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

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.

Patient-therapist congruence and incongruence of process expectations during psychotherapy.

Recent studies suggest that patient-therapist congruence of expectations affects psychotherapy outcome. Nonetheless, most studies assessing expectations in their dyadic context have focused on outcome expectations. This study was aimed to assess whether patients and therapists view expected processes similarly, and whether these beliefs change over time to become more congruent or more dissimilar. Patients (N = 75) were assessed for process expectations at baseline and at 3 months into treatment, and their therapists (N = 17) reported on their general expectations only once, prior to the initiation of treatment. Multilevel models were fitted to assess differences between patients' and therapists' process expectations at baseline and after 3 months and changes in level of congruence. The results indicated that at baseline, therapists perceived the processing of therapist-patient relations as the expected therapeutic process, whereas patients viewed the provision of tools of cognitive control as such. No significant changes in patients' expectations after 3 months of treatment were detected; however, therapists' higher expectations of the provision of tools for cognitive control predicted increases in patients' rankings of this process. These results suggest that patients and therapists are incongruent in their views of the expected therapeutic process, and that therapists' initial views of the therapeutic process affect patients' beliefs. These findings highlight the importance of investigating process expectations in the dyadic context and set the stage for subsequent process-outcome demonstrations, focusing on the effect of patient-therapist congruence of process expectations as a potential predictor or mediator of psychotherapy outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).