Process expectations: Differences between therapists, patients, and lay individuals in their views of what works in psychotherapy

Background: In this study, we aimed to assess the degree to which individuals with varying levels of psychotherapeutic experience have predisposed ideas regarding what works in psychotherapy. Method: Therapists (n = 107), patients (n = 97), and lay individuals with no prior experience in psychotherapy (n = 160) reported their process expectations and ranked seven mechanisms of change in the order of their perceived importance. Results: Therapists rated emotional processing and patient–therapist relations as higher in importance than did patients and lay individuals, but patients and lay individuals rated cognitive and emotional reconstruction higher than did therapists. Furthermore, therapists ranked the exploration of unconscious contents as most important, while patients and lay individuals ranked cognitive control to be the most important mechanism of change. Conclusions: Therapists, patients, and lay individuals expect different mechanisms of change to take place in psychotherapy. Limitations and directions for future research are discussed.