The interplay of clients' role expectations with working alliance: A multilevel analysis

Research on clients' psychotherapy expectations has predominantly focused on the associations of clients' role expectations with working alliance and psychotherapy outcomes. However, limited research has examined their moderating role in multilevel alliance-outcome associations. Utilizing naturalistic data from a Chinese training clinic (6,400 observations nested within 1,016 clients and 176 therapists), the present study conducted multilevel analyses to examine the moderation effects of clients' role expectations, including expectations about client involvement, counselor expertise, and facilitative conditions, on between- and within-client alliance-outcome associations. Results provided little evidence that these expectations moderated the between-client alliance-outcome association. At the within-client level, the alliance-outcome association was stronger when clients held higher expectations regarding client involvement (β = -.16, 95% credible interval [-.35, .02], one-tailed Bayesian p = .043) and counselor expertise (β = -.19, 95% credible interval [-.38, -.00], one-tailed Bayesian p = .022). The interaction involving facilitative conditions was also in the same direction but weaker (β = -.13, 95% credible interval [-.32, .05], one-tailed Bayesian p = .077). These findings shed light on the interplay between clients' treatment expectations and a key process variable, clarifying when alliance improvement is associated with clinical benefit. (PsycInfo Database Record (c) 2026 APA, all rights reserved).