Nonspecific, unintended, and serendipitous effects in psychotherapy.

Abstract

It is important for psychologists to consider the social context in which therapy takes place, as it reveals a plethora of factors that can account for the effects of treatment. These factors are frequently neglected in theoretical formulations about therapeutic procedure and efficacy. They include expectations of change, effects of labeling oneself a patient, reactions of significant others, the regulating effects of the therapeutic structure, unspoken beliefs about the therapist, inadvertent role modeling, and the influence of nonprofessional members of the therapeutic milieu. Recognition of nonspecific effects can help psychologists more accurately understand their clients' progress.Because of my interest in the social context in the pathogenesis and treatment of emotional disorder, I have taken note of a number of nonspecific effects of psychotherapy. These have become apparent to me in my work with individuals and families over the past 30 years. It occurred to me that other psychologists might have overlooked these effects. Since much of my experience has been with child and family therapy, some of my observations will pertain to that type of work. However, the principle of examining the social context for unexpected treatment effects can be more generally applied. In medical terminology, these influences are often classified under the rubric of side effects, which are usually considered deleterious, and placebo effects, which, in spite of some recent renewed respectability (Kirsch, 1990), are still considered to be for the most part uncontrolled and unscientific. These and other nonspecific effects are sources of psychotherapeutic effectiveness and are available for systematic utilization by psychologists who are aware of them.The topics to be covered include some that are familiar in traditional clinical lore-for example, expectancy effects, readiness for change, playing the role of patient, self-sacrifice, and the therapist as a symbol. Others are extrapolations of frequently used notions, such as the importance of the relationship and the inter-LAWRENCH M. PERLMAN received his PhD in clinical psychology from New

College Counseling Center Clients' Expectations About Counseling: How They Relate to Depression, Hopelessness, and Actual‐Ideal Self‐Discrepancies

“…Because expectations relate to how long clients stay in counseling, how satisfied they are with counseling, and how much and how rapidly they improve, it is important to understand clients' expectations when they enter and progress in counseling. If a counselor does not understand a client's expectations, the counselor may work at cross-purposes to the client (Perlman, 2001). Understanding clients' expectations is important so counselors can assess whether their expectations are similar to their clients' expectations.…”