Goals that Build a Life Worth Living
By Adelya Urmanche, PhD
Clinical Director, Silver Hill New York
In intensive outpatient treatment, I meet people at a wide range of starting points.
Some arrive in crisis. They’re emotionally flooded, exhausted, and unsure how they got to this moment. Others are functioning “on paper,” but internally feel stuck, numb, or constantly on edge. Many have tried therapy before and carry a familiar fear:
“What if I do all this work and my life still doesn’t change?”
That question is one reason I care so much about goals. Goals act as a bridge between what’s happening inside (moods, urges, shame, self-criticism, loneliness) and what’s happening outside (relationships, work, school, parenting, health, purpose).
Goals are how treatment becomes life.
At Silver Hill New York, our work is built on helping clients clarify where they are, define where they want to go, and take meaningful steps in that direction. Lasting change requires insight and skills, both applied to real life.
The Compass: DBT’s “Life Worth Living”
One of the foundational elements of Dialectical Behavior Therapy (DBT) is building “a life worth living.” This phrase is deceptively simple.
People sometimes assume it means a life without pain. That’s not realistic—and it’s not the goal. Instead, DBT is about building a life with enough meaning, connection, self-respect, and stability that suffering doesn’t get the final word.
DBT helps us develop concrete skills: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. So that when intense emotions show up, we have options besides shutting down, exploding, escaping, or harming ourselves. But the skills are not the destination. They’re the vehicle.
Recovery isn’t just about feeling better—it’s about building a life you want to return to.
Adelya Urmanche, PhD
Clinical Director, Silver Hill New York
The Roadmap: Good Psychiatric Management
Good Psychiatric Management (GPM), developed in the tradition of Dr. John Gunderson’s work, brings a complementary emphasis. GPM focuses on practical problem-solving, education, and realistic goal-setting, especially when emotional sensitivity and relationship stress make it hard to keep steady footing.
In plain terms, GPM asks:
What patterns are showing up—especially in relationships?
What keeps knocking you off balance? Triggers? Expectations? Self-esteem shifts?
What would be a realistic next step that improves functioning and stability?
How do we support accountability without shame?
GPM is deeply compassionate, and also refreshingly straightforward. It focuses on helping people build lives that work day to day, not just in the therapist’s office.
Goals that Actually Help
Many people come into treatment with goals such as “I want to be less anxious,” “I want to stop overthinking,” or “I want to stop getting triggered.”
These are understandable, but they’re hard to work with, because they’re not directly measurable. They can also be opportunities for self-judgment when progress isn’t linear.
Effective goals are:
Values-based
A goal should connect to what matters—not what you think should matter.
“I want to return to work in a sustainable way.”
“I want to feel proud of how I handle conflict.”
“I want to be present with my kids after a long day.”
Behavioral
Not “I’ll be a different person,” but “I’ll do a specific action.”
“I will practice one DBT skill when I feel the urge to withdraw.”
“I will attend group and complete a coaching plan for two trigger situations.”
“I will have one structured, time-limited conversation with my family using a communication strategy we practiced.”
Realistic
What kind of goal is possible right now? A question we often use is: “What’s the smallest version of this goal that still counts?”
Why We Emphasize Goals in IOP
Our IOP is designed for people who need more than a once-a-week conversation, but don’t require inpatient treatment. The program creates momentum: enough frequency to build real traction, enough real-world contact to practice skills where life actually happens. And goals are what keep that momentum pointed in the right direction.
If you’re considering intensive outpatient treatment, I’d encourage you to ask any program you’re evaluating a simple question:
“How will you help me build a life outside of treatment—not just reduce symptoms inside it?”
The goals you set will determine your path forward. And as therapists, it’s our job to help you define those goals, setting you on a path toward a life with real meaning.
And that’s a goal we can all agree on.