Relationship Between Patient Early Treatment Crying Experiences With Psychotherapy Process and Outcome

This is the first study to investigate the relationship between patient crying events, affect intensity and duration with patient and therapist perceptions of early session process, alliance and treatment outcome. Participants (N = 58) were admitted to a community-based outpatient clinic, where their intake, assessment feedback and third sessions were independently and reliably coded for discrete crying segments and qualities. Patients and therapists completed measures of session experience and therapeutic alliance after the assessment feedback and third session. Total number of crying events were significantly related to more difficult and challenging patient ratings of session process during the feedback session. Average crying affect intensity and duration of these crying events were related to both greater levels of patient rated alliance during the feedback session, while average duration alone related to higher levels of therapist alliance and therapist ratings of session depth. Both variables (average crying affect intensity and duration) were related to greater levels of patient rated session depth during the third session, with-again-average duration also related to higher levels of therapist alliance, therapist ratings of session depth and overall value. In addition, both higher average crying affect intensity and longer average crying duration were positively related to patient outcome changes in global psychopathology and anxiety symptoms. The majority of therapist interventions that immediately preceded patient crying events were affect-focused in nature (i.e., encouragement to express, experience and explore feelings), with the next most frequent intervention being interpretation (i.e., suggest an alternative understanding not previously recognized by the patient). These data further highlight the complex nature of patient crying experiences in psychotherapy that is informed by both the quantity, as well as the quality of that experience.