Relationship between expectation management and client retention in online Cognitive Behavioural Therapy

Ekberg, Stuart, Barnes, Rebecca K., Kessler, David S., Mirza, Selman, Montgomery, Alan A., Malpass, Alice, & Shaw, Alison R.G. (2015) Relationship between expectation management and client retention in online Cognitive Behavioural Therapy. Behavioural and Cognitive Psychotherapy, 43(6), pp. 732-743.

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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. 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 different 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.

Impact and interest:

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ID Code: 73347
Item Type: Journal Article
Refereed: Yes
Keywords: expectation management, initial session, Cognitive Behavioural Therapy (CBT), conversation analysis, psychotherapy process, outcome
DOI: 10.1017/S1352465814000241
ISSN: 1469-1833
Subjects: Australian and New Zealand Standard Research Classification > PSYCHOLOGY AND COGNITIVE SCIENCES (170000) > PSYCHOLOGY (170100) > Health Clinical and Counselling Psychology (170106)
Australian and New Zealand Standard Research Classification > LANGUAGES COMMUNICATION AND CULTURE (200000) > COMMUNICATION AND MEDIA STUDIES (200100) > Communication Technology and Digital Media Studies (200102)
Australian and New Zealand Standard Research Classification > LANGUAGES COMMUNICATION AND CULTURE (200000) > LINGUISTICS (200400) > Discourse and Pragmatics (200403)
Australian and New Zealand Standard Research Classification > LANGUAGES COMMUNICATION AND CULTURE (200000) > LINGUISTICS (200400) > Language in Culture and Society (Sociolinguistics) (200405)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Funding:
  • BUPA FOUNDATION (UK)/n/a
Copyright Owner: Copyright 2014 British Association for Behavioural and Cognitive Psychotherapies
Copyright Statement: This article that has been accepted for publication and will appear in a revised form, subsequent to peer review and/or editorial input by Cambridge University Press, in Behavioural and Cognitive Psychotherapy, published by Cambridge University Press.
Deposited On: 03 Jul 2014 22:29
Last Modified: 02 May 2016 08:38

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