In Puerto Rico, spiritism offers a traditional alternative to community mental health services. The author compares reported expectations and outcomes of mental health center patients and patients of spiritist healers. The spiritists' patients reported significantly higher expectations, especially for mood and feeling complaints. Both patient groups had a similar duration and severity of symptoms. The outcome ratings of spiritists' patients were significantly better than those of therapists', but this difference could be accounted for by the higher expectations of the spiritists' patients. With these exceptions, the findings do not account for the selection of one type of treatment over the other.