Expectations and preferences

Client expectations and preferences have been thought by many to influence the client's willingness to engage in and be influenced by the therapist and the process of therapy. Definitions and methods of assessment are presented of clients' expectancy for therapeutic gain; expectations about the roles they and their therapists will play; and their preferences for therapy roles, type of psychotherapy, and demographic features of the therapist. Included is a review of the empirical evidence based on 76 studies of the relation between client expectations and preferences, on the one hand, and the outcome of psychotherapy, on the other hand. Clients' expectations for therapeutic gain are related to outcome in most studies, although no causal conclusions can be drawn. The literature on role expectations is equivocal, and the relatively few studies on client preferences yield primarily negative or mixed results. Finally, specific implications for therapeutic practices are discussed.