Client expectations and pretreatment attrition at a community mental health center

Abstract

The aim of this study was to contribute to the literature on the relationship between client pretreatment expectations and psychotherapy attendance. It investigated the construct validity of the Milwaukee Psychotherapy Expectancy Questionnaire - Brief (MPEQ-B; Marsden, 2014) and the value of Therapeutic Relationship Expectations and Change Expectations as predictors of intake attendance and the number of therapy sessions attended. Adult clients (n = 102) calling to schedule an intake appointment at a local community mental health center completed a survey of pre-treatment expectations (MPEQ-B) and psychological distress (Outcome Rating Scale, Miller & Duncan, 2000). Other variables (e.g., wait-time, previous therapy experience, number of sessions attended, and demographic variables) were collected from the clients' electronic medical record (EMR). Confirmatory factor analysis of the MPEQ-B supported a two-factor model, which was consistent with previous research (Marsden, 2013; 2014). Logistic regression revealed that client Change Expectations was the only variable to uniquely predict intake attendance. Pre-therapy attrition was more likely for clients with higher ratings of Change Expectations. Multiple regression results indicated that only previous therapy attendance was a statistically significant predictor of number of sessions attended. Overall, these findings advance the literature on client expectations as a multidimensional common factor related to client therapy attendance (intake session and total number of sessions attended). These results also highlight the need for programmatic research using the Milwaukee Psychotherapy Expectancy Questionnaire (MPEQ; Norberg, Wetterneck, Sass, & Kanter, 2011) and MPEQ-B, as well as measures of other types of client expectations, to better understand the influence of client expectations on a range of clinical variables.