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Relationship between Expectation Management and Client Retention in Online Cognitive Behavioural Therapy
Stuart Ekberg1, Rebecca K Barnes2, David S Kessler2
1Queensland University of Technology,Australia.
Behavioural and Cognitive Psychotherapy
|June 25, 2014
Summary
Therapists who comprehensively managed client expectations at the start of online cognitive behavioural therapy (CBT) for depression saw clients stay in treatment longer. This finding highlights the importance of initial client engagement strategies in online mental health services.
Area of Science:
- Psychology
- Psychiatry
- Digital Health
Background:
- Client engagement is crucial for psychotherapy success.
- Limited research exists on therapists' initial client engagement strategies.
- This study analyzes online cognitive behavioural therapy (CBT) for depression.
Purpose of the Study:
- Develop a system to code expectation management in initial online CBT sessions.
- Evaluate the link between expectation management and client retention.
Main Methods:
- Qualitative conversation analysis identified therapist communication practices.
- Developed a coding scheme for expectation management (no, some, comprehensive).
- Applied the scheme to online CBT trial data with high inter-rater reliability (Kappa = 0.78).
Main Results:
- Comprehensive expectation management was linked to 1.4 more sessions (95% CI: -0.2 to 3.0).
- Sensitivity analysis with 21 additional clients showed a similar association (1.6 sessions, 95% CI: 0.2 to 3.1).
- Results were adjusted for client variables.
Conclusions:
- Expectation management in initial online CBT sessions correlates with client retention.
- Findings have implications for improving professional practice in digital mental health.
- Further prospective research is recommended for precise estimation of retention effects.
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