Process variables in university counseling: the role of expectations and therapeutic alliance on intervention outcome

Introduction: Several studies have proven the pivotal role of university counseling interventions in enhancing students’ psychological wellbeing and in reducing pre-treatment distress. However, the mechanisms underlying successful counseling interventions are still unclear. Pre-treatment expectations as well as clients' perceived therapeutic alliance represent two variables that are able to explain part of the effectiveness of psychotherapies regardless of their duration. Aim: The present study aims to investigate whether more positive expectations about the counseling process predict better outcomes and whether this relationship is mediated by students' perceptions of a better therapeutic alliance with clinicians. Methods: The sample included 50 students who underwent counseling intervention at Sapienza University of Rome as of January 2023. They were asked to complete the following self-report questionnaires: Expectations About Counseling-Brief Form (EAC-B) at pre-test, Working Alliance Inventory-Short Form Revised (WAI-SF) at post-test (after the fourth interview) and Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI) at both pre and post-test. A linear regression model was used to investigate the predictive role of expectations at pretreatment (EAC-B) on intervention outcome (CORE-OM, BDI-II, BAI) while mediation analyses were used to test whether therapeutic alliance, as evaluated by the students (WAI-SF), mediated this relationship. Results: Preliminary results suggests that expectations at the pre-test significantly predicted counseling outcome. This relationship was only partly mediated by the therapeutic alliance. Promising findings concern the influence of expectations on the counseling process. Students who showed greater trust in the therapist's ability to provide valuable support for their difficulties showed more significant improvement after the intervention. Discussion: Our results shed light on how expectations and therapeutic alliance contribute to determine the outcome of a university counseling intervention. A deeper understanding of process variables, such as expectations and therapeutic alliance, constitutes a crucial prerequisite for developing more focused treatments in university counseling.