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Introduction to this PDF Document

CFIT Online Learning Center

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CFIT

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CFIT Online Learning Center:Addressing Expectancies about Counseling

Version 1.1

Sarah E. Dew, M.S., Susan Douglas Kelley, Ph.D., & Susan E. Casey, M.S.W.

Editors: Susan Douglas Kelley, Ph.D. and Susan E. Casey, M.S.W.

Acknowledgements

The development of this training module was made possible with the collaborative efforts of Vanderbilt University and Providence Service Corporation. We would also like to thank the following for their contributions:

Expert Reviewers: Robert King, Ph.D., The University of Queensland, Australia & Georgiana Schick Tryon, Ph.D., City University of New York, NY

Clinical Scenarios: Insoo Kim Berg, M.S.W., Brief Family Therapy Center, WI

Web Design: Sitening

Partially supported by NIMH Grant R01-MH068589, Leonard Bickman, Ph.D. (Principal Investigator)

Welcome

ADDRESSING EXPECTANCIES ABOUT COUNSELING


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You are entering the first section.

It should take approximately 5 minutes to complete, with a total of 9 pages.

Welcome



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• What should I expect?

• What is the point of addressing expectancies about counseling?

• What am I going to take away from this learning experience?


Welcome


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What should I expect?

• There are five sections to this module and a total of 98 pages.

• This module takes approximately 2 hours to complete. Keep in mind that this is only an estimate. Time to complete will vary, based on your pace and utilization of hyperlinks. Thus, it may take anywhere between an hour and a half to 3 hours to complete this module.

• If you do not have 2 hours, don’t worry. We have designed it so you can complete one section at a time.

Now sit back and enjoy!


Welcome


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WelcomeA brief introduction to the module and how it is relevant to your clinical practice.

Clinical PracticeThis section includes two parts. The first is General Applications, with a review of three types of expectancies and their functions, and how to apply these concepts in practice. The second is Specific Scenarios, which presents three clinical situations you may encounter with tips for activities and dialogue to address role, process, and outcome expectations.

Bridging ConceptsThis section reviews the theoretical foundations and evidence base for expectancies. We also review the role of expectancies in the therapeutic alliance and how expectancies relate to PSC core values.

ResourcesSeveral additional sources for further information are provided for your continued learning.

Module EvaluationIn the final section, you will find a brief evaluation of the module. Your responses provide us with valuable feedback for continued improvement.

Don’t forget to take the Self-Test (on the CFIT Training page in Qualifacts system) to finish this module.

Welcome


This module includes five sections:


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• Provides the client and caregiver with education about counseling

• Promotes a strengths-based approach to collaboration between counselor, client, and caregiver

• Contributes to building a positive therapeutic alliance

What is the point of addressing expectancies about counseling?

Welcome



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• Comprehensive information on types and examples of expectancies about counseling

• Pointers on how to initiate conversations about client and caregiver expectancies

• Tools and exercises to use for practice, reflection, and supervision

• Powerful questions and activities to help you deal with challenging situations

• Additional resources to further your understanding of client and caregiver expectancies

Welcome


What am I going to take away from this learning experience?Key information, tools, and resources


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1. Understand the multiple functions of expectancies and why they are important to beginning the counseling process.

2. Know the three types and examples of expectancies (role, process, and outcome).

3. Apply specific strategies to address role expectancies, including empowering by asking, acknowledging that clients and caregivers are the experts, and encouraging active participation.

4. Address process expectancies around issues of confidentiality, what happens outside of sessions, and what being in sessions looks and feels like.

5. Understand what to ask, what to listen for, and how to provide guidance to awaken positive outcome expectancies.

6. Understand issues related to addressing expectancies with caregivers.

7. Be able to explain how expectancies are related to the therapeutic alliance.

8. Be able to describe the foundation of evidence and theory underlying expectancies and its relation to treatment outcomes.

9. Be able to access resources to learn more about skills on therapeutic alliance building and repairing strategies.

Learning Objectives


Welcome

ADDRESSING EXPECTANCIES ABOUT COUNSELINGCFIT

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Congratulations! You have completed this section.

If you are pressed for time, return at a later date to continue the module.

First of five sections complete


Welcome

ADDRESSING EXPECTANCIES ABOUT COUNSELINGCFIT

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You are entering the second section (Part I of II).



Clinical Practice Part I: General Applications


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• What are expectancies about counseling?

• Multiple functions of addressing expectancies

• When to address expectancies

• Types and examples of expectancies1. Role expectancies2. Process expectancies3. Outcome expectancies

• Working with caregivers around expectancies

• Some final thoughts on expectancies



Clinical Practice Part I: General ApplicationsCFIT

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What are expectancies about counseling?

Expectancies are different from preferences (the extent to which a person desires an event) and perceptions (a person’s knowledge of an event) (Barich, 2002). Instead, they are “...anticipatory beliefs that clients bring into treatment and can encompass beliefs about procedures, outcomes, therapists, or any other facet of the intervention and its delivery” (Nock & Kazdin, 2001, p. 155).

Consider

• How am I supposed to act in counseling?• What is my counselor going to be like?• How is counseling going to help me?• What’s going to happen?

Expectancies




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How have your expectations shaped your own experiences with healthcare providers?

Your approach to addressing client and counselor expectancies is informed by your own experiences as a consumer of care.

Click on the Reflection Tool for a guided exercise intended to help you reflect on both positive and negative experiences you’ve had in establishing expectations about treatment. You’ll think about how you can build on positive experiences and learn from the negative ones to help you in working with clients and their caregivers.

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Reflection Tool

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CFIT Online Learning Center Addressing Expectancies About Counseling Reflection: How have your expectations shaped experiences with health care providers? DIRECTIONS: The reflections and reflective exercises are intended to give you some thoughts/questions to think about when you have some quiet time. Take a moment to think about the questions and write out the answers. How can you use your own experiences with expectations about treatment to become an even better counselor? The following questions are intended to help you reflect on both positive and negative experiences you’ve had in establishing expectations about treatment. Think about how can you build on positive experiences and learn from the negative ones to help you in working with your clients and their caregivers. Recall a time when you were a first meeting a health care provider for a wellness checkup:

As you were traveling to the appointment, what expectations did you have about how things would go? What made you feel nervous or confident about the upcoming visit?

How did the provider introduce him/herself? What did he/she do to make you feel comfortable? What made you uncomfortable? Did you feel heard?

How was confidentiality introduced? Did the office hand you a brochure? Did they also verbally explain it to you? Did they inquire about any questions you might have?

As you were traveling home, did you think the visit went as expected? What would you have preferred was done differently the next time?

How did you previous interactions with health care providers impact your expectations of this visit? Think about both positive and negative interactions.

Recall a time when you had a significant health problem and went to your doctor or a specialist (or even the emergency room) for help:

How did the stress of being sick impact your ability to be confident and in control? How did your expectations of the provider’s role change based on your need for help?

What was your role in determining the course of action in response to being sick? Were you comfortable with your role? Did you feel like you understood your role? How did you discuss your preferences for treatment? Did you feel respected?

What were your expectations about the outcome of treatment? Did you feel comfortable with the way your provider talked with you about outcomes? What didn’t work well about the way your provider talked about outcomes?

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Function 1: Provides client and caregiver education about counseling

Function 2:Promotes a strengths-based approach to collaboration between counselor, client, and caregiver

Function 3:Establishes how counseling will proceed, contributes to building a positive therapeutic alliance

Multiple functions of addressing expectancies




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On a basic level, addressing expectancies may serve as an opportunity for client and caregiver education.

Based on previous knowledge about counseling (derived from family, friends, media, and prior therapy experience), clients and caregivers may already have preconceived notions of what counseling will be like. Providing an overview of counseling can help orient clients and caregivers to you and your organization.


Function 1. Education about counseling



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Addressing expectancies is a tool that can be used to promote a strengths-based approach to collaboration between counselor, client, and caregiver.

Addressing expectancies is a process of negotiation that builds mutual agreement and understanding about counseling. It demonstrates the counselor’s desire to understand where clients and caregivers are coming from and the importance of their roles in the counseling process.


Function 2. Strengths-based approach



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Establishing how counseling will proceed ensures that the client, caregiver, and counselor have a shared vision of the process and outcomes of counseling. It can help counseling proceed more efficiently by preventing future confusion. From the start, the counselor can model that this will be a “safe” environment for discussing uncomfortable topics.


Function 3. Contributes to building a positive therapeutic alliance



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Client and/or caregiver expectations about counseling may be the “elephant in the room” that everyone would feel more comfortable ignoring.

When counselors initiate a frank conversation about counseling expectations, it demonstrates a willingness to discuss things that may feel uncomfortable.



Modeling appropriate discussion


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Begin addressing expectancies in the initial session to ensure that confusion about expectancies does not hinder engagement or attendance either early on or later in treatment. Ending with a discussion about expectancies can be a nice way of closing the initial session:

• Demonstrating that work will proceed according to a shared vision of counseling.

• Identifying issues for clarification in the next few sessions.

Over the course of working with a family, make sure to check back in about their expectancies to make sure everyone is still on the same page.


When to address expectancies



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Types and examples of expectancies

Expectancies fall into three broad areas related to counseling:

1. Role expectancies2. Process expectancies3. Outcome expectancies




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What is my role as a counselor?

Before we talk further about the types of expectancies clients may have about counseling, let’s think about how you view your own role as a counselor.

Click on the Supervision Tool for a suggested activity to complete with your supervisor. Counselors share similarities in educational background, but each of us comes to our work with a unique style. Some questions to consider together with your supervisor focus on how your training and style impact who you are and what you do as a counselor.


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Supervision Tool

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CFIT Online Learning Center Addressing Expectancies About Counseling Supervision: What is my role as a counselor? DIRECTIONS: The supervision exercises and questions are intended to give you some guided questions to think about and bring to your supervision session and talk over with your clinical supervisor. Questions for supervision: Counselors share similarities in their educational background, just as engineers or lawyers or any other professionals do. But each of us comes to our work with a unique style, based in part on who we are, but also on our training. Think more deeply about your role and expectations about your role. Questions to bring to supervision are: How do your particular training background and/or style impact who you are and what you do as a counselor?

What issues with clients or caregivers has influenced you to seek additional training?

When you ask yourself, is the client’s treatment need within the scope of my practice, how do you answer that question?

How do you know when it is not within your scope of practice?

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What are they?

Role expectancies are “patterns of behavior viewed as appropriate or expected of a person who occupies a particular position…clients have role expectations both of themselves and of the therapist” (Arnkoff, Glass & Shapiro, 2002, p. 336).

Roles are informed by issues such as where you work (i.e., in the home or in an office) and the make-up of the family (Will you be working with siblings? Foster parents? Extended family?). Some general issues regarding role expectancies we cover here include:

• Empowering by asking

• Clients and caregivers are the experts

• Active participation

Type 1. Role Expectancies




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As discussed further in the Collaborative Treatment Planning module, emphasizing the collaborative nature of counseling promotes a strengths-based approach. The counselor works with the client to move the conversation from problems, complaints, and pathology, to resilience, competence and solutions. Asking for the client’s and caregiver’s description of the problem and ‘why we are here together’ allows the counselor to understand their perceptions, moving beyond the diagnosis.

Beginning a discussion about a client’s or caregiver’s expectations creates a collaborative environment where their thoughts and feelings matter. Click here for sample dialogue.

Type 1. Role expectancies

Empowering by asking




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Before we end this session, I’d like to talk for just a little bit about what expectations you have about counseling and the expectations I have about counseling. Because this work is for you, I want to make sure we agree on where this work is going.


What do you expect from me?


1. Role expectancies: Empowering by asking


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A strengths-based approach means that the counselor is not imparting all of his/her knowledge and wisdom on the “broken” client. Instead, counselors emphasize that clients will have to teach the counselor about what it’s like to be them. Acknowledge that the client is the expert in his or her own life, and the same with the caregiver.

This helps the client understand that he/she has unique knowledge and wisdom that the therapist needs. It can also help ensure the client feels heard and actively involved in finding solutions to his/her problems.

Click here for sample dialogue.


Client and caregivers are the experts




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Sometimes, I may tell you about new things, and that may sometimes look like teaching. Other times, though, I’m going to

want you to teach me about stuff.


You know a lot more about what it’s like to be you than I do. I’m going to

need you to help me understand.


1. Role expectancies: Client and caregivers are the experts


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Using your client’s worldview to build relationship

What can your client teach you about him- or herself?

Click on the Practice Tool for a suggested activity you can complete with your client. The Worldview exercise is intended to give you guidance in leading a discussion to help elicit the client’s personal world view. Pointing out and discussing the client’s worldview can prove helpful by providing information about how the client sees the world, letting the client know you are interested in his or her viewpoint, and letting the information acquired guide your work with your client.


ToolboxTimes3


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Practice Tool

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CFIT Online Learning Center Addressing Expectancies About Counseling Practice Tool: Using your client’s worldview to build relationship Each client enters counseling with a particular way of seeing the world. This worldview is shaped by (among other things) their history, experience, and culture. Pointing out and discussing the client’s worldview can prove helpful by:

• Providing information about how the client sees the world • Letting the client know you are interested in his or her viewpoint • Letting the information acquired guide your work with your client

This discussion may proceed differently, depending on the client’s age and developmental level. For children and/or developmentally delayed clients:

► Introduce discussion as talking about how they see the world ► Use props (e.g. sunglasses with colored lenses) to facilitate: Have client put

on the sunglasses and describe how they see the world wearing glasses, contrast with their view of the world without the glasses- does the world look different through different lenses?

► What “lenses” do they see the world through? ► Connect with how the view life and their experiences- approach to therapy

can be affected by the “lens” they see the world through For teens and/or more mature clients: Utilize key reflective questions to facilitate discussion about their world view

► How do they see the world? ► What “lenses” color their view of their experiences? ► How does the way they see the world affect their approach to counseling?

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Clients and caregivers may enter counseling expecting that it will be easy; that is, that counseling will not involve a great deal of work on their part nor will it be an emotionally difficult process. Maybe this is because they are reluctant to participate, or maybe they think counseling means that you do all the work and they are just the passive recipient of your advice.

Emphasize that counseling does sometimes involve hard work on the part of the client and that, at the end of the day, the client and/or caregiver is the one responsible for enacting change in his/her life. Such an active role is consistent with a strengths-based approach, reinforcing the idea that the client and the caregiver can create positive life changes.

This will help ensure that they recognize their own value in the work they will be doing with their counselors. In addition, this may help clients and caregivers feel empowered to help themselves, because they will recognize themselves as active partners in the process.



Active participation



© Vanderbilt University, All rights reservedPage 31

I need your help to figure out what will help you the best. Sometimes I will know some things, like a new way of looking at things. You know other things, like what helps and what doesn’t.


If something isn’t working, let’s either figure out how to change it to

make it work better or let’s try something different. Otherwise,

we’d be wasting both of our time. At the end of the day, we’re in this

work together.


1. Role expectancies: Active participation


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If a client does not seem forthcoming, it may be important for the counselor to reassure the client that he/she won’t get upset or mad at the client for being honest.

Remember that the client may not be used to adults seeking his/her opinion, so time and guidance may be needed to help him/her get used to these new roles.

However, if a client clearly does not seem comfortable with having a more active role in counseling (e.g. because caregiver warned not to talk about problems, because of culture-based reserve, or just because he/she doesn’t feel like talking), these more directive methods may not be useful. Problem solving with a supervisor about the best way to proceed is advisable in these cases.


Active participation




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What are they?

Process expectancies are about what will happen in treatment, such as how it will be structured, what kinds of activities will take place, or how it will feel to be in counseling.

Consider

• Expecting that medication will be a part of a client’s treatment

• Expecting that counseling will focus on problems rather than strengths

• Expecting that counseling will primarily focus on the client’s thoughts or feelings

Type 2. Process expectancies




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Often, clients have certain ideas about what goes on in counseling that may or may not be consistent with the counselor’s vision of counseling for this client. While counselors may not be certain of all of the specific techniques they will use throughout the course of counseling, they usually have a general idea of how they expect counseling to proceed.

Addressing process expectancies includes both general aspects of counseling and the use of specific techniques. Here, we will cover:

•Confidentiality

•What will happen outside of sessions

•What being in sessions will look and feel like

Type 2. Process expectanciesWhat are they?




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Having a clear discussion about confidentiality may help clients and caregivers feel safer talking about sensitive topics. It can also promote a better understanding of how the counselor will work with the client and caregiver individually and together. For example, a client may come in with the expectation that the counselor will tell the caregiver everything that is said in sessions.

Tips on addressing confidentiality:• Define the word for clients and caregivers, explaining what it means

in the context of counseling. • Clearly explain all of the limits to confidentiality. • Discuss how the counselor will share information related by the client

with the caregiver (and vice versa).• Emphasize that “rules” such as confidentiality and its limits are there

to protect clients—not to harm them.• Get the client’s verbal assent that he/she understands what

confidentiality is and is okay with it.


Confidentiality




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Alternative forms of counseling or supplements to counseling (e.g. medication, school-based, group or family work) may be already in place or likely to happen. Processing reactions to these additional supports can include:

• Emphasizing the importance of the work and why it may be helpful or necessary

• Discussing how you will communicate with other providers

• Gaining an understanding of how the client or caregiver feels about it


What will happen outside of sessions




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Other expectations of what will happen outside of sessions may include “homework assignments.” It can be helpful to use a different word, such as lifework that is not associated with school. Lifework signifies a different meaning from homework—that this is work related to the client’s or caregiver’s everyday life. Ask the client to choose their own special word for lifework to foster collaboration. Some other suggestions for lifework:

• Keeping a journal.• Keeping a record of practicing goals during the week (when, what was tried,

what were the outcomes).• More information on lifework can be found in the Collaborative Treatment

Planning module.


What will happen outside of sessions





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Sometimes I might ask you to work on things during the week when I’m not with you. It will be different from homework. Instead of having you do things like math problems or reading about history, we may decide that

keeping a journal of what you’re thinking and feeling may be a good idea.


It’s important for us to understand what is going with you in the week. The more we know about what is going on, the better we’ll be at figuring out how to help. So, I’ll

NEVER ask you to do something just because—it’s always to help you.


2. Process expectancies: What will happen outside of sessions


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A client’s or caregiver’s expectancies about what the sessions will look and feel like may be largely driven by their exposure to and prior experience in counseling. For example, maybe all a youth knows about counseling is what he/she has seen on television or in movies, where mental health services are largely portrayed as psychodynamic therapy.


What being in sessions will look and feel like




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Understanding a client’s or caregiver’s process expectancies gives the counselor an opportunity to do psychoeducation about what counseling will be like. The process will be informed by your individual style and use of counseling techniques. Using the client’s treatment plan, you can tailor your discussion about what to expect. As you get to know the client and caregiver better over time, you’ll be able to revisit and modify expectancies based on progress in developing new skills and building on existing strengths.

While addressing process expectancies will be unique to you and your client, some general areas to cover include:

• How sessions will begin and end• Counseling involves engaging in both talking and activities• Building on strengths and skills• How the client or caregiver may feel in sessions


What being in sessions will look and feel like




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Having a consistent structure, where possible, to your sessions with clients and caregivers can provide a sense of safety and security. While variability can be stimulating, sameness can be reassuring. By having a ritual, or structure, you can also spark anticipation and engagement.

Beginning a session:• Begin with a similar prompt each session “Can you tell me about a success you had in the last week?” followed by an introduction to today’s session, “Today, we’re going to focus on . . .”• Also always be sure to check in on any lifework or provider contacts you made during the time since the last session.

Ending a session:• End with a summary of today’s session, making sure to point out successes, reviewing any expectations for work outside the session, any contacts you might make with providers or anything you have agreed to bring to the next session. • It can also be helpful to end with an activity such as a relaxation exercise, placing artwork completed during that session on the wall or in a folder, etc.


Session ‘Look and Feel’: How sessions will begin and end




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Using the structure of counseling to help support your relationships

Click on the Practice Tool for some tips on structuring your counseling sessions. Some clients have very little consistency in their lives. Providing consistency in the structure of counseling can support your relationship with your clients and may help transform session time into a safe space.

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Practice Tool

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CFIT Online Learning Center Addressing Expectancies About Counseling Practice Tool: Using the structure of counseling to help support your relationships The structure of counseling sessions can be very important. Some clients may have very little consistency in their lives. Providing consistency in the structure of counseling can support your relationship with your clients and may help transform session time into a safe space. Here are some areas in which counseling structure may be utilized: 1) Beginning your sessions: By starting sessions in a similar way each time, it can

help provide your client with consistency, cues/reminders about what counseling with you is like, a transition into the session, and can add a sense of ritual or occasion to your time together ► Some ideas for session starters:

A check-in ritual: Start sessions with the same check-in each time 1. What are one good thing and one bad thing that have happened since

last time? 2. What is one thing the client did that he/she is proud of?

Coming up with an agenda: Work with the client (and family) to come up with a plan for the day’s session

Coming up with a reward/reinforcement plan: Come up with a plan for reinforcement for the session (e.g. if we do ____ for __ minutes, then we’ll do ____ for __ minutes)

Doing an activity together: It may be a mindfulness or centering exercise, a visualization, or some other activity

2) Special in-session language: Work with your client to come up with keywords or

codes that are symbolic, that you two share ► Some ideas for using symbolic language:

Use a key word or gesture to indicate the need for a break (e.g. if work is getting too hard, client may use the symbol to take a break)

Use special words or phrases to identify/label difficult thoughts and feelings (e.g. “When ______ shows up, I have a hard time not focusing on that”)

3) Ending your sessions: By ending sessions in a similar way each time, you can

provide your client with consistency, a transition out of session for your client, reinforcement for a job well done, and a sense of ritual or occasion to your time together ► Some ideas for ending sessions:

1

Recapping where you’ve been: Help the client by summarizing and conceptualizing what happened in your session

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Prompts about where you’re headed: Remind the client of where your work is going, including any homework assignments for the client

Doing an activity together: Ending with a mindfulness or centering exercise, a relaxation/visualization exercise, or some other shared activity

Following through on reinforcement plan: This may involve giving praise, sharing a snack, giving a small prize or doing a preferred activity (e.g. games, cards, etc.) for following appropriate behaviors and working hard in-session

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Some clients or caregivers may expect that all they will do in counseling is talk about their feelings. This perception can reinforce the idea that they are there to be fixed or that all the focus will be on problems.

Talk about the kinds of things you might do together. What kinds of materials might you use in sessions? Will you engage in physical activities together, such as playing basketball? Will you work on art projects together, such as collages or drawing? Will you play games together? Use the information you gained from doing a strengths assessment (reviewed in the Building and Repairing Therapeutic Alliance module).

Also, by learning more about what the client and caregiver like to do and how they work on generating solutions to problems, you can tailor activities to them and build their interest in the work you will do together.

Type 2. Process expectanciesSession ‘Look and Feel’: Counseling involves both talking and activities




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Opening a discussion of specific skills the client may expect to learn (e.g., learning to problem solve, learning to deal with painful thoughts, etc.) promotes a strengths-based environment for counseling work. Tying any new skills the client may learn to skills and strengths they already have can build a sense of resilience, competence, and active participation in solutions.


Type 2. Process expectanciesSession ‘Look and Feel’: Building on strengths and skills




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What are some of things you expect we might do in counseling? [Inquire further about what the client says—what about movies you’ve seen? What

did you do in your work with a previous counselor?]

Building on strengths and skills

Sometimes, we’ll talk about stuff, like feelings, your thoughts, or

what’s been going on in your life. We may also do some activities that will help you learn new skills or new

ways of looking at things.


2. Process expectancies: What being in sessions will look and feel like



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Counseling doesn’t always feel good. Sometimes, the client or caregiver may feel uncomfortable in sessions. Acknowledging that sometimes they may not want to engage in or even attend sessions because of this discomfort can serve to voice unspoken fears and address potential problems in the future. Such a proactive approach builds the expectation that you can and will support them when such a time arises. Two general tips:

• Provide a framework, giving them a reason to continue engaging in this work. Counselors don’t ask clients or caregivers to do work that has no purpose. Support them in keeping that purpose in mind.

• Provide a reminder that such discomfort is temporary, and the work you will do together will help them to feel better in the long run.

Type 2. Process expectanciesSession ‘Look and Feel’: How the client or caregiver may feel in sessions




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You can also introduce the concept of ‘taking a break.’ Clients and caregivers may experience negative feelings or discomfort as being out of control. Where appropriate, counselors can promote a sense of control in sessions within reasonable boundaries. ‘Taking a break’ means that the client or caregiver can make a statement or movement, decided in advance, that means they’d like to take some time to gain control. Some general guidelines:

• Discuss it explicitly beforehand, determining how they will let the counselor know they want a break, how long it will last, and what you will each be doing during the break.• Let them know you will always respond to this request. • After a ‘break’ is requested, restate their request, acknowledge the time and activity, and make a brief statement about the work you will get back to.

‘Taking a break’ is not a tactic for avoidance—in your work together you should come back to whatever was at hand. Instead, it is intended to convey a sense of respect and being okay with the pace of the client or caregiver’s process.


Type 2. Process expectanciesSession ‘Look and Feel’: How the client or caregiver may feel in sessions




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I promise that I’ll never ask you do something that you can’t handle. When you’re feeling this way, you can ask me to take a break and we can do something else for a little while. Something fun like a game or activity. I will always respond to you when you ask this, and I’ll be sure that we come back to whatever we were doing.

I see you asked for a break. Let’s put this away and take five minutes to go out into the hall to play ball. I’ll be sure to remember we were talking about your feelings about your mom’s getting angry all the time. Okay, let’s go.


How the client or caregiver may feel in sessions



2. Process expectancies: What being in sessions will look and feel like

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What are they?

Outcome expectancies are framed by role and process expectancies and must be understood within that context. Generally speaking, outcome expectancies are “expectations that therapy will lead to change” (Arnkoff, Glass, & Shapiro, 2002, p. 335).

Consider

• Expecting that counseling will be useful• Expecting that it will take a long time

for improvement to be evident

Type 3. Outcome expectancies




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What are they?

Just as with other types of expectancies, a client’s or caregiver’s expectations about the outcomes of counseling may be informed by previous counseling relationships or what they have learned about counseling from other sources (TV, movies, friends). Further, outcome expectancies in particular are likely to be influenced by a related but distinct concept—a person’s sense of hope. Hope has been described as a way of thinking about goals (Snyder, Michael, & Cheavens, 1999), including thoughts about a person’s ability to:

• Produce ways to get the goals (pathway thinking), and• Begin and maintain movement on the path toward the goals (agency thinking)

Think of the following ideal scenario: A client wants to feel better, hopes that counseling will help her feel better, and has an expectation that counseling will help her reach this goal. In this case, the client has hope, including pathway thinking (one way to get to her goal of mental well-being is through counseling) and agency thinking (she can achieve her goal through attending and persevering in counseling). The outcome expectancy here is that the specific pathway she is choosing (counseling) will help her achieve her goal.




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An expectation of the positive outcomes of counseling seems to be a necessary condition for hope to exist. However, the two don’t always co-exist. As opposed to the ideal scenario on the previous page, a counselor may work with clients and caregivers who expect that counseling will not be beneficial, even if they may hope that it will help. Or, they may have only vague or no expectations about counseling. Even if they have a goal of ‘feeling better,’ the client or caregiver may have other pathways that seem more appealing than counseling. Some of these pathways may even be part of the reason for referral, such as running away from home or not going to school.

It is vital to assess outcome expectancies, providing guidance as appropriate to awaken positive expectancies. If a person has hope and has positive expectations of counseling, it is likely he/she will more motivated and engaged in the treatment process.

Here, we will cover:• What to ask and what to listen for• Providing guidance to awaken positive expectancies


What are they?




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Type 3. Outcome expectanciesWhat to ask and what to listen for: What are the goals?

Clients and caregivers may vary greatly in their expectations of the outcome of counseling, and these expectations may differ from the counselor’s own expectations. As a general rule of thumb in assessing outcome expectancies, it is helpful to begin by asking broad, unstructured questions followed by more directive questions as needed.

• What are your goals? • What do you hope to achieve? • What would you like to be better in your life?


Goals?




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I’m here to help because I understand that although sometimes you feel okay, other times you’d had difficulty going to school because you were feeling sad? How would you like that to be better?


If further direction is needed, you could restate the presenting problem in simple, non-evaluative terms.


3. Outcome expectancies

What to ask and what to listen for: What are the goals?


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Although this line of inquiry is strongly related to goal clarification (see Collaborative Treatment Planning module), it can be helpful to begin by asking about outcome expectancies in general, not only expectancies specific to the counseling relationship. Listen for:

• Are their goals realistic in the context of what can happen in counseling? • What language does the client use? The caregiver?• Are the goals related to the presenting problem or reason for referral?• Does the response focus on relationships? Skills building? Learning to deal with a problem? • How do these goals relate to the information you have from the intake assessment?• Are the goals internal (e.g., “I will feel better”) and/or external (e.g., “I want him to improve his behavior”)?

Asking about general hopes and expectations can help you to better understand how counseling may be seen as a pathway to achieving the client’s and caregiver’s goals. This way, counselors can work with clients and caregivers to prepare them for things outside of the scope of the limited time they will be in counseling. As opposed to short-term treatment goals, also consider life and developmental changes (graduation, remarriage, moving, any kind of life challenge the client or caregiver may experience).

Type 3. Outcome expectanciesWhat to ask and what to listen for: What are the goals?




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What to ask and what to listen for: How can counseling help?

Next, explore the client’s and caregiver’s expectancies related to counseling. Use their own words as much as possible.

• How do you think counseling can help you achieve [goals stated in their terms]?

Questions like this can help to elicit some of the reasons why the client (or more typically, the caregiver or agency) chose counseling as the particular pathway to change. If the client did not choose to be in counseling, acknowledge that when you ask them what they expect.


Counseling help?




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Sometimes in counseling we work with teachers. How do you think that could help you achieve [goals stated in their terms]?

Sometimes we work on building skills to help people learn positive ways of dealing with problems. How do you think that could help you achieve [goals stated in their terms]?


If further direction is needed, you could give examples of how counseling might help.


3. Outcome expectancies



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Listen for responses that are related to the counselor, the setting, and the treatment modality. What do they expect will be helpful about:

• You as a counselor (or counselors in general)?• Do they expect you will ‘teach’ or ‘give advice’?• Do they expect you will ‘be the expert’?• Do they expect you will work collaboratively?

• Counseling in this particular setting• If in-home treatment, what do they expect will be helpful about this?• Same for any other setting (in the school, outpatient, etc.)

• Treatment modalities (what you will do in treatment)• Do they expect skills building or coping strategies?• Do they expect to ‘be fixed’?

Some clients and caregivers enter counseling expecting it will not help them, it may make things worse, or alternatively, that the problems will be ‘fixed’ and go away. The counselor can help them have reasonable expectations of the outcomes of counseling based on their own expectations and information from the intake assessment.





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Client Expectancies About Counseling

When addressing expectancies with clients, it can be helpful to have tools you can use in sessions.

Click on the Practice Tool for a suggested activity you can complete with a client around addressing expectancies about counseling. The tool provides a worksheet for use in the session.

ToolboxTimes3




Practice Tool

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CFIT Online Learning Center Addressing Expectancies About Counseling Practice Tool: Client expectancies about counseling Objective: To facilitate the discussion of role, process, and outcome expectancies with youth and their caregivers. Materials Provided: Brief guide and handout Materials Needed: Colored markers, post-it notes, photographs or magazines for collage material. Brief Guide: There are many ways to address youth and caregiver expectancies as you begin your counseling relationship together. Naturally, you’re going to use your own creativity and style to provide education about counseling, promote collaboration, and establish agreement and understanding about how counseling will proceed. The attached handout provides a useful template for discussing several areas related to expectancies about counseling. The box provides an area to write down important notes. To engage the youth and begin establishing rapport, make it a fun activity by using colored markers, colored post-it notes, photographs from the youth’s life, or magazines for collage material. The youth can color in the boxes, draw frames on the boxes, put a picture of himself/herself in the ‘expert’ box, cut out key words from magazines, etc. To really make a project out of it, use butcher paper or poster board to ‘super-size’ it for lots of artwork. Since this represents an agreement between you and the youth about counseling, make a show out of each of you signing and dating the bottom and coming up with a title for what you’ll call the counseling to write at the top. This can be a great document to refer back to as you continue to work together—get it out and add to it when something comes up, especially in those areas where the youth may have had difficulty thinking of responses. To help with this, it could be useful for you to use a different color pen/marker for ideas you generated versus ideas generated by the youth (ideally, you want all the ideas generated by the youth). Some ideas for generating discussion are as follows: Roles

• I’m the expert on me o You know a lot more about what it’s like to be you than anyone else o What are some things you could teach me about you? o What are some things I should know about you?

1

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2

• How will my counselor help out o Sometimes I’ll give advice but sometimes I need you to teach me o Let’s write down some ways we think I can help out

• How will my caregiver help out o Together, cross out the word caregiver and write in caregiver(s)

name(s) o Generate a list of some ways they will help out in the counseling

process o Try to get an understanding of how the youth wants them to help out

compared to how they think the caregiver(s) will want to help out • Arrows

o Notice the arrows go both ways—it shows that we’re all going to be working together. You’re going to help me and your caregiver understand better and we’re going to help you out as well

Process

• What kinds of things are we going to do together? o Have you seen any movies where somebody is in counseling? What

kinds of things do they do? o What kinds of things have you done with other counselors? o Sometimes we’ll talk, sometimes we’ll do activities (like this one),

sometimes there will be practice during the week between our meetings (lifework)

o What do you understand the word “confidentiality” to mean (to spark discussion of privacy, limits of confidentiality, etc.)

• What are some ways I might feel? o What are some different feelings you’ve had before? o Who can you share that feeling (specific from list) with? o How do you think you’re going to feel in counseling? o What are okay ways to feel in counseling?

• What are some things we’ll do together? o Let’s talk about how long counseling usually lasts (each session,

duration) o What do you think you might learn from counseling? o What do you want counseling to help you with? (help the youth have

reasonable expectations) o Why do you think you’re in counseling?

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3

I’m the expert on me How will my counselor help out?

How will my caregiver help out?

What kinds of things are we going to do together?

What are some ways I might feel?

What’s going to happen because of counseling?

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Type 3. Outcome expectanciesProviding guidance to awaken positive expectancies

Addressing outcome expectancies sets the stage for collaborative treatment planning (see module), which gets into the specifics of goal clarification and negotiating treatment tasks. From the perspective of outcome expectancies, the goal is to strengthen positive, reasonable expectations of change.

After understanding what a client’s or caregiver’s expectations are, it may be important to process them together. Explore where their outcome expectancies came from, what information they based these expectancies on, etc.

Tips covered here include providing:

• Hope that counseling can help• Psychoeducation on the purpose and benefits of counseling• Information on the duration of counseling




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Regardless of whether a client or caregiver hopes and/or expects that counseling can help, the counselor can hold that hope for them. The goal is not to ‘sell’ them on counseling or to impose expectations; instead, it is to provide a framework based on what the counselor knows to be true. Sometimes the client or caregiver does not hope or expect that counseling can help. In these cases, the counselor can hold that hope for them, keeping it safe until they take ownership of their own hope and expectations.

Some ways to introduce the concept that counseling can help:• While the client and caregiver are the experts on themselves, the counselor has experience and training that can be used to help the client and caregiver. • Working together, we will develop a plan to explore new, different ways of thinking about what is going on in your lives and learn new skills to help you.• If the counselor is using evidence-based practices, briefly talk about how research has found them to be helpful to many youth and families. For example, “Relaxation exercises have been found to work well with many kids who feel anxious about going to school. We can talk more about how we might decide that this is one of the things we’ll work on together.”

Type 3. Outcome expectanciesAwakening positive expectancies: Hope




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How a counselor frames their explanation of the purpose and benefits of counseling is tailored to their unique style, setting, organization, etc. However, some general points that can be considered in providing psychoeducation to clients and caregivers include:

• Emphasizing that this work will not eliminate all the pain that clients and caregivers experience, but it will help them find ways of coping more effectively. Normalizing this experience can help. For example, “We all feel pain at some points in our lives, regardless of how well we cope. While our work won’t take all that pain away, what we will do together is find ways to help you cope and have more times when you feel better.”

• Talking with clients and caregivers about the purpose of counseling in very general terms. For example, some counselors might say “the purpose of counseling is to help you explore some things you seem to be struggling with and to help you get ‘unstuck.’”

• Discussing specific outcomes based on the intake assessment and treatment plan, such as acquiring new skills in X, Y, or Z, learning how to deal with X,Y, or Z improving relationships with caregivers and/or siblings, etc.

Type 3. Outcome expectanciesAwakening positive expectancies: Psychoeducation




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Clients and caregivers may have certain expectations about the length of counseling. This is tied to their outcome expectancies because implicit in the expectation about duration of treatment is how long they expect it will take for them to ‘get better.’

Some clients and caregivers may expect to experience a reduction in symptoms or improvement in functioning in a very short amount of time, perhaps shorter than seems reasonable given the presenting problems. Help them understand that sometimes it takes time and hard work before families experience the benefits of counseling.

Depending on the counselor and the treatment being provided, the counselor may have at least a rough estimate of how long the client will be in counseling. This can be discussed with clients and caregivers by talking about how long others have been in counseling (e.g., “usually, clients are in counseling with me for at least 10 weeks”).

In addition, explicitly stating that you will look together at progress along the way can help clients and caregivers build an expectation that they will be able to see improvement over time.

Type 3. Outcome expectanciesAwakening positive expectancies: Duration




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Being an observer of the therapeutic process with clients and caregivers

How do you think about outcome expectancies with your clients and their caregivers?

Click on the Supervision Tool for a suggested activity to complete with your supervisor. As counselors, we need to be willing to be impeccable observers of ourselves and others. Here are some questions to consider together with your supervisor that center on the issue of observing yourself as a counselor.

ToolboxTimes3




Supervision Tool

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CFIT Online Learning Center Addressing Expectancies About Counseling Supervision: Being an observer of the therapeutic process with clients and caregivers. DIRECTIONS: The supervision exercises and questions are intended to give you some guided questions to think about and bring to your supervision session and talk over with your clinical supervisor. Questions for supervision: As counselors we need to be willing to be impeccable observers of ourselves and others. Therefore, the questions to bring to supervision are: What is it that I have been doing that has brought us to this point in the therapeutic process? For clients who are making great progress? For clients who are making slow or little progress? How does my work with caregivers inform progress?

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When working with youth, it is very unusual to not have some involvement with their caregivers and families. Because caregivers are integral to any treatment a youth receives, understanding their expectations about counseling is particularly important.

In addition to having insight into the youth’s expectancies, caregivers have their own expectancies about their role, and the outcome and process of the youth’s counseling.

Here, we will cover:• Addressing caregiver involvement• Discussing expectancies together and separately

Working with caregivers around expectancies




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Both clients and caregivers have expectancies about the role of the caregiver in the youth’s counseling. If counseling is to be done primarily with the youth, how will you keep the caregiver up-to-date with what is going on? Some counselors typically check in with caregivers prior to beginning a client session.

Sometimes, clients may be very resistant to caregiver involvement in counseling (caregivers may also be resistant to involvement—this is a scenario discussed in the next section). If possible, the counselor can negotiate when and how caregivers will be involved. This models for the client and the caregiver that the counselor is open to taking their feedback into account and that they do have a say in the counseling the youth is receiving.

Working with caregivers around expectanciesCaregiver involvement




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While it is generally helpful to discuss expectancies with the family as a whole, it can be useful to discuss them individually with caregivers and clients in some circumstances, particularly if the client seems to feel coerced into counseling.

Providing separate times to discuss expectancies with caregiver(s) can be a useful relationship-building activity that allots a time to listen and learn from their expert knowledge. This can also be a good time to bring up a discussion of confidentiality.

After discussing what will be shared and how/who will share, a follow-up session with the family all together can ensure that the counselor, the caregiver(s), and the client all have a common understanding of what counseling will entail.

Working with caregivers around expectanciesDiscussing expectancies together and separately




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Congratulations! You have completed the first part of this section.


Second of five sections partially complete




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You are entering the second section (Part II of II).




Clinical Practice Part II: Specific ScenariosCFIT

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In part I, we discussed the general concepts of addressing expectancies and how to operationalize those concepts in practice.

Here in part II, we will demonstrate how to address expectancies using three specific scenarios.

Scenario 1: Caregiver expects that he/she will not have a major role in counseling.

Scenario 2: Client is attending counseling because someone else is “making me go.”

Scenario 3: Counselor has different outcome expectations than client and/or caregiver.




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Before we get started, remember:

All clients meet us with their own expectations and views of what counseling might be like-perhaps they heard stories about “shrinks,” from movies, TV shows, or from friends. This is something we have no control over and yet we have to work with it. Our task is not to change their previous ideas or misconceptions about who or what we are, but to work with them in as respectful, friendly, positive manner as possible so that it is a healing experience for them.




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Scenario 1: Caregiver expects that he/she will not have a major role in counseling—that the youth needs to “be fixed.”

It is normal for a caregiver to think this way, since it is the youth that is displaying problematic behavior, and not the caregiver. In fact, if the difficult youth was “fixed,” life could be much better for the caregiver. Accept this as a perfectly normal and sensible way to look at the situation.

However, the caregiver likely knows the youth better than anyone else and therefore, the caregiver is in an excellent position to be a consultant to the counselor. The counselor should thus invite the caregiver to play such a role.

The counselor might say something like: “Because you know Darrell better than anybody, I would like to ask you to help me out when I work with him, so that we can figure out what to do to help him as soon as possible. Would that be OK with you?”




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Scenario 1: The youth needs to “be fixed.”

If the signal from the caregiver is that he/she strongly objects to being involved in talking with a counselor, then negotiate periodic meetings to update the caregiver on the youth’s progress and to get information from the caregiver about whether what is being tried in counseling is working or not. When the youth’s progress is noticeable, the caregiver will likely be much more willing to be involved and play an active role.

Being respectful of the relationship between the caregiver and the client is very important. Invite the caregiver to joint meetings from time to time in addition to meeting with the caregiver separately “to update” and to “get more information” about the youth.




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Are you guiding or being guided? Uncovering your own biases

The following scenario brings up the issue of ‘agendas’—whose agenda is being met through counseling?

Click on the Reflection Tool for a guided exercise intended to help you reflect on the influence of stereotypes and biases on your expectations of clients and caregivers. You’ll think about the impact of such stereotypes on your own approach to discussing client and caregiver expectancies.

ToolboxTimes3




Reflection Tool

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CFIT Online Learning Center Addressing Expectancies About Counseling Reflection: Are you guiding or being guided? Uncovering your own biases DIRECTIONS: The reflections and reflective exercises are intended to give you some thoughts/questions to think about when you have some quiet time. Take a moment to think about the questions and write out the answers. Reflection:

When a therapist has no investment in changing anybody, looking good as a therapist, or some other personal agenda, [s/he] can be open to [the clients’] reality and allow it to wash over her[him] without prejudice or defense. As Gestalt therapist Fritz Perls once expressed it, [s/he] can be the bull’s-eye the arrow hits every time. With this freedom, [s/he] can follow closely the expression of [the clients’] experience and use this sensitivity to guide [them] precisely where [they] want to go (Johanson & Kurtz, 1991, pg. 30).

Reflective Exercise: We are all influenced by stereotypes—some unique to ourselves and some common to our larger cultures. As much as we might try, no one is immune to stereotypes nor is all-knowing of their own biases. As a counselor, it can be useful to engage in ‘bias unearthing’ activities periodically. Honest reflection is key. Some issues to think about before you even see a client: gender, age, diagnosis, presenting problem, area of town, years in the ‘system’, etc. Think about that moment when you learn you are going to be working with a new client. With each piece of information, what mental images are you forming in your head? What challenges are you anticipating in building the relationship, working together in counseling, terminating successfully? What about the client do you find yourself drawn to, anticipating with pleasure or a sense of familiarity? How are such stereotypes useful to you? How do they limit your ability to truly ‘follow the client’ as stated above?

Johanson, G. & Kurtz, R. (1991). Grace unfolding: Psychotherapy in the spirit of the Tao-te ching. New York: Bell Tower.

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Scenario 2: Client is attending counseling because someone else is “making me go.”

It is quite healthy for teenagers not to want to spend their time talking to a counselor. Rather than worrying about life and death issues, most teenagers should be too busy leading an exciting life, having fun, learning new skills, learning about life, engaging in sports, special hobbies, earning money and so on.




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Scenario 2: Someone else is “making me go.”

Negotiating goals with such youth should be based on their own words. For example, “So, what do you have to do to get your parents off your back?” If this is the way they see themselves, we join with this perspective, and then lead them to achieving what is important to them. This is where the youth’s motivation and energy will be directed, not toward controlling his behavior,” or “becoming a better student.”

Working with youth is very complex because almost everyone who touches his/her life has an agenda both for the youth and the counselor. Negotiating all of these agendas to everyone’s satisfaction will be a challenge and takes time.




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Scenario 3: The counselor has different outcome expectations than the client and/or caregiver, but doesn’t know how to help the client/caregiver focus. The counselor thinks that the family is being unrealistic.

Unfortunately this situation is common, and comes from “expert-driven” thinking; that is, the counselor may believe that he/she knows better than the clients. Of course the agency, the funding body, caregiver, client and other stake holders all have expectations of desired outcomes. However, the actual work that needs to be carried out must be done by the client, caregiver, and other people who are viewed as having problems that “need to be fixed.” Therefore, it is a constant process of negotiation in which a spirit of give and take is a necessary ingredient to create change.




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Scenario 3: Different expectations

Compliance is usually short lived. When people feel they are being demanded to change, they change as little as possible, for as short a period as possible. However, when it is their idea to change, they change as much as possible, for as long as possible. This is human nature and we are not here to change human nature. Some negotiation skills we cover here include:

• Listen for what is important to the person.• Listen carefully for what the person knows how to do.• Listen carefully for who is important to the person.• Listen carefully for what the person is willing to do.• Use scaling questions to help the person assess their own situation.




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Listen for what is important to the client.

This is where the motivation and energy to do something lies. For certain youth, “getting someone off my back,” might be the most important thing, then perhaps getting his high school diploma or going back to school. Therefore, we must listen for what is important and then work with the youth/caregiver to lay out what kind of positive changes this will bring to him/her.

Listen carefully for what the person knows how to do.

These are the resources the person brings into counseling and we need to help the person use this knowledge and skill to help them achieve what is important to them.




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Listen carefully for who is important to the person.

For example, many caregivers become motivated to do what is needed when we remind them about how important their role is for the child, grandchild, friend, or parent who they love very much and are willing to put out effort to make things happen.

Listen carefully for what the person is willing to do.

Once it becomes clear that they have a will to create changes for their loved ones, then the counselor needs to encourage and support this, because making changes is difficult to do. Once it is clear what the person is willing to do, gently remind them of this whenever they become discouraged by a setback or disappointment.




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Use scaling questions to help the person assess their own situation.

It is more useful for the client or caregiver to assess their own situation, rather than having counselor do the assessment and tell them what to do. Scaling questions are useful tools for self-assessment. For example:

“On a scale of 1 to 10, where 10 means you will do just about anything to get the judge (probation officer) off your back, and 1 means it does not make any difference to you, where would you say you are at between 1 and 10?”

“Suppose I ask your best friend where she thinks you are at on the same scale. What number would she say you are at?”


Clinical Practice Part II: Specific Scenarios


CFIT

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Use scaling questions to guide self-assessment.

“What about your parent (probation officer, etc.)—where would he/she say you are at?”

“When you move up 1 point higher on the same scale, what would your parent (best friend, probation officer, judge, teacher, etc.) see you doing that you are not doing right now?”

Scaling questions are an effective tool to use regardless of the content the counselor is looking for. How important, willing, hopeful, confident, safe, and any other concerns and information can be learned through scaling questions.


Clinical Practice Part II: Specific Scenarios


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What can I learn from clients’ and caregivers’ pretreatment expectancies?

Click on the Supervision Tool for a suggested activity to complete with your supervisor. You’ll think back over your cases and consider the pretreatment expectancies brought to the relationship by clients and caregivers. Together with your supervisor, you can process what you learned from these experiences.

ToolboxTimes3




Supervision Tool

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CFIT Online Learning Center Addressing Expectancies About Counseling Supervision: What can I learn from clients’ and caregivers’ pretreatment expectancies? DIRECTIONS: The supervision exercises and questions are intended to give you some guided questions to think about and bring to your supervision session and talk over with your clinical supervisor. Questions for supervision: Think back over your cases and consider the pretreatment expectancies brought to the relationship by clients and caregivers. What role expectancies were challenging (e.g., counselor as ‘advice-giver’)?

What process expectancies seemed to challenge your counseling style (e.g., ‘I won’t talk to you’, or ‘my other therapist played ice hockey with me’ when you don’t play)?

What outcome expectancies seem unrealistic or unattainable (e.g., too short a time for significant progress or ‘being completely fixed.’) What did you learn from these experiences? How can you initiate a discussion about expectancies with this in mind?

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Second of five sections complete




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You are entering the third section.




Bridging ConceptsCFIT

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• What is the evidence that expectancies are important for counselors to address?

• How do client and caregiver expectancies relate to therapeutic alliance?

• How do expectancies correspond to PSC’s core values?



© Vanderbilt University, All rights reservedPage 94

What is the evidence?

In your role as a counselor, it’s important to know that the interventions you use are based on evidence of what works.

Theoretical Foundation

Two theoretical frameworks inform our understanding of client and caregiver expectancies: cognitive dissonance and empowerment theory.

EXPECTANCIES




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THEORETICAL FOUNDATIONS Two theoretical frameworks can provide relevant information for this approach: Cognitive dissonance theory describes situations in which people may experience psychological discomfort (known as cognitive dissonance). In this case, when people realize that they have two mutually incompatible beliefs, values or goals they are required to make cognitive changes including modifications to dysfunctional beliefs, values or goals. When clients begin counseling, they may have divergent expectations from their counselors. When this happens, clients may choose whether to dismiss their counselors’ expectations about counseling or they may choose to adjust their preconceptions so they are more congruent with the counselor’s expectations. This process may also occur for the other involved parties (i.e. counselors and caregivers may also experience cognitive dissonance because of divergent expectations about counseling). Empowerment theory proposes that a person’s ownership of a solution to a problem or a means to an end is as important as the objective quality of the solution. A solution with high objective quality but weak ownership will not be implemented. Client expectancies about counseling represent one component of counseling that clients may affect a client’s ownership of the counseling process. Because addressing client expectancies asserts that clients do have preconceived ideas about counseling that are worth hearing and considering, clients are able to feel heard. This process ensures that clients are more likely to follow through with counseling, by helping them gain ownership over the counseling process from the beginning.

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Evidence Base

Addressing client and counselor expectancies appears to be a promising area for intervention, with an evidence rating of Three Stars. Research shows that addressing expectancies contributes to better outcomes, including positive therapeutic alliance. Going beyond providing a simple brochure seems to be more helpful in preparing families for counseling, such as providing some before verbal preparation prior to beginning treatment.

Click here on evidence base to access a comprehensive review.

What is the evidence?




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EVIDENCE BASE Expectancies about counseling: What works? Evidence rating: what does it mean? The 3 star evidence rating indicates findings from one randomized controlled trial or two or more controlled studies with equivalent client groups. Interpret with caution—many of the studies reviewed lacked methodological rigor.

Few studies used randomization to intervention and control conditions. Few studies adequately used pre-post intervention design (i.e. expectancies

were not always assessed before and after the intervention). What does the research on expectancies suggest? Research suggests that expectancies are potentially important to both the counseling process and counseling outcomes (see Dew & Bickman, 2005 for a review).

Positive outcome expectancies are associated with client improvement. Differences between client and counselor role expectancies may contribute to

attrition from treatment. Studies generally suggest that expectancies predict therapeutic alliance (TA;

Al-Darmaki & Kivlighan, 1993) Positive TA is associated with clear expectations about roles and positive outcome expectancies.

Expectations of improvement and that counseling is useful were associated with clients developing more positive alliances with their therapists (Connolly Gibbons et al., 2003; Joyce & Piper, 1998; Meyer et al., 2002).

Client expectations about their own and their counselor’s roles impact client ratings about TA (Al-Darmaki & Kivlighan, 1993).

Recent evidence indicates that TA mediates the relationship between expectancies and outcome (Meyer et al., 2002).

Interventions to improve client expectancies have included preparation videotapes, audiotapes, and brochures (Tinsley, Bowman & Ray, 1988).

Overall, approximately half of the adult expectancies intervention studies identified cited expectancy change.

Change reportedly occurred in about 86% of the child-focused intervention studies.

Expectancy interventions appear to impact client and caregiver role and outcome expectancies (Dew & Bickman, 2005).

Some studies have focused specifically on expectancy interventions with child and adolescent populations.

Verbal preparation prior to beginning treatment, such as using audiotapes (Bonner & Everett, 1982) or videotapes (Shuman & Shapiro, 2002) contributed to more ‘accurate’ expectations for children and caregivers than no preparation or brochures only.

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Clients and their caregivers who listened to a pretreatment preparation audiotape were found to have more knowledge about therapy and higher outcome expectancies than those children and caregivers who did not receive preparation (Bonner & Everett, 1986).

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References

Al Darmaki, F., & Kivlighan, D. M. (1993). Congruence in client-counselor expectations for relationship and the working alliance. Journal of Counseling Psychology, 40, 379-384.

Bonner, B., & Everett, F. (1982). Influence of client preparation and therapist

prognostic expectations on children's attitudes and expectations of psychotherapy. Journal of Clinical Child Psychology, 11, 202-208.

Bonner, B.L. & Everett, F.L. (1986). Influence of client preparation and problem

severity on attitudes and expectations in child psychotherapy. Professional Psychology: Research and Practice, 17, 223-229.

Connolly Gibbons, M. B., Crits Christoph, P., de la Cruz, C., Barber, J. P., Siqueland,

L., & Gladis, M. (2003). Pretreatment expectations, interpersonal functioning, and symptoms in the prediction of the therapeutic alliance across supportive-expressive psychotherapy and cognitive therapy. Psychotherapy Research, 13, 59-76.

Dew, S.E. & Bickman, L. (2005). Client expectancies about therapy. Mental Health

Services Research, 7, 21-33. Joyce, A. S., & Piper, W. E. (1998). Expectancy, the therapeutic alliance, and

treatment outcome in short-term individual psychotherapy. Journal of Psychotherapy Practice and Research, 7, 236-248.

Meyer, B., Pilkonis, P. A., Krupnick, J. L., Egan, M. K., Simmens, S. J., & Sotsky, S. M.

(2002). Treatment expectancies, patient alliance and outcome: Further analyses from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 70, 1051-1055.

Shuman, A. L., & Shapiro, J. P. (2002). The effects of preparing parents for child

psychotherapy on accuracy of expectations and treatment attendance. Community Mental Health Journal, 38, 3-16.

Tinsley, H.E.A., Bowman, S.L. & Ray, S.B. (1988). Manipulation of expectancies about

counseling and psychotherapy: Review and analysis of expectancy manipulation strategies and results. Journal of Counseling Psychology, 35, 99-108.

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CFIT Online Learning Center EVIDENCE RATING SYSTEM All evidence informing evidence-based practice is not equal. To help you evaluate the strength of the evidence cited, we use a star rating system with a maximum of seven stars for the highest rating of evidence, and one star for the lowest acceptable rating of evidence. The number of stars reflects two factors: evidence quality (the number and quality of studies that provide the evidence) and relevance (the extent to which the evidence relates to similar population and similar problems to those you are likely to be working with. The star rating system is at best a rough guide and you are invited to evaluate the quality and relevance of evidence cited by following up on the references provided. As new studies are being published each week, it is also important to attempt to keep abreast of emerging evidence by using databases such as Medline, Psych Info and Social Work Abstracts. Interpretation of Star Ratings ******* Findings from one or more meta-analyses with equivalent client groups

****** Findings from one or more meta-analyses with related but not equivalent client groups

***** Findings from two or more randomized controlled trials (RCTs) with equivalent client groups

**** Findings from two or more randomized controlled trials with related but not equivalent client groups

*** Findings from one randomized controlled trial or two or more controlled studies with equivalent client groups

** Findings from one randomized controlled trial or two or more controlled studies with related but not equivalent client groups

* Expert consensus or results of uncontrolled studies

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Both expectancies and therapeutic alliance (TA) represent common factors of counseling. While clients have expectations about counseling before ever participating in it, TA cannot develop until counseling begins. Because of this, counselors may focus on or intervene with expectancies and TA at different points in treatment.

How do client and caregiver expectancies relate to therapeutic alliance?




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A client’s or caregiver’s expectations about counseling can predict TA. Because of this relationship, it is likely that interventions focused on expectancies may also impact the therapeutic alliance.

Expectancy interventions that are also alliance building activities:

• Because addressing expectancies promotes a mutual agreement and understanding of counseling early on, addressing expectancies may help promote active collaboration between the client or caregiver and the counselor.

• Having an open conversation about expectancies may help the counselor join with the client or caregiver, which may promote TA.

• Addressing expectancies can serve as a model that counselors are open to challenging discussions, helping clients and caregivers feel more comfortable bringing up difficult issues (such as a problem with the counselor or the work that is happening) in general.

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Although you will typically address expectancies early on, it is important to continue to address expectancies throughout treatment. Common situations that can contribute to therapeutic ruptures include:

• Client or caregiver misunderstandings about expectancies, which may not become apparent until later in treatment. It can be useful to check in periodically to make sure everyone is still on the same page.

• Changing the focus of treatment. For example, initially a counselor might focus on establishing rapport with a client, spending time mostly with the client and caregiver separately. Later, the counselor may decide to spend more time with the client and the caregiver together. At any such transition points, it can be helpful to revisit expectancies.

• Changing expectations about treatment outcomes. It may be your experience that clients and caregivers’ expectations may change as treatment progresses. Or, you may modify treatment goals along the way. Again, these are opportunities to check in about expectations to ensure mutual understanding.

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The training modules included in the CFIT Learning Center support all six of the core values of Providence Service Corporation.

Community- based & multi-

systemic services

Identifying and building on strengths

Respectful organizational

culture

Local viability that is

nationally supported

Best practice models

Cultural diversity

How does addressing expectancies correspond to PSC’s core values?




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In the introductory module, we talked about how ‘common factors’ correspond generally to PSC’s core values. Here, we relate expectancies specifically to the six core values:

Community based and multi-systemic. Expectancies about counseling are based on the client’s perceptions, which are affected by the perceptions of the caregiver and family system, as well as the larger community that the family lives in.

Identifying and building on strengths. Negotiation with clients about their expectancies encourages the development of hopes and positive goals, rather than focusing on pathology or deficits.

Local viability that is nationally supported. Addressing expectancies about counseling is a component of generic counseling that does not rely on highly specialized expertise or intensive training. It can be readily adapted within regions that have few resources and many resources. It also emphasizes awareness of perceptions and beliefs about counseling that may vary from region to region. By addressing expectancies about counseling, the counseling process can proceed more smoothly and efficiently.

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Respectful organizational culture. Focusing on and addressing client expectancies ensures that both counselor and client develop a shared framework for working together. This process is respectful, both of the needs and priorities of the client and the role and function of the counselor.

Best practice models. Addressing client expectancies ensures that both client and counselor are clear about the goals of counseling and share realistic hopes about outcomes. When negotiating expectancies with clients, counselors have reference to client strengths.

Cultural diversity. Addressing expectancies about counseling is based on the idea that different clients and families have different perceptions and beliefs about counseling. These perceptions may be based on popular media, personal experience, experience of others, and/or cultural beliefs. Addressing expectancies allows counselors to understand how clients and families view therapy and how their cultures may influence these expectancies. This knowledge can help counselors understand the roles that clients’ and families’ cultures may play in their counseling experience.

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You are entering the fourth section.



Resources


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We have listed a variety of resources for continued learning including:

• Toolbox Times Three (these are the same practice, reflection, and supervision tools that appeared throughout the module summarized for your convenience)

• Books and Articles (these are great sources of further information on topics related to the module, including clinical manuals where available)

• Cited References (these are references cited throughout the module, including the linked pages)


Resources


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A Work in ProgressYour opinions and experience are vital to the

continued improvement of the CFIT Learning Center. Do you know of a resource not listed here? Do you have a practice, reflection, or supervision tool we might add to the Toolbox Times Three? Or, come back and tell us about your experience using the tools and resources we have listed. Please email us at [email protected].


Resources


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mailto:[email protected]


Resources

Practice Tools

Using your client’s worldview to build relationship

Using the structure of counseling to help support your relationships

Client expectancies about counseling

Supervision Tools

Reflection Tools

ToolboxTimes3

How have your expectations shaped your own experiences with healthcare providers?

Are you guiding or being guided? Uncovering your own biases.

What is my role as a counselor?

Being an observer of the therapeutic process with clients and caregivers

What can I learn from clients’ and caregivers’ pretreatment expectancies?

Click here to open up all the tools in one document for easy printing.


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CFIT Online Learning Center Addressing Expectancies About Counseling Practice Tool: Using your client’s worldview to build relationship Each client enters counseling with a particular way of seeing the world. This worldview is shaped by (among other things) their history, experience, and culture. Pointing out and discussing the client’s worldview can prove helpful by:

• Providing information about how the client sees the world • Letting the client know you are interested in his or her viewpoint • Letting the information acquired guide your work with your client

This discussion may proceed differently, depending on the client’s age and developmental level. For children and/or developmentally delayed clients:

► Introduce discussion as talking about how they see the world ► Use props (e.g. sunglasses with colored lenses) to facilitate: Have client put

on the sunglasses and describe how they see the world wearing glasses, contrast with their view of the world without the glasses- does the world look different through different lenses?

► What “lenses” do they see the world through? ► Connect with how the view life and their experiences- approach to therapy

can be affected by the “lens” they see the world through For teens and/or more mature clients: Utilize key reflective questions to facilitate discussion about their world view

► How do they see the world? ► What “lenses” color their view of their experiences? ► How does the way they see the world affect their approach to counseling?

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CFIT Online Learning Center Addressing Expectancies About Counseling Practice Tool: Using the structure of counseling to help support your relationships The structure of counseling sessions can be very important. Some clients may have very little consistency in their lives. Providing consistency in the structure of counseling can support your relationship with your clients and may help transform session time into a safe space. Here are some areas in which counseling structure may be utilized: 1) Beginning your sessions: By starting sessions in a similar way each time, it can

help provide your client with consistency, cues/reminders about what counseling with you is like, a transition into the session, and can add a sense of ritual or occasion to your time together ► Some ideas for session starters:

A check-in ritual: Start sessions with the same check-in each time 1. What are one good thing and one bad thing that have happened since

last time? 2. What is one thing the client did that he/she is proud of?

Coming up with an agenda: Work with the client (and family) to come up with a plan for the day’s session

Coming up with a reward/reinforcement plan: Come up with a plan for reinforcement for the session (e.g. if we do ____ for __ minutes, then we’ll do ____ for __ minutes)

Doing an activity together: It may be a mindfulness or centering exercise, a visualization, or some other activity

2) Special in-session language: Work with your client to come up with keywords or

codes that are symbolic, that you two share ► Some ideas for using symbolic language:

Use a key word or gesture to indicate the need for a break (e.g. if work is getting too hard, client may use the symbol to take a break)

Use special words or phrases to identify/label difficult thoughts and feelings (e.g. “When ______ shows up, I have a hard time not focusing on that”)

3) Ending your sessions: By ending sessions in a similar way each time, you can

provide your client with consistency, a transition out of session for your client, reinforcement for a job well done, and a sense of ritual or occasion to your time together ► Some ideas for ending sessions:

1

Recapping where you’ve been: Help the client by summarizing and conceptualizing what happened in your session

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Prompts about where you’re headed: Remind the client of where your work is going, including any homework assignments for the client

Doing an activity together: Ending with a mindfulness or centering exercise, a relaxation/visualization exercise, or some other shared activity

Following through on reinforcement plan: This may involve giving praise, sharing a snack, giving a small prize or doing a preferred activity (e.g. games, cards, etc.) for following appropriate behaviors and working hard in-session

2

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CFIT Online Learning Center Addressing Expectancies About Counseling Practice Tool: Client expectancies about counseling Objective: To facilitate the discussion of role, process, and outcome expectancies with youth and their caregivers. Materials Provided: Brief guide and handout Materials Needed: Colored markers, post-it notes, photographs or magazines for collage material. Brief Guide: There are many ways to address youth and caregiver expectancies as you begin your counseling relationship together. Naturally, you’re going to use your own creativity and style to provide education about counseling, promote collaboration, and establish agreement and understanding about how counseling will proceed. The attached handout provides a useful template for discussing several areas related to expectancies about counseling. The box provides an area to write down important notes. To engage the youth and begin establishing rapport, make it a fun activity by using colored markers, colored post-it notes, photographs from the youth’s life, or magazines for collage material. The youth can color in the boxes, draw frames on the boxes, put a picture of himself/herself in the ‘expert’ box, cut out key words from magazines, etc. To really make a project out of it, use butcher paper or poster board to ‘super-size’ it for lots of artwork. Since this represents an agreement between you and the youth about counseling, make a show out of each of you signing and dating the bottom and coming up with a title for what you’ll call the counseling to write at the top. This can be a great document to refer back to as you continue to work together—get it out and add to it when something comes up, especially in those areas where the youth may have had difficulty thinking of responses. To help with this, it could be useful for you to use a different color pen/marker for ideas you generated versus ideas generated by the youth (ideally, you want all the ideas generated by the youth). Some ideas for generating discussion are as follows: Roles

• I’m the expert on me o You know a lot more about what it’s like to be you than anyone else o What are some things you could teach me about you? o What are some things I should know about you?

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2

• How will my counselor help out o Sometimes I’ll give advice but sometimes I need you to teach me o Let’s write down some ways we think I can help out

• How will my caregiver help out o Together, cross out the word caregiver and write in caregiver(s)

name(s) o Generate a list of some ways they will help out in the counseling

process o Try to get an understanding of how the youth wants them to help out

compared to how they think the caregiver(s) will want to help out • Arrows

o Notice the arrows go both ways—it shows that we’re all going to be working together. You’re going to help me and your caregiver understand better and we’re going to help you out as well

Process

• What kinds of things are we going to do together? o Have you seen any movies where somebody is in counseling? What

kinds of things do they do? o What kinds of things have you done with other counselors? o Sometimes we’ll talk, sometimes we’ll do activities (like this one),

sometimes there will be practice during the week between our meetings (lifework)

o What do you understand the word “confidentiality” to mean (to spark discussion of privacy, limits of confidentiality, etc.)

• What are some ways I might feel? o What are some different feelings you’ve had before? o Who can you share that feeling (specific from list) with? o How do you think you’re going to feel in counseling? o What are okay ways to feel in counseling?

• What are some things we’ll do together? o Let’s talk about how long counseling usually lasts (each session,

duration) o What do you think you might learn from counseling? o What do you want counseling to help you with? (help the youth have

reasonable expectations) o Why do you think you’re in counseling?

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3

I’m the expert on me How will my counselor help out?

How will my caregiver help out?

What kinds of things are we going to do together?

What are some ways I might feel?

What’s going to happen because of counseling?

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CFIT Online Learning Center Addressing Expectancies About Counseling Reflection: How have your expectations shaped experiences with health care providers? DIRECTIONS: The reflections and reflective exercises are intended to give you some thoughts/questions to think about when you have some quiet time. Take a moment to think about the questions and write out the answers. How can you use your own experiences with expectations about treatment to become an even better counselor? The following questions are intended to help you reflect on both positive and negative experiences you’ve had in establishing expectations about treatment. Think about how can you build on positive experiences and learn from the negative ones to help you in working with your clients and their caregivers. Recall a time when you were a first meeting a health care provider for a wellness checkup:

As you were traveling to the appointment, what expectations did you have about how things would go? What made you feel nervous or confident about the upcoming visit?

How did the provider introduce him/herself? What did he/she do to make you feel comfortable? What made you uncomfortable? Did you feel heard?

How was confidentiality introduced? Did the office hand you a brochure? Did they also verbally explain it to you? Did they inquire about any questions you might have?

As you were traveling home, did you think the visit went as expected? What would you have preferred was done differently the next time?

How did you previous interactions with health care providers impact your expectations of this visit? Think about both positive and negative interactions.

Recall a time when you had a significant health problem and went to your doctor or a specialist (or even the emergency room) for help:

How did the stress of being sick impact your ability to be confident and in control? How did your expectations of the provider’s role change based on your need for help?

What was your role in determining the course of action in response to being sick? Were you comfortable with your role? Did you feel like you understood your role? How did you discuss your preferences for treatment? Did you feel respected?

What were your expectations about the outcome of treatment? Did you feel comfortable with the way your provider talked with you about outcomes? What didn’t work well about the way your provider talked about outcomes?

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CFIT Online Learning Center Addressing Expectancies About Counseling Reflection: Are you guiding or being guided? Uncovering your own biases DIRECTIONS: The reflections and reflective exercises are intended to give you some thoughts/questions to think about when you have some quiet time. Take a moment to think about the questions and write out the answers. Reflection:

When a therapist has no investment in changing anybody, looking good as a therapist, or some other personal agenda, [s/he] can be open to [the clients’] reality and allow it to wash over her[him] without prejudice or defense. As Gestalt therapist Fritz Perls once expressed it, [s/he] can be the bull’s-eye the arrow hits every time. With this freedom, [s/he] can follow closely the expression of [the clients’] experience and use this sensitivity to guide [them] precisely where [they] want to go (Johanson & Kurtz, 1991, pg. 30).

Reflective Exercise: We are all influenced by stereotypes—some unique to ourselves and some common to our larger cultures. As much as we might try, no one is immune to stereotypes nor is all-knowing of their own biases. As a counselor, it can be useful to engage in ‘bias unearthing’ activities periodically. Honest reflection is key. Some issues to think about before you even see a client: gender, age, diagnosis, presenting problem, area of town, years in the ‘system’, etc. Think about that moment when you learn you are going to be working with a new client. With each piece of information, what mental images are you forming in your head? What challenges are you anticipating in building the relationship, working together in counseling, terminating successfully? What about the client do you find yourself drawn to, anticipating with pleasure or a sense of familiarity? How are such stereotypes useful to you? How do they limit your ability to truly ‘follow the client’ as stated above?

Johanson, G. & Kurtz, R. (1991). Grace unfolding: Psychotherapy in the spirit of the Tao-te ching. New York: Bell Tower.

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CFIT Online Learning Center Addressing Expectancies About Counseling Supervision: What is my role as a counselor? DIRECTIONS: The supervision exercises and questions are intended to give you some guided questions to think about and bring to your supervision session and talk over with your clinical supervisor. Questions for supervision: Counselors share similarities in their educational background, just as engineers or lawyers or any other professionals do. But each of us comes to our work with a unique style, based in part on who we are, but also on our training. Think more deeply about your role and expectations about your role. Questions to bring to supervision are: How do your particular training background and/or style impact who you are and what you do as a counselor?

What issues with clients or caregivers has influenced you to seek additional training?

When you ask yourself, is the client’s treatment need within the scope of my practice, how do you answer that question?

How do you know when it is not within your scope of practice?

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CFIT Online Learning Center Addressing Expectancies About Counseling Supervision: Being an observer of the therapeutic process with clients and caregivers. DIRECTIONS: The supervision exercises and questions are intended to give you some guided questions to think about and bring to your supervision session and talk over with your clinical supervisor. Questions for supervision: As counselors we need to be willing to be impeccable observers of ourselves and others. Therefore, the questions to bring to supervision are: What is it that I have been doing that has brought us to this point in the therapeutic process? For clients who are making great progress? For clients who are making slow or little progress? How does my work with caregivers inform progress?

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CFIT Online Learning Center Addressing Expectancies About Counseling Supervision: What can I learn from clients’ and caregivers’ pretreatment expectancies? DIRECTIONS: The supervision exercises and questions are intended to give you some guided questions to think about and bring to your supervision session and talk over with your clinical supervisor. Questions for supervision: Think back over your cases and consider the pretreatment expectancies brought to the relationship by clients and caregivers. What role expectancies were challenging (e.g., counselor as ‘advice-giver’)?

What process expectancies seemed to challenge your counseling style (e.g., ‘I won’t talk to you’, or ‘my other therapist played ice hockey with me’ when you don’t play)?

What outcome expectancies seem unrealistic or unattainable (e.g., too short a time for significant progress or ‘being completely fixed.’) What did you learn from these experiences? How can you initiate a discussion about expectancies with this in mind?

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Resources

Arnkoff, D.B., Glass, C.R., & Shapiro, S.J. (2002). Expectations and preferences. In J.C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 335-356). London: Oxford Press.

Barich, A.W. (2002). Client expectations about counseling. In G. S. Tryon (Ed.), Counseling based on process research: Applying what we know (pp. 27-65). Boston: Allyn and Bacon.

Dew, S.E. & Bickman, L. (2005). Client expectancies about therapy. Mental Health Services Research, 7, 21-33.

Frank, J.D. & Frank, J.B. (1991). Persuasion and healing: A comparative study of psychotherapy (3rd Ed.). Baltimore: Johns Hopkins Press.

Grencavage, L.M. & Norcross, J.C. (1990). Where are the commonalities among the therapeutic common factors? Professional Psychology: Research and Practice, 21, 372-378.

Kim, B.S.K., Ng, G.F., & Ahn, A.J. (2005). Effects of client expectations for counseling success, client-counselor worldview match, and client adherence to Asian and European American cultural values on counseling process with Asian Americans. Journal of Counseling Psychology, 52, 67-76.

Books and Articles


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Resources

Nock, M. K., & Kazdin, A. E. (2001). Parent expectancies for child therapy: Assessment and relation to participation in treatment. Journal of Child and Family Studies, 10, 155-180.

Rosenthal, D. & Frank, J.D. (1956). Psychotherapy and the placebo effect. Psychological Bulletin, 53, 294-302.

Tinsley, H.E.A., Bowman, S.L. & Ray, S.B. (1988). Manipulation of expectancies about counseling and psychotherapy: Review and analysis of expectancy manipulation strategies and results. Journal of Counseling Psychology, 35, 99-108.

Vogel, D.L., Wester, S.R., Wei, M., & Boysen, G.A. (2005). The role of outcome expectations and attitudes on decisions to seek professional help. Journal of Counseling Psychology, 52, 459-470.

Watkins, C.E. & Terrell, F. (1988). Mistrust level and its effects on counseling expectations in Black clientele counselor relationships: An analogue study. Journal of Counseling Psychology, 35, 194-197.

Books and Articles


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Resources

Cited References

Al Darmaki, F., & Kivlighan, D. M. (1993). Congruence in client-counselor expectations for relationship and the working alliance. Journal of Counseling Psychology, 40, 379-384.

Arnkoff, D.B., Glass, C.R., & Shapiro, S.J. (2002). Expectations and preferences. In J.C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 335-356). London: Oxford Press.

Barich, A.W. (2002). Client expectations about counseling. In G. S. Tryon (Ed.), Counseling based on process research: Applying what we know (pp. 27-65). Boston: Allyn and Bacon.

Bonner, B., & Everett, F. (1982). Influence of client preparation and therapist prognostic expectations on children's attitudes and expectations of psychotherapy. Journal of Clinical Child Psychology, 11, 202-208.

Bonner, B., & Everett, F. (1986). Influence of client preparation and problem severity on attitudes and expectations in child psychotherapy. Professional Psychology: Research and Practice, 17, 223-229.


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Resources

Cited References

Connolly Gibbons, M. B., Crits Christoph, P., de la Cruz, C., Barber, J. P., Siqueland, L., & Gladis, M. (2003). Pretreatment expectations, interpersonal functioning, and symptoms in the prediction of the therapeutic alliance across supportive-expressive psychotherapy and cognitive therapy. Psychotherapy Research, 13, 59-76.

Dew, S.E. & Bickman, L. (2005). Client expectancies about therapy. Mental Health Services Research, 7, 21-33.

Hayes, S.C., Strosahl, K., & Wilson, K.G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. NY: Guilford.

Johanson, G., & Kurtz, R. (1991). Grace unfolding: Psychotherapy in the spirit of the Tao-te ching. NY: Bell Tower.

Joyce, A. S., & Piper, W. E. (1998). Expectancy, the therapeutic alliance, and treatment outcome in short-term individual psychotherapy. Journal of Psychotherapy Practice and Research, 7, 236- 248.


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Resources

Cited References

Lambert, M. J. & Ogles, B. M. (2004). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.). Bergin & Garfield’s Handbook of Psychotherapy and behavior change (5th Ed., pp. 139-193). New York: Wiley.

Meyer, B., Pilkonis, P. A., Krupnick, J. L., Egan, M. K., Simmens, S. J., & Sotsky, S. M. (2002). Treatment expectancies, patient alliance and outcome: Further analyses from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 70, 1051-1055.

Nock, M. K., & Kazdin, A. E. (2001). Parent expectancies for child therapy: Assessment and relation to participation in treatment. Journal of Child and Family Studies, 10, 155-180.

Safran, J.D. & Muran, J.C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. NY: Guilford.

Shuman, A. L., & Shapiro, J. P. (2002). The effects of preparing parents for child psychotherapy on accuracy of expectations and treatment attendance. Community Mental Health Journal, 38, 3-16.


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Resources

Cited References

Snyder, C.R., Michael, S.T., & Cheavens, J.S. (1999). Hope as a psychotherapeutic foundation of common factors, placebos, and expectancies. In M.A. Hubble, B.L. Duncan & S.D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 179-200). Washington DC: American Psychological Association.

Tinsley, H.E.A., Bowman, S.L. & Ray, S.B. (1988). Manipulation of expectancies about counseling and psychotherapy: Review and analysis of expectancy manipulation strategies and results. Journal of Counseling Psychology, 35, 99-108.


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Fourth of five sections complete


Resources


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You are entering the final section.

It should take approximately five minutes to complete.

Module Evaluation



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Your evaluation of this CFIT learning module is vital to continued improvement. Your responses to this brief survey are completely anonymous. Your name and ID number are not linked in any way, so please feel free to answer as completely and honestly as possible.

Click on the link below to complete the survey. Once you’re done, you’ll return to this page.

Module Evaluation

Module Evaluation



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http://www.surveymonkey.com/s.asp?u=802132378606

Congratulations! You have completed this module.

When you leave this page and return to the CFIT Training section of the CareLogic system, don’t forget to take the self-test (only seven questions long) to finish this module.

Last of five sections complete

Module Evaluation



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CFIT Online Learning Center Glossary Cognitive Dissonance: Cognitive dissonance is a psychological phenomenon that occurs when a person realizes the incompatibility or inconsistency between two or more of their attitudes, beliefs or behaviors. For example, if a person states a belief yet his/her behavior is inconsistent with that statement, he/she may experience this type of psychological conflict. Cognitive dissonance may be resolved by either modifying the belief or the behavior. Common Factors: Lambert and Ogles (2004, p. 151) define common factors as “those dimensions of the treatment setting (therapist, therapy, client) that are not specific to any particular technique.” The broad categories that common factors may fall into are: client characteristics, therapist characteristics, change processes, treatment structure and therapeutic relationship. Disembedding: Disembedding refers to the process of disengaging from a communication pattern (e.g., therapeutic alliance rupture). This process includes both the therapist recognizing his or her participation and contribution to this process, and then actively stopping the rupture cycle, often through the technique of metacommunication (see definition below). Goals: Goals represent short-term things that individuals want to achieve. In the context of values, goals are like stops along the way or places you want to visit during life’s journey (Hayes, Strosahl & Wilson, 1999). Goals are things that can be achieved or accomplished- they can be checked off of a list. Goals might be directed toward pursuing life values or may be based on desired counseling outcomes. Lifework: While clients often work with their counselors on developing goals and learning new skills to help achieve these goals, often clients need to practice or work on these counseling-related goals and skills in their everyday lives. Thus, lifework represents tasks and goals set by the counselor and client that will help enhance or facilitate the work that happens in session. Thus, these are tasks the client agrees to undertake between sessions. Metacommunication: Metacommunication is the skill of disengaging from an alliance rupture by talking with the client about the current interaction (Safran & Muran, 2000). This is done by moving the conversation toward a discussion of the rupture interaction in the here-and-now experience. Therapeutic Alliance (TA): TA is commonly regarded as having three components:

a bond between the counselor and the client based on mutual linking, respect, and trust

a set of common goals that provides the framework for the counseling work that is done together

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agreement about the kinds of tasks that will result in these goals being achieved

Therapeutic Rupture: The three components of TA are closely interlinked and a failure in one will usually result in a failure in the others. Even though the counselor and client might have common goals, if the client does not think the counselor is understanding or respectful, she or he will be reluctant to work with the counselor to achieve these goals. These kinds of problems constitute ‘alliance rupture,’ which is sometimes unavoidable in counseling. It is important to recognize and repair it at the earliest opportunity. Values: As described in Hayes, Strosahl & Wilson (1999), values represent desired long-term life directions. Values are like the life’s journey. While people may take steps toward or away from their values, they never achieve or fail at them. In this way, values are like a life path or direction. Different people may place different value on different areas of life and may want different things from those life areas. Common areas of life that people may value include: dating/marriage, education, family, friendships, health, parenting, recreation/fun, and work. References Hayes, S.C., Strosahl, K., & Wilson, K.G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. NY: Guilford. Lambert, M. J. & Ogles, B. M. (2004). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.). Bergin & Garfield’s Handbook of psychotherapy and behavior change (5th Ed., pp. 139-193). New York: Wiley. Safran, J.D. & Muran, J.C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. NY: Guilford.

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Documents

CFIT Online Learning Center - Peabody Collegepeabody.vanderbilt.edu/docs/pdf/cepi/CFIT_Module_3_Expectancies.pdf · status to appear and be updated, and to have access to the self-test