Empathy is a basic psychological process that involves the development of synchrony in dyads. It is also a foundational ingredient in specific, evidence-based behavioral treatments like motivational interviewing (MI). Ratings of therapist empathy typically rely on a gestalt, “felt sense” of therapist understanding and the presence of specific verbal behaviors like reflective listening. These ratings do not provide a direct test of psychological processes like behavioral synchrony that are theorized to be an important component of empathy in psychotherapy. To explore a new objective indicator of empathy, we hypothesized that synchrony in language style (i.e., matching how statements are phrased) between client and therapists would predict gestalt ratings of empathy over and above the contribution of reflections. We analyzed 122 MI transcripts with high and low empathy ratings based on the Motivational Interviewing Treatment Integrity (MITI) global rating scale. Linguistic inquiry and word count was used to estimate language style synchrony (LSS) of adjacent client and therapist talk turns. High empathy sessions showed greater LSS across 11 language style categories compared to low empathy sessions (p < .01), and overall, average LSS was notably higher in high empathy vs. low empathy sessions (d = 0.62). Regression analyses showed that LSS was predictive of empathy ratings over and above reflection counts; a 1 SD increase in LSS is associated with 2.4 times increase in the odds of a high empathy rating, controlling for therapist reflections (odds ratio = 2.4, 95% CI: 1.36, 4.24, p < .01). These findings suggest empathy ratings are related to synchrony in language style, over and above synchrony of content as measured by therapist reflections. Novel indicators of therapist empathy may have implications for the study of MI process as well as the training of therapists.

Emotional arousal during relationship conflict is a major target for intervention in couple therapies. The current study examines changes in conflict-related emotional arousal in 104 couples that participated in a randomized clinical trial of two behaviorally-based couple therapies. Emotional arousal is measured using mean fundamental frequency of spouse’s speech, and changes in emotional arousal from pre- to post-therapy are examined using multilevel models. Overall emotional arousal, the rate of increase in emotional arousal at the beginning of conflict, and the duration of emotional arousal declined for all couples. Reductions in overall arousal were stronger for TBCT wives than for IBCT wives but not significantly different for IBCT and TBCT husbands. Reductions in the rate of initial arousal were larger for TBCT couples than IBCT couples. Reductions in duration were larger for IBCT couples than TBCT couples. These findings suggest that both therapies can reduce emotional arousal, but that the two therapies create different kinds of change in emotional arousal.

Therapists can impact the likelihood a given patient will benefit from psychotherapy. However, therapists are rarely held accountable for their patients' outcomes. As a result, low performing providers likely continue to practice alongside providers with high response rates. In the current study, we conducted a Monte Carlo simulation to illustrate a thought experiment—what happens to patient outcomes if therapists with the worst outcomes were removed from practice? We drew initial samples of 50 therapists from three simulated populations of 1,000 therapists with a mean patient response rate of 50% and different effect sizes for therapist variability in outcomes. We simulated 30 patient outcomes for each therapist, with outcome defined as response to treatment versus no response. We removed therapists with response rates in the bottom 5% and replaced them with a random sample of therapists from the population. Over 10 years, the difference in responses between the lowest and highest performing therapists was substantial (between 697 and 997 additional responses to treatment). After repeatedly removing the lowest performing providers 40 times (simulating a 10 year time span), response rates increased substantially. The cumulative number of patient responses (i.e., summing the total number of responses across 10 years) increased by 4266, 6404, and 9307 when therapists accounted for 5%, 10%, or 20% of the patient outcome variance, respectively. These findings indicate that performance-based retention of therapists could improve the quality of psychotherapy in health systems by improving the average response rate and decreasing the probability that a patient will be treated by a therapist who has little chance of helping.

The present study examined associations between use of protective behavioral strategies (PBS) by college students and their friends and drinking-related outcomes during Spring Break (SB). Moreover, this study examined the influence of friends’ own PBS use on participants’ PBS use during SB. Participants included college students (N = 694) and their nominated friends (N = 131) who were part of a larger study of SB drinking. Data were collected via web-based surveys that participants and friends took after SB, which assessed SB PBS, drinking, and related negative consequences. Results indicated that higher levels of Serious Harm Reduction (SHR) strategies and Limiting/Stopping (LS) strategies were associated with increased consumption, higher likelihood of experiencing any consequences, and an increased number of consequences. A different pattern emerged for Manner of Drinking (MD) strategy use; participants utilizing higher levels of MD strategies drank less and had fewer consequences. LS and MD strategies used by the participant’s friends appeared to have less of an impact on the participant’s drinking outcomes. However, greater friends’ use of SHR strategies was associated with increased alcohol use by the participant, but not with consequences. Greater friends’ use of SHR strategies was associated with greater SHR strategy use by the participant. Friends’ LS and MD strategies were not associated with participant drinking, consequences, or PBS. These findings highlight the potential utility of interventions that focus on drinking behaviors on specific high-risk occasions for those at risk as well as for their friends.

Maladaptive emotional reactivity and dysfunctional communication during couple conflict are both destructive to couple functioning, and observational research has elucidated how conflict escalates. However, much of the evidence is based on measures that combine content (i.e., what was said) and the emotion with which it was said, which are then examined using sequential analyses. Despite the general presumptions about underlying emotional reactivity and escalation in negative emotions as part of relationship distress and deterioration, little empirical data are available that directly examine these continuous shifts in emotions. The current study examined concurrent and longitudinal associations between relationship satisfaction and trajectories of change in vocally expressed emotional arousal during couple conflict in 62 couples who participated in a relationship education program. Contrary to expectations and patterns found in distressed couples, trajectories followed a U‐shape rather than an inverted U‐shape curve, with steeper and more persistent decreases in emotional arousal predicting more stable relationship satisfaction over time. In addition, there were within‐couple effects. These results suggest that early signs for relationship deterioration may be less in the form of overt escalation as would be seen in distressed couples. Instead, couples who subsequently deteriorate more are less effective in calming emotional arousal. They also are less able to remain at lower emotional arousal. It is possible that the more pronounced escalation toward the end of the conversation in more at‐risk couples is a precursor of the greater escalation patterns seen in distressed couples; this should be examined empirically. Limitations and implications are discussed.