Goal setting and consensus is the process by which client and therapist collaboratively identify the problems to be addressed in therapy and the behavior change toward which the client will work. It is an integral part of the working aspect of the therapeutic relationship, also known as the therapeutic alliance. A collaborative, mutually respectful working relationship is related to both a stronger overall therapeutic relationship as well as to overall treatment outcome. The current research in this important aspect of goal-directed therapy is correlational; much work is needed to establish causality. This chapter presents goal setting and collaboration from a clinical perspective with an emphasis on its use in cognitive behavioral therapy.