Bowker, H., Saxon, D. and Delgadillo, J. orcid.org/0000-0001-5349-230X (2025) First impressions matter: the influence of initial assessments on psychological treatment initiation and subsequent dropout. Psychotherapy Research, 35 (3). pp. 368-378. ISSN 1050-3307
Abstract
Objective
This study investigated if patients’ experience of an initial assessment may be associated with outcome expectations, and with subsequent treatment attendance.
Method
The sample comprised n = 6051 patients with depression/anxiety disorders, nested within k = 148 assessing therapists. Multilevel modelling (MLM) was used to examine therapist effects on treatment initiation and subsequent dropout, adjusting for patient-level characteristics. We tested associations between early outcome expectancy measured at an initial assessment with attendance at a first therapy session, and with dropout after initiation. Variability in mean expectancy ratings in the caseloads of assessing therapists was examined using the intracluster correlation coefficient (ICC).
Results
Therapist effects partly explained the variance in treatment initiation and dropout. Pre-treatment outcome expectations significantly predicted treatment initiation but not dropout for the subgroup of patients who started treatment. Approximately 16% of variability in mean expectancy ratings was explained by therapist effects (ICC = 0.159) after controlling for patient-level covariates.
Conclusions
Patients assessed by some therapists are more likely to have higher outcome expectations, which influences their decision to initiate treatment thereafter. Once patients start therapy, early expectancy measured at assessment no longer influences their attendance, but the “first impression” from an initial assessment does influence their subsequent likelihood of dropout.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. |
Keywords: | psychotherapy; dropout; attrition; attendance; expectations |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Science (Sheffield) > Department of Psychology (Sheffield) |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 23 Jan 2024 17:16 |
Last Modified: | 12 Mar 2025 15:05 |
Status: | Published |
Publisher: | Taylor and Francis Group |
Refereed: | Yes |
Identification Number: | 10.1080/10503307.2024.2308164 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:207860 |