Researchers comparing expectations within two groups of therapy clients found how some experience 'pleasant surprise' at the content and process of their sessions — and that this shift in expectations may actually be beneficial to the therapeutic outcome.
A surprise might do you good
It’s hardly surprising that if you go into therapy with a genuine hope of a positive result, you’re more likely to emerge with exactly that — and the opposite is also true. So a negative or pessimistic outlook is more likely in clients whose outcomes are poorer.
But a group of Canadian cognitive behaviour therapists wanted to know more than this; they wanted to explore clients’ expectations, and specifically, whether these expectations matched their actual experiences of therapy. And more importantly, they wanted to see if this had any link to the results and effects, after therapy was complete.
The research project
Nine ‘good-outcome’ clients and nine ‘poor-outcome’ clients were chosen for comparison. All were asked a series of questions designed to reveal in some detail what they had felt about therapy before, during and after treatment. Questions focussed on the therapist’s role, what they felt were the most and least helpful aspects of their sessions, and how comfortable they had felt. They were then asked how closely any of this matched their previous expectations.
The results
Results fell into two categories — ‘therapy was not what I expected’ and ‘therapy was what I expected’ , with categories each containing sub-sections. In the first category, where expectations are not met, therapy can bring about a ‘pleasant surprise’ feeling or a disappointed one. In the second category, therapy could match high expectations by being a good experience, or low ones by being a poor one. The most common answers showed that clients were in fact surprised by at least some of their experiences, either positively or negatively….but it was the ‘pleasant surprise’ clients that did better at the end of therapy.
The results showed that ‘good-outcome’ clients were firmly in that ‘pleasantly surprised’ camp — often surprised that they were able to work with the therapist and to take the lead at times, and more comfortable with the whole process than they thought they would be. Poor-outcome clients generally reported disappointment or that low expectations were confirmed. Good-outcome clients also reported gaining more from treatment than expected.
The theory behind it
The theoretical underpinnings informing this study come from the theory of ‘expectancy violation’ which holds that surprise experiences in communications have an impact on further interactions — so if someone behaves in a way you don’t expect, it affects the way you relate to them in the future. In addition, ‘decision affect theory’ proposes that pleasantly surprising experiences are inevitably more pleasurable than the ones you knew were going to happen all along.
So it seems that you’re more likely to make the most of CBT if you keep your expectations low or neutral — and then find things are not as bad, or rather better, than you thought. Spot the implications though: does this mean that a well-informed client, who’s read something about CBT and who knows what to expect, is less likely to benefit? And that keeping clients in the dark about what happens in therapy gives the best results?
The House Partnership, 8th May 2016
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Professor Paul Salkovskis, a clinical psychologist and director of the Centre for Anxiety Disorders and Trauma, discusses Cognitive Behavioural Therapy for Obsessive Compulsive Disorder. And Karen reveals how this form of therapy helped her overcome OCD.
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Kadam Morten Clausen, resident teacher at the Kadampa Meditation Centre in New York, discusses how stress is all about our perceptions of others and of the world. Mindfulness practices, as encouraged at The House Partnership, can help you find a path to a life free of stress.
Iain and Susan are struggling to work out why their sex life has ground to a halt. A short promotional film for the BBC animated documentary: Wonderland: The Trouble With Love and Sex.
Levni Yilmazis is an independent film-maker, artist and publisher. This is his ironic take on the less-than-helpful advice some people give when you're experiencing depression.
Though it has been proposed that food issues such as extreme dieting, anorexia and bulimia are on the rise and influenced by media pressures, analysis of texts about and by many of history's key figures suggests that these problems have been around for centuries.
A clip from the BBC's Weird Nature series showing how Vervet Monkeys in the Caribbean have taken to stealing cocktails from people on the beach. Studies show that they have the same percentage of teetotal and alcoholic individuals as the human population.
