Common Factors: Client Expectations

What Are Common Factors?

Common factors are important factors or ingredients that make therapy and the therapist effective based on research.

These factors can be incorporated into any therapeutic treatment approach/model/framework.

Why Managing Client Expectations Is Important

  • Clients often come to therapy during moments of distress

  • Thus, they often feel pressured and overwhelmed, after attempting other methods of coping with their concerns

  • The therapist should instill hope there is possibility for something new and that the current life situation can be resolved or decreased

  • Clients’ expectations must be managed

    • Some clients come to treatment with a medical based framework (deficit based to get rid of symptoms entirely)

    • Some clients want to see instant results quickly in 1-2 sessions

    • Some clients expect the therapist to give them advice or tell them what to do

    • Some clients have never been to therapy before and have no idea what to expect during treatment

    • And more

  • Therapists cannot promise to get rid of symptoms entirely due to ethical reasons. Often times, this is not possible due to the complexity of mental health, but can be decreased and managed.

  • If expectations are not managed, this can lead to conflicts, disagreements, and ruptures

Questions To Reflect On

  • How do I manage client expectations?

  • What are my own feelings and thoughts when clients have expectations of me that may or may not align with my own worldviews/expectations?

  • What are my own expectations of therapy and the therapist if I attend my own personal therapy?

  • How has my expectations of therapy changed throughout the years if I attend my own personal therapy? Has it?

  • How do I work with clients presenting with high anxiety symptoms? How do I help them regulate their anxiety before discussing expectations?

  • Am I an anxious person? What tends to activates my anxiety? What helps soothe my anxiety?

  • How do I manage my own anxiety as a therapist?

  • What are my own wounds/past experiences/counter transference around client expectations? Am I aware of this? Have I had individuals close to me historically expect things from me in terms of what I can provide them or help them with?

  • How do I offer clients hope?

  • And more

Statements And Questions You Can Try Out

  • Expectations can be managed through outlining your role as the therapist such as

    • Providing thorough education on symptoms

    • Providing education on the therapeutic process and what is possible and not possible

    • Providing a written and verbal treatment plan

    • Answering client questions

    • And more

  • Provide education on the client role such as

    • Attending sessions consistently

    • Coming into sessions with topics to discuss

    • Providing both negative and positive feedback to tailor treatment

    • Completing homework or assignments outside of therapy

    • Practicing self management skills outside of session

    • And more

  • Validating the client’s concerns

  • Reassuring the client

  • Normalizing the client’s concerns

  • Build and work on building a strong therapeutic alliance and develop this skill

  • Establish a strong therapeutic rapport and develop this skill

  • Repairing ruptures or disagreements in the moment as they occur

  • Asking where their ideas/stories/beliefs/expectations of therapy come from (context)

  • Ask what worked in therapy prior and what did not work. Continue doing what works and do not do what did not work previously.

  • Ask what their best hopes are for therapy

  • Create collaborative client goals for treatment. Work with the client as therapy is a dual process requiring effort from both individuals.

  • Provide psychoeducation on the therapeutic process and what they can expect

  • Providing clients a diagnosis if they seek one or if it would help their treatment

  • Provide clients with a treatment plan

  • Ask clients regularly if they understand what you are talking about so you two are on the same page and if not, clarify for them

  • Ask clients for feedback regularly verbally and/or through researched based methods to measure outcomes (PHQ-9, GAD-7, etc.)

  • And more

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Common Factors: The Therapist & Genuineness

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Common Factors: The Client