Relationship Between Congruence of Client and Therapist: Expectations and Preferences and Continuation in Psychotherapy (Treatment, Dropout).

Abstract

The purpose of this study was to examine the relationship between client and therapist role expectation and role preference congruence as it related to premature termination from psychotherapy. The study also investigated the changes that occur in role expectations and role preferences over six therapy sessions. The study was a field study setting using three outpatient clinics from a rural community. Ninety-two clients and 15 master level therapists participated. A pretest, posttest, control group design was used. A 2 x 2 x 2 x 2 (Subject x Outcome x Time x Measure) multivariate factor design was used. The primary instrument used in the study was the Psychotherapy Expectancy-Preference Inventory (Hoffman, 1982) which measures both role expectations and preferences simultaneously in 4 areas: support, advice, client initiative, and how warm and relaxed the relationship. The results of the study indicate that all subjects began treatment with expectations significantly different from their preferences. The clients who remained in therapy (remainers) differed from clients who dropped out of therapy (drop outs) in that they wanted to take more initiative and control in the therapy process and believed they would. Remainer clients also wanted and believed they would receive less advice than drop out clients did. Therapists wanted and believed that remainer-clients would take more initiative and control than drop out-clients for the therapy session. Therapists had an increased belief and desire over six sessions that the relationship with remainer-clients would be more equalitarian, spontaneous and comfortable than it would be for drop out-clients. Client expectations and preferences for therapist support and direction became more congruent over the course of six sessions (ie. clients became more internally congruent in this area). However, therapist dyads' (client and therapist pairs) expectations and preferences did not become more congruent over time as predicted.