Are patient expectations still relevant for psychotherapy process and outcome

Greenberg, Roger P.; Constantino, Michael J.; Bruce, Noah

doi:10.1016/j.cpr.2005.03.002

Cited by 478Psychotherapy Techniques and ApplicationsPain Management and Placebo EffectPsychoanalysis and Psychopathology Research

Are patient expectations still relevant for psychotherapy process and outcome

Greenberg, Roger P., Constantino, Michael J., Bruce, Noah·2006·Clinical Psychology Review

DOI 10.1016/j.cpr.2005.03.002

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Abstract

Patient expectations have been regarded as a variable affecting the course of psychotherapy for more than 50 years. Yet, even though expectations are often considered a factor common to most psychotherapy systems, their importance may be undervalued. This paper places the expectancy issue in a historical context, discusses the varied definitions of expectancy, and reviews the extant expectancy research literature. Discussion of results affirms the continuing relevance of patient expectations, suggests that they may be even more vital to the psychotherapy process than is often acknowledged, highlights research strengths and weaknesses, and calls attention to areas on which clinicians and researchers might focus to improve treatment effectiveness.

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Differential prescription for psychotherapy on the basis of client role preferences.
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Clients' perceptions of therapists with high attrition rates.
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The Dyadic Transaction: An Investigation Into the Nature of the Psychotherapeutic Process
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How important are the common factors in psychotherapy? An update
Wampold, B. E. (2015) · World Psychiatry · doi:10.1002/wps.20238 · Cited by 1,728 · see citing works
Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials
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Patients’ Accounts of Increased “Connectedness” and “Acceptance” After Psilocybin for Treatment-Resistant Depression
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mHealth: A Mechanism to Deliver More Accessible, More Effective Mental Health Care
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Psychotherapy: The humanistic (and effective) treatment.
Wampold, B. E. (2007) · American Psychologist · doi:10.1037/0003-066x.62.8.857 · Cited by 385 · see citing works
Expectations
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Self-citation
A meta-analysis of the association between patients’ early treatment outcome expectation and their posttreatment outcomes.
Constantino, M. J., Vîslă, A., Coyne, A. E., & Boswell, J. F. (2018) · Psychotherapy · doi:10.1037/pst0000169 · Cited by 260 · see citing works
Self-citation
A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression
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Therapist effectiveness: Implications for accountability and patient care
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The acute effects of exercise on cigarette cravings, withdrawal symptoms, affect, and smoking behaviour: systematic review update and meta-analysis
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A randomized controlled pilot study of a brief web-based mindfulness training
Glück, T. M., & Maercker, A. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-175 · Cited by 168 · see citing works
Emotion malleability beliefs, emotion regulation, and psychopathology: Integrating affective and clinical science
Kneeland, E. T., Dovidio, J. F., Joormann, J., & Clark, M. S. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.03.008 · Cited by 167 · see citing works
The 2011 Leona Tyler Award Address: The Relationship—and Its Relationship to the Common and Specific Factors of Psychotherapy
Wampold, B. E., & Budge, S. L. (2012) · The Counseling Psychologist · doi:10.1177/0011000011432709 · Cited by 157 · see citing works
Clinician interventions and participant characteristics that foster adaptive patient expectations for psychotherapy and psychotherapeutic change.
Constantino, M., Ametrano, R., & Greenberg, R. (2012) · Psychotherapy · doi:10.1037/a0029440 · Cited by 145 · see citing works
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Focusing the therapist's attention on the patient's strengths: a preliminary study to foster a mechanism of change in outpatient psychotherapy.
Flückiger, C., & Holtforth, M. G. (2008) · Journal of Clinical Psychology · doi:10.1002/jclp.20493 · Cited by 113 · see citing works
Meeting the mental health needs of today’s college student: Reinventing services through Stepped Care 2.0.
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Working with patients’ strengths: A microprocess approach
Flückiger, C., Caspar, F., Holtforth, M. G., & Willutzki, U. (2009) · Psychotherapy Research · doi:10.1080/10503300902755300 · Cited by 132 · see citing works
Monitoring mindfulness practice quality: An important consideration in mindfulness practice
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Do biogenetic causal beliefs reduce mental illness stigma in people with mental illness and in mental health professionals? A systematic review
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Practice recommendations for reducing premature termination in therapy.
Swift, J. K., Greenberg, R. P., Whipple, J. L., & Kominiak, N. K. (2012) · Professional Psychology Research and Practice · doi:10.1037/a0028291 · Cited by 116 · see citing works
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Therapist Effects on and Predictors of Non‐Consensual Dropout in Psychotherapy
Zimmermann, D., Rubel, J. A., Page, A. C., & Lutz, W. (2016) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2022 · Cited by 114 · see citing works
The role of treatment expectancy in youth receiving exposure-based CBT for obsessive compulsive disorder
Lewin, A. B., Peris, T. S., Bergman, R. L., McCracken, J. T., & Piacentini, J. C. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.06.001 · Cited by 111 · see citing works
Self-esteem Interventions in Adults – A Systematic Review and Meta-analysis
Niveau, N., New, B., & Beaudoin, M. (2021) · Journal of Research in Personality · doi:10.1016/j.jrp.2021.104131 · Cited by 97 · see citing works
CHANGES IN SELF-EFFICACY AND OUTCOME EXPECTANCY AS PREDICTORS OF ANXIETY OUTCOMES FROM THE CALM STUDY
Brown, L. A., Wiley, J. F., Wolitzky-Taylor, K. B., Roy‐Byrne, P., Sherbourne, C. D., Stein, M. B., Sullivan, G., Rose, R. D., Bystritsky, A., & Craske, M. G. (2014) · Depression and Anxiety · doi:10.1002/da.22256 · Cited by 106 · see citing works
Findings from World Mental Health Surveys of the perceived helpfulness of treatment for patients with major depressive disorder
Harris, M. G., Kazdin, A. E., Chiu, W. T., Sampson, N. A., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Altwaijri, Y., Andrade, L. H., Cardoso, G., et al. (2020) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2020.1107 · Cited by 100 · see citing works
Suggestion, Cognition, and Behavior
Michael, R. B., Garry, M., & Kirsch, I. (2012) · Current Directions in Psychological Science · doi:10.1177/0963721412446369 · Cited by 99 · see citing works
Outcome expectancy as a predictor of treatment response in cognitive behavioral therapy for public speaking fears within social anxiety disorder
Price, M., & Anderson, P. L. (2012) · Psychotherapy · doi:10.1037/a0024734 · Cited by 99 · see citing works
Treatment Expectations and Preferences as Predictors of Outcome of Acupuncture for Chronic Back Pain
Sherman, K. J., Cherkin, D. C., Ichikawa, L., Avins, A. L., Delaney, K. M., Barlow, W. E., Khalsa, P. S., & Deyo, R. A. (2010) · Spine · doi:10.1097/brs.0b013e3181c2a8d3 · Cited by 100 · see citing works
360° Video virtual reality exposure therapy for public speaking anxiety: a randomized controlled trial
Reeves, R., Elliott, A., Curran, D., Dyer, K., & Hanna, D. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102451 · Cited by 82 · see citing works
Biological conceptualizations of mental disorders among affected individuals: A review of correlates and consequences.
Lebowitz, M. S. (2014) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12056 · Cited by 88 · see citing works
Greater expectations: using hierarchical linear modeling to examine expectancy for treatment outcome as a predictor of treatment response.
Price, M. S., Anderson, P., Henrich, C. C., & Rothbaum, B. O. (2008) · The Behavior Therapist · doi:10.1016/j.beth.2007.12.002 · Cited by 92 · see citing works
Testing a model of change in the experiential treatment of depression.
Pos, A. E., Greenberg, L. S., & Warwar, S. H. (2009) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0017059 · Cited by 89 · see citing works
Premature termination in psychotherapy: Strategies for engaging clients and improving outcomes.
Swift, J. K., & Greenberg, R. P. (2014) · American Psychological Association eBooks · doi:10.1037/14469-000 · Cited by 88 · see citing works
Self-citation
Effects of Interactions With Animals On Human Psychological Distress
Crossman, M. K. (2016) · Journal of Clinical Psychology · doi:10.1002/jclp.22410 · Cited by 89 · see citing works
Emphasizing Malleability in the biology of depression: Durable effects on perceived agency and prognostic pessimism
Lebowitz, M. S., & Ahn, W. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.06.005 · Cited by 86 · see citing works
Erwartungsfokussierte Psychotherapeutische Interventionen (EFPI)
Rief, W., & Glombiewski, J. A. (2016) · Verhaltenstherapie · doi:10.1159/000442374 · Cited by 85 · see citing works
Expectancy/Credibility Change as a Mediator of Cognitive Behavioral Therapy for Generalized Anxiety Disorder: Mechanism of Action or Proxy for Symptom Change?
Newman, M. G., & Fisher, A. J. (2010) · International Journal of Cognitive Therapy · doi:10.1521/ijct.2010.3.3.245 · Cited by 83 · see citing works
A machine learning ensemble to predict treatment outcomes following an Internet intervention for depression
Pearson, R., Pisner, D., Meyer, B., Shumake, J., & Beevers, C. G. (2019) · Psychological Medicine · doi:10.1017/s003329171800315x · Cited by 81 · see citing works
Psychological Interventions for the Fear of Public Speaking: A Meta-Analysis
Ebrahimi, O. V., Pallesen, S., Kenter, R., & Nordgreen, T. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00488 · Cited by 62 · see citing works
Decreasing treatment dropout by addressing expectations for treatment length
Swift, J. K., & Callahan, J. L. (2011) · Psychotherapy Research · doi:10.1080/10503307.2010.541294 · Cited by 84 · see citing works
Patient experiences with a transitional, low-threshold clinic for the treatment of substance use disorder: A qualitative study of a bridge clinic
Snow, R. L., Simon, R., Jack, H. E., Oller, D. A., Kehoe, L., & Wakeman, S. E. (2019) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2019.09.003 · Cited by 83 · see citing works
The importance of listening to patient preferences when making mental health care decisions
Swift, J. K., Mullins, R. H., Penix, E. A., Roth, K. L., & Trusty, W. T. (2021) · World Psychiatry · doi:10.1002/wps.20912 · Cited by 83 · see citing works
Efficacy of Cognitive Behavioral Therapy for Anxiety-Related Disorders: A Meta-Analysis of Recent Literature
Bhattacharya, S., Goicoechea, C., Heshmati, S., Carpenter, J. K., & Hofmann, S. G. (2023) · Current Psychiatry Reports · doi:10.1007/s11920-022-01402-8 · Cited by 82 · see citing works
The Role of Change in Athletes’ Careers: A Scheme of Change for Sport Psychology Practice
Samuel, R. D., & Tenenbaum, G. (2011) · The Sport Psychologist · doi:10.1123/tsp.25.2.233 · Cited by 79 · see citing works
How to Change Negative Outcome Expectations in Psychotherapy? The Role of the Therapist’s Warmth and Competence
Seewald, A., & Rief, W. (2022) · Clinical Psychological Science · doi:10.1177/21677026221094331 · Cited by 80 · see citing works
Starting off on the right foot: Common factor elements in early psychotherapy process.
DeFife, J. A., & Hilsenroth, M. J. (2011) · Journal of Psychotherapy Integration · doi:10.1037/a0023889 · Cited by 74 · see citing works
Believing is seeing: An evolving research program on patients' psychotherapy expectations
Constantino, M. J. (2012) · Psychotherapy Research · doi:10.1080/10503307.2012.663512 · Cited by 72 · see citing works
Self-citation
The three-legged stool of evidence-based practice in eating disorder treatment: research, clinical, and patient perspectives
Peterson, C. B., Becker, C. B., Treasure, J. L., Shafran, R., & Bryant‐Waugh, R. (2016) · BMC Medicine · doi:10.1186/s12916-016-0615-5 · Cited by 71 · see citing works
Clients' pretreatment counseling expectations as predictors of the working alliance.
Patterson, C. L., Uhlin, B. D., & Anderson, T. (2008) · Journal of Counseling Psychology · doi:10.1037/a0013289 · Cited by 70 · see citing works
The relationship between therapist and client hope with therapy outcomes
Coppock, T. E., Owen, J. J., Zagarskas, E., & Schmidt, M. (2010) · Psychotherapy Research · doi:10.1080/10503307.2010.497508 · Cited by 70 · see citing works
Psychological treatment of insomnia in hypnotic-dependant older adults
Soeffing, J. P., Lichstein, K. L., Nau, S. D., McCrae, C. S., Wilson, N. M., Aguillard, R. N., Lester, K. W., & Bush, A. J. (2007) · Sleep Medicine · doi:10.1016/j.sleep.2007.02.009 · Cited by 69 · see citing works
Control expectancies as predictors of psychotherapy outcome: a systematic review.
Delsignore, A., & Schnyder, U. (2007) · British Journal of Clinical Psychology · doi:10.1348/014466507x226953 · Cited by 73 · see citing works
Predictors of treatment outcome in modular cognitive therapy for obsessive-compulsive disorder
Steketee, G. S., Siev, J., Fama, J. M., Keshaviah, A. P., Chosak, A., & Wilhelm, S. (2011) · Depression and Anxiety · doi:10.1002/da.20785 · Cited by 68 · see citing works
The relation between outcome expectation, therapeutic alliance, and outcome among depressed patients in group cognitive-behavioral therapy
Vîslă, A., Constantino, M. J., Newkirk, K., Ogrodniczuk, J. S., & Söchting, I. (2016) · Psychotherapy Research · doi:10.1080/10503307.2016.1218089 · Cited by 68 · see citing works
Self-citation
Focusing on situation‐specific expectations in major depression as basis for behavioural experiments – Development of the Depressive Expectations Scale
Κube, T., D’Astolfo, L., Glombiewski, J. A., Doering, B. K., & Rief, W. (2016) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12114 · Cited by 65 · see citing works
Effectiveness of a Guided Web-Based Self-help Intervention to Prevent Depression in Patients With Persistent Back Pain: The PROD-BP Randomized Clinical Trial
Sander, L. B., Paganini, S., Terhorst, Y., Schlicker, S., Lin, J., Spanhel, K., Buntrock, C., Ebert, D. D., & Baumeister, H. (2020) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2020.1021 · Cited by 63 · see citing works
Parents’ perception of child and adolescent mental health problems and their choice of treatment option in southwest Ethiopia
Abera, M., Robbins, J. M., & Tesfaye, M. (2015) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-015-0072-5 · Cited by 63 · see citing works
Impact of a treatment rationale on expectancy and engagement in cognitive behavioral therapy for social anxiety
Ahmed, M., & Westra, H. A. (2009) · Cognitive Therapy and Research · doi:10.1007/s10608-008-9182-1 · Cited by 63 · see citing works
Engagement in psychotherapy: Factors contributing to the facilitation, demise, and restoration of the therapeutic alliance.
Constantino, M. J., Castonguay, L. G., Zack, S., & DeGeorge, J. (2010) · American Psychological Association eBooks · doi:10.1037/12139-001 · Cited by 62 · see citing works
Self-citation
Therapy was not what I expected: A preliminary qualitative analysis of concordance between client expectations and experience of cognitive–behavioural therapy
Westra, H. A., Aviram, A., Barnes, M. E., & Angus, L. E. (2010) · Psychotherapy Research · doi:10.1080/10503301003657395 · Cited by 61 · see citing works
Mindfulness-based group therapy for men with situational erectile dysfunction: A mixed-methods feasibility analysis and pilot study
Bossio, J. A., Basson, R., Driscoll, M., Correia, S., & Brotto, L. A. (2018) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2018.08.013 · Cited by 60 · see citing works
On the Maintenance of Expectations in Major Depression – Investigating a Neglected Phenomenon
Κube, T., Rief, W., & Glombiewski, J. A. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00009 · Cited by 62 · see citing works
Strategies to Predict, Measure, and Improve Psychosocial Treatment Adherence
Gearing, R. E., Townsend, L. D., Elkins, J., El‐Bassel, N., & Osterberg, L. G. (2013) · Harvard Review of Psychiatry · doi:10.1097/hrp.10.1097/hrp.0000000000000005 · Cited by 64 · see citing works
Effectiveness of a guided Internet- and Mobile-based intervention for patients with chronic back pain and depression (WARD-BP): a multicenter, pragmatic randomized controlled trial
Baumeister, H., Paganini, S., Sander, L. B., Lin, J., Schlicker, S., Terhorst, Y., Moshagen, M., Bengel, J., Lehr, D., & Ebert, D. D. (2021) · Psychotherapy and Psychosomatics · doi:10.1159/000511881 · Cited by 55 · see citing works
Patient Expectations and Therapeutic Alliance as Predictors of Outcome in Group Cognitive-Behavioral Therapy for Insomnia
Constantino, M. J., Manber, R., Ong, J. C., Kuo, T. F., Huang, J. S., & Arnow, B. A. (2007) · Behavioral Sleep Medicine · doi:10.1080/15402000701263932 · Cited by 58 · see citing works
Self-citation
Animal Visitation Programs in Colleges and Universities
Crossman, M. K., & Kazdin, A. E. (2015) · Elsevier eBooks · doi:10.1016/b978-0-12-801292-5.00024-9 · Cited by 58 · see citing works
The role of pretreatment outcome expectancies and cognitive–behavioral skills in symptom improvement in an acute psychiatric setting
Webb, C. A., Kertz, S. J., Bigda-Peyton, J. S., & Björgvinsson, T. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.02.016 · Cited by 55 · see citing works
Defining and Predicting Patterns of Early Response in a Web-Based Intervention for Depression
Lutz, W., Arndt, A., Rubel, J. A., Berger, T., Schröder, J., Späth, C., Meyer, B., Greiner, W., Gräfe, V., Hautzinger, M., et al. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7367 · Cited by 58 · see citing works
Predicting successful treatment outcome of web-based self-help for problem drinkers: secondary analysis from a randomized controlled trial
Riper, H., Kramer, J., Keuken, M., Smit, F., Schippers, G., & Cuijpers, P. (2008) · Journal of Medical Internet Research · doi:10.2196/jmir.1102 · Cited by 52 · see citing works
Psychological Treatment of Hypnotic-Dependent Insomnia in a Primarily Older Adult Sample
Lichstein, K. L., Nau, S. D., Wilson, N. M., Aguillard, R. N., Lester, K. W., Bush, A. J., & McCrae, C. S. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.09.006 · Cited by 54 · see citing works
Integrating situation-specific dysfunctional expectations and dispositional optimism into the cognitive model of depression – A path-analytic approach
Κube, T., Siebers, V. H. A., Herzog, P., Glombiewski, J. A., Doering, B. K., & Rief, W. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.12.082 · Cited by 56 · see citing works
Development and psychometric evaluation of the Milwaukee Psychotherapy Expectations Questionnaire
Norberg, M. M., Wetterneck, C. T., Sass, D. A., & Kanter, J. W. (2011) · Journal of Clinical Psychology · doi:10.1002/jclp.20781 · Cited by 53 · see citing works
The impact of alliance ruptures on client outcome expectations in cognitive behavioral therapy
Westra, H. A., Constantino, M. J., & Aviram, A. (2011) · Psychotherapy Research · doi:10.1080/10503307.2011.581708 · Cited by 52 · see citing works
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Authors: Greenberg, R. P., Constantino, M. J., & Bruce, N.
Affiliations: SUNY Upstate Medical University (US)
Stanford Medicine (US)
Stanford University (US)
Corresponding author: Greenberg, Roger P.
ORCID: Constantino, Michael J.
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2006-10
Volume: 26
Issue: 6
Pages: 657-678
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2005.03.002
OpenAlex: W2076227492
Cited by: 477
References: 149
Citations by year: 2026: 15 · 2025: 14 · 2024: 17 · 2023: 43 · 2022: 30 · 2021: 32 · 2020: 18 · 2019: 34 · 2018: 36 · 2017: 23 · 2016: 37 · 2015: 26 · 2014: 27 · 2013: 26 · 2012: 23
FWCI: 1.04
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Psychology Review (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute for Health and Care Research
National Institutes of Health
National Institute of Mental Health (5 T32 MH19938-10, T32MH019938)
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords: patient expectations, therapeutic process, psychotherapy outcome, expectancy, treatment effectiveness, history of psychotherapy research
MeSH terms: Adolescent, Attitude to Health, Mental Disorders, Child, Humans, Patients, Psychotherapy, Treatment Outcome

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Are patient expectations still relevant for psychotherapy process and outcome

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