Objective: Young people represent a vulnerable age group for mental health concerns and tend not to seek help. Client expectations and preferences related to roles, therapy processes and outcomes of therapy have been linked with engagement, help-seeking, and clinical outcomes for adults, however, very little is known regarding the effects of these factors on young people’s help-seeking experience. This thesis by published works makes an original contribution to knowledge by comprehensively examining young people’s expectations, preferences and actual experience of therapy and the effects of these factors on therapy outcomes and also addresses a number of methodological weaknesses in previous research. This thesis is comprised of five research papers: paper one aimed to qualitatively explore young people’s pre-treatment expectations of therapy; papers two and three aimed to quantitatively examine relationships and differences between young people’s expectations, preferences, and experience of therapy as well as age and gender effects; the fourth paper aimed to explore the effects of expectations, preferences and experience of therapy on clinical outcome, mental health service use, and future help-seeking intentions; and paper five aimed to examine the effects of disconfirmed expectations on these important outcome variables. Method: The methodology involved a longitudinal multi-method design with qualitative, cross-sectional, and prospective components. Participants in the qualitative study included 20 young people aged 12-25 years who participated in a brief interview immediately prior to their initial assessment at a youth mental health care service, which was targeted at mild to moderate early presentations of mental health problems. Participants involved in the quantitative study included a total of 228 young people aged 12-25 years who completed an initial questionnaire on contact with the youth mental health care service, and of these,102 who completed a follow-up questionnaire two months later. Results: The most prominent theme that emerged from the qualitative study was that young people were unsure of what to expect from attending a mental health service. The quantitative study found that young people’s preferences for therapy were very optimistic, whereas initial expectations and actual experience of therapy were significantly more pessimistic. Females were less likely to expect the therapist to like and accept them or expect the therapist to self-disclose when compared to males. Younger participants had lower preferences to be motivated, open, and personally responsible in therapy and were more likely to expect the therapist to be directive when compared to older adolescents and young adults. Young people’s actual experiences of therapy and their preference for personal commitment were positively associated with the outcome variables; however no significant associations were evident for initial expectations. Further, young people whose actual experience of therapy was more negative than their initial expectations related to the therapist’s role and processes of therapy had a poorer clinical outcome and attended fewer sessions. Finally, young people who had a negative experience of their role as a client attended fewer sessions and those who had negative expectations and experience related to their outcome had a poorer clinical outcome. Conclusions: Results indicate that young people require age appropriate education on what to expect from seeking help from mental health services and highlight a need for clinicians to help young consumers to have realistic expectations as well as a positive experience of therapy. Further, the client’s level of personal commitment in the therapeutic relationship was strongly identified as a factor that needs to be promoted and maintained. It is important that clinicians work collaboratively with younger consumers, build a strong therapeutic alliance, and tailor psychological interventions to meet the clients’ individual needs, desires and expectations as this will promote engagement and more positive clinical outcomes.
|Date of Award
|Debra Rickwood (Supervisor) & Debra Stevens (Supervisor)