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Daniel C. Greif is a 2015 graduate of the PsyD Program in Clinical Psychology at Antioch University, New England

Dissertation Committee

  • James Fauth, Ph.D., Committee Chair
  • Barbara Belcher-Timme, Psy.D. Committee Member
  • Roberta Caplan, Ph.D. Committee Member

Keywords

therapy alliance, expectations of therapy, therapy outcome, client engagement, psychotherapy

Document Type

Dissertation

Publication Date

2015

Abstract

Clients begin psychotherapy with expectations that may or may not be met during treatment. Discrepancies between pretherapy expectations and the therapy experience may influence client response to treatment. This naturalistic observational pilot study investigated whether the discrepancy between initial expectations of the working alliance and the experience of the alliance predicts early client engagement and outcome. Participants were adult therapy clients at a university training clinic. Each participant completed the Expected-Working Alliance Inventory before their first session and a shortened version of the Working Alliance Inventory after. We hypothesized that the difference between expected alliance scores and actual alliance scores would predict level of client engagement and outcome. We found that participants in this study engaged at a higher rate than generally seen among therapy clients, with 82% remaining in treatment after four weeks. Even with this unusually high engagement rate, the results showed that the expected-actual alliance discrepancy predicted client engagement. Most notably, exceeding alliance expectations was associated with greater early therapy engagement. The expected-actual alliance discrepancy did not predict client outcomes. The results showed a pattern of better outcomes when the alliance exceeded expectations, but this finding was not significant, which may be due in part to a small sample size. Overall, this pilot study suggests that while initial client expectations about the therapy relationship are complex, efforts to surpass alliance expectations may lead to greater early therapy engagement. In addition, recommendations for further research and other clinical implications are discussed.

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