What do you expect from psychological care? A qualitative study of depressed patients’ expectations treated in mental healthcare settings

Depressed patients' psychological care expectations

Submitted: November 15, 2024
Accepted: February 21, 2025
Published: March 26, 2025
Abstract Views: 218
PDF: 63
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Depression is one of the main reasons for seeking mental health services; however, few studies have focused on the perspective of depressed patients to understand what they expect from this instance. This study aims to develop a comprehensive model of patients’ initial expectations regarding psychological treatment in mental healthcare settings. Semi-structured interviews were conducted with sixteen depressed adult patients referred to psychological care before their first session. Data was analyzed using grounded theory and consensual qualitative methods. Patients had expectations regarding the characteristics of psychological treatment, the psychologist, and changes. Patients expect psychological care to have a clear purpose and to last the time required until they feel better. They expect the psychologist to be an active and responsive professional. Regarding changes, patients expect to understand why they have depression, develop personal resources, and improve their self-esteem and mood. Facilitating factors (e.g., preferences for psychological support over medical treatment) and hindering factors (e.g., institutional constraints) were identified in achieving these expectations. Based on patients’ expectations, a helping relationship that is more responsive to their needs is underlined. Therapeutic skills and contextual factors are key facilitating elements to meet these expectations. The findings discuss how addressing expectations can serve as input for delivering more satisfactory treatment to patients.

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Altimir, C., Capella, C., Núñez, L., Abarzúa, M., & Krause, M. (2017). Meeting in difference: Revisiting the therapeutic relationship based on patients' and therapists’ experiences in several clinical contexts. Journal of clinical psychology, 73(11), 1510–1522. doi: 10.1002/jclp.22525 DOI: https://doi.org/10.1002/jclp.22525
American Psychological Association, Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271–285. doi: 10.1037/0003-066X.61.4.271 DOI: https://doi.org/10.1037/0003-066X.61.4.271
Anderson, T., Crowley, M. E., Himawan, L., Holmberg, J. K., & Uhlin, B. D. (2015). Therapist facilitative interpersonal skills and training status: A randomized clinical trial on alliance and outcome. Psychotherapy research: journal of the Society for Psychotherapy Research, 26(5), 511–529. doi: 10.1080/10503307.2015.1049671 DOI: https://doi.org/10.1080/10503307.2015.1049671
Ashcroft, R., Menear, M., Greenblatt, A., Silveira, J., Dahrouge, S., Sunderji, N., Emode, M., Booton, J., Muchenje, M., Cooper, R., Haughton, A., & McKenzie, K. (2021). Patient perspectives on quality of care for depression and anxiety in primary health care teams: A qualitative study. Health expectations: an international journal of public participation in health care and health policy. doi: 10.1111/hex.13242 DOI: https://doi.org/10.1111/hex.13242
Baune, B.T., Florea, I., Ebert, B., Touya, M., Ettrup, A., Hadi, M., & Ren, H. (2021) Patient Expectations and Experiences of Antidepressant Therapy for Major Depressive Disorder: A Qualitative Study. Neuropsychiatric Disease and Treatment, 17, 2995-3006. doi: 10.2147/NDT.S325954 DOI: https://doi.org/10.2147/NDT.S325954
Beck, A., Rush, J., Shaw, B., & Emery, G. (2012). Terapia Cognitiva de la Depresión [Cognitive Therapy of Depression] (20th ed.). Desclée de Brouwer.
Benaquisto, L. (2008). Axial coding. In L. M. Given (Ed.), The Sage encyclopedia of qualitative research methods (Vol. 1, pp. 51-52). Thousand Oaks, CA: SAGE.
Blatt, S. J., Quinlan, D. M., Zuroff, D. C., & Pilkonis, P. A. (1996). Interpersonal factors in brief treatment of depression: further analyses of the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of consulting and clinical psychology, 64(1), 162–171. doi: 10.1037//0022-006x.64.1.162 DOI: https://doi.org/10.1037//0022-006X.64.1.162
Blatt, S. J., D'Afflitti, J. P., & Quinlan, D. M. (1976). Experiences of depression in normal young adults. Journal of Abnormal Psychology, 85, 383-389. doi: 10.1037/0021-843X.85.4.383 DOI: https://doi.org/10.1037//0021-843X.85.4.383
Bordin, E. S. (1979). The generalizablity of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 16, 252–260. DOI: https://doi.org/10.1037/h0085885
Bosmans, J. E., van Schaik, D. J., de Bruijne, M. C., van Hout, H. P., van Marwijk, H. W., van Tulder, M. W., & Stalman, W. A. (2008). Are psychological treatments for depression in primary care cost-effective?. The journal of mental health policy and economics, 11(1), 3–15.
Callahan, J. L., Gustafson, S. A., Misner, J. B., Paprocki, C. M., Sauer, E. M., Saules, K. K., Schwartz, J. L., Swift, J. K., Whiteside, D. M., Wierda, K. E., & Wise, E. H. (2014). Introducing the association of psychology training clinics’ collaborative research network: A study on client expectancies. Training and Education in Professional Psychology, 8(2), 95–104. doi: 10.1037/tep0000047 DOI: https://doi.org/10.1037/tep0000047
Chapman, A. L., Hadfield, M., & Chapman, C. J. (2015). Qualitative research in healthcare: an introduction to grounded theory using thematic analysis. The journal of the Royal College of Physicians of Edinburgh, 45(3), 201–205. doi: 10.4997/JRCPE.2015.305 DOI: https://doi.org/10.4997/jrcpe.2015.305
Chevance, A., Ravaud, P., Tomlinson, A., Le Berre, C., Teufer, B., Touboul, S., Fried, E., Gartlehner, G., Cipriani, A., & Tri Than, V. (2020). Identifying outcomes for depression that matter to patients, informal caregivers, and health-care professionals: qualitative content analysis of a large international online survey. Lancet Psychiatry, 7, 692-702. doi: 10.1016/S2215-0366(20)30191-7 DOI: https://doi.org/10.1016/S2215-0366(20)30191-7
Connolly Gibbons, M. B., Crits-Christoph, P., de la Cruz, C., Barber, J. P., Siqueland, L., & Gladis, M. (2003). Pretreatment expectations, interpersonal functioning, and symptoms in the prediction of the therapeutic alliance across supportive-expressive psychotherapy and cognitive therapy. Psychotherapy Research, 13(1), 59–76. doi: 10.1093/ptr/kpg007 DOI: https://doi.org/10.1093/ptr/kpg007
Constantino, M. J., Vîslă, A., Coyne, A. E., & Boswell, J. F. (2018). A meta-analysis of the association between patients' early treatment outcome expectation and their posttreatment outcomes. Psychotherapy, 55(4), 473-485. doi: 10.1037/pst0000169 DOI: https://doi.org/10.1037/pst0000169
Constantino, M. J., Arnow, B. A., Blasey, C., & Agras, W. S. (2005). The association between patient characteristics and the therapeutic alliance in cognitive-behavioral and interpersonal therapy for bulimia nervosa. Journal of consulting and clinical psychology, 73(2), 203–211. doi: 10.1037/0022-006X.73.2.203 DOI: https://doi.org/10.1037/0022-006X.73.2.203
Creswell, J. & Poth, C. (2018). Qualitative Inquiry and Research Design, Choosing Among Five Approaches (4th Ed.). SAGE.
Cuijpers, P., Reijnders, M., & Huibers, M. J. H. (2019). The role of common factors in psychotherapy outcome. Annual Review of Clinical Psychology, 15, 207-231. doi: 10.1146/annurev-clinpsy-050718-095424 DOI: https://doi.org/10.1146/annurev-clinpsy-050718-095424
Cuijpers, P. (2011). The patient perspective in research on major depression. BMC Psychiatry, 11(89), 1-2. doi: 10.1186/1471-244X-11-89 DOI: https://doi.org/10.1186/1471-244X-11-89
De la Parra, G., Zúñiga, A.K., Gómez-Barris, E., & Dagnino, P. (2021). Complex depression in high-pressure care settings: strategies and therapeutic competences. De la Parra, G., Dagnino, P., Bhen, A. Eds. In: Depression and Personality Dysfunction: An Integrative Functional Domains Perspective, 213-244, Springer Nature. DOI: https://doi.org/10.1007/978-3-030-70699-9_9
De la Parra, G., Errazuriz, P., Gomez-Barris, E., & Zúñiga, A.K. (2019). Propuesta para una psicoterapia efectiva en atención primaria: un modelo basado en la experiencia y la evidencia empírica [A proposal for effective psychotherapy in primary care: a model based on experience and empirical evidence] Temas de la Agenda Pública, 14(113), 1-20. Available from: https://politicaspublicas.uc.cl/publicacion/propuesta-para-una-psicoterapia-efectiva-en-atencion-primaria-un-modelo-basado-en-la-experiencia-y-evidencia-empirica/
De la Parra, G., Gómez-Barris, E., Zúñiga, A., Dagnino, P., & Valdés, C. (2018). From the "couch" to the outpatient clinic: a model of psychotherapy for institutions. Learning from (empirical) experience. Revista Argentina de Clínica Psicológica, 27(2), 182-202. doi: 10.24205/03276716.2018.1057 DOI: https://doi.org/10.24205/03276716.2018.1057
De la Parra, G., Dagnino, P., Valdés, C., & Krause, M. (2017). Beyond self-criticism and dependency: structural functioning of depressive patients and its treatment. Research in Psychotherapy: Psychopathology, Process and Outcome, 20, 43–52. doi: 10.4081/ripppo.2017.236 DOI: https://doi.org/10.4081/ripppo.2017.236
Demyttenaere, K., Frank, E., Castle, D., & Cindik-Herbrüggen, E. (2019). Integrating Patients' Expectations into the Management of Their Depression: Report of a Symposium at the European College of Neuropsychopharmacology Congress. Advances in therapy, 36(3), 73–90. doi: 10.1007/s12325-019-01038w DOI: https://doi.org/10.1007/s12325-019-01038-w
Elkin, I. (1994). The NIMH Treatment of Depression Collaborative Research Program: Where we began and where we are. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. 114–149). John Wiley & Sons.
Flick, U. (2018). The SAGE Handbook of Qualitative Data Analysis. SAGE Publications Ltd. DOI: https://doi.org/10.4135/9781526416070
Frank, J. D., & Frank, J. B. (1991). Persuasion and healing: A comparative study of psychotherapy (3rd ed.). Johns Hopkins University Press.
Ehrenthal, J. C., Dinger, U., Horsch, L., Komo-Lang, M., Klinkerfuß, M., Grande, T., Schauenburg, H. (2012) Der OPD-Strukturfragebogen (OPD-SF): Erste Ergebnisse zu Reliabilität und Validität. Psychotherapie Psychosomatik Medizinische Psychologie, 62, 25-32. doi: 10.1055/s-0031-1295481 DOI: https://doi.org/10.1055/s-0031-1295481
Ferrando, L., Bobes, J. Gibert, S., Soto, M., & Soto, O. (2000). Mini International Neuropsychiatric Interview (M.I.N.I), versión en español 5.0.0. Instituto IAP.
Glasser, B. G., & Strauss, A. L. (1967). The Discovery of Grounded Theory. Aldine Publishing Company.
Greenberg, R. P., Constantino, M. J., & Bruce, N. (2006). Are patient expectations still relevant for psychotherapy process and outcome? Clinical Psychology Review, 26(6), 657-678. doi: 10.1016/j.cpr.2005.03.002 DOI: https://doi.org/10.1016/j.cpr.2005.03.002
Gunderson, J. G., & Links, P. (Collaborator). (2014). Handbook of good psychiatric management for borderline personality disorder. American Psychiatric Publishing, Inc. DOI: https://doi.org/10.1176/appi.books.9781615378432
Hawton, K., Casañas, I., Comabella, C., Haw, C., & Saunders, K. (2013). Risk factors for suicide in individuals with depression: a systematic review. Journal of affective disorders, 147(1-3), 17–28. doi: 10.1016/j.jad.2013.01.004 DOI: https://doi.org/10.1016/j.jad.2013.01.004
Hill, C. & Knox, S. (2021). Essentials of consensual qualitative research. American Psychological Association. doi: 10.1037/0000215-000 DOI: https://doi.org/10.1037/0000215-000
Hill, C. E., Knox, S., Thompson, B. J., Williams, E. N., Hess, S. A., & Ladany, N. (2005). Consensual qualitative research: An update. Journal of Counseling Psychology, 52(2), 196–205. doi: 10.1037/0022-0167.52.2.196 DOI: https://doi.org/10.1037/0022-0167.52.2.196
Johnston, O., Kumar, S., Kendall, K., Peveler, R., Gabbay, J., & Kendrick, T. (2007). Qualitative study of depression management in primary care: GP and patient goals, and the value of listening. The British journal of general practice: the journal of the Royal College of General Practitioners, 57(544), 872–879. doi: 10.3399/096016407782318026 DOI: https://doi.org/10.3399/096016407782318026
Kan, K., Jörg, F., Buskens, E., Schoevers, R. A., & Alma, M. A. (2020). Patients' and clinicians' perspectives on relevant treatment outcomes in depression: qualitative study. BJPsych open, 6(3). doi: 10.1192/bjo.2020.27 DOI: https://doi.org/10.1192/bjo.2020.27
Keeley, R. D., West, D. R., Tutt, B., & Nutting, P. A. (2014). A qualitative comparison of primary care clinicians' and their patients' perspectives on achieving depression care: implications for improving outcomes. BMC family practice, 15, 13. doi: 10.1186/1471-2296-15-13 DOI: https://doi.org/10.1186/1471-2296-15-13
Leichsenring, F., & Schauenburg, H. (2014). Empirically Supported Methods of Short-Term Psychodynamic Therapy in Depression - Towards an Evidence-Based Unified Protocol. Journal of Affective Disorders, 169, 128–143. doi: 10.1016/j.jad.2014.08.007 DOI: https://doi.org/10.1016/j.jad.2014.08.007
Levitt, H. M. (2021). Essentials of critical-constructivist grounded theory research. American Psychological Association. doi: 10.1037/0000231-000 DOI: https://doi.org/10.1037/0000231-000
Luyten, P., & Blatt, S. J. (2012). Psychodynamic Treatment of Depression. Psychiatric Clinics of North America, 35(1), 111–129. doi: 10.1016/j.psc.2012.01.001 DOI: https://doi.org/10.1016/j.psc.2012.01.001
Manning, C., & Marr, J. (2003). 'Real-life burden of depression' surveys--GP and patient perspectives on treatment and management of recurrent depression. Current medical research and opinion, 19(6), 526–531. doi: 10.1185/030079903125002117 DOI: https://doi.org/10.1185/030079903125002117
Mergenthaler, E., & Gril, S (1996). Descripción de las reglas para la transcripción de sesiones de psicoterapia. Revista Argentina de Clínica Psicológica, 5(2),163-176.
Meyer, B., Pilkonis, P. A., Krupnick, J. L., Egan, M. K., Simmens, S. J., & Sotsky, S. M. (2002). Treatment expectancies, patient alliance and outcome: Further analyses from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 70(4), 1051–1055. doi: 10.1037/0022-006X.70.4.1051 DOI: https://doi.org/10.1037//0022-006X.70.4.1051
Ministry of Health of the Government of Chile. (2017). Guía Clínica: Para el tratamiento de la Depresión en personas mayores de 15 años: Actualización en Psicoterapia. [Clinical Guide: For the treatment of Depression in people over 15 years of age: Updating in Psychotherapy]. Ministry of Health, Government of Chile. Available from: https://diprece.minsal.cl/wrdprss_minsal/wpcontent/uploads/2017/07/GPC_depresion_psicoterapia.pdf
Ministry of Health of the Government of Chile (2013). Guía clínica AUGE depresión en personas de 15 años y más (Series guías clínicas MINSAL) [AUGE Clinical Guide: Depression in People Aged 15 and Older (MINSAL Clinical Guidelines Series)]. Ministry of Health, Government of Chile. Available from: http://www.minsal.cl/portal/url/item/7222754637c08646e04001011f014e64.pdf
Mulder, R., Murray, G., & Rucklidge, J. (2017). Common versus specific factors in psychotherapy: opening the black box. The Lancet Psychiatry, 4(12), 953-962. doi: 10.1016/S2215-0366(17)30100-1 DOI: https://doi.org/10.1016/S2215-0366(17)30100-1
OPD Taskforce (2008). Operationalized Psychodynamic DiagnosticsOPD-2: manual of diagnosis and treatment planning. Cambridge, MA: Hogrefe.
Ormel, J., Spinhoven, P., De Vries, Y., Cramer, A., Siegle, G., Bockting, C. & Hollon, S. (2019). The antidepressant standoff: why it continues and how to resolve it. Psychological Medicine, 1–10. doi: 10.1017/S0033291719003295 DOI: https://doi.org/10.1017/S0033291719003295
Owusu‐Frimpong, N., Nwankwo, S., & Dason, B. (2010). Measuring service quality and patient satisfaction with access to public and private healthcare delivery. International Journal of Public Sector Management, 23(3), 203-220. doi: 10.1108/09513551011032455 DOI: https://doi.org/10.1108/09513551011032455
Prins, M. A., Verhaak, P. F. M., van der Meer, K. Penninx, B. W. J. H., & Bensing, J. M. (2009). Primary care patients with anxiety and depression: Need for care from the patient's perspective. Journal of Affective Disorders, 119, 163-171. doi: 10.1016/j.jad.2009.03.019 DOI: https://doi.org/10.1016/j.jad.2009.03.019
Rizvi, S. L., Reynolds, S. K., Comtois, K. A., & Linehan, M. M. (2000, November). Therapeutic alliance in the treatment of borderline personality disorder [Paper presentation]. Association for Advancement of Behavior Therapy, New Orleans, LA.
Seewald, A., & Rief, W. (2023). How to Change Negative Outcome Expectations in Psychotherapy? The Role of the Therapist’s Warmth and Competence. Clinical Psychological Science, 11(1), 149–163. https://doi.org/10.1177/21677026221094331 DOI: https://doi.org/10.1177/21677026221094331
Sotsky, S. M., Glass, D. R., Shea, M. T., Pilkonis, P. A., Collins, J. F., Elkin, I., Moyer, J. (1991). Patient predictors of response to psychotherapy and pharmacotherapy: Findings in the NIMH Treatment of Depression Collaborative Research Program. American Journal of Psychiatry, 148, 997–1008. doi: 10.1176/ajp.148.8.997 DOI: https://doi.org/10.1176/ajp.148.8.997
Strauss, A. & Corbin, J. (2002). Bases de la Investigación cualitativa. Técnicas y procedimientos para desarrollar la teoría fundamentada [Basis of qualitative research. Techniques and procedures to develop the grounded theory]. Editorial Universidad de Antioquía.
Swift, J. K., & Derthick, A. O. (2013). Increasing hope by addressing clients’ outcome expectations. Psychotherapy, 50(3), 284–287. doi: 10.1037/a0031941 DOI: https://doi.org/10.1037/a0031941
Toro-Devia, O., & Leyton, G. (2023). COVID-19 pandemic and mental healthcare: Impact on health insurance with guaranteed universal access in Chile. Frontiers in public health, 10, 1005033. doi: 10.3389/fpubh.2022.1005033 DOI: https://doi.org/10.3389/fpubh.2022.1005033
Van Grieken, R. A., Beune, E. J., Kirkenier, A. C., Koeter, M. W., van Zwieten, M. C., & Schene, A. H. (2014). Patients׳ perspectives on how treatment can impede their recovery from depression. Journal of affective disorders, 167, 153–159. doi: 10.1016/j.jad.2014.05.065 DOI: https://doi.org/10.1016/j.jad.2014.05.065
Van Schaik, D. J., Klijn, A. F., Van Hout, H. P., Van Marwijk, H. W., Beekman, A. T., De Haan, M., & Van Dyck, R. (2004). Patients' preferences in the treatment of depressive disorder in primary care. General hospital psychiatry, 26(3), 184-189. doi: 10.1016/j.genhosppsych.2003.12.001 DOI: https://doi.org/10.1016/j.genhosppsych.2003.12.001
Vîslă, A., Constantino, M., Newkirk, K., Ogrodniczuk, J. & Söchting, I. (2018) The relation between outcome expectation, therapeutic alliance, and outcome among depressed patients in group cognitive-behavioral therapy, Psychotherapy Research, 28,3, 446-456. doi: 10.1080/10503307.2016.1218089 DOI: https://doi.org/10.1080/10503307.2016.1218089
Wampold, B. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–777. doi: 10.1002/wps.20238 DOI: https://doi.org/10.1002/wps.20238
Weitkamp, K., Klein, E., Hofmann, H., Wiegand-Grefe, S., & Midgley, N. (2017). Therapy expectations of adolescents with depression entering psychodynamic psychotherapy: A qualitative study. Journal of Infant, Child & Adolescent Psychotherapy, 16(1), 93–105. doi: 10.1080/15289168.2016.1268883 DOI: https://doi.org/10.1080/15289168.2016.1268883
Westra, H. A., Aviram, A., Barnes, M. & Angus, L. (2010). Therapy was not what I expected: A preliminary qualitative analysis of concordance between client expectations and experience of cognitive-behavioural therapy. Psychotherapy Research, 20(4), 436-446. doi: 10.1080/10503301003657395 DOI: https://doi.org/10.1080/10503301003657395
Westra, H. A., Constantino, M. J., & Aviram, A. (2011). The impact of alliance ruptures on client outcome expectations in cognitive behavioral therapy. Psychotherapy Research, 21(4), 472–481. doi: 10.1080/10503307.2011.581708 DOI: https://doi.org/10.1080/10503307.2011.581708
Weinberger, J., & Eig, A. (1999). Expectancies: The ignored common factor in psychotherapy. In I. Kirsch (Ed.), How expectancies shape experience (pp. 357–382). American Psychological Association. DOI: https://doi.org/10.1037/10332-015

Supporting Agencies

National Agency for Research and Development (ANID), Millennium Institute for Research on Depression and Personality-MIDAP

How to Cite

Zúñiga Caiseo, A. K., De la Parra, G., Núñez, L., & Krause, M. (2025). What do you expect from psychological care? A qualitative study of depressed patients’ expectations treated in mental healthcare settings: Depressed patients’ psychological care expectations. Research in Psychotherapy: Psychopathology, Process and Outcome. https://doi.org/10.4081/ripppo.2025.839

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