Outcome expectations and working alliance may be more important for patients from rural areas during the transition to college life: An exploratory within-patient analysis

ABSTRACTObjective Research has given limited attention to the distinction between patients from rural and urban areas, especially concerning the frequent overlap between rural living and low socio-economic status (SES). To shed more light on this, we explored the differential treatment processes between patients from rural and urban areas.Method Seven hundred and fourteen patients recruited from a university counseling center in China filled out the questionnaires for Outcome Expectation (OE), Session Alliance Inventory (SAI) and Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) each session. Data was analyzed using the disaggregated cross-lagged panel model and the asymmetric fixed-effect model.Results The findings indicated a reciprocal within-patient relation between OE and SAI for the whole sample. SAI mediated the effect of OE on next-session CORE-OM for patients from rural areas, with a significantly greater indirect effect than for patients from the urban areas. Asymmetric effects were found for OE among patients from urban areas, for whom drops in OE predicted worse next-session CORE-OM more strongly than improvements in OE predicted improved CORE-OM.Conclusion This study provided preliminary evidence for differential OE-alliance-outcome predictions between patients with different SES and affirmed a reciprocal OE-alliance relation in a Chinese sample during the transition period of college.Keywords: working allianceoutcome expectationtreatment outcomecross-lagged panel modelasymmetric fixed-effect modelsocioeconomic statusrural area Disclosure StatementNo potential conflict of interest was reported by the author(s).Supplemental DataSupplemental data for this article can be accessed at https://doi.org/10.1080/10503307.2023.2256461.Notes1 We report how we determined our sample size, all data exclusions (if any), all manipulations, and all measures in the study. All data and study materials are available upon the request from the corresponding author.2 For the aim of the present study, we kept the county group in the analysis, but particularly report the results of patients from rural and urban areas.Additional informationFundingThis work was supported by the Major Program of the National Social Science Foundation of China: [Grant Number 22&ZD187].