Client expectation about counseling, working alliance, and symptom outcome: A longitudinal investigation in China

Abstract

Objective: The aim of this longitudinal study was investigating how specific dimensions of client expectations about counseling relate to the initial level and subsequent trajectory of the working alliance and symptom change in psychotherapy conducted by Chinese beginning therapist trainees. Methods: Participants included 173 Chinese therapist trainees and their 1,916 clients. At intake, clients completed a measure (Anderson, T., Patterson, C. L., McClintock, A. S., & Song, X. [2013]. Factorial and predictive validity of the Expectations About Counseling-Brief (EAC-B) with clients seeking counseling. Journal of Counseling Psychology, 60(4), 496-507. https://doi.org/10.1037/a0034222) assessing their expectations about counseling along three dimensions: Client Involvement, Counselor Expertise, and Facilitative Conditions. Before every session, clients reported their symptom severity level; after every session, both therapists and clients reported their perceived strength of the working alliance. Results: Multilevel modeling results showed that (1) clients with higher initial symptom levels showed lower expectations on Client Involvement (B = -.586, SE = .292, p = .045) but higher expectations on Counselor Expertise (B = .992, SE = .231, p < .001); (2) clients with higher initial working alliance ratings showed higher expectations on Client Involvement (B = .162, SE = .039, p < .001) and Facilitative Conditions (B = .152, SE = .033, p < .001); and (3) clients with higher expectations on Counselor Expertise appeared to show a greater average decrease in symptom level (i.e., greater improvement in therapy) over the course of therapy (B = -.060, SE = .024, p = .011). Conclusion: The findings confirms that client expectations, particularly for counselor expertise, are both a product of initial clinical factors and a predictor of therapeutic success. Conceptual and clinical implications, especially with regard to the Chinese cultural context, are discussed.

Keywords: Chinese cultural context; client expectation about counseling; client symptom outcome; multilevel modeling; working alliance.