Client pre-treatment expectations have a significant impact on psychotherapy outcome, therapeutic alliance, and attendance. Client expectations are thought to account for approximately 11-14% of variance in premature termination from psychotherapy. However, measures that conflate treatment beliefs and distinct measurement techniques for the same outcome construct obscure the relationship between expectations and psychotherapy outcomes. Clarifying these associations is necessary to support development of useful methods and processes that support client retention in evidence-based treatments. With drop-out rates of approximately 20% across treatment settings, and as high as 69.4% in psychology training clinics, risk of attrition is a significant liability to effective treatment. The meta-analytic findings presented herein clarify the association of pre-treatment expectations with psychotherapy outcome, considering competing definitions for client expectations and discrepant psychotherapy outcome measurement. Implications for attrition, treatment outcomes, and therapeutic alliance are discussed.