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Salud mental

versión impresa ISSN 0185-3325


ALCAZAR OLAN, Raúl José. Expectativas, percepción del paciente hacia su terapeuta y razones para asistir a dos o más sesiones. Salud Ment [online]. 2007, vol.30, n.5, pp.55-62. ISSN 0185-3325.

In Mexico, patients who seek psychological therapy attend on average only three sessions, which are not enough to truly benefit from therapy

One variable that might be related with dropping out is the patient’s expectations. When the patient attends the first session and does not find what he expected he might not return for additional sessions. Unfortunately, contradictory evidence prevents us from fully understanding the role of patients' expectations in determining whether patients will attend additional sessions after their first interview.

In addition, if the patient perceives unfavorable qualities in his therapist he may choose not to return for more sessions. This was the case in some studies but in some others the patients' perceptions of their therapists' qualities were not useful predictors of which patients would return after the first interview.

In any case, every time that a patient does not return without warning his therapist the question may remain: why didn't the patient return?

Thus, the aims of this study were: 1. To document the expectations subjects had before their first interview, 2. To identify whether these expectations were met, 3. To determine if there is a relationship between having one's expectations met and attending a second session, 4. To document subjects' reasons for attending two or more sessions, and 5. To compare the perceptions of the therapists' personal qualities among patients who did return or not for a second session.


Thirty-nine subjects who attended a psychotherapy session at any time were contacted. The average age was 32.05 years (range from 20 to 63 years), 26 were single and 13 were married. Since this was an exploratory study, an open questions interview was used. Questions included: what expectations did you have before your therapeutic interview? Were your expectations met? Did you return after your first interview? Why did you attend two or more sessions? What qualities did you perceive in your therapist? All of the answers subjects gave were encoded and frequencies were computed. The responses of subjects who attended two or more sessions were compared with answers of subjects who did not.


Before the first interview, subjects expected therapists would be attentive, supportive, friendly, and honest. Second, subjects expected concrete results from the first interview: they expected solutions to their problems and doubts, and to feel better in general. They also expected they would be able to confide in their therapists. Last, subjects expected that their pain would be eased, that they would be able to talk about their problems, and that they would not be afraid.

When patients' expectations were met they explained that their therapists were attentive listeners. They described their therapists as kind, objective and reliable. They also felt that their therapists were able to help them, often by offering another perspective on their problems. These subjects felt better after the session. On the contrary, when patients' expectations were not met they explained that their therapists did not listen, were critical, acted as if conducting a test, and arrived late to the session. Also, subjects did not feel that they could confide in their therapists and were disappointed that they did not help them to solve their problems.

After the first interview, 19 subjects returned for a second session and eight did not. Twelve of these subjects reported having their expectations met on the first interview, while 27 subjects reported that their expectations were not met. Having one's expectations met was significantly correlated with attending a second session (r = +.34, p < .05).

The main reasons subjects reported when asked why they attended two or more sessions were the following: I had to continue the treatment, I wanted to feel better, I wanted to overcome my problems, I needed help, I thought the therapist would improve in the next session, and the therapist helped me. Reasons subjects gave for not attending were: the therapist did not listen to me, the therapist was not friendly, I did not like the therapist, the therapist criticized me, I learned that the best way to solve my problems is by my self, the therapy was expensive, I had to study, and I had to work.

Subjects who attended a second session perceived more positive qualities in their therapists (e.g. the therapist was kind, reliable, punctual, intelligent, respectful, understanding) than negative (e.g. arrived late, unkind, authoritarian, aggressive, impulsive, incompetent). Subjects who did not attend a second session perceived more negative qualities in their therapists. Finally, those who attended a second session perceived that their therapists were more experienced than subjects who did not attend a second session.


Having one's expectations met was significantly correlated with attending a second session, a finding that contradicts other studies. In addition, when patients perceived therapists did not listen to them, they were less likely to attend additional sessions, a finding that is consistent with other research. Finally, also in agreement with other studies, subjects who attended a second session perceived more positive qualities in their therapists than those who did not attend a second session for these perceived more negative qualities in their therapists.

One problem that sometimes arises when drop out subjects are interviewed, is that they may lie because they do not want to have any problems with the institution providing them the service or because they do not want to meet their therapists again. However, it is likely that this was not the case for this research. Since interviews were not conducted in a consulting room or a psychological services setting, it is also likely that the "social desirability" was reduced. That is, subjects had the opportunity to speak the truth because the researcher did not know the therapists or institutions they were talking about.

One important limitation to this study was that subjects were asked retrospectively about events that took place prior to the interview. So, it is possible that subjects' answers were distorted due to the effect of time on memory. Clearly, more research is needed in prospective studies to explore the relationship between the attendance of more than one session and patient's expectations of therapy sessions and their perceptions about therapists.

Palabras llave : Expectations; perception; drop out; attendance; therapist.

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