Relationship between expectation management and client retention in online cognitive behavioural therapy
Background: Engaging clients from the outset of psychotherapy is important for therapeutic success. However, there is little research evaluating therapists’ initial attempts to engage clients in the therapeutic process. This article reports retrospective analysis of data from a trial of online cogni...
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| Format: | Article |
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Cambridge University Press
2015
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| Online Access: | https://eprints.nottingham.ac.uk/44876/ |
| _version_ | 1848797018084868096 |
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| author | Ekberg, Stuart Barnes, Rebecca Kessler, David Mirza, Selman Montgomery, Alan A. Malpass, Alice Shaw, Alison |
| author_facet | Ekberg, Stuart Barnes, Rebecca Kessler, David Mirza, Selman Montgomery, Alan A. Malpass, Alice Shaw, Alison |
| author_sort | Ekberg, Stuart |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background: Engaging clients from the outset of psychotherapy is important for therapeutic success. However, there is little research evaluating therapists’ initial attempts to engage clients in the therapeutic process. This article reports retrospective analysis of data from a trial of online cognitive behavioural therapy (CBT) for depression. Qualitative and quantitative methods were used to evaluate how therapists manage clients’ expectations at the outset of therapy and its relationship with client retention in the therapeutic intervention. Aims: To develop a system to codify expectation management in initial sessions of online CBT and evaluate its relationship with retention. Method: Initial qualitative research using conversation analysis identified three communication practices used by therapists at the start of first sessions: no expectation management, some expectation management, and comprehensive expectation management. These findings were developed into a coding scheme that enabled substantial inter-rater agreement (weighted Kappa = 0.78; 95% CI: 0.52 to 0.94) and was applied to all trial data. Results: Adjusting for a range of client variables, primary analysis of data from 147 clients found comprehensive expectation management was associated with clients remaining in therapy for 1.4 sessions longer than those who received no expectation management (95% CI: -0.2 to 3.0). This finding was supported by a sensitivity analysis including an additional 21 clients (1.6 sessions, 95% CI: 0.2 to 3.1). Conclusions: Using a combination of qualitative and quantitative methods, this study suggests a relationship between expectation management and client retention in online CBT for depression, which has implications for professional practice. A larger prospective study would enable a more precise estimate of retention. |
| first_indexed | 2025-11-14T19:57:12Z |
| format | Article |
| id | nottingham-44876 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:57:12Z |
| publishDate | 2015 |
| publisher | Cambridge University Press |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-448762020-05-04T20:06:22Z https://eprints.nottingham.ac.uk/44876/ Relationship between expectation management and client retention in online cognitive behavioural therapy Ekberg, Stuart Barnes, Rebecca Kessler, David Mirza, Selman Montgomery, Alan A. Malpass, Alice Shaw, Alison Background: Engaging clients from the outset of psychotherapy is important for therapeutic success. However, there is little research evaluating therapists’ initial attempts to engage clients in the therapeutic process. This article reports retrospective analysis of data from a trial of online cognitive behavioural therapy (CBT) for depression. Qualitative and quantitative methods were used to evaluate how therapists manage clients’ expectations at the outset of therapy and its relationship with client retention in the therapeutic intervention. Aims: To develop a system to codify expectation management in initial sessions of online CBT and evaluate its relationship with retention. Method: Initial qualitative research using conversation analysis identified three communication practices used by therapists at the start of first sessions: no expectation management, some expectation management, and comprehensive expectation management. These findings were developed into a coding scheme that enabled substantial inter-rater agreement (weighted Kappa = 0.78; 95% CI: 0.52 to 0.94) and was applied to all trial data. Results: Adjusting for a range of client variables, primary analysis of data from 147 clients found comprehensive expectation management was associated with clients remaining in therapy for 1.4 sessions longer than those who received no expectation management (95% CI: -0.2 to 3.0). This finding was supported by a sensitivity analysis including an additional 21 clients (1.6 sessions, 95% CI: 0.2 to 3.1). Conclusions: Using a combination of qualitative and quantitative methods, this study suggests a relationship between expectation management and client retention in online CBT for depression, which has implications for professional practice. A larger prospective study would enable a more precise estimate of retention. Cambridge University Press 2015-11 Article NonPeerReviewed Ekberg, Stuart, Barnes, Rebecca, Kessler, David, Mirza, Selman, Montgomery, Alan A., Malpass, Alice and Shaw, Alison (2015) Relationship between expectation management and client retention in online cognitive behavioural therapy. Behavioural and Cognitive Psychotherapy, 43 (6). pp. 732-743. ISSN 1469-1833 expectation management initial session cognitive behavioural therapy (CBT) conversation analysis psychotherapy process outcome https://www.cambridge.org/core/journals/behavioural-and-cognitive-psychotherapy/article/relationship-between-expectation-management-and-client-retention-in-online-cognitive-behavioural-therapy/FF2E6377B889451EA8E4B6F39CED2428 doi:10.1017/S1352465814000241 doi:10.1017/S1352465814000241 |
| spellingShingle | expectation management initial session cognitive behavioural therapy (CBT) conversation analysis psychotherapy process outcome Ekberg, Stuart Barnes, Rebecca Kessler, David Mirza, Selman Montgomery, Alan A. Malpass, Alice Shaw, Alison Relationship between expectation management and client retention in online cognitive behavioural therapy |
| title | Relationship between expectation management and client retention in online cognitive behavioural therapy |
| title_full | Relationship between expectation management and client retention in online cognitive behavioural therapy |
| title_fullStr | Relationship between expectation management and client retention in online cognitive behavioural therapy |
| title_full_unstemmed | Relationship between expectation management and client retention in online cognitive behavioural therapy |
| title_short | Relationship between expectation management and client retention in online cognitive behavioural therapy |
| title_sort | relationship between expectation management and client retention in online cognitive behavioural therapy |
| topic | expectation management initial session cognitive behavioural therapy (CBT) conversation analysis psychotherapy process outcome |
| url | https://eprints.nottingham.ac.uk/44876/ https://eprints.nottingham.ac.uk/44876/ https://eprints.nottingham.ac.uk/44876/ |