title: Managing clients' expectations at the outset of online Cognitive Behavioural Therapy (CBT) for depression.
abstract: Engaging clients in psychotherapy by managing their expectations is important for therapeutic success. Initial moments in first sessions of therapy are thought to afford an opportunity to establish a shared understanding of how therapy will proceed. However, there is little evidence from analysis of actual sessions of therapy to support this.
  
  
  
  This study utilised recorded session logs to examine how therapists manage clients' expectations during the first two sessions of online Cognitive Behavioural Therapy (CBT).
  
  
  
  Expectation management was investigated through conversation analysis of sessions from 176 client-therapist dyads involved in online CBT. The primary focus of analysis was expectation management during the initial moments of first sessions, with a secondary focus on expectations at subsequent points.
  
  
  
  Clients' expectations for therapy were most commonly managed during the initial moments of first sessions of therapy. At this point, most therapists either produced a description outlining the tasks of the first and subsequent sessions (n = 36) or the first session only (n = 108). On other occasions (n = 32), no attempt was made to manage clients' expectations by outlining what would happen in therapy. Observations of the interactional consequences of such an absence suggest clients may struggle to engage with the therapeutic process in the absence of appropriate expectation management by therapists.
  
  
  
  Clients may more readily engage from the outset of therapy when provided with an explanation that manages their expectation of what is involved. Therapists can accomplish this by projecting how therapy will proceed, particularly beyond the initial session.
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Qld, Australia.
authors.forename: Stuart
authors.initials: S
authors.lastname: Ekberg
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Rebecca K
authors.initials: RK
authors.lastname: Barnes
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: David S
authors.initials: DS
authors.lastname: Kessler
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Alice
authors.initials: A
authors.lastname: Malpass
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Alison R G
authors.initials: AR
authors.lastname: Shaw
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003142:Communication; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D013637:Tape Recording; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cognitive Behavioural Therapy; conversation analysis; depression; expectation management; first session openings; online therapy
references.citation: Sociol Health Illn. 2009 Sep;31(6):835-53
references.pmid: 19843270
references.citation: Ann Behav Med. 2009 Aug;38(1):4-17
references.pmid: 19787305
references.citation: Health Commun. 2006;19(2):89-102
references.pmid: 16548700
references.citation: Am Psychol. 1986 Feb;41(2):159-64
references.pmid: 3516036
references.citation: Clin Psychol Rev. 2006 Oct;26(6):657-78
references.pmid: 15908088
references.citation: J Psychiatr Ment Health Nurs. 2009 Dec;16(10):927-37
references.pmid: 19930367
references.citation: Health Technol Assess. 2012 Jul;16(30):i-xii, 1-509
references.pmid: 22747798
references.citation: Health Expect. 2001 Mar;4(1):58-70
references.pmid: 11286600
references.citation: Health Expect. 2010 Sep;13(3):273-84
references.pmid: 20550590
references.citation: Med Care Res Rev. 1996 Mar;53(1):3-27
references.pmid: 10156434
references.citation: Psychother Res. 2009 Jul;19(4-5):418-28
references.pmid: 19034715
references.citation: Commun Med. 2004;1(2):159-69
references.pmid: 16808698
references.citation: Soc Sci Med. 1999 Dec;49(11):1501-17
references.pmid: 10515632
references.citation: Med Educ. 2005 Jan;39(1):113-5
references.pmid: 15612908
references.citation: Clin Psychol Rev. 2010 Aug;30(6):710-20
references.pmid: 20547435
references.citation: Lancet. 2009 Aug 22;374(9690):628-34
references.pmid: 19700005
references.citation: Behav Cogn Psychother. 2015 Nov;43(6):732-43
references.pmid: 24960277
references.citation: Psychotherapy (Chic). 2006 Fall;43(3):258-63
references.pmid: 22122094
references.citation: Health Expect. 2009 Mar;12(1):45-59
references.pmid: 19250152
references.citation: Prim Care Companion J Clin Psychiatry. 2010;12(4):
references.pmid: 21085550
references.citation: J Consult Clin Psychol. 2010 Jun;78(3):429-37
references.pmid: 20515218