivation in the rehabilitation literature is
highlighted. Three major contributors to the study of goals
and motivation from the eld of social cognition are
For personal use only.
introduced and their work summarized. They include: (i) Deci
and Ryans Self-Determination Model; (ii) Emmons work on
goals and personal strivings, and (iii) Karniol and Ross
discussion of temporal inuences on goal-setting.
Results: It is argued that there is a need for a greater emphasis
upon theory development in rehabilitation research and that
closer collaboration between researchers in rehabilitation and
social psychology oers considerable promise. Instances where
the three theories from social cognition might have relevance
to clinical rehabilitation settings are described. Some possible
directions for research are also briey sketched.
Conclusion: Both rehabilitation and social cognition have
much to gain from increased dialogue.
Theoretical aspects of motivation and goal-setting in
rehabilitation
In a recent review of advances in rehabilitation Wade
and deJong commented that all the major advances in
the eld of rehabilitation to date, have been in the realm
of service delivery.1 They compared this with other
branches of medicine where technological progress and
the development of eective single treatments have
constituted the major advances. Importantly, they
* Author for correspondence; Richard J. Siegert, Department
of Medicine-RTRU, Wellington School of Medicine & Health
Sciences, University of Otago, PO BOX 7343, Wellington
South, New Zealand. e-mail: rsiegert@wnmeds.ac.nz
Disability and Rehabilitation ISSN 09638288 print/ISSN 14645165 online # 2004 Taylor & Francis Ltd
http://www.tandf.co.uk/journals
DOI: 10.1080/09638280410001644932
argued that this dierence has made it dicult for reha-
bilitation services to compete for funding against other
medical specialities that can point to their demonstrably
eective single measure treatments. Wade and deJong
noted that one of the major advances in rehabilitation
has been the transition from a largely medical model
emphasising pathology and diagnosis, to broader
psychosocial and socio-cultural models. They also
suggested that further progress in rehabilitation will
stem mostly from the accumulation of evidence based
interventions. Hence they advocated rehabilitation
approaches that are pragmatic, functional, or task
oriented in contrast with a theory-based, impairment
oriented approach (p. 1387).
Wade and deJongs review is an excellent and concise
summary of contemporary rehabilitation practice.
However, we believe that it exemplies one weakness
of the rehabilitation canona tendency to overvalue
pragmatism and empiricism at the expense of theory
development. Such an approach is hardly surprising
given the nature of clinical rehabilitation. Rehabilitation
specialists are faced everyday with the daunting task of
helping individuals whose physical and social selves
have been severely compromised by trauma or disease.
There is a desperate need in such situations for immedi-
ate and practical solutions and not for abstruse philoso-
phy. Any clinician who did not believe this would
quickly be brought back down to earth by their patients.
However, the need for a pragmatic stance in the clinic
should not exclude the development of a rich theoretical
foundation for the broader eld of rehabilitation. The
central argument we wish to make in the present article
is that rehabilitation needs theory development just as
much as it needs an evidential basis, and furthermore,
that theory building is compatible with a tough-minded,
evidence-based zeitgeist. The point at issue here is that
for rehabilitation to advance as a scientic discipline,
it needs conceptual and theoretical advances, not solely
 R. J. Siegert and W. J. Taylor
empirical ones. It is not enough merely to ask what
works? in rehabilitation. We also need a body of theory
that explains how an intervention works and that can
guide the development of new and more eective techni-
ques.
In the present article we consider the use of goal
setting in rehabilitation as a practical but largely
atheoretical specic intervention. We also look at the
controversy surrounding the closely related concept of
motivation. Then we briey review three important
theoretical approaches on goals and motivation from
the eld of social cognition, each of which, we will
argue, has relevance for rehabilitation. Finally, we spec-
ulate on how these three models might have applied rele-
vance for goal setting in clinical rehabilitation settings
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and also to drive research.
Goals and goal-setting in rehabilitation
It is a sine qua non in rehabilitation practice that goals
and goal setting are a fundamental component of any
sound rehabilitation programme. Moreover, goal setting
is assumed to be an essential part of every individual
patients rehabilitation. For example, Barnes and Ward
(p. 8) stated that the essence of rehabilitation is goal-
For personal use only.
setting and that If rehabilitation is to be taken forward,
agreed goals and outcomes are essential.2 On a similar
note McLellan advised that the measurement of
outcomes is vital to successful rehabilitation and that
this demands the setting of precise goals by the rehabili-
tation team in conjunction with the patient and their
family.3 McLellan claimed that many studies have
demonstrated the eectiveness of goal setting. . . and is
quite critical of goal setting where the goals are vague
and lacking in precision (p. 235).4 Similarly, Bower writ-
ing on rehabilitation and the child with multiple handi-
caps noted that Treatment goal-setting is at the centre
of attempts to reduce disability and resolve handicaps
for children and their families (p. 347).5 Thus it is widely
accepted that goals and goal-setting are an essential and
eective component of a modern approach to rehabilita-
tion.
A number of writers also advocate the SMART acro-
nym as a guideline for goal-setting. This acronym stands
for a number of ideal criteria that should be considered
when setting rehabilitation goals. McLellan stated that
the ideal goal should be Specic, Measurable, Activity-
related, Realistic, and Time-specied. Barnes and Ward
(p. 9) give a slightly dierent set of criteriaSpecic,
Measurable, Achievable, Relevant, and Time-Limited.
Another important feature of goal-setting which several
writers mention is that it is a collaborative process
2
whereby the patient, the patients family, and the reha-
bilitation team, negotiate a set of shared goals. Barnes
and Ward observed that there can be discrepancies,
and even conict, between the goals that the patient,
the family, and the rehabilitation specialists view as
important or realistic. They also commented that goal-
setting is a dynamic process that can be changed and
adjusted according to progress (p. 8). Finally, some
authors also stressed the importance of developing
short, medium, and long-term goals.
It might seem then that goal-setting is a reasonably
straightforward component of contemporary rehabili-
tation practice. However, there is a growing body of
research on this issue that suggests that, while
certainly desirable, goal-setting may be a more compli-
cated procedure than it has been portrayed. For
example, Wressle, Oberg and Henriksson reported a
study which examined how treatment goals, as seen
by stroke patients and rehabilitation professionals
respectively, were related to the discipline-specic
interventions or treatments provided, and also to the
eventual outcomes.6 Their study involved 21 geriatric
stroke patients and a range of professionals (occupa-
tional therapists, physiotherapists, physicians) directly
involved in their rehabilitation. Qualitative interviews
and diaries were used to track the relationship among
goals and interventions longitudinally, and also to see
how these reected the ICIDH categories of impair-
ment, disability and handicap. The authors reported
a number of interesting ndings, among them that
patients tended to adopt a passive role in hospital
and had a minimal role in goal-setting. Wressle et
al. observed a tendency for professionals to frame
goals in terms of physical outcomes primarily
concerned with mobility and physical independence.
Goals that were essentially psychological in nature,
were relatively rare. The authors questioned whether
rehabilitation goals are not largely driven by economic
factors and the demand to empty hospital beds as
quickly as possible. They concluded that the patient
does not participate in the goal-setting process (p.
86). McPherson et al. reported similar ndings in a
qualitative study that looked at what people with
arthritis considered were the most important outcomes
in terms of their long-term health care and rehabilita-
tion.7 They concluded that health professionals and
their patients dier notably in what they consider
are the good or important outcomes. Again, such a
nding suggests that goal-setting in rehabilitation is
more complicated than has sometimes been suggested,
especially in terms of incorporating the patient or
clients perspective.
 Motivation and goal-setting
It has also been suggested that the practice of goal-
setting itself implies a set of assumptions or a world-
view that may not necessarily be shared by all clients
or patients.8 Kielhofner and Barrett commented that
Goal-setting takes its meaning and ambience from
cultures that emphasize a strong future orientation and
the attendant idea of progress toward some denable
good (p. 346).8 They noted further that The occupa-
tional form of setting and following up on goals belongs
to a narrative in which people progress forward in time,
calculate steps of action, mark passages, and set objec-
tives to get somewhere in the future (p. 351)perhaps
reecting the culture of the mostly middle-class profes-
sionals involved in rehabilitation. Which is not to decry
goal-setting, but rather to suggest that we cannot apply
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it in a cookbook fashion to all our patients. Kielhofner
and Barrett argued that occupational forms, such as
goal-setting, always operate within a social context
and as such are imbued with meaning by all partici-
pants. Consequently, for goal-setting to succeed, we
need to consider the clients understanding of the
process and its meaning (the work of Kielhofner is also
a good example of the heuristic value of theory develop-
ment for stimulating rehabilitation research).9
Another important dimension of goal-setting that
For personal use only.
tends to be overlooked or underestimated is the inu-
ence of the context in which it takes place. For example,
in an inpatient rehabilitation ward, or a stroke unit, the
focus is primarily upon activities of daily living. The
individual must achieve maximal independence in such
domains as mobility, hygiene, continence, dressing
oneself, eating, communication and personal safety.
The goals of rehabilitation are physically focused and
primarily set by the rehabilitation team in consultation
with the patient. In contrast, when the patient is
discharged back into the community, their goals are
likely to be broader, with more emphasis upon social
functioning and reintegration within their family and
the community. Typically, the patient will be taking a
much more dominant role in goal-setting by this stage,
and family members will be increasingly involved.
Factors relating to the individual circumstances of the
patient, their life history, their family background, social
support network, and other community variables will
play a much more important role than in the highly
structured inpatient environment. In fact, there is
evidence that one of the most common problems
encountered in the goal-setting process is the lack of
continuity from inpatient to community rehabilitation
goals.10 Again, we will argue that a more theoretically
driven approach to goal-setting may go some way
towards addressing this kind of problem and provide a
better t between individual and contextual factors in
rehabilitation.
Motivation and rehabilitation
A concept that is closely related to the idea of goals is
that of motivation. Eccles and Wigeld note that the
word motivation stems from the Latin word meaning
to move, and in this basic sense the study of motivation
is the study of action (p. 110).11 They observe that in
contemporary psychology the focus today is on the
study of the relation of beliefs, values, and goals with
action. (p. 110). Within the eld of rehabilitation moti-
vation is typically viewed as an important concept, but
also one that is dicult to measure objectively and
prone to value judgement. The clearest statement to this
eect has been in the work of Maclean and Pound and
Maclean, Pound, Wolfe, and Rudd.12, 13
Maclean and Pound critically reviewed the concept of
patient motivation in the physical rehabilitation litera-
ture (p. 495). In this paper they observed that rehabilita-
tion professionals frequently evaluate their patients in
terms of how motivated they are, and also that there
is a widespread belief that the more motivated patients
have more positive outcomes. At the same time they
comment that the term itself is loosely dened and the
evidence is mostly anecdotal. In reviewing the literature
on motivation they observed that studies typically fell
into three broad groups. The rst group, which
comprised mainly clinical research, tended to view
motivation as a personality trait. In other words motiva-
tion is seen as a relatively enduring characteristic of the
individual and their behaviour. It is something that
tends to be seen as inside the individual and relatively
unaected by the environment. The second group of
studies in this review focussed mainly on the extent to
which environmental or social variables could eect
motivation. Such studies tended to look at how motiva-
tion might be inuenced by qualities of the rehabilita-
tion team itself or by the patients social support
network. A third group of studies acknowledged the
importance of both the characteristics of the individual
and also of their environment, and in some cases even
explored the interactions. Maclean and Pound were
particularly critical of the rst group of studies that
regard motivation as an aspect of the patients person-
ality. The major problem they observed is that such an
approach is highly correlated with a moralistic stance
that blames the patient.
Is motivation then a useful concept for rehabilita-
tion, or is it as King and Barraclough (cited in
Maclean & Pound) have suggested simply unhelpful?
3
 R. J. Siegert and W. J. Taylor
Can we dene motivation in a precise and meaningful
fashion that clinicians and researchers can agree on? Or
is the concept hopelessly subjective and beyond scienti-
c analysis? There are a number of practical reasons
why it may be both premature and unwise to abandon
the concept of motivation altogether. First, as noted by
Maclean and Pound this is probably unrealistic as the
concept itself is so deeply ingrained in the thinking of
rehabilitation professionals (p. 505). Another reason
for not abandoning the concept of motivation alto-
gether, is that, notwithstanding the problems with
dening the concept, there are numerous quantitative
studies suggesting that it can be a good predictor of
outcome in rehabilitation.14, 15 A third reason for not
abandoning motivation as a useful concept in rehabili-
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tation is that motivation and goals are inextricably
linked (as we will attempt to demonstrate below).
Thus, using goals and goal-setting without any refer-
ence to motivational theory may rob it of a powerful
theoretical framework.
In the present paper we argue that goal-setting as a
technique in rehabilitation will benet in the long term
from developing a clearer and more complex theoretical
framework. In the next section we will provide a brief
overview of some relevant ideas about motivation and
For personal use only.
goals from the eld of social cognition that could help
develop such a framework. However, the subject of
motivation and goal-directed behaviour in contempor-
ary psychology already consists of a vast and diverse
body of literature. We will not attempt to provide any
systematic review of this area and in fact several excel-
lent examples already exist.11, 16 Rather, our goal is to
describe a few examples of some theoretical and empiri-
cal models drawn from the eld of social psychology,
that might be particularly relevant for theory building
in rehabilitation. We will focus on three important theo-
retical approaches: (i) Deci and Ryans self-determina-
tion model; (ii) Emmons work on subjective goals and
well-being, and (iii) Karniol and Ross ideas on tempor-
al inuences on goal-setting.17 19
Goals and motivationthe view from social psychology
DECI AND RYANS SELF-DETERMINATION MODEL
Deci and Ryan have advanced a model of human
behaviour which views human beings as inherently
active, self-directed organisms which have three funda-
mental human needs: for autonomy, competence, and
interpersonal relatedness.17 Autonomy refers to indivi-
duals propensity to self-regulate and organise their
experiences and to function as unied, integrated human
4
beings. Relatedness refers to a propensity to establish a
sense of emotional connectedness to other human beings
and to seek the subsequent goals of feeling loved and
cared for. Competence refers to the propensity to estab-
lish a sense of mastery over ones environment, to seek
challenges and to increasingly master them. Paramount
among these needs they argue is the need to be autono-
mous or self-determining. Ryan and Deci argue that it is
through the fullment of these three basic needs that
humans nd psychological growth and well-being.16
The fullment of the three basic needs is considered to
be a natural aim of human life that delineates many
of the meanings and purposes underlying human
actions (p. 147).
One practical application of Ryan and Decis model
would be in providing a framework for goal-setting
and planning that is holistic in approach and avoids
the criticism that it is primarily concerned with emptying
hospital beds quickly. This narrow focus is much less
likely if rehabilitation teams work with a patient to
develop goals in each of the three separate domains.
Consider the example of a person with a spinal cord
injury (SCI) who is approaching re-entry into the
community as a paraplegic. Goals within the competence
domain will initially centre around mobility, bladder
and bowel function, grooming and dressing and other
activities of daily living (ADLs). As these are mastered
and competency increases new challenges may be added,
such as driving or involvement in wheelchair sporting
activities. At the same time, developing goals in the
domain of relatedness will ensure that social needs are
not neglected. These goals might focus upon ensuring
the person has strong social support networks or provid-
ing counselling on sexuality issues after SCI. The notion
of autonomy suggests that the individual with the SCI is
actively involved in setting their own goals at all stages.
It suggests also that the more control invested in that
person, the more likely that they are to achieve the
goals.
Another central concept in self-determination theory
is that of intrinsic motivation. Deci and Ryan dened
intrinsically motivated behaviours as those for which
the rewards are internal to the person (p. 194). Such
behaviours are inherently interesting to the person and
are rewarding because they produce feelings of compe-
tency and self-determination. They can be contrasted
with extrinsically motivated behaviours that are
performed to obtain some form of external reward such
as money or praise. Involvement in behaviours that are
intrinsically motivating is thought to increase feelings of
competency and self-determination. The ability to full
these three basic needs for autonomy, competency and
 Motivation and goal-setting
relatedness is thought to contribute directly to subjective
well-being.
One implication of this notion of intrinsic motivation
for rehabilitation practitioners, is that we need to get to
know the client as a person, before we can assist them to
set meaningful goals. We need to attempt to enter their
world view and garner their perspective upon their
current situation if we wish to establish what activities
might be intrinsically motivating for that individual.
Consider the example of working with stroke patients
who have a mild aphasia to improve their language abil-
ities. A more extroverted client who thrives on the
company of others may nd conversation exercises in
a group intrinsically motivating. By contrast, a client
who has always been rather shy and introverted may
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initially nd such an approach aversive and punishing.
However, they may thrive on a cognitively challenging
task that is less socially demanding, such as crossword
puzzles. They can then be gradually involved in similar
tasks with a more social elementsuch as card games
or scrabble.
There are a number of other aspects of this theory
that are relevant to the subject of goals and goal-setting.
For example, Ryan and Deci cited studies that suggest
that positive well-being is associated with goals that
For personal use only.
are challenging but not with goals that are too easy
nor too dicult. They also distinguished between
approach (or positive) goals, such as wanting to master
a new skill, and avoidance (or negative) goals, such as
not wanting to look foolish. They cite a range of studies
which suggest that higher subjective well-being is asso-
ciated with achieving approach goals whereas not so
for avoidance goals. However, the most salient aspect
of Deci and Ryans theory for rehabilitation and goal-
setting, is the extensive body of research which they have
reported over two decades, on the eects of intrinsic and
extrinsic motivation.16, 17 In general, Deci and Ryan
argued that intrinsic goals are more powerful motivators
than extrinsic or externally imposed goals. Moreover,
extrinsic goals can actually serve to disrupt behaviour
that is intrinsically motivated.
EMMONS SUBJECTIVE GOALS AND WELL-BEING
Robert Emmons has described a theoretical approach
to goals that emphasises the relationship that goals have
with personal strivings and subjective well-being.
Emmons said that personal strivings are stable features
of our personality that represent durable concerns. . .ex-
pressed in a variety of situations (p. 315).18 For exam-
ple, we may value physical attractiveness greatly and
devote much time and energy to our diet, exercise and
grooming. Or we might consider that a close and happy
family is the most important thing in life and behave
accordingly. We might strive to be a good Christian
or a well-respected academic. According to Emmons,
these personal strivings represent what a person is typi-
cally or characteristically trying to do (p. 315).18
Thus in Emmons view, the kinds of personal strivings
that characterise an individual, will have a close rela-
tionship with the type of goals that matter to that
person. Similarly, the extent to which they achieve those
goals will have an impact upon their well-being. In
Emmons words goals play a central role in determining
the degree to which a person is satised with his or her
life, and the degree to which that person experiences
positive and negative emotional states (p. 315). He
considered that emotions serve three important func-
tions in the regulation of goal-directed behaviour: (1)
they help us decide which goals are important to us,
(2) they energise us and help direct our attention and
resources towards goal attainment, (3) they provide
feedback to us.
One important implication of Emmons ideas for
rehabilitation practice is that a clients emotions and
feelings are an integral part of the goal-setting process.
Their emotions help them to decide which goals are
worth striving for in the rst place, they provide energy
or drive (that component of motivation known as voli-
tion) and they communicate how well the client thinks
they are progressing toward their goals. Indeed, rather
than treat the clients emotions as primarily symptoms
or problems that arise in reaction to their circumstances,
we need to closely monitor them throughout the rehabi-
litation process and acknowledge their communication
value. To take a not uncommon example, that of a
young man recovering from a traumatic brain injury
(TBI), who is frequently hostile and aggressive toward
sta on a rehabilitation ward. While such behaviour
can have diverse causes, it sometimes represents an
indirect message that the young man is unhappy with
the goals he has supposedly set in conjunction with the
rehabilitation team. Mark Ylvisaker eloquently made
this point in reecting upon his years of experience of
working with young male survivors of severe TBI.19
He noted that the typical young, male survivor of a
severe TBI, often led a life prior to their injury which
was characterised by impulsiveness, substance abuse,
risk-taking and other stereotypically macho attributes.
Ylvisaker commented wryly that the goals for social
rehabilitation with such young men frequently resemble
an attempt to turn a Dobermann into a poodle, and not
surprisingly they are frequently unsuccessful. It is Ylvi-
sakers contention that in such cases successful rehabili-
5
 R. J. Siegert and W. J. Taylor
tation hinges upon helping the young man with a brain
injury develop a new sense of identity. An identity that,
while still broadly Dobermann in nature, is more
consistent with pro-social values and a non-delinquent
lifestyle. The point at issue here is that successful goal-
setting must incorporate the clients perspective and a
rmer theoretical perspective on goal-setting can facili-
tate this.
Emmons is very clear that our moods and emotions
are aected by our goal strivings. However, he is less
concerned with short-term mood states than with long-
er-term emotional adjustment and life satisfactionor
subjective well being (SWB). He is as concerned with
the meaning an individual nds in their life as much as
their happiness. For example, religious saints and politi-
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cal prisoners have been known to sacrice their own
happiness in the search for a meaningful existence.
Emmons argued that long term SWB is not determined
simply by summing positive and negative mood states
but requires a broader and more durable sense of mean-
ingfulness and purpose in ones lived existence. Emmons
put it thus Meaning comes from involvement in person-
ally fullling goals, the integration of these goals into a
coherent self-system, and the integration of these goals
into a broader social system (p. 333).18
For personal use only.
Emmons theory also involves detailed consideration
of how goals dier among people and how these dier-
ences (e.g. in their content) relate to SWB. However,
space precludes even a supercial account of this
complex theory and we will focus on just one further
aspect of the theory that may have useful implications
for rehabilitation. This is Emmons observation that
personal strivings and goals can vary according to their
degree of abstractness. An example of a more abstract
or high-level goal that Emmons gives is a person who
wants to come to terms with suppressed feelings and
emotions. A more concrete or low level goal described
by Emmons is to keep my room clean (p. 320).18
It is not dicult to think of similar examples of high
level and low-level goals that have more relevance to a
rehabilitation setting. For example, a person with
Parkinsons disease who has suered increasing restric-
tions on their mobility and independence may wish to
continue their spiritual relationship with God and also
deepen their social relationships with their fellow
parishioners. These are high-level goalscharacterized
by a high degree of abstraction. They would probably
not meet the SMART criteria. However, they may well
be able to strive toward these higher-level goals through
quite concrete, lower-level goals. The goals might be to
attend one church service weekly and one parish social
function each monthsimple, measurable, achievable,
6
and realistic goals with time frames. In this sense, the
rehabilitation canon exemplied in the SMART acro-
nym misses the point somewhat. We all have high-level
goals, and they add meaning to our livesand the best
path toward achieving such high level goals is through
specic and achievable lower-level goals. As Emmons
puts it, The most adaptive form of self-regulatory beha-
viour may be to select concrete, manageable goals that
are linked to personally meaningful, higher-order repre-
sentations (p. 54).21 The real message here for rehabili-
tation practitioners is that goals are hierarchical in
nature. By organising lower level goals (i.e. SMART
goals) in relation to higher order goals, we keep the indi-
viduals existential self and personal values to the fore-
front and allow for the role of meaning in life as a
central focus in rehabilitation.
There is a close parallel with short and long term
goals here: long term goals tend to require a number
of specic steps along the way, which may not always
be obviously linked to the long term goal. For example,
a patient with stroke who wants to return to work will
need to identify precisely what it is that prevents him
from working. It may be that the ability to drive a
manual gear-change car is necessary, in which case a
short-term goal may be to improve left arm function
in order to operate the gear lever. Goals can often be
broken down into tasks, which when accomplished, lead
to a new level of competence, and eventual attainment
of the goal. It may be that tasks are more suitable than
goals when applying the SMART approach.
KARNIOL AND ROSS TEMPORAL INFLUENCES ON
GOAL-SETTING
In a review paper Karniol and Ross surveyed the
importance of the role of time in relation to motivation
and goal setting.19 In particular, they were concerned
with elucidating the ways in which an individuals perso-
nal history and autobiographical memory might interact
with their particular vision for the future, to inuence
their goals and motivation in the present. Their article
is an interesting and readable introduction to much of
the literature from social psychology on this topic. Once
again, we will just select a few key ideas from their
review paper that might have particular relevance for
rehabilitation. We recommend their original article for
a more in-depth overview of this area.
One central idea in Karniol and Ross article is that
goal-setting is not always just a simple linear process
that occurs in a void. Rather, individuals are inuenced
by their past and also by their cognitive representations
of possible futures. Karniol and Ross state that In
 Motivation and goal-setting
general, people imagine various futures, consider the
advantages and disadvantages of each, select their
preferred end states, and then develop plans to achieve
their desired goals while avoiding negative outcomes
(p. 595). In this process, the individuals memory of
the past, can also play a vital role in determining the
range and the nature of the goals that people will consid-
er in the present, and how achievable they rate each
goal. Karniol and Ross called this the push of the past.
The role of aect or emotion is also seen as important in
this process with emotional factors inuencing our
choice of goalsand our success in meeting our goals
inuencing our emotional well-being. Hence the process
is a recursive one in which emotions and goals inuence
each other, and our past and our conception of the
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future can both impact upon our choice of goals.
For example, many people who develop a severe
disability still wish to return to those activities that they
cherished before the onset of their disability. But over
time, their valued activities may change, especially if it
becomes clearer to them that such activities are now
unrealistic. An example of this is a very good tennis
player who has a brainstem stroke that leads to hemisen-
sory loss, vertigo and diplopia. Despite determined
eorts, she remains vertiginous with sudden movements
For personal use only.
so that playing tennis is clearly impossible. Following a
period of dysphoria and adjustment, she renews an
interest in gardeningan activity that she feels she is
able to accomplish and one that has been enjoyable in
the past. Thus, the process of goal-setting often looks
backwards to determine what holds meaning for the
individual, but is also informed by subsequent experi-
ence.
Another common clinical situation that illustrates
how Karniol and Ross ideas might usefully connect
with rehabilitation practice is that of the depressed
patient who the rehabilitation team is trying to engage
in goal-setting. According to Karniol and Ross, an indi-
viduals memory of their past plays a major role in their
ability to generate or even consider new goals. It will
also directly eect how achievable they rate these goals.
There is an abundance of evidence now that depressed
mood actually alters how individuals process informa-
tion.22, 23 For example, depressed people may have better
memories for recalling negative information than non-
depressed people. Consequently, depressed clients may
have some diculty in actually recalling positive
memories to use in the process of developing new goals
for the future. They may have similar problems in gener-
ating a mental construct of a future positive self, and
they may tend to rate even relatively easy goals as quite
dicult. The practical implication of this for rehabilita-
tion professionals in such circumstances is to treat the
depression assertively before attempting to engage the
client in the more cognitively demanding aspects of
goal-setting, such as setting longer-term or more
abstract life goals. Rather, the initial focus of goal-
setting should be on increasing the frequency of pleasant
daily activities aimed at improving the clients mood.
Conclusion
Goal-setting is an essential component of any modern
approach to rehabilitation. It provides a framework by
which rehabilitation professionals and their clients can
work together to enhance the clients physical indepen-
dence and psychological well-being. However, much of
the literature on goals and goal-setting in rehabilitation,
has tended to neglect theory and theory development, in
favour of a pragmatic and empirical, and largely
atheoretical approach. We have argued that a scientic
approach to rehabilitation must incorporate both a rich
theoretical foundation and a rigorous, empirical sense of
inquiry. The challenge of course, for rehabilitation
researchers, is how to best integrate these two dimen-
sions of their work. In the present paper we have drawn
from the social psychology literature on goals and moti-
vation, to illustrate that there already exists a rich and
sophisticated body of theory with a sound empirical
base, that relates closely to goal-setting in the eld of
rehabilitation. There are also real benets for social
psychology in a closer dialogue between the two disci-
plines. Much of the literature in social psychology is
based upon research with North American college
students. This severely limits the generalizability and
external validity of these theories. Emmons himself
commented that Rarely have studies on goal content
. . . included non-college-based samples (p. 318).18 What
better real-life laboratory for testing scientic theories
on goals and motivation than the rehabilitation setting?
Developing a comprehensive research agenda that
bridges the two elds is somewhat beyond the scope of
the present discussion. Consequently, we will conclude
this article by suggesting just a single example of a rele-
vant research issue on goal-setting in rehabilitation, that
arises directly from each one of the three theoretical
approaches to goals and motivation that we have
previously described. The work of Deci and Ryan makes
some assumptions about the relative merits of intrinsic
vs. extrinsic motivation. An obvious issue for research-
ers here would be to determine whether goals in rehabi-
litation settings can, in fact, be reliably categorized in
these terms. Then, assuming that they can, it would be
fruitful to see whether intrinsic goals are actually asso-
7
 R. J. Siegert and W. J. Taylor
ciated with better outcomes than extrinsic ones? The
work of Emmons emphasizes personal strivings, goals
and subjective well-being. One important issue that
follows directly from this theory concerns the relation-
ship between personal strivings, the abstractness of goals
and personal well-being. In other words, how do we best
establish a clients meaningful, higher order goals and
then help them to achieve these through more specic
and concrete lower level goals and tasks? Most impor-
tantly, if we can achieve this t, does it actually lead
to improved psychological well-being for clients? Final-
ly, Karniol and Ross highlight temporal inuences on
goal-setting. An interesting research application of their
ideas would be to study situations where clients who had
been making steady progress became stuck or reached
Disabil Rehabil Downloaded from informahealthcare.com by Linkopings University on 07/20/13
an impasse. In these circumstances, we might wish to
examine whether reviewing the clients previous life
experiences with them, could help them to develop
new coping skills or have relevance to their attempts
to build a new sense of self-identity. Clearly there are
many other worthwhile areas of inquiry that could be
pursued to enhance the day-to-day practice of goal-
setting in rehabilitation.
References
For personal use only.
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