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Constantino M.J., Arnkoff D.B., Glass C.R. et al.
Journal of Clinical Psychology: 2011, 67(2), p. 184–192.
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Meta-analytic review commissioned by a US task force concludes that patients who enter psychotherapy with positive expectations about outcomes tend to actually have better outcomes, suggesting that therapists should regularly assess expectations and take steps to enhance them if appropriate.
Summary Patients' expectations have long been considered a contributory factor to successful psychotherapy. Expectations come in different guises. In this article, we focus on outcome expectations – expectations about the consequences of participating in treatment including benefits and possible negatives, as distinct (though these interact) from expectations about what treatment will consist of. Our research review includes a comprehensive meta-analysis A study which uses recognised procedures to summarise quantitative results from several studies of the same or similar interventions to arrive at composite outcome scores. Usually undertaken to allow the intervention's effectiveness to be assessed with greater confidence than on the basis of the studies taken individually. of the association between pre-therapy or early therapy outcome expectations and post-treatment outcomes, involving 8016 patients across 46 independent samples. The overall weighted effect size A standard way of expressing the magnitude of a difference (eg, between outcomes in control and experimental groups) applicable to most quantitative data. Enables different measures taken in different studies to be compared or (in meta-analyses) combined. Based on expressing the difference in the average outcomes between control and experimental groups as a proportion of the variability in the outcome across both groups. The most common statistic used to quantify this difference is called Cohen's d. Conventionally this is considered to indicate a small effect when no greater than 0.2, a medium effect when around 0.5, and a large effect when at least 0.8. was 0.24, indicating a small but significant link between early positive expectations of outcomes and actual treatment outcomes. However, this finding is vulnerable to the potential impact of a few negative studies which may have been missed by the analysis or may emerge in future.
There is some evidence that expectations affect outcomes via an improved collaborative working relationship with the therapist, and perhaps too by promoting greater patient adherence to treatment. What determines whether patients have positive expectations remains unclear, but it may be related to the severity of their symptoms or their general level of hope versus hopelessness.
Finally, we discuss limitations of the research base and offer practice suggestions based on our findings. Among these are the suggestion that therapists explicitly assess patients' prognostic expectations at the beginning of treatment. Depending on what is revealed (verbally or through a brief measure), therapists can verify and validate their patients' beliefs, and consider behaving in ways which match the patient's level of optimism. These methods may include carefully nuanced comments intended to enhance optimism, such as reminding the patient of how far they have already come or of research indicating positive outcomes, or cautions to check unrealistically high expectations without damaging self-esteem. Throughout therapy, therapists should consider regularly checking patients' outcome expectations and responding accordingly.
commentary This article was in a special issue of the Journal of Clinical Psychology devoted to adapting psychotherapy to the individual patient. For other Findings entries from this issue see:
What works for whom: tailoring psychotherapy to the person
Adapting psychotherapy to the individual patient: Stages of change
Adapting psychotherapy to the individual patient: Preferences
Adapting psychotherapy to the individual patient: Culture
Adapting psychotherapy to the individual patient: Coping style
Adapting psychotherapy to the individual patient: Attachment style
Adapting psychotherapy to the individual patient: Resistance/reactance level
Adapting psychotherapy to the individual patient: Religion and spirituality
Last revised 09 March 2011
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