Fifty-two psychotherapy sessions were coded for silences that reflect processes of client disengagement (e.g., withdrawal, resistance). The study examined the presence of these silences and clients' reports of in-session emotion and symptom change. Results indicated that disengagement predicted poorer proximal and distal outcome as measured by the Beck Depression Inventory for Primary Care (BDI-PC) and poorer proximal outcome on the Symptom Checklist-5, but it was not significantly predictive of Outcome Questionnaire-45 scores. Interitem analyses revealed that disengagement had a significant proximal effect on depressive mood and negative self-evaluative items assessed by the BDI-PC, but across time these effects were sustained for the negative self-evaluative items only.
Although few studies have examined the experience of depression, no research has been conducted on the experience of sadness in psychotherapy. In this study, clients were interviewed about their experience of sadness using an interpersonal process recall method, these interviews were subjected to grounded theory analysis, and a model of sadness experienced in psychotherapy was derived. The resulting core category--in therapy, the experience of sadness is a struggle against the fear of becoming trapped within the painful, existential question "Who am I?"--captures the essence of the experience of the clients' sadness and describes the struggle, the causes of sadness, and ways therapists facilitated sadness exploration. The findings are discussed in reference to clinical application and future psychotherapy research.
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