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

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. (PsycInfo Database Record (c) 2022 APA, all rights reserved).