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.

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 in the therapeutic process. 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 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.

Citation

Ekberg, S., Barnes, R. K., Kessler, D. S., Mirza, S., Montgomery, A. A., Malpass, A., & Shaw, A. R. (2015). Relationship between Expectation Management and Client Retention in Online Cognitive Behavioural Therapy. Behavioural and Cognitive Psychotherapy, 43(6), 732-743. https://doi.org/10.1017/S1352465814000241

• Journal Article Type: Article
• Acceptance Date: Jan 1, 2014
• Online Publication Date: Jun 24, 2014
• Publication Date: 2015-11
• Deposit Date: Aug 15, 2017
• Publicly Available Date: Aug 15, 2017
• Journal: Behavioural and Cognitive Psychotherapy
• Print ISSN: 1352-4658
• Electronic ISSN: 1469-1833
• Publisher: Cambridge University Press
• Peer Reviewed: Not Peer Reviewed
• Volume: 43
• Issue: 6
• Pages: 732-743
• DOI: https://doi.org/10.1017/S1352465814000241
• Keywords: expectation management, initial session, cognitive behavioural therapy (CBT), conversation analysis, psychotherapy process, outcome
• Public URL: https://nottingham-repository.worktribe.com/output/981233
• Publisher URL: https://www.cambridge.org/core/journals/behavioural-and-cognitive-psychotherapy/article/relationship-between-expectation-management-and-client-retention-in-online-cognitive-behavioural-therapy/FF2E6377B889451EA8E4B6F39CED2428
• Additional Information: © British Association for Behavioural and Cognitive Psychotherapies 2014
• Contract Date: Aug 15, 2017