Academic journal article Journal of College Counseling

Exploring Pretreatment Expectancies in a Campus Mental Health Setting: The Validation of a Novel Expectancies Measure

Academic journal article Journal of College Counseling

Exploring Pretreatment Expectancies in a Campus Mental Health Setting: The Validation of a Novel Expectancies Measure

Article excerpt

Client expectancies have been consistently associated with treatment efficacy, suggesting the importance of further research on expectancies to improve client outcomes (e.g., Joyce & Piper, 1998; Wierzbicki & Pekarik, 1993). In fact, Lambert (1992) estimated that 15% of the variability in psychotherapeutic improvement can be accounted for by clients' expectations in treatment. A recent meta-analysis of the expectancies literature (Constantino, Arnkoff, Glass, Ametrano, & Smith, 2011) using 46 independent samples and more than 8,000 clients further supported these significant relations between pre- or early-therapy expectancies and treatment outcome. However, these relations are understudied in campus mental health settings.

Client expectations may include (a) role and (b) outcome/effectiveness expectations (Dew & Bickman, 2005), as well as (c) process (Cyr & Bouchard, 1990) and (d) control (Delsignore & Schnyder, 2007) expectancies. Role expectations can be thought of as the client's expectations for the clinician's role or interpersonal style during treatment. A study by Tracey and Dundon (1988) noted the ambiguity in the definition of role expectancies within the literature and the lack of a psychometrically sound measure of such expectancies. Study results supported a unified measure of several constructs, including client anticipations, preferences, and expectations (r values among constructs from .56 to .95; Tracey & Dundon, 1988). This measure, the Psychotherapy Expectancies Inventory-Revised (PEI-R), was also used in our study. As opposed to role expectancies, outcome expectations reflect expected improvement from therapy, whereas process expectations pertain to the content of sessions, and control expectations refer to the client's perceived locus of control during therapy. Recent studies have also reported significant relations between expectancies and treatment outcome.

In particular, there have been many studies documenting relations between role expectations and treatment outcome (e.g., Nock & Kazdin, 2001; Reis & Brown, 2006). Several studies have also supported relations between outcome expectations with adaptive treatment processes (e.g., alliance quality) and treatment outcome (Constantino, Arnow, Blasey, & Agras, 2005; Meyer et al., 2002). Regardless of whether expectations are high or low, unmet expectancies may lead to problematic psychotherapy outcomes (Tracey & Dundon, 1988). Only recently has there been increased attention to these relations within campus mental health settings. This research is thought to be important given differences in the purpose (Todd, Kurdas, & Gloster, 1994), treatment process (Neufeldt & Nelson, 1998), client and therapist variables (primarily demographic variables for each; Callahan & Hynan, 2005), and treatment outcome (Callahan, Aubuchon-Endsley, Borja, & Swift, 2009; Swift, Callahan, & Levine, 2009) in campus service settings, as compared to other outpatient clinics.

Client Expectancies in Campus Clinics

In a previous investigation, role expectations at intake predicted premature termination (Aubuchon-Endsley & Callahan, 2009). All clients presenting for intake completed the PEI-R (Berzins, 1971; Rickers-Ovsiankina, Geller, Berzins, & Rogers, 1971), and normative reference ranges for total and factor scores were computed for use in campus settings. The positive likelihood ratio (7.20) revealed that those who obtain a total PEI-R score outside of the established reference range (i.e., those with PEI-R total scores < 85.36 or > 126.30) are 7 times more likely to prematurely terminate than those obtaining scores within the range. In another study (Callahan et al., 2009), the effect of clients' pretreatment role expectations on premature termination was moderated by pretreatment effectiveness expectancies.

Swift and Callahan (2008) found that client expectations can be modified to reduce premature termination. …

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