Therapist emotion and emotional change with clients: Effects on perceived empathy and session quality.

Abstract

Therapists’ emotion and therapist–client emotional congruence are associated with psychotherapy process and outcome. However, their presession emotional states are not consistently accounted for across studies, and the underlying mechanism is unclear. This study introduces the concepts of directional correspondence (DC), where therapists’ and clients’ emotions move in a similar direction from pre to postsession, and absolute agreement (AA), where therapist and client become closer in emotions from pre to postsession, to examine congruence in emotional change in therapist and client from pre to postsession. In addition, clients’ perception of therapist empathy was investigated as a mediator between therapists’ emotion/therapist–client emotional congruence and session outcome. Sixty nine clients and 49 therapists participated in this study over the course of therapy (593 sessions in total). They rated their emotions before and after each session, and clients rated therapist empathy and session quality after each session. Multilevel models showed that therapist presession emotions, therapist–client presession emotional similarity, and DC did not predict therapist empathy and session quality. However, AA predicted better therapist empathy, which in turn predicted better session quality. The partial mediation path was also stronger when therapist and client had more dissimilar presession emotions. Thus, clients may rate a session based on their perception of therapist empathy, which may reflect therapist and client moving toward more similar emotions over a session. In addition, the positive effect of therapist and client growing closer in emotions is especially pronounced when they start sessions in different emotional states. Implications of the findings are discussed.

Development and preliminary validation of the Clinician Affective REsponse (CARE) scale

“…The crucial importance of the emotions experienced during the session is further supported by a recent study showing that the emotions of the therapists before the session predict neither their empathy with the patient nor the quality of the session (Chui et al , 2022 ). This is particularly important when considering that an empathetic and positive relationship is not only essential for facilitating change but also necessary for the successful execution of psychotherapeutic interventions (Hayes & Vinca, 2017 ; Peluso & Freund, 2018 ).…”

Exploring the Impact of Therapeutic Presence on Working Alliance in Metaverse Counseling

“…Therapeutic presence allows clients to engage in a deeper connection with their therapists, promoting the growth of a therapeutic bond (Zhao et al, 2023). A growing body of evidence (e.g., Chui et al, 2022; Hayes & Vinca, 2017) has demonstrated the positive impact of therapeutic presence, as perceived by clients, on the ability to predict empathy, strengthen therapeutic relationships, and enhance therapy session outcomes. Therefore, it is essential to recognize and assess therapeutic presence from the perspective of the client as a significant factor in the therapeutic process.…”

A curvilinear association between therapists’ use of discourse particles and therapist empathy in psychotherapy.

“…One aspect of which is the relationship between the therapist's emotion and the psychotherapy process and outcome. For instance, Chui et al (2022) found that clients' perception of therapist empathy was a mediator between the therapist's emotion and the session outcome. Within which, clients' experience of therapist empathy has long been hypothesized to be a key process in psychotherapy contributing to client change and shown to be a moderately strong predictor of therapy outcome (Elliott et al, 2011(Elliott et al, , 2018.…”

“…Given that the left hemisphere is generally responsible for linguistic functions, the above neurological evidence supports that discourse particles, despite verbal linguistic elements, encode affective/emotional functions. Also, past studies have shown that therapists’ emotions, attitudes, and nonverbal communication are associated with perceived therapist empathy (Chui et al, 2022; L. S. Greenberg, 2008; L.…”

“…There are three possible methods of characterizing therapist emotion in psychotherapy literature. The first method is to use affective/emotional measures (e.g., Chui et al, 2016Chui et al, , 2022, such as the Positive Affect and Negative Affect Schedule (Watson et al, 1988). A second method is to use text-based emotional vocabulary count (e.g., Burkhardt et al, 2022;Tanana et al, 2021), such as the Linguistic Inquiry and Word Count (LIWC; Tausczik & Pennebaker, 2010).…”