Are patient expectations still relevant for psychotherapy process and outcome

Two studies examined parents' pre-treatment expectancies for their child's psychotherapy among children (N = 405, ages 2–15) referred for oppositional, aggressive, and antisocial behavior. Study I focused on the development of a measure to assess expectancies. The results indicated that the measure was internally consistent. Moreover, socioeconomic disadvantage and ethnic minority status, severity of child dysfunction, child age, and parental stress and depression were significant predictors of lower parent expectancies for child therapy. Study II examined the relation of parent expectancies and participation in therapy. The results indicated that parent expectancies predicted subsequent barriers to treatment participation, treatment attendance, and premature termination from therapy. Overall, these findings have implications for the study of expectancies for therapy, for identifying families at risk for premature termination from treatment, and for the development of interventions designed to increase parent participation in child therapy.

Parent expectancies for child therapy: Assessment and relation to participation in treatment.

Parental engagement in the treatment process is influenced by parents' beliefs about the cause of their children's problems, perceptions about their ability to handle such problems, and expectations about the ability of therapy to help them. This paper examines the role of parental cognitions related to attributions and expectations in relation to engagement in child mental health treatment. Reviewed studies indicate that parental attributions and expectations influence three aspects of treatment: help seeking, engagement and retention, and outcome. This paper integrates findings from developmental and clinical research, highlights gaps in the literature, presents the beginnings of a model regarding the parental attributional process as it relates to engagement in treatment, recommends future research directions, and discusses clinical implications.

Engagement in child and adolescent treatment: the role of parental cognitions and attributions.

Parent training (PT) programs have been found to reduce some behavioral impairment associated with children's attention deficit hyperactivity disorder (ADHD) as well as improve parenting competence, but poor uptake and participation by parents are formidable barriers that affect service effectiveness. We used a discrete-choice experiment (DCE) to examine how parent preferences for treatment format (i.e., group vs. individual) might influence their participation in PT. Participants were 445 parents seeking mental health services for children with elevated symptoms of ADHD in Ontario, Canada. Parents completed a DCE composed of 30 choice tasks used to gauge PT format preference. Results showed that 58.7% of parents preferred individual PT; these parents were most interested in interventions that would make them feel more informed about their child's problems and in understanding-as opposed to solving-their child's problems. A minority of parents (19.4%) preferred group PT; these parents were most interested in active, skill-building services that would help them solve their child's problems. About one fifth of parents (21.9%) preferred the Minimal Information alternative (i.e., receiving neither individual or group PT); these parents reported the highest levels of depression and the most severe mental health problems in their child. Results highlight the importance of considering parent preferences for format and suggest that alternative formats to standard PT should be considered for multiply stressed families.

Examining Parents' Preferences for Group and Individual Parent Training for Children with ADHD Symptoms.

Interviews carried out with 22 Bangladeshi families who were clients of the Child & Family Consultation Service revealed that congruence in problem definition between family and therapist was linked with good outcome as rated by the family. The stated preference of most families was for a Bangladeshi professional to work with them, and this request has now been implemented. Shared meanings about the purpose and style of therapy are clearly relevant when working with ethnic minority groups.

Charlotte Burck

Papers

A Study of Families' Expectations and Experiences of a Child Guidance Clinic