Disconfirmed expectations of therapy and young people’s clinical outcome, help-seeking intentions, and mental health service use

Abstract

Objective: Disconfirmed client expectations of therapy have been linked with poorer clinical outcomes and higher premature termination of therapy for adult clients, however, research with young people has been lacking. The present study aimed to address this gap by examining the effects of disconfirmed expectations in relation to roles, outcomes, and processes of therapy on young people’s clinical outcome, mental health service use, and future help-seeking intentions. Age and gender differences were also examined. Method: Participants included 102 young people aged 12–25 years who completed an initial questionnaire on contact with a youth mental health care service, which was targetted at mild to moderate early presentations of mental health problems, and a follow-up questionnaire 2 months later. Results: Findings showed that young people who experienced negatively disconfirmed expectations related to their role as a client or the processes of therapy had a poorer clinical outcome and attended fewer sessions. Furthermore, young people who had a negative experience of their role as a client or the therapist’s role attended fewer sessions and those who had a negative experience of their outcome expectations had a poorer clinical outcome. No age or gender differences were found. Conclusions: The potentially detrimental effect of having a worse therapy experience than expected on outcomes and engagement for young people indicate a need for clinicians to help young consumers to have realistic expectations as well as a positive experience of therapy.