Managing clients’ expectations at the outset of online Cognitive Behavioural Therapy (CBT) for depression

Ekberg, Stuart, Barnes, Rebecca K., Kessler, David S., Malpass, Alice, & Shaw, Alison R.G. (2016) Managing clients’ expectations at the outset of online Cognitive Behavioural Therapy (CBT) for depression. Health Expectations, 19(3), pp. 557-569.

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Abstract

Background

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.

Objective

This study utilised recordings to examine how therapists manage clients’ expectations during the first two sessions of online Cognitive Behavioural Therapy (CBT). Methods 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.

Analysis

Clients’ expectations for therapy were most commonly managed during the initial moments of first sessions of therapy. At this point, most therapists either outlined 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.

Conclusion

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.

Impact and interest:

1 citations in Scopus
1 citations in Web of Science®
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ID Code: 73348
Item Type: Journal Article
Refereed: Yes
Keywords: expectation management, Cognitive Behavioural Therapy (CBT), depression, online therapy, first session openings, Conversation Analysis (CA)
DOI: 10.1111/hex.12227
ISSN: 1369-7625
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 Wiley-Blackwell Publishing Ltd.
Copyright Statement: This is the accepted version of the following article: [full citation], which has been published in final form at [Link to final article].
Deposited On: 03 Jul 2014 22:17
Last Modified: 02 May 2016 12:14

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