Expectancy, the therapeutic alliance, and treatment outcome in short-term individual psychotherapy

Patient and therapist expectancies regarding the "typical session" were measured during a controlled trial of short-term, time-limited individual psychotherapy. Relationships between expectancy ratings and measures of the therapeutic alliance and treatment outcome were examined. Significant relationships were tested in the presence of a competing predictor variable, either pre-therapy disturbance (depression) or the patient's quality of object relations (QOR). Expectancies were associated strongly with the alliance but only moderately with treatment outcome. In most instances, expectancy and QOR combined in an additive fashion to account for variation in alliance or outcome. The patient's capacity for mature relationships and expectancies for therapy appear to be important determinants of treatment process and outcome. The clinical value of establishing accurate, moderate expectancies prior to therapy is considered.