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Contents
- Abstract
- Study 1: Measuring Expectations
- Method
- Participants
- Measures
- Procedure
- Results
- Expected Recovery Rates
- Comparing Expectations to the Dose–Effect Literature
- Study 2: Altering Expectations
- Method
- Participants
- Measures
- Delay discounting instrument
- Measure of duration expectations
- Procedure
- Results
- Replicating the Expected Recovery Rates
- The Effect of Education
- Discussion
- Appendix A
Figures and Tables
Abstract
Many clients prematurely terminate therapy before they have recovered. One possible explanation for treatment dropout is unmet expectations. Although the effects of unmet role expectations have received much attention in the literature, little is known about unmet outcome expectations. Two studies were designed to look at duration and effectiveness outcome expectations held by individuals within a primary referral base for a training clinic setting—a setting with a slower rate of recovery than other outpatient settings. Study 1 (N = 110) used a delay discounting method to find rate-of-recovery expectations associated with differing treatment lengths. Results indicated expectations much higher than the demonstrated effectiveness of therapy associated with training clinics. Study 2 (N = 307) replicated Study 1 and examined the possibility of altering outcome expectations through education. Study 2 results indicated that outcome expectations may be altered through client education. Both studies' results are discussed in terms of reducing premature termination and overall treatment outcome.
Premature termination or treatment dropout is a major problem seen in the practice of psychotherapy (Garfield, 1994; Reis & Brown, 2006). A number of studies indicate that approximately 30% of clients attend only an intake session, with the average client attending somewhere between three and five sessions (Garfield, 1994; N. B. Hansen, Lambert, & Forman, 2002). Further, a large number of clients, generally reported as between 40% and 60%, terminate therapy before they have seen any reliable benefits (Callahan & Hynan, 2005; Clarkin & Levy, 2003; Garfield, 1994; Wierzbicki & Pekarik, 1993). Although many different variables may be related to premature termination, it has been suggested that unmet client expectations may play a large role (Garfield, 1994; Wierzbicki & Pekarik, 1993).
When looking at unmet expectations, it is important to distinguish between two types: role expectations and outcome expectations (Dew & Bickman, 2005