Distinct positive and negative dimensions of psychotherapy treatment expectations across three independent samples

Treatment expectations are central to psychotherapy outcomes but are typically assessed as a unidimensional construct focusing on anticipated improvement. This study investigated whether expectations of improvement, worsening, and side effects, as measured by the Generic Rating Scale for Previous Treatment Experiences, Treatment Expectations, and Treatment Effects (GEEE), represent distinct dimensions in psychotherapy. We examined three samples differing in treatment context and symptom burden: patients currently in psychotherapy (N = 102), prescreened patients awaiting psychotherapy (N = 83), and a community sample of former psychotherapy patients who reported current mental health problems (N = 219). Across all groups, expectations of improvement were distinct from expectations of worsening and side effects, whereas the latter two showed moderate overlap. Improvement expectations correlated strongly with the Credibility/Expectancy Questionnaire (CEQ), while worsening and side effect expectations did not, indicating discriminant validity. In the psychotherapy sample, depressive symptoms were negatively associated with improvement expectations and positively with worsening and side effect expectations. The findings support the GEEE as a brief and multidimensional tool that extends beyond existing measures by capturing both positive and negative facets of treatment expectations. Differentiating these domains may help identify patients at risk of disengagement and inform tailored interventions to foster more adaptive expectation profiles in psychotherapy.