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Relationship between Expectation Management and Client Retention in Online Cognitive Behavioural Therapy

Published online by Cambridge University Press:  24 June 2014

Stuart Ekberg ,
Rebecca K. Barnes ,
David S. Kessler ,
Selman Mirza ,
Alan A. Montgomery ,
Alice Malpass  and
Alison R. G. Shaw
Stuart Ekberg*
Affiliation:
Queensland University of Technology, Australia
Rebecca K. Barnes
Affiliation:
University of Bristol, UK
David S. Kessler
Affiliation:
University of Bristol, UK
Selman Mirza
Affiliation:
University of Oxford, UK
Alan A. Montgomery
Affiliation:
University of Nottingham, UK
Alice Malpass
Affiliation:
University of Bristol, UK
Alison R. G. Shaw
Affiliation:
University of Bristol, UK
*
Reprint requests to Stuart Ekberg, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia. E-mail: stuart.ekberg@qut.edu.au
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Abstract

Background: Engaging clients from the outset of psychotherapy is important for therapeutic success. However, there is little research evaluating therapists’ initial attempts to engage clients in the therapeutic process. This article reports retrospective analysis of data from a trial of online cognitive behavioural therapy (CBT) for depression. Qualitative and quantitative methods were used to evaluate how therapists manage clients’ expectations at the outset of therapy and its relationship with client retention in the therapeutic intervention. Aims: To develop a system to codify expectation management in initial sessions of online CBT and evaluate its relationship with retention. Method: Initial qualitative research using conversation analysis identified three communication practices used by therapists at the start of first sessions: no expectation management, some expectation management, and comprehensive expectation management. These findings were developed into a coding scheme that enabled substantial inter-rater agreement (weighted Kappa = 0.78; 95% CI: 0.52 to 0.94) and was applied to all trial data. Results: Adjusting for a range of client variables, primary analysis of data from 147 clients found comprehensive expectation management was associated with clients remaining in therapy for 1.4 sessions longer than those who received no expectation management (95% CI: -0.2 to 3.0). This finding was supported by a sensitivity analysis including an additional 21 clients (1.6 sessions, 95% CI: 0.2 to 3.1). Conclusions: Using a combination of qualitative and quantitative methods, this study suggests a relationship between expectation management and client retention in online CBT for depression, which has implications for professional practice. A larger prospective study would enable a more precise estimate of retention.

Keywords

Expectation managementinitial sessioncognitive behavioural therapy (CBT)conversation analysispsychotherapy processoutcome
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 43 , Issue 6 , November 2015 , pp. 732 - 743
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2014 

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References

Barber, J. P. (2009). Toward a working through of some core conflicts in psychotherapy research. Psychotherapy Research, 19, 1–12.CrossRefGoogle Scholar
Beck, J. S. (2011). Cognitive Behavior Therapy: basics and beyond. New York: Guilford Press.Google Scholar
Beck, A., Steer, R. and Brown, G. (1987). Manual for the Beck Depression Inventory. San Antonio: The Psychological Corporation.Google Scholar
Blackburn, I.-M., James, I. A., Milne, D. L., Baker, C., Standart, S., Garland, A., et al. (2001). The Revised Cognitive Therapy Scale (CTS-R): psychometric properties. Behavioural and Cognitive Psychotherapy, 29, 431–446.CrossRefGoogle Scholar
Blagys, M. D. and Hilsenrot, M. J. (2002). Distinctive activities of cognitive-behavioral therapy: a review of the comparative psychotherapy process literature. Clinical Psychology Review, 22, 671–706.CrossRefGoogle ScholarPubMed
Boyd, E. (1998). Bureaucratic authority in the “company of equals”: the interactional management of medical peer review. American Sociological Review, 63, 200–224.Google Scholar
Castonguay, L. G., Constantino, M. J., McAleavey, A. A. and Goldfried, M. R. (2010). The therapeutic alliance in cognitive-behavioral therapy. In Muran, J. C. and Barber, J. P. (Eds.), Therapeutic Alliance: an evidence-based guide to practice (pp. 150–171). New York: Guilford Press.Google Scholar
Castonguay, L. G. and Holtforth, M. G. (2005). Change in psychotherapy: a plea for no more “nonspecific” and false dichotomies. Clinical Psychology: Science and Practice, 12, 198–201.Google Scholar
Cohen, J. (1968). Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychological Bulletin, 70, 213–220.Google Scholar
Constantino, M. J., Glass, C. R., Arnkoff, D. B., Ametrano, R. M. and Smith, J. Z. (2011). Expectations. In Norcross, J. C. (Ed.), Psychotherapy Relationship that Work: evidence-based responsiveness (pp. 354–376). New York: Oxford University Press.CrossRefGoogle Scholar
Crits-Christoph, P., Crits-Christoph, K. and Gibbons, M. B. C. (2010). Training in alliance-fostering techniques. In Muran, J. C. and Barber, J. P. (Eds.), Therapeutic Alliance: an evidence-based guide to practice (pp. 304–319). New York: Guilford Press.Google Scholar
Del Re, A. C., Flückiger, C., Horvath, A. O., Symonds, D. and Wampold, B. E. (2012). Therapist effects in the therapeutic alliance-outcome relationship: a restricted-maximum likelihood meta-analysis. Clinical Psychology Review, 32, 642–649.Google Scholar
DeRubeis, R. J., Brotman, M. A. and Gibbons, C. J. (2005). A conceptual and methodological analysis of the nonspecifics argument. Clinical Psychology: Science and Practice, 12, 174–183.Google Scholar
Efron, B. and Tibshirani, R. J. (1993). An Introduction to the Bootstrap (6th ed.). New York: Chapman and Hall.Google Scholar
Ekberg, S., Barnes, R. K., Kessler, D. S., Malpass, A. and Shaw, A. R. G. (in press). Managing clients’ expectations at the outset of online Cognitive Behavioural Therapy (CBT) for depression. Health Expectations.Google Scholar
Elliott, R. (2010). Psychotherapy change process research: realizing the promise. Psychotherapy Research, 20, 123–135.Google Scholar
Fleiss, J. L. (1981). Statistical Methods for Rates and Proportions (2nd ed.). New York: Wiley.Google Scholar
Hansen, N. B., Lambert, M. J. and Forman, E. M. (2002). The psychotherapy dose-response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9, 329–343.Google Scholar
Hardy, G. E., Cahill, J. and Barkham, M. (2007). Active ingredients of the therapeutic relationship that promote client change: a research perspective. In Gilbert, P. and Leahy, R. L. (Eds.), The Therapeutic Relationship in the Cognitive Behavioral Psychotherapies (pp. 24–42). Hove: Routledge.Google Scholar
Harnett, P., O’Donovan, A. and Lambert, M. J. (2010). The dose response relationship in psychotherapy: implications for social policy. Clinical Psychologist, 14, 39–44.Google Scholar
Heritage, J., Robinson, J. D., Elliott, M. N., Beckett, M. and Wilkes, M. (2007). Reducing patients’ unmet concerns in primary care: the difference one word can make. Journal of General Internal Medicine, 22, 1429–1433.Google Scholar
Horvath, A. O., Del Re, A. C., Flückiger, C. and Symonds, D. (2011). Alliance in individual psychotherapy. In Norcross, J. C. (Ed.), Psychotherapy Relationships that Work: evidence-based responsiveness (2nd ed.), (pp.25–69). New York: Oxford University Press.CrossRefGoogle Scholar
Horvath, A. O. and Symonds, B. D. (1991). Relation between working alliance and outcome in psychotherapy: a meta-analysis. Journal of Counseling Psychology, 38, 139–149.CrossRefGoogle Scholar
Howard, K. I., Kopta, S. M., Krause, M. S. and Orlinsky, D. E. (1986). The dose-effect relationship in psychotherapy. American Psychologist, 41, 159–164.Google Scholar
Kazdin, A. E. (2009). Understanding how and why psychotherapy leads to change. Psychotherapy Research, 19(4–5), 418–428.Google Scholar
Kessler, D., Lewis, G., Kaur, S., Wiles, N., King, M., Weich, S., et al. (2009). Therapist-delivered internet psychotherapy for depression in primary care: a randomised controlled trial. Lancet, 374 (9690), 626–634.CrossRefGoogle ScholarPubMed
Kozart, M. F. (2002). Understanding efficacy in psychotherapy: an ethnomethodological perspective on the therapeutic alliance. American Journal of Orthopsychiatry, 72, 217–231.Google Scholar
Landis, J. R. and Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.Google Scholar
Lewis, G., Pelosi, A. J., Araya, R. and Dunn, G. (1992). Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychological Medicine, 22, 465–486.Google Scholar
Mangione-Smith, R., Stivers, T., Elliott, M., McDonald, L. and Heritage, J. (2003). Online commentary during the physical examination: a communication tool for avoiding inappropriate antibiotic prescribing? Social Science and Medicine, 56, 313–320.CrossRefGoogle ScholarPubMed
McCabe, R., Healey, P. G. T., Priebe, S., Lavelle, M., Dodwell, D., Laugharne, R., et al. (2013). Shared understanding in psychiatrist-patient communication: association with treatment adherence in schizophrenia. Patient Education and Counseling, 93, 73–79.Google Scholar
Peräkylä, A. (2013). Conversation analysis in psychotherapy. In Sidnell, J. and Stivers, T. (Eds.), The Handbook of Conversation Analysis (pp. 551–574). Chichester: Blackwell.Google Scholar
Peräkylä, A., Antaki, C., Vehiläinen, S. and Leudar, I. (2008). Analysing psychotherapy in practice. In Peräkylä, A., Antaki, C., Vehiläinen, S. and Leudar, I. (Eds.), Conversation Analysis and Psychotherapy (pp. 5–25). Cambridge: Cambridge University Press.Google Scholar
Persons, J. B. (2001). Structure of the therapy session. In Persons, J. B., Davidson, J. and Tompkins, M. A. (Eds.), Essential Components of Cognitive-Behavior Therapy for Depression (pp.57–87). Washington DC: American Psychological Association.Google Scholar
Robinson, J. D. and Heritage, J. (2006). Physicians’ opening questions and patients’ satisfaction. Patient Education and Counseling, 60, 279–285.Google Scholar
Rosenthal, D. and Frank, J. D. (1956). Psychotherapy and the placebo effect. Psychological Bulletin, 53, 294–302.CrossRefGoogle ScholarPubMed
Rosenzweig, S. (1936). Some implicit common factors in diverse methods of psychotherapy. American Journal of Orthopsychiatry, 6, 412–415.CrossRefGoogle Scholar
Schegloff, E. A. (1993). Reflections on quantification in the study of conversation. Research on Language and Social Interaction, 26, 99–128.CrossRefGoogle Scholar
Sharpless, B. A., Muran, J. C. and Barber, J. P. (2010). Coda: recommendations for practice and training. In Muran, J. C. and Barber, J. P. (Eds.), Therapeutic Alliance: an evidence-based guide to practice (pp. 341–354). New York: Guilford Press.Google Scholar
Shaw, B. F., Elkin, I., Yamaguchi, J., Olmsted, M., Vallis, T. M., Dobson, K. S., et al. (1999). Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression. Journal of Consulting and Clinical Psychology, 67, 837–846.Google Scholar
Sidnell, J. and Stivers, T. (2013). The Handbook of Conversation Analysis. Chichester: Blackwell.Google Scholar
Stiles, W. B., Shapiro, D. A. and Elliott, R. (1986). Are all psychotherapies equivalent? American Psychologist, 41, 165–180.CrossRefGoogle ScholarPubMed
Stivers, T. and Majid, A. (2007). Questioning children: interactional evidence of implicit bias in medical interviews. Social Psychology Quarterly, 70, 424–441.Google Scholar
Strunk, D. R., Brotman, M. A. and DeRubeis, R. J. (2010). The process of change in cognitive therapy for depression: predictors of early inter-session symptom gains. Behaviour Research and Therapy, 48, 599–606.Google Scholar
Stivers, T., Enfield, N. J., Brown, P., Englert, C., Hayashi, M., Heinemann, T., et al. (2009). Universals and cultural variation in turn-taking in conversation. Proceedings of the National Academy of Sciences, 106, 10587–10592.CrossRefGoogle ScholarPubMed
Strunk, D. R., Brotman, M. A., DeRubeis, R. J. and Hollon, S. D. (2010). Therapist competence in cognitive therapy for depression: predicting subsequent symptom change. Journal of Consulting and Clinical Psychology, 78, 429–437.Google Scholar
Wampold, B. (2005). Establishing specificity in psychotherapy scientifically: design and evidence issues. Clinical Psychology: Science and Practice, 12, 194–197.Google Scholar
Webb, C. A., DeRubeis, R. J. and Barber, J. P. (2010). Therapist adherence/competence and treatment outcome: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 200–211.Google Scholar
World Health Organization (2007). International Statistical Classification of Diseases and Related Health Problems: 10th revision. Geneva: World Health Organization.Google Scholar
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