December 2024 Clinical Supervision Topic: Expectations
When people think about therapy, they often focus on specific techniques, diagnoses, or evidence-based approaches. While those are important, research shows that common factors—elements present in all types of therapy—account for a significant portion of successful outcomes. Among these factors, expectations play a surprisingly powerful role.
What Are Common Factors?
Common factors are the universal elements that contribute to therapeutic success across all approaches, whether you’re practicing CBT, psychoanalysis, or solution-focused therapy. These include:
The therapeutic alliance (a strong bond between therapist and client).
Empathy and warmth from the therapist.
Client hope and expectations for improvement.
Among these, expectations stand out as a key driver of change. They shape how clients perceive therapy and engage in the process, influencing their overall success.
How Expectations Impact Therapy
Expectations in therapy go beyond just "hope." They influence:
Engagement: When clients expect that therapy will help them, they’re more likely to actively participate in sessions and follow through with homework or coping strategies.
Perception of Progress: A client’s belief in therapy can shape how they measure and interpret their progress, making them more attuned to positive changes.
Placebo Effect: Research shows that simply expecting improvement can trigger real physiological and emotional shifts. This is often compared to the placebo effect in medicine.
Therapist Influence: A therapist’s confidence in the process can shape a client’s expectations. If the therapist conveys optimism and trust in the therapeutic journey, clients are more likely to share that outlook.
What the Research Says
Studies have consistently highlighted the importance of client expectations:
Lambert & Barley (2001): Found that common factors, including expectations, account for up to 30% of therapy outcomes.
Kirsch (1999): Explored how expectation-driven effects in therapy align with placebo mechanisms, showing measurable improvements based solely on belief in the treatment.
Constantino et al. (2011): Reviewed the role of expectations in psychotherapy and found they predict better outcomes, especially when paired with strong therapeutic alliances. (Also check out this article).
How Therapists Can Foster Positive Expectations (this is the most important section!)
As therapists, we have the opportunity—and responsibility—to nurture healthy expectations in our clients. Here’s how:
Be Transparent: Explain the therapeutic process and set realistic goals. Clients are more likely to trust therapy if they understand what to expect.
Build Confidence: Help clients recognize their strengths and past successes. Remind them that they have the capacity to change and grow.
Celebrate Small Wins: Highlight even small progress to reinforce the belief that therapy is working.
Maintain Hope: Convey optimism about their potential for improvement, without promising specific outcomes. Your confidence can be contagious.
Final Thoughts
Expectations are an important but often overlooked piece of the therapeutic puzzle. By understanding and fostering positive expectations, therapists can strengthen the common factors that contribute to healing and growth. Whether you’re a seasoned clinician or just starting your practice, don’t underestimate the power of belief—yours and your client’s—in shaping the therapeutic journey.
