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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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