Search Results

Patients’ expectations have long been considered a contributory factor to successful psychotherapy. Expectations come in different guises, with outcome expectations centered on prognostic beliefs about the consequences of engaging in treatment. This chapter defines outcome expectations and present assessment methods and clinical examples of outcome expectations. The research review includes a comprehensive meta-analysis (N = 8,016 patients across forty-six independent samples) of the association between pre- or early-therapy outcome expectations and posttreatment outcomes. The overall weighted effect size was d = .24, p 〈 .001, indicating a small, but significant positive effect of outcome expectations on adaptive treatment outcomes. This chapter also provides a narrative review of mediators of the expectation–outcome link and patient factors that relate to their outcome expectations. Finally, this chapter discusses limitations of the research base and offer therapeutic practices based on the findings.

In its simplest form, the American dream is the belief that success should be determined by effort, not unfair advantage. This idea is embedded in the psyche of most Americans and shapes the way we collectively view individuals’ outcomes. It forms the lens through which we judge social policies that undergird opportunities or compound disadvantage. It is powerful enough to influence the way that people see their own success and failure and that of others. It can blind Americans to the structural forces that chart our fates. Indeed, Americans who want so badly to believe that there is a logic to the forces that shape their outcomes and a real path to their promised future may even excuse patently unfair institutions and the injustices they perpetuate. While these system- justifying beliefs can buffer people from the stress of contemplating abject inequity, as evidence mounts that things are not working as they should, defenses slip, doubts rise, and cracks emerge in the American dream. Today, there is a growing sense that this dream is more nostalgic memory than an accurate representation of the way the world works. A 2014 survey found that 48% of Americans believed that the American dream once was true but is not true anymore. These doubts represent more than just whispered anxieties or casual statements of political frustration. Instead, we contend that belief in the American dream is an expression of deeply rooted faith in our institutions and their ability to deliver on their promises, which in turn becomes a covenant in modern governance. This means that Americans’ increasing skepticism about whether institutions will ensure that their efforts pay off threatens the foundation of civil society. In other words, our inclination to rationalize societal arrangements has limits. When we can no longer explain away inequitable outcomes from schools, the labor market, and government policies, the social contract Americans have forged together is broken.

The theory of planned behavior (TPB) and stages of change (SOC) models have been used to predict physical activity (PA) in people with disabilities. The purpose of this chapter is to give an overview of the TPB and SOC models and the research findings stemming from testing them in people with impairments. The health action process approach (HAPA), designed with individuals with disabilities, is also introduced, along with suggested future research using the HAPA. The HAPA is in many ways a meta-theory, as it incorporates many constructs from theories discussed here and in other chapters. For instance, various forms of self-efficacy, outcome expectations, coping, planning, and social support are all included in the HAPA. In addition, the HAPA includes a three-stage model in which people are labeled as pre-intenders, intenders, or actors. Researchers intending to use the SOC theories and the TPB should know that they have come under criticism, and these criticisms are addressed in the chapter.