Client preferences for psychotherapy style have been understudied, despite their value in adding to our understanding of psychotherapy process and outcome. Furthermore, current research trends point towards investigating the match between client and therapist in determining outcome (ATI research). One match that has not been studied as much is the match between client preference for type of therapy and therapist therapy style. Two styles that seem particularly important are insight- and actionoriented therapy, which are often distinct therapy approaches. Clients often come to counseling anticipating either receiving insight or making a plan for action. This research has implications for enhancing client outcome due to its promise to determine better client-therapist matches. The present study employed an experimental laboratory method with two independent variables. The independent variables were client preferences for insight oriented therapy versus action oriented therapy, and counseling style provided (insight oriented therapy vs. action oriented therapy). Dependent variables were changes in target problem, relationship strength (RS), session depth, session evaluation (SES), therapist credibility, and change in preference for insight versus action. Control participants watched a videotape of Carl Rogers performing psychotherapy.
Hypothesis 1 was that clients who receive their preferred therapy style will have a more positive outcome than clients who do not receive their preferred therapy style. Result indicated that hypothesis 1 was not supported.
Hypothesis 2 was that credibility will be associated with better outcome. Results indicated that hypothesis 2 was partially supported. Hypothesis three was that match between client preferences and treatment received will be a greater predictor of outcome than credibility.
Hypothesis 3 was not supported. Hypothesis 4 was that clients who perceive their therapists as credible will shift more towards the style received than clients who do not perceive their therapists as credible. Hypothesis 4 was not supported. Limitations and suggestions for future research are discussed.
Differences Between Expectations and Preferences
Grantham and Gordon (1986) stated the following: “Expectation as anticipation and expectation as preference are different aspects of human cognition that warrant distinct treatment. Tinsley and Benton (1978) and Tinsley, Workman, and Kass (1980) emphasized expectancy in their work and used the terms expectancy, expectations, and preferences interchangeably. In doing so, they destroyed the distinction that theorists have been trying to draw for the last 30 years.” (p. 397). Much of the previous literature has generally failed to differentiate between preferences and expectations. Definitions of the two terms vary from study to study, and rarely is a clear differentiation made. In this section, I review theory that has attempted to differentiate between these two concepts.
Next, I review studies that have empirically differentiated between preferences and expectations. Theory. The contradictory findings about the relationship between expectation and satisfaction may partly result from previous researchers evaluating expectations too globally. The tendency not to define expectation precisely may have accounted for the ambiguity in the literature . Several authors stressed the need to differentiate between expectation as the anticipation of an event and expectation as the preference for an event, noting that the two usages frequently have been confounded in previous research. Duckro, Beal, and George noted that a significant problem area in the research on role expectations (the client’s expectation of the role that the counselor will play in his or her sessions) has been the ambiguous definition of expectation. Originally, the word clearly meant anticipation , and the implication was that anticipation held some degree of certainty. Hence, many researchers were very careful to define expectation for their subjects as anticipation. Duckro and colleagues next differentiate between expectation as anticipation (the anticipation that an event will occur) and expectation as preference (the preference that some event should occur) as two different aspects of human cognition. However, most researchers in the area of role expectations have not differentiated between the two aspects, leaving their subjects to interpret expectation however they want.
What are Clients’ Preferences?
Although there is much research describing clients’ expectations for counseling, research about clients’ preferences for counseling is limited. Galassi, Crace, Martin, James, and Wallace (1992; reviewed above) found that career clients had fairly clear ideas about what they wanted (preferences) from career counseling. Particularly, clients wanted to have chosen or confirmed a career or major by the end of counseling, and wanted to talk about specific careers and/or decision making. Clients also expressed a preference for counselor advice and facilitating client decision making. Clients preferred assignments to read/research careers, internships/hands-on experience, and to interview people in careers. Finally clients desired career/person or major/person matches from testing.
Although this study provides valuable information about what clients prefer in career counseling, the results must be interpreted cautiously. The methodology of this study asked clients to describe their preferences for therapy, and thus in order to participate in the study they were required to record fairly clear ideas about what they preferred in counseling. Thus, it may not be appropriate to assume that clients have clear preferences for counseling unless they are primed to think about what they would prefer before having counseling. In addition, these clients were asked what they prefer to happen in career counseling, and of course the results cannot be generalized to personal counseling. In sum, although there is much research on client preferences for therapists’ sex (Boulware &Holmes, 1970; Simmons & Helms, 1976), race (Acosta & Sheehan, 1976; Jackson & Kirschner, 1973), and response style (Fancher & Gatkin, 1971; Holen & Kinsey, 1975), there is little research answering the question of what counseling style clients prefer in counseling. Galassi et al. (1992) found that career clients wanted concrete results from the counseling, wanted to talk about specific careers and decision making, wanted counselor advice and directiveness, and hands-on experience in exploring careers.
Relationship Between Preference-Treatment Congruence and Outcome
Kelly (1955) said that almost all clients hold a highly personalized conceptualization of the nature of the psychotherapy relationship and of the psychotherapist’s role. He argued that in the beginning stages of therapy, the psychotherapist must accept the client’s preconception of the therapist’s role, because failure to confirm the client’s expectations results in confusion or disappointment. Many research studies were published that confirmed this hypothesis that disconfirmed expectations would result in negative outcome (Frank, Gliedman, Imber, Nash, & Stone, 1957; Heine & Trossman, 1960; Lennard & Bernstein, 1960). However, most of the research conducted after the 1960s either failed to support the negative effects of disconfirmed client expectancies or was equivocal (Volsky, Magoon, Norman, & Hoyt, 1965). Duckro et al. (1979) summarized the studies conducted between 1962 and 1979 and reported that 21 studies (49%) supported the hypothesized relationship that failure to confirm client expectations would result in negative consequences, while 22 studies (51%) did not support this hypothesis.
Fancher, R. E. & Gutkin, D. (1971). Attitudes toward science, insight therapy, and behavior therapy. Journal of Clinical Psychology, 27(1), 153-155. Frank, J. D., Gliedman, L.H., Imber, S. D., Nash, E. H., Stone, A. R. (1957). Why patients leave psychotherapy. Archives of Neurology & Psychiatry (Chicago), 77, 283- 299.
Dissertation Done by Melissa Kay Goates-Jones, University of Maryland