Patient and therapist change process expectations: Independent and dyadic associations with psychotherapy outcomes

Abstract

Objective: Patients and therapists possess psychotherapy-related expectations, such as their forecast of what processes will promote improvement. Yet, there remains limited research on such change process expectations, including their independent and dyadic associations with psychotherapy outcome. In this study, we explored the predictive influence of participants’ change process expectations, and their level of congruence, on therapeutic outcomes. Methods: Patients (N = 75) and therapists (N = 17) rated their change process expectations at baseline, and patients rated their psychological distress at baseline and three months into treatment. Results: Multilevel models indicated that patients’ expectations for therapy to work through sharing sensitive contents openly and securely were positively related to subsequent improvement (B = −1.097; p = .007). On the other hand, patients’ expectations for therapy to work through the exploration of unexpressed contents were negatively related to improvement (B = 1.388; p = .049). When patients rated the sharing of sensitive contents openly and securely higher than their therapists, they reported better outcomes (B = −16.528; p = .035). Conclusion: These findings suggest that patients’ expectations produce diverse effects during early stages of treatment, and that patients’ belief in their ability to share sensitive contents may constitute a potential target to improve therapy effectiveness.