Influence of client preparation and problem severity on attitudes and expectations in child psychotherapy.

Abstract

The purpose of this study was to assess the effects of client preparation and problem severity on children's and parents' understanding, attitudes, and expectations of child psychotherapy. Thirty-eight children with one of their parents served as subjects. Half of the children and parents received preparation information, and the other half were not prepared. Following preparation versus no-preparation procedures, children and parents completed questionnaires assessing problem severity, knowledge of and attraction to therapy, and prognostic expectations. Therapists rated problem severity and expectations for treatment outcome. Preparation increased children's and parents' knowledge of therapy, attraction-receptivity to therapists and treatment, and expectations for therapy outcome. Children and parents were found to be quite attracted and receptive to psychotherapy and to have very positive expectations for treatment outcome. The study's findings further indicated that therapists saw the children's problems as more severe and had lower prognostic expectations than did children and parents. No relation was found between problem severity and attraction-receptivity to treatment or expectations for treatment outcome.Current research in psychotherapy outcome is revealing psychotherapy to be a multidimensional process with a multidetermined outcome. The major determinants of successful psychotherapy are presently thought to lie in the characteristics of the client, the therapist, and the client-BARBARA L. BONNER received her doctorate in clinical psychology from Oklahoma State University in 1984. She is presently serving a 2-year postdoctoral fellowship in pediatric psychology and adolescent medicine at the University of Oklahoma Health Sciences Center. Dr. Bonner's current research interests are child psychotherapy outcome and the treatment and prevention of child sexual abuse.

Validation and Use of the Youth and Caregiver Treatment Outcome Expectations Scale (TOES) to Assess the Relationships Between Expectations, Pretreatment Characteristics, and Outcomes

“…Of the three previous studies that assessed youth and caregiver expectations, only one explicitly assessed outcome expectations. Bonner and Everett (1986) found that youth (aged 6-12) and caregiver outcome expectations were similar, and reported no significant differences between the two. While youth may, in part, base their expectations about treatment on information they obtain from their caregivers, this seems more likely to be the case for younger children who may not have acquired information about mental health treatment from other sources, such as their own experiences, the media, peers, or other individuals.…”

“…Additionally, research has found that youth age relates to both youth (e.g., Waas and Anderson 1991) and caregiver outcome expectations for youth treatment (Nock and Kazdin 2001), with more positive expectations associated with younger youth. However, other research failed to replicate this relationship (e.g., Bonner and Everett 1986). Prior research also concluded that the mental health of caregivers impacts their outcome expectations for their youths' mental health treatment.…”

“…When both informants' expectations are measured, the results are mixed. For example, one study found a small, positive relationship between youth and caregiver expectations (Day and Reznikoff 1980b) whereas another study found no such relationship (Bonner and Everett 1986). These results indicate youth and caregivers do not necessarily share the same expectations.…”

Parent Management of Attendance and Adherence in Child and Adolescent Therapy: A Conceptual and Empirical Review

“…Bonner and Everett (1986) reported that parents and children randomly assigned to a condition receiving an audiotape description of what to expect in therapy (i.e., roles, outcomes, structure, and content) reported increased knowledge of therapy, higher receptivity of therapy, and more favorable outcome expectancies than those assigned to a control condition who heard only a brief introduction audiotape. This study supports the usefulness of therapy preparation strategies for changing parent and child perceptions of therapy; however, the rates of subsequent therapy participation were not reported, limiting the inferences that can be drawn about the actual efficacy of this approach.…”

Investigating Adherence Promoters in Evidence-Based Mental Health Interventions with Children and Adolescents

“…Concrete promoters are direct tangible goods or services that facilitate participation or address recognizable obstacles, such as providing travel expenses, food, or child care, and scheduling service delivery at convenient times or locations (Burns et al 2008;Miranda et al 2003). Finally, motivational enhancement interventions influence clients' positive expectations for treatment (Bonner and Everett 1986;Katz et al 2004;McKay et al 2004;Miller and Rollnick 2002;Nock and Kazdin 2005;Steinberg et al 2004). Examples include pre-treatment motivational enhancement interviewing, ongoing therapeutic strategies such as problem solving and encouragement, and the use of financial or other incentives to encourage treatment participation.…”