A comprehensive review was undertaken of investigations in which an attempt was made to manipulate clients' expectations for counseling or psychotherapy. Six strategies that have been used in attempting expectancy manipulation were described, and their effectiveness evaluated. Three sets of conclusions seem to be supported by the present data. First, the use of a complicated experimental intervention to manipulate expectancies seems to be both unnecessary and unfruitful. Audiotaped and videotaped interventions are most likely to be effective. Verbal interventions have typically been ineffective and the effectiveness of printed documents is in doubt. Second, experience in actual counseling sessions may have an effect on clients' expectancies, but it is unclear whether the changes observed are a function of counseling or are due to some interaction involving the confounding factors that previous investigators have failed to eliminate. Third, identification of the specific conditions under which these expectancy manipulation strategies will produce expectancy changes requires further research. Finally, recurring methodological shortcoming are examined and suggestions for future research are offered.
Background
The mental health impact of the pandemic after the initial lockdowns has not been well studied in the USA. Thus, the purpose of this study was to conduct a comprehensive and systematic national assessment of the prevalence of depression and anxiety in the adult US population.
Methods
A multi-item, valid and reliable questionnaire was deployed online via mTurk and social media sites to recruit adult US participants in the general population across the USA. A total of 1978 individuals participated in the study, where the majority were: females (51%), whites (74%), non-Hispanic (81%), married (56%), employed full time (68%) and with a bachelor’s degree or higher (78%).
Results
The prevalence of depression (39%), anxiety (42%) and psychological distress (39%) were computed from the PHQ-4 scale. In multiple regression analyses, depression, anxiety and psychological distress burden (assessed by PHQ-4 scale) was predicted significantly based on race, ethnicity, age, having children at home, employment as a healthcare worker, annual household income and area of residence. Males were more likely to have depression, and females were more likely to have anxiety symptoms.
Conclusions
Given the high prevalence of depression and anxiety, interdisciplinary and multisectoral approaches are recommended in the USA along with population-based interventions on mental health improvement.
Counseling psychologists working in practice settings were surveyed regarding their perceptions of the occurrence and effects of their clients' unrealistic expectations about counseling. A majority perceived some of their clients as having unrealistically high expectations about the need for concreteness; the likelihood of counselor nurturance, directiveness, and empathy; and the probability of a beneficial outcome. Most responded that some of their clients have unrealistically low expectations about the need for immediacy, motivation, openness, and responsibility, and the likelihood of confrontation. Psychologists view most unrealistic expectations as having a detrimental effect on counseling. Exceptions that can have a facilitative effect on counseling are unrealistically high client expectations about the needs to be motivated and open and to assume personal responsibility and unrealistically low expectations for counselor directiveness.
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