Couple and Family Counseling

ORIGINAL PAPER

Expectations About Couple Therapy Over Time

Rachel B. Tambling1 • Shayne R. Anderson1,2 • Alison G. Wong3

Published online: 18 August 2016

� Springer Science+Business Media New York 2016

Abstract One common factor of therapy, expectations, has

been demonstrated to be a significant contributor to out-

come in individual therapy. Despite this, little is known

about expectations about couple therapy. This paper pre-

sents the qualitative results of a study exploring clients’

expectations before beginning couple therapy and after six

sessions. Results indicate that clients form pre-therapy

expectations about their therapist, the process of therapy,

and their partner. Results also showed that after six ses-

sions, clients’ expectations about therapy were often met or

modified in ways that were positive. Implications for

therapists and researchers are included.

Keywords Expectations � Couple therapy � Expectancy effects

Introduction

Researchers in the field of couple and family therapy have

demonstrated that couple therapy is generally effective and

efficacious in creating positive changes in the lives of cli-

ents with mental health problems, decreasing the likelihood

of divorce, and improving individual and family health and

well-being (c.f. Sprenkle 2003). Despite generally positive

outcomes, incidences of premature termination from ther-

apy are high (Wierzbicki and Pekarik 1993) and some

couples fail to improve during couple treatment (Jacobson

and Addis 1993). In recent years, there has been an

emphasis on understanding therapy experiences, including

client experiences over the course of therapy. Such inqui-

ries have resulted in analyses that suggest that treatment

failures may represent a failure of therapists to provide

treatment that meets the expectations of clients (Joyce and

Piper 1998). Past research has suggested a link between

clients’ expectations about therapy, positive therapy

experiences, and good therapy outcomes.

Lambert (1992), in his analysis of common factors that

contribute to change in psychotherapy, identified expecta-

tions as the third most influential factor. Lambert suggested

that expectations explain approximately 15 percent of the

variation in therapy outcome and are more influential than

model, technique, or training. This provocative research

echoed what many clinicians already knew—clients’

hopes, expectations, and understanding about therapy

impact therapy outcomes.

Research has clearly established that clients enter into

therapy with expectations about the process of therapy and

the personality, training, or experience of the therapist and

that these expectations influence in session behaviors and

outcomes (Glass et al. 2001; Joyce et al. 2000; Tinsley

et al. 1984). Specifically, expectations of improvement

have been linked to positive feelings about therapy, suc-

cessful engagement, and positive outcomes in therapy

(Tinsley et al. 1984). Decades of research has addressed

expectations in individual and group treatment (see Tam-

bling 2012 for a review), clearly indicating that expecta-

tions are predictive of a variety of therapy outcomes,

suggesting expectancy effects exist in therapy settings.

While most research has explored expectations in

& Rachel B. Tambling [email protected]

1 Department of Human Development and Family Studies,

University of Connecticut, Storrs, CT 06269, USA

2 School of Family Life, Brigham Young University, Provo,

UT, USA

3 Graduate School of Psychology, Fuller Theological

Seminary, Pasadena, CA, USA

123

Contemp Fam Ther (2016) 38:353–360

DOI 10.1007/s10591-016-9390-x

individual and group treatment, one study (Tambling and

Johnson 2010), found expectations about the therapist and

the experience of therapy inform clients’ actual experi-

ences in couple therapy, specifically. Others (Tambling

et al. 2014) found that clients attend couple therapy with

clear expectations regarding their therapist, therapy expe-

rience, and the outcome of therapy prior to their first ses-

sion. Clients also form expectations about their partner’s

behaviors and partner-initiated topics of discussion in

therapy. Combined, these studies all suggest that expecta-

tions are powerful factors that contribute to therapy

experiences.

While it is clear that expectations about therapy are

formed prior to therapy, very little is known about the ways

that expectations are confirmed, disconfirmed, modified,

and developed over time. Virtually nothing is known about

the ways in which actual experiences in therapy influence

the modification of expectations, or whether expectations

about therapy are confirmed or disconfirmed by actual

therapy experiences.

The present, exploratory, study examined clients’

expectations about therapy. Specifically, the present study

focuses on the ways in which expectations about therapy

are modified, confirmed, or disconfirmed following the

initiation of therapy. This research was conducted as part

of a larger study of expectations about couple therapy.

Interview data were examined using qualitative methods.

The following three exploratory research questions were

addressed:

1. Are expectations about therapy from the initial therapy

session confirmed or disconfirmed during subsequent

therapy sessions?

2. What new expectations are formed following the onset

of therapy?

3. In what ways do clients of couple therapy believe that

therapy will help with their presenting problems; is this

impacted by therapy experiences?

Methods

Procedures

Data for the present study were interviews of participants

in a larger study of expectations about couple therapy. The

results of the exploration of pre-therapy expectations has

been published and additional information regarding pre-

therapy expectations can be found in that manuscript

(Tambling et al. 2014). Participants were twenty individ-

uals in ten couples seeking therapy at a university-based

marriage and family therapy clinic. All couples consisted

of individuals over the age of 18 in a relationship over

6 months long who both deemed their relationship as

romantic and significant. The sample consisted of 19

heterosexual couples and one same-gender couple. Thir-

teen (65 %) of the participants identified as Caucasian,

three as Indian (15 %), two as Hispanic (10 %), one as

Asian (5 %), and one identified as Pakistani (5 %). All

participants possessed at least a high school education:

10 % completed trade school, 10 % were currently enrol-

led in a 4-year college program, 15 % graduated from a

2-year college, 15 % graduated from a 4-year college,

25 % had a Master’s degree, 15 % completed some grad-

uate studies, and 10 % completed post-Master’s studies.

Incomes ranged from $20,000 to over $70,000 annually.

On average, participants were 29.14 years old, ranging

from 21.08 to 37 years of age. Participants were recruited

through university list-serve emails and paid newspaper

advertisements in the local community. After consent was

obtained from both partners, participants were interviewed

conjointly by a member of the research team prior to their

first session of therapy, and after each of the second

through fourth therapy sessions. Interviews focused on

clients’ expectations about therapy using a semi-structured

interview protocol. Interview questions addressed therapist

expectations, role expectations, and process expectations.

Interviewers inquired about the ways in which expectations

were met or not met, as well as new expectations that may

have been formed since the onset of therapy. Interviews

were audio-recorded, and then transcribed and analyzed

using a discovery-oriented qualitative analysis.

Interview Protocol

The interview protocol was developed by the first author,

an expert in expectations about couple therapy, following a

comprehensive and systematic review of the extant litera-

ture about expectations about therapy. The interview

questions were then evaluated and discussed with a second

researcher not involved in the present study who is familiar

with the literature about expectations about couple therapy.

The interview protocol is provided as ‘‘Appendix A’’.

Questions focused on the ways in which expectations were

met or not met by actual therapy experiences and the ways

in which expectations were modified over time. All inter-

views were conducted by a member of the research team,

each of whom have training in interview techniques and are

familiar with research about expectations about couple

therapy. Questions were posed as written, and interviewers

were encouraged to obtain answers from both couple

members and to ask follow up questions. Interviews ranged

in time from 15 to 25 min, approximately.

354 Contemp Fam Ther (2016) 38:353–360

123

Qualitative Analysis

Reliability and Validity

The researchers enhanced validity by following the rec-

ommendations of Silverman (2000). First, a recursive

analysis process was used in which the researcher began by

reading through all the transcripts to get a sense for the data

as a whole. Codes and themes were developed during sub-

sequent readings of transcripts. As emerging themes were

developed, the researchers re-read transcripts to ensure that

the codes and themes represented the whole of the data. The

primary way in which reliability was enhanced was by

carefully documenting all procedures. The researcher and

interviewers kept detailed field notes of impressions, ques-

tions, and ideas and met weekly to discuss these ideas.

Further, the researchers kept a detailed process journal

during coding. To ensure that the interpretation of the data

was reliable, a researcher familiar with the therapeutic

process, but unfamiliar with research related to expectations

about therapy read a random sample of three transcripts to

evaluate whether the coding of the transcripts seemed rea-

sonable and credible. After discussions with the reviewer

were complete, the researcher then conducted a final read of

the data to determine that the codes represented were those

that were a good fit for the data.

Analysis

Interview data were analyzed qualitatively to explore pat-

terns and themes that were grounded in the participants’

experiences. Data were analyzed systematically and

recursively to locate and identify emerging themes using a

constant comparison analysis (Silverman and Marvasti

2008; Strauss and Corbin 1994). ATLAS.ti software was

used to aid in the management and organization of the data.

First, the second author read through all the transcripts

from all the groups to get a sense of the data as a whole.

The researcher kept a logbook with observations, ques-

tions, and ideas noted. Emerging themes were developed,

modified, and compared during subsequent readings of the

transcripts. This process increased the likelihood that the

codes captured all relevant data and that codes represented

good descriptors of the data as a whole. A second member

of the research team independently read and coded the

transcripts, following the same process, and developing a

second preliminary code list. The two coders met and

discussed the codes. Discussion proceeded until consensus

was developed and a final code list established. Both coders

were familiar with literature about expectations about

counseling, are couple therapists, and were familiar with

the methods of the present study.

Results

During the analysis, unique instances of dialog were coded,

and from those codes, themes were developed. A list of

codes and themes is included in Table 1. Expectations were

generally positive about the therapist and the therapy pro-

cess. Many clients identified expectations that were related

to the therapist being kind, calm, and engaging. Clients

seemed to expect their partners to be open and honest and

for the process of therapy to be helpful. Notably, the

researchers found consistency across transcripts in the

ways in which clients talked about expectations being met

or not met. The researchers elected to use language con-

sistent with previous literature regarding expectations

about couple therapy being met or not met (c.f. Tambling

2012), referring to that phenomenon as the confirmation or

disconfirmation of expectations.

During the coding process, a consistent theme began to

emerge across categories of codes. That is, that expecta-

tions were occasionally not met, resulting in a disconfir-

mation of expectations. What is unique about this research

is that this disconfirmation was not negative, as clients

reported that expectations were not met in positive ways.

One participant stated it in this way:

Participant: It doesn’t fit with what I expected, but

I’m quite happy with the turnout

This finding is unique to this study. No previous study of

expectations noted the disconfirmation of expectations in a

positive direction. Thus, this unique finding is of note as a

general phenomenon of interest in the present study.

Research Question 1. To answer the first research

question—whether expectations from the first therapy

session were confirmed or disconfirmed as a result of

therapy—coders focused on responses to questions

directly related to the ways in which expectations are

met or not met. Table 1 presents the results of this

inquiry. In general, role expectations were confirmed.

With regard to expectations about the therapist, six

couples reported that their expectations were confirmed

in that the therapist was warm, calm, and young. One

participant stated:

Participant: Yeah, I think she met my expectations,

um I remember saying that I thought my therapist

would be female and that she’d be friendly, so she did

a really nice job with that. Meeting those.

Two couples reported that their expectations were not met.

One couple reported that they had two therapists instead of

one, as they had expected. Others identified the therapist as

being younger than expected, or more relatable than

expected. Of note, one couple reported that their

Contemp Fam Ther (2016) 38:353–360 355

123

expectations were not met, but were exceeded. They noted

feeling more comfortable and understood than they had

expected.

With regard to process expectations, or expectations

about the way in which therapy will be conducted, expec-

tations were generally confirmed. Five couples reported that

the process was as expected in that they were challenged by

the therapist and worked on communication skills. Two

couples indicated that their expectations were not met in that

the approach was not as expected. They did not elaborate on

this point, but indicated that it was simply not what they had

imagined. Three couples noted that their expectations were

disconfirmed in positive ways, through the use of more

activities, more engagement, and experiences that were more

positive than previous experiences in therapy.

Finally, all couples reported that their expectations about

their partner were confirmed, or disconfirmed in ways that

exceeded their expectations. Respondents reported that

partners were either more open than expected or as open as

expected, such as the following quote demonstrates:

Participant: A little different, um, I think I expected

[my partner] to be more closed and he was you know

more closed than I am, but he was more open than I

expected him to be like he was more insightful and

thoughtful and shared more than I expected him to

and that was very exciting for me.

Couples reported that their partners seemed motivated and

spoke honestly. Others reported that their partner was more

expressive and insightful than anticipated.

Research Question 2. To answer research question 2,

determining whether new expectations were formed as a

result of therapy, coders examined both questions related to

the formation of new expectations, and the responses to all

questions. Results of this inquiry are presented in Table 2.

Most participants were able to identify at least one new

expectation that had emerged as a result of therapy. For

many respondents, these expectations were related to the

role they, or their partner, would take in therapy. Some

noted more clear expectations about their partner’s

behavior, such as the following:

Participant: Well, I feel like I expect him to um, tell

me more about what he’s feeling and what’s going on

um, in his life and with uh, certain like vices that he

has. Um, I feel like that’s still like, not completely

happening, but it’s happening more. Um, I’ll have to

like probe him about it and then he’ll like, eventually

he’s honest with me about it, but, so that’s the

expectation I have.

Notably, many participants found themselves having

more positive outcome expectations following the onset of

therapy, such as the following participant exemplar

indicates:

Participant: Yeah, I think we might actually, now we

might actually be able to achieve our goal of not

really, you know, not having our arguments escalate

you know to a level that uh, is really causing a lot of

problems and brought us to therapy in the first place

and you know, honestly I was a little, you know,

Table 1 Qualitative themes, expectation confirmation and disconfirmation

Role expectations Process expectations Expectations of partner

Confirmed—6 couples

Competent

Warm

Calm

Unbiased

Female

Friendly

Challenged current behavior and thinking

Got us talking about the issues

Disconfirmed—2 couples

Younger

Didn’t point out our flaws

Had two therapists instead of one

More relatable

Exceeded—1 couple

Felt more understood and comfortable than

expected

Therapist remembered more details than expected

Confirmed—5 couples

Helpful

Challenges

Communication skills

Felt heard

Disconfirmed—2 couples

Therapist’s model was different than

expected

Exceeded expectations—3 couples

More use of activities

Better than previous experiences in therapy

More comfortable and engaging

Confirmed—6 couples

Opened up about feelings

Spoke honestly

Motivated to make changes

Wants to make relationship better

Exceeded—4 couples

Revealed unexpected emotions and

thoughts

More emotionally expressive

More insightful than expected

More open to criticism

Applied skills learned in therapy

356 Contemp Fam Ther (2016) 38:353–360

123

disheartened or skeptical that uh, that would be

possible when we came here, but uh, you know, I

think, uh, I think it might actually be possible now.

Research Question 3. Finally, research question 3

addressed outcome expectations formed following the

onset of therapy. Participants were asked, ‘‘Think about the

problems that brought you to therapy. What do you expect

will change about these as a result of therapy?’’ Responses

were explored for themes. Most clients reported a desire for

therapy to continue, and expressing pleasure with the

outcome after the first four sessions. One participant stated:

Participant: We’ve found it- I’ve found it very help-

ful. And we want to continue working on like our

communication skills, resolving arguments, things

like that, so we’re definitely, we’ve had a great

experience doing, taking part in the study and

working with [the therapist] and we want to continue

doing that.

The following themes emerged among expectations

about outcomes: easier to compromise, problems will be

managed better, be more considerate and aware of partner’s

perspectives, discover more about self, develop skills,

improve communication, more honesty, continue being

able to discuss things more calmly/avoid escalation, better

recognize problems and ask for help, and view problems

more realistically. One participant shared a common

experience, stating:

Participant: I hope to be more considerate and aware

of what might be going on from the other perspec-

tives. From my husband’s perspective, from my kid’s

perspectives. It’s not just what I’m feeling all the

time.

Discussion

Overall, results indicated that expectations were generally

confirmed. For the most part, clients’ experiences in ses-

sion were congruent with that which they expected. For

example, therapists were competent, understanding, and

warm. Clients reported that they experienced therapy pro-

cesses that were expected, including challenges and

homework assignments. Most clients reported that they

expected therapy to be helpful and it was. This is consistent

with previous literature about expectations about therapy,

which suggests that clients generally have positive expec-

tations about therapy (Tambling 2012). Such a view is also

consistent with the generally accepted view of the role of

expectations in the common factors literature. In his review

of common factors, Lambert (1992) suggests that expec-

tations about therapy can positively impact therapy pro-

cesses and outcomes. The implication of such statements is

that positive, or realistic, expectations about therapy can

influence therapy processes and outcomes in useful ways.

Findings of the present study support the contention that

positive expectations beget positive outcomes (Table 3).

Results indicated that clients reported that they formed

new expectations over the course of therapy. Though the

majority of interviewees did not respond to this question as

the researchers intended it, the information is useful. The

researchers had anticipated that clients would form realistic

expectations about the future of therapy after having more

experience with therapy, but most clients were vocal about

the ways in which their expectations of the partner were

evolving over time. Most of these expectations related to

the way in which the couple would interact with one

another. For example, participants reported that they

expected to communicate better, share more, and to solve

problems more effectively. The researchers had expected

that clients might form new expectations about therapy;

however, the majority of participants responded to the

prompt by sharing expectations about their couple rela-

tionship. Future researchers may wish to reconsider how to

ask this question to learn both about therapy expectations

and relationship expectations. Finally, participants reported

that their experiences with their partner in therapy were as

expected. Clients reported that partners were open and

talkative in therapy.

While most experiences were consistent with expecta-

tions, some clients experienced deviations from their

Table 2 Qualitative themes, new expectations formed

Expectations for self Expectations for partner Expectations for couple Expectations for

therapy

Use techniques learned in therapy

Slow interactions and evaluate expectations

Prioritize the relationship

Take appropriate responsibility rather than placing all

expectations on partner

Consistent emotional

expression

Informing partner about

everyday life

Express concerns and

vices

Honesty

Use strategies learned in therapy

more consistently

Communicate more

Talk more openly without need of

therapist

Return to conversation after taking a

break

Fast progress

Bigger changes

More solutions

Contemp Fam Ther (2016) 38:353–360 357

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expectations. The most notable way in which expectations

differed from experiences is with regard to therapy pro-

cesses. Clients reported deviations from expectations most

with regard to the way that therapy was conducted. While

some of these failures to confirm expectation were good

(i.e. therapy was better, or the clients felt more heard),

some reflect a fundamental confusion about what therapy

will be like. For example, some clients reported that they

expected to talk about their past more or less than they did.

Others reported that they expected a more traditionally

psychodynamic or more psychoeducational style. Thera-

pists may use this information as an indicator that clients

do not know what to expect from therapy and may wish to

talk with clients early in the course of therapy about how

therapy will be conducted.

Other disconfirmations were related to role expectations.

In particular, clients reported that therapists were younger

than expected. This finding is likely an artifact of the

research setting. The research was conducted in a training

clinic, where all therapists are masters and doctoral stu-

dents. Thus, the majority of therapists are indeed young.

Other ways that therapists did not meet expectations may

be interpreted as a positive failure to meet expectations.

For example, therapists were unlike therapists portrayed in

media, as the therapists in this study were professional and

personable. Therapists were also noted to be more atten-

tive, honest, and relatable than expected. These disconfir-

mations were generally experienced as positive, and may

enhance the potential positive impact of the common factor

of expectations.

Finally, participants reported several disconfirmations

related to the partner’s behavior. Clients reported that their

partners were more open than expected and tried more

things from therapy than expected. Interestingly, partici-

pants reported that they were able to learn a lot about their

partners with the help of the therapist. Participants reported

that partners surprised them in ways that likely benefitted

the relationship.

Table 3 Thematic groupings and codes

Thematic grouping Codes

Expectations about the therapist Female

Graduate student

Young

Soothing/calm

Friendly/nice

Media-influenced

Expectations about the process Talk about issues and efforts to solve

Go deeper/challenge

Guidance/advice/suggestions

Be offered a different perspective

Media-influenced

Therapist behavior Ask questions

Assess/learn about clients

Listen

Therapy topics Presenting problem

Conflict

Communication

Relationship history

Personal history

Partner behavior One partner will do most of the talking

Listen

Talk/open up

Be cooperative/work together

Outcome Learn skills/techniques

Communicate better

Acceptance and understanding of partner

Decrease negative behaviors

Increase self-awareness

Resolve problems

358 Contemp Fam Ther (2016) 38:353–360

123

Overall, results from this study suggest that clients not

only form and modify expectations about therapy, includ-

ing the therapist and the process of therapy, but also form

and modify expectations about the partner and the partner’s

behavior. These results, taken together, provide an

encouraging picture of therapy. Participants of this study

expected therapy to be helpful and generally found that it

was, albeit in occasionally unexpected ways. Further, cli-

ents found that their expectations disconfirmations were

generally good, and enhanced positive feelings about the

therapy process.

There are several limitations of this study which impact

the interpretation of results. First, the sample is small and

was drawn from only one clinic. Thus, the results may be

limited to the clinic, or a population similar to the sample

that was studied. Further, the clinic from which participants

were drawn was a training clinic and the results may not be

generalizable to typical community clinics or private

practices. As with all qualitative research, bias on the part

of the researchers is not only possible, but likely. The

researchers were all experts in expectation formation and

maintenance and their understandings of the topical area

may have impacted the interpretation and distillation of

themes.

As this is one of few studies of expectations in couple

therapy, little is known about the ways in which the results

of this study might fit with other, similar studies. Given the

relative lack of information about research on expectations

about couple therapy, future research which explores

expectations in a couple therapy context is warranted.

Future studies are needed that not only explore expecta-

tions in a couple therapy setting, but examine those

expectations over time. Further, future researchers may

wish to take a more comprehensive view of expectations

exploration and engage in research which includes more in-

depth interviews. It was beyond the scope of this project to

conduct a qualitative study truly informed by grounded

theory. Such an inquiry would be valuable. It is possible

that a great deal of information about expectations was

missed given the interview protocol used, so a more thor-

ough exploration would be useful.

There are several implications for therapists given the

findings of the present study. First, the results of this study

suggest, once again, that expectations are formed prior to

therapy. Therapists should inquire about expectations

during the first session of therapy to gather important data

about the ways in which clients anticipate therapy will

progress. The results of the present study also suggest that

expectations, particularly those about the partner, are

modified during the course of therapy. Therapists may wish

to inquire with clients about the ways in which their

expectations are confirmed or disconfirmed during the

course of therapy and whether those experiences are

helpful, or positive. It may also be useful for therapists to

inquire about the role of the partner in therapy and to make

more overt the process by which clients are positively

surprised by their partner in therapy. Collectively, the

results of this study suggest that clients do think about

therapy and the therapeutic process. Therapists are

encouraged to explore the expectations process as part of

any discuss of therapeutic processes.

Despite some limitations, this study provides prelimi-

nary evidence to suggest that expectations about couple

therapy are impacted by the therapy process. Expectations

are generally confirmed, but disconfirmations are present.

It is interesting to note that many of the disconfirmations

present in this study were positive disconfirmations, a

unique finding. Future research is needed to further explore

this phenomenon and better understand client expectations

about therapy, and the way in which expectations impact

therapy outcomes.

Compliance with Ethical Standards

Conflict of interest The authors declare that they have no conflict of interest.

Appendix A: Interview Protocol, Follow up Session

The following are questions about the ways in which your

expectations were related to your therapy experiences. You

may not have thought about some of these questions.

1. In what ways was your therapist like or not like what

you expected?

2. In terms of what’s happening in therapy, how does this

fit or not fit with what you expected?

3. In what ways has your therapist surprised you?

4. In terms of how your partner has behaved in therapy,

how does this fit or not fit with what you expected?

5. In what ways has your partner surprised you?

6. What new expectations have you developed since

you’ve begun therapy?

7. Think about the problems that brought you to therapy.

What do you expect will change about these problems

as a result of therapy?

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