Participant factors as correlates of patients’ psychotherapy outcome expectation: A meta-analytic and box-count review

Abstract

ABSTRACT Objective More positive pre- or early therapy patient outcome expectation (OE) has consistently correlated with better treatment outcomes. Thus, it is important to identify factors that contribute to patients’ OE, which can inform therapist responsivity to such risk or facilitative markers. With growing research on OE correlates—centered primarily on patient characteristics/treatment factors and, to a lesser extent, therapist factors—a comprehensive synthesis is warranted to elucidate replicated and mixed associations and stimulate further research. Accordingly, we set a pragmatic cutoff of k ≥ 5 for meaningful empirical aggregation of participant factor-OE associations; otherwise, we conducted box counts. Method We searched for articles published through March 2022 that included a clinical sample, a measure of patient’s pre- or early treatment OE, and an explicit test of the factor-OE association. Results Patient problem severity, problem chronicity, education, age, and quality of life were meta-analyzed. Greater severity correlated with lower/less optimistic OE (r = −0.13, p < .001) and higher QOL correlated with higher/more optimistic OE (r = 0.18, p < .001). Box counts revealed that few variables had consistent associations with OE. Conclusions Some factors can help forecast patient OE, though additional research is needed to enhance confidence and clinical meaning.