Emotion words in counseling interactions: Effects on session quality and perceived therapist empathy

Identifying and labeling emotions are important parts of the therapeutic process, but how these linguistic patterns shape clients' perception of sessions remains underexplored. This study addresses the gap by examining the associations between therapists' and clients' use of emotion words and the counseling process. Eight sessions from each of 64 therapist-client dyads at a training clinic were transcribed. Positive and negative emotion words were extracted using the Linguistic Inquiry and Word Count, and the emotion word ratio, linguistic style matching, and linguistic style coordination were calculated. Multilevel modeling examined the associations between these three linguistic indicators and client postsession ratings of therapist empathy and session quality, controlling for session number. Linguistic style matching did not predict session quality or perceived empathy. Greater client use of positive emotion words predicted lower perceived empathy. After controlling the match of positive emotion words, increased therapist use of positive emotion words predicted higher perceived empathy. When clients followed therapists' negative emotion words, clients rated session quality higher; conversely, when therapists followed clients' negative emotion words, clients rated session quality and perceived empathy lower. This study underscores the distinct roles of therapists and clients in emotion word use during sessions. Clients' positive emotion words may reflect defenses and limit opportunity for therapists to explore deeper and express empathy, while therapists' positive emotion words beyond simple reflection may be perceived as empathic. Clients tend to rate sessions higher when they follow therapists' lead in exploring negative emotions, but lower if therapists merely mirror clients' negative emotions. (PsycInfo Database Record (c) 2026 APA, all rights reserved).