ROLE PREPARATION AND EXPECTATION OF IMPROVEMENT IN PSYCHOTHERAPY

Abstract
An explanation of the process of psychotherapy combined with the suggestion that the patient should improve in a few months has been shown to produce better therapy results. The present study sought to determine whether the explanation or the suggestion was the more powerful aid to improvement. It also attempted to determine whether these procedures increased the therapist's liking for and feeling of being able to help the patient. Thirty-six psychoneurotic patients were randomly assigned to four groups, who received different indoctrinations by a research psychiatrist. 1) The first group was assigned to a psychotherapist without further explanation. 2) Those in the second group were told firmly that they should feel and function better after 4 months of psychotherapy. 3) The third group had the process of psychotherapy explained to them by means of Orne's anticipatory socialization interview. This interview is a didactic preparation for psychoanalytically oriented psychotherapy explaining how treatment works, what the patient's role is, and what can be expected of the therapist. It offers a rationale for why the patient should discuss his past life. 4) The fourth group had the process of psychotherapy explained and, in addition, were told firmly that they should expect to feel and function better in 4 months of psychotherapy. The therapists were nine senior residents who knew that research in psychotherapy was taking place but were ignorant of and retrospectively unable to guess the procedure and aims. They were requested to see the patients for a minimum of 4 months. They completed questionnaires devoted to how much they liked the patient and how much they felt that they could help him after their first interview. Independent assessment before and after 4 months of treatment was made by a psychiatrist. At the end of treatment the patients who received an explanation of psychotherapy improved slightly but significantly (p < .05) more than those who did not receive it. Improvement was based on total social, sexual, and work adjustment, and there was no significant difference in symptomatic change or attendance in the groups. Suggestion that they would feel better in 4 months had no effect on outcome. Moreover, patients who received this suggestion were found by the therapists to be less likable than those who did not.