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Identity Negotiation in Psychotherapy: The Influence

of Diagnostic and Rapport-building Strategies on the

Effects of Clinical Expectations

JONATHAN TANDOS ARTHUR A. STUKAS

La Trobe University, Bundoora, Victoria, Australia

In therapy, the expectations or hypotheses that therapists have of their clients, and the therapeutic strategies they employ with them, could influence identity negotiation processes. In the current study, 38 postgraduate therapist trainees interacted with 72 undergraduate clients in audiotaped counseling sessions. Therapists were led to expect that their clients were depressed or were given no expectation, and were asked to employ either diagnosis or rapport building with their clients. Therapists with expectations of client depression elicited similar levels of depressed behavior in their clients during diagnosis and rapport building as well as when they had no expectation and diagnosed their clients. Therapists focused on rapport building without an expectation elicited significantly less depressed behavior from their clients. Both applied and theoretical implications are discussed.

Keywords: Self-fulfilling prophecies; Self-verification; Diagnosis; Rapport- building; Therapy.

Counseling interactions involve a very large and complex information-processing task for therapists (Heppner & Krauskoff, 1988), in which it may not be feasible to attend to all of the available information about a client while performing other cognitive tasks (Turk & Salovey, 1985, 1986). Therefore, in the early stages of therapy, therapists may rely on information that helps them to form quick impressions of clients to guide their interactions with them, such as referral reports, a client’s initial presentation, or generalizations from other clients with similar symptoms or backgrounds (e.g., Snyder & Thomsen, 1988). This top-down (rather than bottom-up) approach may create certain risks, if faulty information is utilized to develop expectations of a client. The effects of such initial expectations on clients’ behavior are of central concern in this study.

Received 23 November 2007; accepted 14 April 2009; first published online 27 June 2009.

This research was supported by a grant from the Australian Research Council to Art Stukas. This

research was conducted as part of Jonathan Tandos’s doctoral thesis, submitted to La Trobe University.

We thank Jennifer Boldero, Marc Kiviniemi, and Stephanie Madon for their comments on the thesis

and Anthony Lyons, Mark Snyder, and the Social Psychology Unit at La Trobe University for their

support and counsel. Three anonymous reviewers and the editor offered feedback that improved this

article.

Correspondence should be addressed to: Art Stukas, School of Psychological Science, La Trobe

University, Bundoora, Victoria 3086, Australia. E-mail: A. [email protected]

Self and Identity, 9: 241–256, 2010

http://www.psypress.com/sai

ISSN: 1529-8868 print/1529-8876 online

DOI: 10.1080/15298860902979331

� 2009 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business

Behavioral Confirmation

Studies of impression formation and management have shown that the expectations that people hold about others can guide their perception and treatment of those others (e.g., Hilton & Darley, 1991; Snyder & Stukas, 1999). Moreover, such expectations can influence others’ behavior, resulting in a self-fulfilling prophecy in which ‘‘targets’’ provide behavioral confirmation of the expectations held about them (by ‘‘perceivers’’) through their own actions (Snyder & Swann, 1978a, 1978b; Snyder, Tanke, & Berscheid, 1977). Behavioral confirmation is often accompanied by perceptual confirmation; the perceivers’ sense that targets have confirmed their expectations (Chen & Bargh, 1997; Copeland & Snyder, 1995), and sometimes by changes in targets’ subsequent self-perceptions (Fazio, Effrein, & Falender, 1981; Harris, 1990; Snyder & Swann, 1978b).

In the therapeutic context, clients might be led by therapists to act in ways that confirm therapists’ expectations or hypotheses of them, even when such behavior is atypical of clients. This could be because therapists may tend to form quick expectations of their clients based on referral reports, initial impressions, or from similarities to clients they have seen previously (Snyder & Thomsen, 1988), rather than attend to more individuating information. Therapists are also granted greater power than their clients in therapy by virtue of possessing more information about clients than clients have of them (i.e., informational power; French & Raven, 1959), and by being perceived as expert by their clients (i.e., expert power; French & Raven), which may set the stage for behavioral confirmation of therapist expectations by clients (see Copeland, 1994; Harris, Lightner, & Manolis, 1998). Such an outcome could have important and potentially detrimental implications for both assessment and therapy, if therapists hold erroneous expectations of clients (see Harris, 1994; Snyder & Thomsen, 1988).

Self-verification

However, the way clients behave in therapy may not always be the result of their reactions to a therapist’s expectation-driven prompts or appraisals. Clients may see themselves in ways that are contrary to a therapist’s impressions of them, and they may be motivated to ensure that their therapist sees them as they see themselves. The tendency for people to validate their self-views by eliciting self-confirming feedback from others has been termed self-verification (Swann, 1983). Self-verification theorists contend that targets strive to confirm their self-conceptions out of a desire to boost perceptions of predictability and control in their own worlds. These theorists also assert that people will seek to confirm their self-views even if these views are negative, as for example, with individuals who are depressed (Swann, Wenzlaff, Krull, & Pelham, 1992a; Swann, Wenzlaff, & Tafarodi, 1992b). Depressed clients may prefer their therapists to perceive them as depressed to support their self- views, and even resist therapist efforts towards positive self-concept change (see McNulty & Swann, 1991).

Identity Negotiation

To consider the effects of both behavioral confirmation and self-verification in social relationships, these processes have been investigated within a single framework focused on identity negotiation (McNulty & Swann, 1994; Swann, 1987). According

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to this perspective, one person’s expectancy-confirming overtures and another person’s self-verification strivings may interact in a process of mutual influence. In a clinical context, therapists may engage in confirmatory hypothesis-testing at the same time as clients engage in self-verification strivings, resulting in the ‘‘negotia- tion’’ of the client’s identity in the interaction. There are several possible outcomes from such an identity negotiation. First, therapists may dominate and lead clients to behave in a manner that confirms their expectations (Snyder & Thomsen, 1988). Second, clients may dominate and elicit feedback from therapists that is consistent with clients’ self-views (Swann & Ely, 1984). Third, therapists may be reluctant to abandon their initial expectancies and clients may be resistant to changing their self- conceptions (Major, Cozzarelli, Testa, & McFarlin, 1988). A fourth possibility is that behavioral confirmation and self-verification could occur simultaneously, resulting in a process of mutual influence whereby therapists’ impressions become similar to client self-conceptions and vice versa (Madon et al., 2001; McNulty & Swann, 1994). We know of no previous identity negotiation studies in therapy that address these possibilities. In this study, we focused on how important therapist factors (specifically, the strategies used in therapeutic interactions) may influence client behavior, therapist perceptions of clients, and client self-perceptions in therapy.

Therapeutic Strategy as a Moderator

Previous research focused on the motivational foundations of behavioral confirma- tion (Snyder, 1992) suggested that therapist motives may be important moderators of identity negotiation outcomes in therapy. Specifically, Snyder and Haugen (1994) found that when perceivers were randomly assigned to acquire a stable and predictable impression of the target (i.e., knowledge function motive), they tended to elicit behavioral confirmation from targets, possibly due to directing the interaction more, thereby soliciting information from targets to confirm their expectations. In contrast, when perceivers were assigned to ensure a smooth and coordinated interaction with the target (i.e., social-adjustive function motive), they did not elicit behavioral confirmation, perhaps due to directing the interaction less and being more open to target contributions.

These perceiver motives have clear counterparts in the clinical context. Within most theoretical orientations used in therapy, there are two strategies generally considered necessary in the initial stages of therapy (Burke, 1989): assessment or diagnosis (akin to the knowledge function), and rapport-building (akin to the social- adjustive function). Copeland and Snyder (1995) investigated the effects of these therapeutic strategies in a student analog study of a counseling interaction, using expectations of introversion and extraversion. They predicted that diagnostic concerns may promote information-seeking strategies that test therapists’ working hypotheses of clients, but prohibit clients from fully expressing themselves. In contrast, rapport-building concerns may help therapists to get along with clients and clients to feel comfortable to express themselves. As predicted, Copeland and Snyder found that diagnostic strategies led to both perceptual and behavioral confirmation of expectations, whereas rapport-building strategies did not.

However, further research provides a contrasting view of the effects of perceiver motives on identity negotiation outcomes. Leyens, Dardenne, and Fiske (1998) randomly assigned perceivers to interview candidates (expected to be either introverted or extraverted) for a job by pursuing either an information-seeking goal

Identity Negotiation in Psychotherapy 243

(akin to the knowledge function or diagnosis) or an empathy-generating goal (akin to the social-adjustive function or rapport-building).

1 Perceivers selected questions

to ask targets from a list that included questions that matched (or did not match) their expectations. Under an empathy-generating goal, interviewers selected a higher proportion of matching questions than non-matching questions compared to interviewers under an information-seeking goal. Matching questions, when they are phrased to ‘‘lead’’ targets in a congruent direction, have been shown to elicit behavioral confirmation of expectations (Snyder & Swann, 1978a). Leyens et al. (1998) suggested that such questions, although selected less frequently than open- ended questions, can demonstrate to an interaction partner that one understands them, thus boosting empathy but also potentially eliciting behavioral confirmation. And, leading questions are actually chosen more frequently once perceivers feel they have gathered behavioral evidence from targets that suggests that initial expectations may be correct (Leyens, 1989).

In summary, past research provides competing hypotheses about the effects of diagnostic and rapport-building strategies on identity negotiation outcomes. Copeland and Snyder’s (1995) findings suggest that the use of diagnostic (knowledge function) strategies is more likely to elicit behavioral confirmation from targets than the use of rapport-building (social-adjustive) strategies. In contrast, Leyens et al.’s (1998) findings suggest that that the use of rapport-building (empathy-generating) strategies may be more likely to favor client behavioral confirmation in therapy, compared to the use of diagnostic or information-seeking strategies. Whether the absence of therapist strategies that promote behavioral confirmation can leave the door open to clients to engage in successful self-verification attempts is unknown.

The Current Study

Overall, this study had two main aims. The first was to investigate the extent to which clinically-relevant therapist expectations contribute to how clients behave in therapy, how therapists subsequently view their clients’ behavior, and how clients see themselves. We hypothesized that when therapists expected their clients to be depressed, clients would behave in a more depressed manner, therapists would view their clients as more depressed, and clients would see themselves as acting in a more depressed fashion than when therapists were not given any information about their clients. When therapists were given no information, we predicted that clients would have a greater opportunity to verify their non-depressed self-concepts (as only non- depressed targets were recruited).

The second aim was to test competing predictions in the literature by examining whether therapists’ motivations either to diagnose or to build rapport with their clients moderate the effects of therapists’ expectations on client behaviors, therapists’ impressions of clients, and clients’ self-impressions in therapy. That is, we expected that the effects of therapist expectation (depressed versus no expectation) may be greater depending on the motive employed by the therapist. A pattern of findings suggesting that diagnostically-motivated therapists elicit greater behavioral con- firmation (and correspondingly less self-verification) than rapport-motivated therapists would support previous research by Copeland and Snyder (1995). Conversely, findings indicating that rapport-motivated therapists elicit greater behavioral confirmation (and less self-verification) than diagnostically-motivated therapists would support research by Leyens and colleagues (Leyens, 1989: Leyens et al., 1998). In this regard, our results should help to determine whether diagnostic

244 J. Tandos & A. A. Stukas

motives or rapport-building motives are more or less likely to contribute to confirmation or self-verification effects.

Method

Participants

Undergraduate students (61 female, 11 male; median age¼19 years; age range, 17– 42 years), who had agreed to be contacted for psychological research studies, served as client participants, and were informed that they could discuss a real issue of their choice with a therapist in an experiment investigating communication processes in counseling. Prior to their interactions, all clients were assessed as non-depressed using our Depression Questionnaire (a composite of other well-known measures; see materials section) as within the non-depressed range (i.e., below the midpoint on the 7-point scale).

2

Postgraduate students (35 female, 3 male; median age¼28.5; age range, 21–55 years) were recruited to participate as therapists and informed that they would be trialing the use of different therapeutic strategies with clients in first counseling sessions. Therapist participants were enrolled in masters or doctoral courses in clinical psychology (n¼10), counseling psychology (n¼10), health psychology (n¼7), clinical neuropsychology (n¼4), and child, adolescent and family psychology (n¼4). Three therapists did not indicate their course stream. The mean duration of previous face-to-face counseling experience was 25.82 months (SD¼44.50, median 11 months, range 0–240 months). Therapist participants were matched with client participants according to their availability for scheduling.

Materials

Depression questionnaire. Clients, therapists, and objective coders used a 27-item semantic differential scale to describe clients’ behavior in the interaction (as in previous studies; Snyder & Swann, 1978a; Stukas & Snyder, 2002). The items broadly tapped depression versus non-depression (e.g., dejected vs. cheerful; gloomy vs. jolly). Items were drawn from the Depression Adjective Check Lists (Lubin, 1967), the Multiple Affect Adjective Check List (Zuckerman & Lubin, 1965), the Profile of Mood States (McNair, Lorr, & Droppleman, 1971) and the Semantic Differential Feeling and Mood Scale (Lorr & Wunderlich, 1988). Our new scale, adapted so all items were responded to on 7-point scales (with some reverse scored), was internally consistent: across therapists, clients, and raters, all Cronbach’s as 4 .90. Scale scores were created by averaging the items (so that higher scores indicated greater depression).

Design

The design was a 2 6 2 mixed between/within-subjects design, with Therapist Expectation (depressed expectation vs. no expectation) as the between-subjects factor and Therapeutic Strategy (diagnostic strategy vs. rapport-building strategy) as the within-subjects factor. Therapists used a different strategy in each of two interactions with separate clients who were either both described as depressed, or neither of whom were described as depressed. Therapist strategy was selected as the

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within-subjects variable to maximize the degree to which therapists acted differently with clients in each of the two interactions. All but four therapists interacted with two clients and the order of strategy used in the interactions was counterbalanced.

Procedure

Before the interaction, clients and therapists provided demographic details and clients completed the Depression Questionnaire to obtain their overall self- impressions. Both were separately instructed to treat their interaction as though it were a real counseling session. Most therapists participated in two experimental interactions consecutively, with a break of 20–30 minutes between sessions. Before each 15-minute interaction, therapists were also given information to read about their client (expectation manipulation), and instructions to employ a particular strategy with the client (strategy manipulation).

Expectation manipulation. All therapists were provided with clients’ real demographic information. Therapists in the no-expectation conditions were told that no further information was available. Therapists in the depressed-expectation conditions were given a profile sheet that contained a clinical impression, ostensibly from a trained clinical member of staff in the psychology department, about the client’s mood (e.g., appeared despondent, or unmotivated/miserable) and behavior (e.g., frequently looked down at the floor, or tone of voice slow and hesitant), and a Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) score of either 21 or 22, ‘‘indicating the possibility that the client is moderately depressed’’. Finally, the profile sheets noted that the information contained was confidential and should not be discussed with the client or anyone else. Two parallel profiles were created and their order was counterbalanced across therapists.

Strategy manipulation. In the diagnosis condition, therapists were instructed to focus on ‘‘assessment of clients’’, to ‘‘gather information to accurately diagnose’’ their client. In the rapport condition, therapists were instructed to focus on the ‘‘building of rapport’’, to ‘‘communicate empathy with’’ their client. All therapists were asked not to reveal their assigned goals to clients and to forego other methods (or combined methods) in lieu of these goals. Therapists in the diagnosis condition were also instructed that they would write a brief assessment report of their client, however they were never actually required to do so.

Clients were then introduced to their therapist by the experimenter, who arranged the recording equipment and left the client and therapist to have their 15-minute face-to-face interaction. After the interaction, participants were moved to different rooms to complete the Depression Questionnaire, with therapists rating clients and clients rating their own behavior in the interaction. Therapists also completed two 7- point Likert items to indicate how much they used diagnostic and rapport-building strategies (i.e., manipulation checks). Both participants were separately debriefed by the experimenter.

Two female independent coders who were blind to the experimental conditions and aims and hypotheses of the study evaluated client behaviors from audiotapes of the experimental sessions using the Depression Questionnaire. Training and practice sessions were provided and then coders evaluated interactions separately. Once all interactions were rated by the two coders, ratings were averaged together. Inter-rater reliability between the two coders was acceptable (R¼ .74).

246 J. Tandos & A. A. Stukas

Results

Therapist Strategy Manipulation Checks

Therapists answered two 7-point Likert-type questions after each experimental session that tapped the extent to which they attempted to diagnose or to build rapport with their clients. For the diagnosis item (‘‘To what extent did you try to diagnose your client?’’), a within-subjects ANOVA revealed a significant main effect for therapist instruction, F(1, 34)¼72.02, p 5 .001, Z2¼ .69, such that therapists instructed to diagnose their clients (M¼5.35, SD¼1.37) reported that they tried to diagnose much more than therapists instructed to build rapport with their clients (M¼2.44, SD¼1.44). A similar within-subjects ANOVA on the rapport item (‘‘To what extent did you try to generate rapport and empathy with your client?’’) also revealed a significant main effect for therapist instruction, F(1, 34)¼16.63, p 5 .001, Z2¼ .34, such that therapists instructed to build rapport with their clients (M¼6.06, SD¼0.78) reported trying to generate rapport more than therapists instructed to diagnose their clients (M¼4.97, SD¼1.34). These analyses suggest that the strategy manipulations were successful.

3

Perhaps because therapists did make an effort to act differently when instructed to use different therapeutic strategies, we found that, despite the fact that pairs of clients saw the same therapist, data from our rapport and diagnosis conditions were statistically independent. Following Kenny, Kashy, and Cook’s (2006) instructions for one-with-many designs with distinguishable partners (pp. 269–270), our levels of non-independence were: for coders r¼ .22 (p¼ .21), for therapists r¼ .25 (p¼ .14), and for clients r¼ .10 (p¼ .59); therefore we treated our data as independent in the following analyses.

4

Confirmation Effects

To shed light on the extent to which therapist strategy moderated the effects of expectation on outcomes, such that clients came to act, look, and consider themselves to be more depressed (i.e., behavioral and perceptual confirmation) or less depressed in the interactions, separate analyses were conducted with each of the three main outcome measures. Descriptive statistics are shown in Table 1.

Client behavior. We entered coders’ ratings of client depressed behavior into a 2 (Expectation: depressed vs. none) 6 2 (Strategy: diagnosis vs. rapport) ANOVA with clients’ own pre-interaction ratings as a covariate, to demonstrate whether our experimental conditions led clients to change their behavior above and beyond their predispositions to act according to how they typically see themselves. This analysis revealed no main effects of either Expectation or Strategy (Fs 5 2), however, there was a significant Expectation by Strategy interaction, F(1, 67)¼4.16, p¼ .045, Z2¼ .05 (see Figure 1 for a graphical representation). Follow-up simple main effects tests (still controlling for the covariate) indicated that our randomly assigned expectation had a significant effect only in the rapport conditions, such that clients were rated as acting in a more depressed fashion when therapists were given the depressed expectation (M¼4.09, SD¼0.60) than when they were not (M¼3.71, SD¼0.36), t(68)¼2.22, p¼ .03. In the diagnosis conditions, clients were rated similarly in the depressed expectation (M¼3.96, SD¼0.51) and no expectation (M¼4.02, SD¼0.49) conditions, t(68)¼0.69, p¼ .49. These results suggest that behavioral confirmation may be more likely when therapists act to create rapport

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with their clients rather than seek to diagnose them. However, the overall pattern of means reveals that clients acted in the least depressed fashion in the no-expectation condition with therapists seeking to build rapport, as demonstrated by a post hoc contrast comparing this condition to the three other conditions, t(68)¼1.97, p¼ .05. We discuss potential interpretations of this pattern below. In addition, it is worth noting that clients’ pre-interaction ratings, our covariate, also had a significant effect on coders’ ratings of clients’ behavior in the interaction, F(1, 67)¼11.39, p¼ .001, Z2¼ .13; therefore, our clients generally remained true to their own self-conceptions during the interaction.

Therapist perceptions. We entered therapists’ ratings of client depressed behavior into a 2 (Expectation: depressed vs. none) 6 2 (Strategy: diagnosis vs. rapport) ANOVA, revealing a significant main effect of Expectation, F(1, 68)¼4.46, p¼ .038, Z2¼ .06, such that therapists provided with a depressed expectation (M¼3.83, SD¼0.77) rated their clients as more depressed than therapists provided with no expectation (M¼3.43, SD¼0.85). There was no significant main effect for Strategy and no significant two-way interaction (Fs 5 2). However, this main effect of expectation does not allow us to clearly distinguish whether therapists’ perceptions are accurate (because therapists acting on the expectation elicited depressed behavior from clients) or distorted by the lens of the assigned expectation, seeing depressed behavior when it isn’t really there. Therefore, we conducted the ANOVA a second time, with coders’ objective ratings of clients’ behavior as a covariate, to control for

TABLE 1 Descriptive Statistics for Client Pre-interaction, Client Post-interaction, Therapist and Averaged Coder Ratings According to Experimental Condition

Condition

Rater Expectation Strategy Mean SD

Client pre Depressed Diagnosis 3.08 0.71 No Diagnosis 2.94 0.66 Depressed Rapport 2.86 0.69 No Rapport 2.75 0.43

Total: 2.91 0.62 Client post Depressed Diagnosis 3.27 0.57

No Diagnosis 3.10 0.66 Depressed Rapport 3.06 0.93 No Rapport 2.98 0.70

Total: 3.10 0.72 Therapist Depressed Diagnosis 3.82 0.75

No Diagnosis 3.63 0.92 Depressed Rapport 3.84 0.80 No Rapport 3.23 0.75

Total: 3.63 0.81 Coder Depressed Diagnosis 3.96 0.51

No Diagnosis 4.02 0.49 Depressed Rapport 4.09 0.60 No Rapport 3.71 0.36

Total: 3.95 0.49

248 J. Tandos & A. A. Stukas

actual differences in client behavior. In this analysis, there were no significant effects, with the expectation main effect now non-significant, F(1, 68)¼2.61, p¼ .11, Z2¼ .02, due to the significant relation between coders’ ratings of clients and therapists’ ratings of clients, F(1, 68)¼32.47, p 5 .001, Z2¼ .30. This suggests that therapists were largely accurate in their perceptions.

Client self-perceptions. To explore whether clients’ perceptions of their behavior during the therapeutic interaction differed from their pre-interaction self-ratings, and whether clients in certain experimental conditions indicated greater changes, we conducted a 2 (Expectation: depressed vs. none) 6 2 (Strategy: diagnosis vs. rapport) 6 2 (Time: client pre-test vs. post-test) repeated-measures ANOVA. This analysis revealed no significant main or interaction effects for our manipulated variables (Expectation and Strategy; Fs 5 2) and no interactions between these variables and changes in clients’ self-reports over time. However, there was a significant main effect for Time, F(1, 68)¼5.89, p¼ .02, partial Z2¼ .08, such that, compared to their pre-test self-concept (M¼2.91, SD¼0.63), clients tended to rate their subsequent behavior in the interaction as more depressed (M¼3.10, SD¼0.72), regardless of the condition to which they were allocated.

Self-verification Effects

To examine whether clients were able to bring therapists to see them as they saw themselves (i.e., succeed in their self-verification efforts), we used hierarchical

FIGURE 1 Mean coder ratings of client depression as a function of therapist expectation and strategy, with bars depicting 95% confidence intervals.

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regression analyses to determine whether clients’ own pre-interaction self-ratings influenced therapists’ perceptions of clients above and beyond the influence of our experimental conditions. We entered our dummy-coded expectation and strategy variables on the first step in the analysis, their interaction term on the second step, and clients’ pre-interaction self-concept ratings on the third and final step. This analysis yielded only the significant main effect of Expectation (discussed earlier; b¼ .25) on the first step. When entered on the final step, clients’ pre-interaction ratings were not a significant predictor of therapists’ perceptions, b¼ .17, t(67)¼1.43, p¼ .16. This suggests that any efforts clients may have demonstrated to act according to how they saw themselves at the start of the study were not sufficiently strong enough to overwhelm the effects of our experimental manipula- tions on therapist perceptions.

Perhaps, however, clients’ attempts to self-verify were not powerful enough to overcome the misdirection provided by our expectation instructions for therapists (at least in the rapport conditions). In this case, self-verification attempts might be more readily perceptible to our objective raters. Therefore, to provide another test of self- verification strivings (if not exactly self-verification success), we again performed an hierarchical regression analysis to test whether clients’ pre-interaction self-ratings had an influence on our coders’ ratings of clients’ behavior while controlling for the effects of our experimental manipulations. We entered our dummy-coded expectation and strategy variables on the first step in the analysis, their interaction term on the second step, and clients’ pre-interaction self-concept ratings on the third and final step. This analysis yielded the significant interaction term (discussed earlier; b¼7.22) on the second step, and, when entered on the final step, clients’ pre-interaction ratings were found to be a significant predictor of coders’ ratings of clients behavior, b¼ .37, t(67)¼3.38, p¼ .001. Therefore, although not exactly a clear demonstration of self- verification, there is some evidence that clients were acting consistently with their earlier self-perceptions despite also being influenced both by the general change over time experienced on average by all clients and by the specific effects of the experimental manipulations, apparent most clearly in the rapport conditions.

Discussion

The focus of the current study was to examine the effects of therapist expectations and therapist strategies on the identity negotiation process in the initial stages of therapy. In particular, we sought to investigate the possible moderation of expectation effects by therapeutic strategy, and to clarify which of the competing predictions from the literature was better supported. Copeland and Snyder (1995) found that diagnostic motives (rather than rapport motives) led perceivers to elicit behavioral confirmation of their expectations, whereas Leyens et al. (1998) found that rapport motives (rather than diagnostic motives) led perceivers to choose questions that might increase the likelihood of confirmation.

The results from our objective raters seem to support Leyens et al. (and Leyens, 1989) by demonstrating that therapists pursuing a rapport-building goal led clients to act significantly more depressed when a depressed expectation was included in their instructions than when it was not. Therapists pursuing a diagnostic goal did not elicit different behavior from clients expected to be depressed or in the no-expectation condition. However, clients in both diagnosis conditions (with and without an expectation) and the rapport condition with an expectation of depression all received similar ratings of depressed behavior from our raters. This suggests

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either that attempts to diagnose in the ‘‘no expectation’’ condition may have also led to increased depressed behavior in clients or that attempts to build rapport in the absence of an expectation resulted in greater opportunities for clients to demonstrate non-depressed behavior.

Typically, in behavioral confirmation research (see Snyder & Stukas, 1999), no-expectation conditions are not used because perceivers’ ‘‘default’’ expectations may come into play. Without knowing otherwise, perceivers may assume that targets are happy and normal, thus making it difficult to show experimental effects of positive expectations when a no-expectation condition is used as a comparison. For this reason, opposing expectations are typically used (e.g., extraversion–introversion; Copeland & Snyder, 1995) rather than no-expectation conditions. However, the opposing expectation for client depression (i.e., that clients are happy and adjusted) lacks ecological validity in the therapeutic setting (i.e., therapists rarely encounter a client referred to them because of happiness!), thus making a no-expectation condition a more suitable choice for comparison in the current study.

In retrospect, however, such a condition may also be problematic. Whereas the default expectation in social interaction might be that the target is happy, a therapist’s default expectation for a client may be negative. Indeed, the default expectation may even be that the client could be depressed, given that depression is generally believed to be the most common presenting problem in therapy (Greist & Jefferson, 1992). Furthermore, the probability of therapists adopting a default negative expectation may be increased if their task is to diagnose their client, since the act of diagnosis itself might prompt therapists to search for clinically relevant information or evidence of psychopathology in their clients. It could be that diagnosis does increase the likelihood of behavioral confirmation (in keeping with Copeland & Snyder, 1995; and in contrast to Leyens et al., 1998), but that in our study, diagnostically motivated therapists who were not given an expectation generated their own negative/depressed expectation to test. If this happened, our operationalization of the no-expectation condition may not have been effective when paired with diagnosis instructions, resulting in no differences in client behavior between the expectation and no-expectation conditions, with clients in each showing higher levels of depression.

In contrast, a different pattern of results was observed between expectation and no-expectation conditions when therapists were instructed to build rapport with their clients. Rapport motivated therapists with no expectation led their clients to display less depressed behavior than in other conditions. Perhaps these therapists simply discarded attempts to diagnose their clients (as confirmed by our manipulation check) and, instead, aimed for an easy-going and comfortable interaction with their clients with no reference to clinical concerns, eliciting more typical, undepressed behavior from them. If this is the case, then the dip in (perceived and actual) depressed behavior in this condition would not be representative of what may really happen during therapy, when real clinical concerns may be unavoidable.

However, it is possible that rapport building strategies do lead to increases in clients’ confirmatory behavior when therapists have a preconceived expectation compared to when they do not (e.g., in the absence of referral information or when a client might initially seem well-adjusted in a first session). When rapport-motivated therapists have a preconceived expectation, their efforts to build rapport may inevitably focus on the expectation, perhaps in an attempt to show clients that they do understand them, which may constrain and influence client responses in an expectation-confirming direction. Rapport-motivated therapists without an

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expectation may focus solely on having a smooth and comfortable interaction with their clients without anchoring their efforts to a particular identity for the client. They may also be less inclined to actively test clinically relevant hypotheses (requiring the generation of negative expectations, if none are available) about their clients (the hallmarks of a diagnostic strategy). Under these conditions, therapists may also more readily notice behavioral evidence that clients are not depressed, leading to the elicitation of further non-depressed behavior.

Therapists with a depressed expectation were also predicted to perceive their clients as more depressed, as compared to therapists with no expectation. Again, this effect was expected to be moderated by therapeutic strategy. However, when we controlled for real differences in client behavior (our coders’ ratings), we found that what appeared to be a significant main effect of our manipulated expectation in the predicted direction (i.e., perceptual confirmation) became non-significant. This suggests that, rather than therapist perceptions being distorted in the direction of their expectations, therapists actually perceived their clients’ behavior accurately, registering those differences in client behavior that may have resulted from their own expectation-influenced behavior towards their clients.

When we turned to examine self-verification, we found a non-significant effect of client pre-interaction self-concepts on therapist perceptions, after controlling for the effects of our experimental manipulations. Therefore, it seems that clients were not able to obtain a self-verifying outcome, namely not able to bring therapists to see them as they (originally) saw themselves. Nonetheless, further analyses using coder ratings of actual client behavior as a dependent variable suggested that clients may have engaged in some degree of self-verification striving, or at least acted consistently with their original self-concepts, even with therapists who held erroneous expectations about them. However, our previous behavioral confirmation analysis of coder ratings suggests that an expectation effect still influenced client behavior above and beyond the effect of their self-views when therapists had rapport-building goals. In this study, we did not assess individual differences in client self-verification motives (influenced by personality variables, confidence in their self-views, or reasons for attending therapy), which may produce significant variability in attempts to act consistently with past self-views, and investigation of these potential moderators would be a useful addition to future research.

In general, and in keeping with other identity negotiation studies (McNulty & Swann, 1994; Madon et al., 2001), it therefore appears that clients’ self-concepts and therapists’ expectations both seem to influence behavior, rather than one triumphing at the expense of the other (cf. Swann & Ely, 1984). However, our results did not show the process of mutual influence often found in these other identity negotiation studies. Just as client self-concepts did not strongly influence therapist perceptions, clients’ perceptions of their own behavior in the interaction were not influenced by therapists’ expectations (or the strategies they used). Despite coders’ ratings of behavioral differences, it may have been too much to expect that self-perceptions also would change as a function of therapist expectation or strategy after only one short interaction. Indeed, in previous behavioral confirmation studies, changes in target self-perceptions have not always accompanied actual behavioral confirmation (Judice & Neuberg, 1998; Vorauer & Miller, 1997). Nonetheless, on average, clients rated their behavior in the interaction as more depressed than their pre-tested self- perceptions, regardless of the condition to which they were allocated. Phenomen- ologically, the experience of engaging in therapy and discussing one’s difficulties may evoke a certain level of depression or distress in most clients; that is, the effect may be

252 J. Tandos & A. A. Stukas

due to the therapeutic context itself and the ways in which it primes certain self- perceptions on the part of clients (see Snyder & Stukas, 2007, for an elaboration of this argument). Perhaps this could make clients more likely to be induced to confirm negative expectations in therapy than targets in other contexts (e.g., classrooms, parties, etc.), although whether this eventually leads to client self-concept change as a result of repeated interactions is a question for future research.

Our study provides the first empirical investigation of the effects of therapist expectations and strategies in the therapeutic context from an identity negotiation framework (building on work by Copeland & Snyder, 1995; Harris & Rosenthal, 1986; Vrugt, 1990; and Wilson-Dallas & Baron, 1985). Actual therapist trainees were used (rather than undergraduates randomly assigned to the role of counselor), and undergraduate clients were free to discuss personal issues with their therapist rather than directed to discuss specified topics. Moreover, an actual face-to-face therapeutic interaction was used and expectations focused on client depression, which is clearly relevant for therapists. These features increase the generalizability of the study findings to real first therapy sessions. However, the therapeutic interactions here were brief, and in actual therapy sessions, therapists often use a combination of diagnostic and rapport-building strategies as well as other possible strategies. Nonetheless, the experimental manipulation of these strategies suggests that they may have differential effects on client behavior when therapists are not given explicit expectations about their clients.

A clear practical implication of these results is that therapists have the potential to influence the behavior of their clients through the strategies they use with them in an initial therapy session. To be sure, in the initial stages of a first therapy session, therapists without priorinformation about their clients may not yethave formulated an expectation, and may be more focused on building rapport than on diagnosing their clients. In doing so, they may be offering clients the best chance to display behavior unadulterated by potential confirmatory biases. But therapists may not work without expectations for long, with some theorists suggesting that they can generate hypotheses about their clients as early as 60 seconds into an initial interview (Gauron & Dickinson, 1969). Indeed, one interpretation of the present results is that the mere act of diagnosis could facilitate therapists to generate ‘‘default’’ expectations that may not even be based on initial client behaviors. Once generated, such hypotheses could drive therapists’ diagnostic efforts toward the elicitation of expectation-confirming behavior from clients. And, even when they are motivated toward developing rapport the presence of erroneous expectations may make behavioral confirmation more likely.

Client behavioral confirmation of erroneous expectations in initial sessions may then influence therapists’ subsequent hypotheses of the causes of their clients’ ‘‘problems,’’ treatment decisions and expectations of prognosis, which may also become self-fulfilling (Snyder & Thomsen, 1988). It seems wise, therefore, to suggest that therapists implement strategies to undermine possible biases by maintaining an awareness of the possible self-fulfilling effects of the hypotheses they test, using as many open-ended and unbiased questions as possible, and declining to access referral information about a client until after the initial session (Harris, 1994). However, further longitudinal research is required to evaluate whether initial self- fulfilling prophecies are perpetuated and maintained in therapy, or whether effects become extinguished over repeated interactions. Such research could also provide a more thorough account of the effects of therapist-initiated self-fulfilling prophecies on client self-perceptions, addressing whether therapists have the potential to influence their clients’ overall self-concepts over time.

Identity Negotiation in Psychotherapy 253

Notes

1. Although empathy and rapport are not identical conceptually, they can be seen as serving a similar function, if one accepts empathy generation as the therapeutic skill

of communicating understanding to a client (Deutsch & Maddle, 1975; Egan, 1998), which deepens a therapist’s harmonious and engaging connection with a client, and therefore advances the generation of rapport.

2. The assessment of clients as non-depressed is confined to the completion of our Depression Questionnaire by clients prior to the interaction only; this instrument should not be considered as offering diagnoses of depression such as could be indicated by a suitable diagnostic instrument such as the BDI-II (Beck et al., 1996) or

by clinical judgment. 3. Although objective coding of therapist behavior would provide a more exact check

on their strategy use, we are confident that our within-therapist manipulation of

strategy across two interactions further encouraged therapists to differentiate their approaches with clients.

4. The pattern of results is essentially the same when we treat our data as non-

independent (with therapist strategy as a repeated measure), however the complexity of the analyses makes for a less-clear presentation.

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