The "A" in SOAP: Charting Goals for Client Progress

In my opinion, the "A" in SOAP charting is the most difficult section to address. As massage practitioners, we generally use this section for client goals, particularly when an insurance claim is involved. Goals are supposed to be SMART (specific, measurable, attainable, relevant, and time-bound); they should be based on ADLs (activities of daily living); and there should be two types of goals, short term goals (STGs) and long term goals (LTGs).

The problem I most run into is setting goals that are both SMART and based on ADLs. Why? Because many of my clients claim not to be restricted in activities of daily living: they are simply working on through the pain, and they claim there is nothing they really cannot do. In Hands Heal, Diana Thompson suggests asking the client about sleep patterns because even if they are not seeing restrictions in ADLs, people in pain are often suffering sleep problems/deficiencies. So, when a client does have a sleep problem, this can become the foundation of the goals if nothing else can be pinpointed. However, many clients have pain, but no trouble sleeping, so this option is out for them.

It is extremely tempting, then, to fall back on pain levels as the basis of the goals. For example, “The client will have no more than 4/10 pain after six massages.” I was taught, however, that this is a no-no because pain levels are subjective and hence not truly specific or measurable, and therefore not SMART (ACK!) It’s frustrating, though, because if there is one thing the client is sure of, it’s how much pain he is in at any one time.

I know that all of us want to handle SOAP goals professionally, particularly in cases where client care depends on the insurance company continuing to pay for services. What I would like readers to do is share successful methods of forming SMART goals for massage clients. I know that many of us would be eternally grateful for any tips and advice on this issue!