Patients’ General Versus Personal Expectations About Psychotherapy Change Processes

AI Summary

Participants reported consistently higher general change process expectations than expectations for their own therapy across all measured processes.
Largest expectation gap was for anticipating cognitive control tools; smallest gap for opportunities to explore unexpressed content.
Greater gaps were seen in those with extensive prior therapy and higher distress, indicating need for strong, personalised efforts to instil confidence.

TL;DR (AI Generated)

OBJECTIVE: People have different beliefs about what leads to therapeutic success; however, not much is known about differences between individuals' general change process expectations (CPEs) and the way those expectations operate during their own therapy experience (i.e., personal CPEs).

METHODS: Individuals currently engaged in psychotherapy (N=270) completed the Expectations of Active Processes in Psychotherapy Scale twice, first with reference to their general CPEs and then with reference to their own therapy.

Prior therapy experience (F=3.73, df=2 and 267, p=0.025, η2=0.029) and distress level (F=3.10, df=2 and 267, p=0.040, η2=0.020) significantly moderated this disparity, such that highly experienced and highly distressed individuals reported greater gaps (in the same direction) between their general and personal CPEs.

Basic summary

Am J Psychother. 2026 Sep 28:appipsychotherapy20250079. doi: 10.1176/appi.psychotherapy.20250079. Online ahead of print.

ABSTRACT

OBJECTIVE: People have different beliefs about what leads to therapeutic success; however, not much is known about differences between individuals’ general change process expectations (CPEs) and the way those expectations operate during their own therapy experience (i.e., personal CPEs). The primary aim of this study was to examine these differences; a secondary aim was to evaluate whether a person’s previous therapeutic experience and distress level moderate these differences.

RESULTS: For each therapy process, participants reported significantly higher general CPEs compared with CPEs for their own therapy. The highest gap was observed in the expectation that therapy will provide tools for cognitive control (t=8.17, df=269, p<0.001), whereas the lowest gap was observed in the expectation that therapy will allow for the exploration of unexpressed content (t=4.02, df=269, p<0.001). Prior therapy experience (F=3.73, df=2 and 267, p=0.025, η²=0.029) and distress level (F=3.10, df=2 and 267, p=0.040, η²=0.020) significantly moderated this disparity, such that highly experienced and highly distressed individuals reported greater gaps (in the same direction) between their general and personal CPEs.

CONCLUSIONS: The results suggest that patients, especially those with more severe problems, may require strong, personalized efforts to instill confidence in the therapeutic process.

PMID:42789775 | DOI:10.1176/appi.psychotherapy.20250079

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