Patient-Therapist Congruence and Incongruence of Process Expectations During Psychotherapy

Recent studies suggest that patient-therapist congruence of expectations affects psychotherapy outcome. Nonetheless, most studies assessing expectations in their dyadic context have focused on outcome expectations. This study was aimed to assess whether patients and therapists view expected processes similarly, and whether these beliefs change over time to become more congruent or more dissimilar. Patients (N = 75) were assessed for process expectations at baseline and at 3 months into treatment, and their therapists (N = 17) reported on their general expectations only once, prior to the initiation of treatment. Multilevel models were fitted to assess differences between patients' and therapists' process expectations at baseline and after 3 months and changes in level of congruence. The results indicated that at baseline, therapists perceived the processing of therapist-patient relations as the expected therapeutic process, whereas patients viewed the provision of tools of cognitive control as such. No significant changes in patients' expectations after 3 months of treatment were detected; however, therapists' higher expectations of the provision of tools for cognitive control predicted increases in patients' rankings of this process. These results suggest that patients and therapists are incongruent in their views of the expected therapeutic process, and that therapists' initial views of the therapeutic process affect patients' beliefs. These findings highlight the importance of investigating process expectations in the dyadic context and set the stage for subsequent process-outcome demonstrations, focusing on the effect of patient-therapist congruence of process expectations as a potential predictor or mediator of psychotherapy outcomes. Clinical Impact Statement Question: Do patients' beliefs about the mechanisms creating therapeutic change differ from those of their therapists, and do these views change throughout therapy to become more congruent with their therapists' views or, alternatively, more dissimilar? Findings: Patients' and therapists' process expectations were incongruent at the beginning of therapy and remained incongruent at 3 months into treatment. Nonetheless, changes in patients' perceptions of the therapeutic process during the first 3 months of treatment were associated with their therapists' initial views. Meaning: Therapists should be aware of potential differences in beliefs and perceptions about the therapeutic process, as these g