Picture this: Sarah, a 52-year-old office manager with osteoarthritis, sits across from you nodding enthusiastically. You’ve just set the perfect SMART goal together—walk 30 minutes daily for 8 weeks to improve joint mobility.
It’s Specific, Measurable, Achievable, Relevant, and Time-bound. She even writes it down.
Three weeks later, she’s back in your clinic, feeling guilty. “I’ve only managed it twice,” she admits, her voice heavy with guilt. “I don’t know what’s wrong with me.”
Sound familiar?
Here’s what I’ve learned after 30 years in practice: nothing’s wrong with Sarah. What’s wrong is our approach to goal-setting.
The SMART Goals Trap
For decades, healthcare has embraced SMART goals as the gold standard. And yes, they’re logical. Structured. Evidence-based, even. But there’s a fundamental flaw that we’ve been overlooking.
SMART goals assume humans are rational beings who simply need the right framework to succeed. They focus entirely on the mechanics—what to do, when to do it, how much to do—while completely ignoring the psychology of change.
Think about it. When Sarah agreed to walk 30 minutes daily, did we ever ask her what she truly wished for? Did we help her visualise how incredible she’d feel playing with her grandchildren without wincing? Did we anticipate that she’d feel too exhausted after work, or worry about neighbours judging her slow pace?
Of course not. We ticked the SMART boxes and wondered why she “lacked motivation.”
What Elite Athletes Know About Goals
There’s a reason Olympic athletes don’t just set SMART goals. They use something far more powerful: mental rehearsal. They spend time daily visualising their desired outcome in vivid detail, feeling the emotions of success, anticipating obstacles, and mentally rehearsing their response.
As Eric Barker notes in “Barking Up the Wrong Tree,” this approach—called WOOP (Wish, Outcome, Obstacle, Plan)—”is applicable to most any of your goals, from career to relationships to exercise and weight loss.”
But here’s what’s revolutionary for us as clinicians: WOOP doesn’t just help athletes perform better. It helps ordinary people like Sarah follow through on the changes they desperately want to make.
WOOP: The Missing Psychology of Change
Let’s reimagine Sarah’s consultation using WOOP:
Wish: “What do you truly wish for, Sarah?” After some gentle probing, she reveals it’s not just about walking. She wishes she could feel confident and energetic enough to take her grandchildren to the park without dreading how stiff she’ll feel afterwards.
Outcome: “Close your eyes and imagine you’ve achieved this wish. How does it feel?” Sarah visualises herself laughing as she chases her grandson around the playground, feeling strong and capable. She pictures the pride in her daughter’s eyes watching her mum actively engaged instead of sitting on the sideline.
Obstacle: “What’s most likely to get in your way?” Sarah admits she gets home from work exhausted and tells herself she’ll walk after dinner, but then feels too full and tired. She also worries about looking foolish walking slowly while neighbours drive past.
Plan: “When you feel too tired after work, what will you do?” Together, you create a specific if/then plan: “If I feel too tired after work, then I’ll put on my walking shoes immediately when I arrive home and walk for just 10 minutes around the block before even going inside. If I’m worried about neighbours, then I’ll remind myself that I’m taking care of my health so I can be there for my grandchildren.”
This plan MUST be hers and not your suggestions.
The Power of Daily Visualisation
But here’s where WOOP goes beyond traditional goal-setting. You give Sarah one simple starting point: “Spend two minutes each morning visualising yourself playing confidently with your grandchildren. Feel how strong and capable you are. This isn’t wishful thinking—it’s mental training, just like athletes use.”
This daily visualisation serves two purposes. First, it keeps her emotionally connected to her deeper motivation. Second, it mentally rehearses success, making the desired behaviour feel more familiar and achievable.
Even is she doesn’t do the exercise she can visualise her outcome and this may help her commit to the exercise the next day.
Beyond Compliance to Connection
This is the transformation I want you to consider: shifting from being “goal-setters” to being “motivation-builders.”
SMART goals ask: “What specific, measurable action will you take?”
WOOP asks: “What do you deeply wish for, and how can we prepare you—both emotionally and practically—to achieve it?”
The difference is profound. SMART goals focus on the mechanics of change. WOOP addresses the psychology of change.
When you help patients connect with their genuine wishes and visualise their desired outcomes, you’re not just setting goals—you’re building intrinsic motivation. When you anticipate obstacles and create if/then plans, you’re not just being thorough—you’re acknowledging that change is messy and human nature is predictable.
The Clinical Reality
Your patients aren’t failing because your goals aren’t SMART enough. They’re failing because they’re not emotionally connected to why they’re doing this, and they’re not prepared for the inevitable obstacles that derail even the best intentions.
SMART goals give them a target. WOOP gives them the emotional fuel and practical strategies to hit it.
What This Means for Your Practice
This week, try this with one patient: Instead of jumping straight into goal-setting, work through these five steps:
- Wish: What do you wish for your future? (Help them articulate their deeper desire)
- Outcome: What will happen when you achieve this wish? How will your life be different?
- Obstacles: What obstacles might get in your way? (Be honest about real barriers)
- Plan: What’s your plan to work around these obstacles? (Create specific strategies that account for the obstacles they’ve identified)
- Start simple: Begin by spending 2 minutes each morning visualising your future wish—just like an athlete preparing for competition.
This gives your patients both the emotional connection to their deeper desires and the practical tools to overcome what’s really going to stop them.
A Different Kind of Success
When you next see Sarah, you won’t be asking, “Did you walk 30 minutes daily?” You’ll be asking, “How did the visualisation feel this week? When obstacles showed up, how did your if/then plan work?”
The conversation shifts from compliance-checking to collaboration. From judgment to curiosity. From disappointment to problem-solving.
Because here’s what I’ve learned: patients don’t need better goals. They need better preparation for the journey toward those goals.
SMART goals assume rationality. WOOP embraces humanity.
And that’s precisely why it works.
Ready to move beyond goal-setting to motivation-building? If this approach resonates with you and you’re curious about more communication tools that actually work in real consultations, let’s explore how these insights can transform your practice.
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