Therapist affect focus and patient outcomes in psychodynamic therapy: An updated systematic review and meta-analysis

In this preregistered Prospero (CRD42022334071) review, the authors updated a meta-analysis review that examined the relation between therapist facilitation of patient emotional experience/expression and outcome in psychodynamic psychotherapy. Computer, manual, and backwards searches were conducted for relevant publications, and 14 independent samples of short-term dynamic psychotherapy were included in the meta-analysis. Data analysis included calculation of an overall effect size of the relationship between therapist affect focus and outcome, statistical significance, and test for homogeneity. In addition, moderator analyses were conducted to examine the potential impact of the methodological quality of individual studies. The overall weighted average r was .265, which was statistically significant, p < .001 (k = 14; 95% confidence interval [.130, .392]), indicating that therapist affect focus was associated with greater degree of patient change over the course of psychodynamic therapy. The results were not demonstrably heterogeneous, Q(13) = 14.787, p = .321, I² = 12.085, and publication bias analyses did not indicate cause for concerns regarding the results (all ps > .05). Trim-and-fill results indicated an adjusted weighted average r of .250 (decrease of 5.660%). None of the moderator analyses examining study methodology quality were statistically significant (all ps > .10). These data indicate that therapist facilitation of patient affective experience/expression is associated with patient improvement over the course of psychodynamic psychotherapy. The size of this relation was not significantly related to methodological quality. (PsycInfo Database Record (c) 2025 APA, all rights reserved).