While patients believe that psychotherapy is an effective tool for eliciting positive changes in one’s thoughts or beliefs, according to study findings published today in The American Journal of Psychotherapy, those same patients have less confidence that these mechanisms of change will work for them—especially patients with extensive prior experience with psychotherapy.Why It’s Relevant
Patient expectations are known to significantly influence psychotherapy success. However, most research in this area has focused on outcomes: Will this therapy work? Less is known about treatment expectations: How does psychotherapy work, and what is my role?
By the Numbers
- Researchers surveyed 270 adults (ages 18 to 70) currently engaged in psychotherapy about seven processes believed to facilitate positive change, such as sharing sensitive content with the therapist and learning cognitive tools. Participants first rated how important these processes were in general and then their importance in their own therapy.
- Across all seven processes, general expectations that the process facilitates change were higher than personal expectations.
- The largest gap was for the belief that “therapy provides tools for cognitive control,” which had a general rating of 5.04 (on a scale of one to seven) and a personal rating of 4.47. The smallest gap was for the need to “establish a positive therapist-client relationship,” which had a 4.77 general rating and a 4.55 personal rating.
- Personal expectations for change were lower among patients with 2.5 or more years of experience with psychotherapy compared with those with less or no psychotherapy history.
The Other Side
The researchers acknowledged that providing all participants with the general assessment first followed shortly by the personal assessment may have influenced responses (e.g., participants may have been more fatigued or intentionally did not want to provide the same answers). The participants were also 90% women, and most had 12+ years of education, which limits the generalizability of results.
Takeaway Message
“These findings highlight the importance of strong, personalized efforts to instill confidence in a treatment’s likely effectiveness for patients, especially for certain change processes,” the researchers wrote.
Related Information
Source
Todaya Asor, et al. Patients’ general versus personal expectations about psychotherapy change processes. American Journal of Psychotherapy. Published September 28, 2026. doi:10.1176/appi.psychotherapy.20250079
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