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.
December 2023 Clinical Supervision Topic: Expectations
Expectations are one of the common factors of clinical work, especially therapy. What do our skills around expectation management look like?
Check out previous years here, including one of my favorite podcast episodes.
Expectations are one of the common factors of clinical work, especially therapy.
What do our skills around expectation management look like? Here’s an article studying how it can look in the first few sessions of CBT therapy.
Let’s consider the following:
when do we know it’s time to check in on expectations?
which client expectations are most helpful to gauge?
what are your expectations of the typical course of care you provide?
how do we make sure our clients’ and our own expectations are aligned?
what do we do if expectations are misaligned?
Looking forward to exploring this with you soon.
December 2021 Clinical Supervision Topic: Expectations
How does your client explain their problem? How do they expect the work you do together will help? Let’s explore expectations together.
Whatever the client thinks is going to lead to change is 90% likely to be the thing that works for them.
It’s December, and we are reflecting on the year.
Many of your clients may be reflecting on their year and thinking of the progress they’ve made overall, and in the life goals they have. As they are coming to you for help towards those goals, they may reflect on the work they’ve done together with you. Has it made a difference? Was it what they thought it would be?
This month we’re exploring expectations. (Expectations are one of the factors in the common factors model.) Feel free to review last year’s post on this, including (and especially) the podcast episode with Eric Vance and Krista Tippett.
Expectations (both yours and your clients’) are big determinants of how things will go in the work you do together. In this article (also linked above), we learn a bit more about how this works.
In preparation for our sessions this month, I’d like to hear about one of your clients and your thoughts on:
The things your client tried in order to solve their problem prior to them working with you
Their explanation for their distress
Your explanation for their distress
On a scale of 0-10 (10 is 100%), how much do your clients believe working with you will help them overcome their problem?
Look forward to seeing you all soon.
December Clinical Supervision Topic: Expectations
Our client’s expectations, and our ability to create solid, positive expectations for treatment outcomes, go a long way in how things actually play out in our work.
December is here and we are looking at expectations. Expectations go a long way in our work with our clients, and are constantly there, whether recognized or not. We bump up against them with many of our other factors, including eliciting feedback, goal consensus and of course, therapeutic alliance.
This month, please check out this podcast episode with Krista Tippett and Erik Vance, episode entitled, “The Drugs Inside Your Head”. It is all about the placebo effect, and it is fascinating. Take what you know about the placebo effect and multiply it by a million. That is this episode. And once you start to understand the power of expectations, you’ll see why understanding your client’s expectations is crucial to the work you do.
A few things to reflect upon:
What are my typical client’s expectations for our work together?
Do my clients believe my explanation of their problem, and what I state will be the solution to their problem? How do I explore this?
What are the expectations I create for my clients? Examples include: we’ll meet weekly, they will do homework, I will do certain tasks on their behalf, I’ll attend to their emotions in session, by doing therapy with me they will change their thoughts then they’ll feel better, by engaging in treatment with me they will recover from their addiction, that by working together they will eventually feel less overall stress, etc.
Look forward to seeing you all!