Abstract
The relationship between client emotional expression and therapist interventions was studied in two working alliance conditions. An events-focused methodology was used to examine a total of 8 events taken from a variety of therapeutic orientations. Results indicated that, in the presence of a good client–therapist relationship, therapists showed higher levels of empathy and effectively focused on the immediately expressed feelings; in turn, their clients were engaged in exploration of feelings. In poor-relationship dyads, clients expressed negative feelings toward the therapists. Interventions rated as effective by clinical judges were characterized by accurate therapist understanding of clients' emotional expressions and working with strains in the therapeutic relationship. Ineffective interventions were associated with inaccurate assessments of clients' emotional states. Intensive analysis of these sessions led to three distinct models of in-session emotional expression events. Theoretical and practical implications of these models will be discussed.
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REFERENCES
Alexander, F., & French, T. M. (1946). Psychoanalytic therapy: Principles and applications. New York: Ronald Press.
Agras, S., Leitenberg, H., & Barlow, D. H. (1968). Social reinforcement in the modification of agoraphobia. Archives of General Psychiatry, 19, 423–427.
Beck, A. (1970). Cognitive therapy: Nature and relation to behavior therapy. Behavioral Therapy, 1, 184–200.
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research, and Practice, 16, 252–260.
Bordin, E. S. (1994). Theory and research on the therapeutic working alliance: New directions. In A. O. Horvath & L. S. Greenberg (Eds.), The working alliance: Theory, research, and practice (pp. 13–37). New York: Wiley.
Breuer, J., & Freud, S. (1895). Studies on hysteria. New York: Basic Books.
Butler, S. F., & Strupp, H. H. (1991). The role of affect in time-limited dynamic psychotherapy. In J. D. Safran & L. S. Greenberg (Eds.), Emotion, psychotherapy, and change (pp. 83–112). New York: Guilford.
Clarke, K. M. (1989). Creation of meaning: An emotional processing task in psychotherapy. Psychotherapy, 26, 139–148.
Clarke, K. M. (1996). Change processes in a creation of meaning event. Journal of Consulting and Clinical Psychology, 64, 465–470.
Cohen, J. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20, 37–46.
Ebel, R. L. (1950). Estimation of the reliability of ratings. Psychometrika, 16, 407–424.
Elliott, R. (1984). A discovery-oriented approach to significant events in psychotherapy: Interpersonal process recall and comprehensive process analysis. In L. Rice & L. Greenberg (Eds.), Patterns of change: Intensive analysis of psychotherapeutic process (pp. 249–286). New York: Guilford.
Elliott, R. (1989). Comprehensive Process Analysis: Understanding the change process in significant therapy events. In M. Packer & R. B. Addison (Eds.), Entering the circle: Hermeneutic investigation in psychology (pp. 165–184). New York: SUNY Press.
Elliott, R., & Anderson, C. (1994). Simplicity and complexity in psychotherapy research. In R. L. Russell (Ed.), Reassessing psychotherapy research (pp. 65–113). NewYork: Guilford.
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35.
Foreman, S. A.,& Marmar, C. R. (1985). Therapist actions that address initially poor therapeutic alliances in psychotherapy. American Journal of Psychiatry, 142, 922–926.
Frank, J. D., & Frank, J. B. (1991). Persuasion and healing (3rd ed.). Baltimore, MD: Johns Hopkins University Press.
Frijda, N. (1988). The laws of emotion. American Psychologist, 43(5), 349–358.
Garfield, S. L. (1989). The pratice of brief psychotherapy. New York: Pergamon Press.
Gendlin, J. (1996). Focusing-oriented psychotherapy: A manual of the experiential method. New York: Guilford.
Guidano, V. F. (1991). The self in process: Toward a post-rationalist cognitive therapy. New York: Guilford.
Guidano, V. F. (1995). Self-observation in constructivist psychotherapy. In R. A. Neimeyer & M. J. Mahoney (Eds.), Constructivism in psychotherapy (pp. 93–108). Washington, DC: American Psychological Association.
Greenberg, L. S. (1984). Task analysis of interpersonal conflict. In L. Rice & L. Greenberg (Eds.), Patterns of change: Intensive analysis of psychotherapeutic process. New York: Guilford.
Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating emotional change: The momentby-moment process. New York: Guilford.
Greenberg, L. S., & Safran, J. D. (1987). Emotions in Psychotherapy. New York: Guilford.
Greenberg, L. S., & Safran, J. D. (1989). Emotion in psychotherapy. American Psychologist, 44, 19–29.
Hill, C. E., Corbett, M. M., Kanitz, B., Rios, P., Lightsey, R., & Gomez, M. (1992). Client behavior in counseling and therapy sessions: Development of a pantheoretical measure. Journal of Counseling Psychology, 39, 539–549.
Horvath, A. O. (1994).Research on the alliance. In A. O. Horvath & L. S. Greenberg (Eds.), The working alliance: Theory, research, and practice (pp. 259–286). New York: Wiley.
Horvath, A. O., & Greenberg, L. S. (1986). The development of the Working Alliance Inventory. In L. S. Greenberg & W. M. Pinsof (Eds.), The psychotherapeutic process: A research handbook (pp. 529–556). Guilford Clinical Psychology and Psychotherapy Series. New York: Guilford.
Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36, 223–233.
Horvath, A. O., & Luborsky, L. (1993). The role of the therapeutic alliance in psychotherapy. Journal of Consulting and Clinical Psychology, 61, 561–573.
Iwakabe, S., Stalikas, A., & Rogan, K. (June, 1995). A method for analysing client emotional processes in counselling. Paper presented at the Canadian Psychological Association conference, Charlottetown, Canada.
Iwakabe, S., Stalikas, A., Gazzola, N., & Rogan, K. (July, 1995). A preliminary report on the application of the Strength of Client Feeling Scale-Revised: Measuring emotional processes in psychotherapy. Paper presented at the Fourth European Congress of Psychology, Athens, Greece.
Kazdin, A. E. (1981). Drawing valid inferences from case studies. Journal of Consulting and Clinical Psychology, 49, 183–192.
Kosmicki, F. X., & Glickauf-Hughes, C. (1997). Catharsis in psychotherapy. Psychotherapy: Theory, Research and Practice, 34, 154–159.
Labott, S. M., Elliott, R., & Eason, P. S. (1992). “If you love someone, you don't hurt them”: A comprehensive process analysis of a weeping event in therapy. Psychiatry, 55, 49–61.
Luborsky, L. (1976). Helping alliances in psychotherapy. In J. L. Cleghorn (Ed.), Successful psychotherapy (pp. 92–116). New York: Brunner/Mazel.
Mahoney, M. J. (1991). Human change processes: The scientific foundations of psychotherapy. New York: Basic Books.
Mahrer, A. R. (1986). Therapeutic experiencing: The process of change. New York: Norton.
Mahrer, A. R. (1989). How to do experiential psychotherapy: A manual for practitioners. Ottawa, Canada: University of Ottawa Press.
Mahrer, A. R., Stalikas, A., Boissoneault, M., T rainor, K., & Pilloud, L. (1990) A scale for assessing strength of client feeling. Canadian Journal of Counselling, 24, 107–115.
Martin, J., Paivio, S., & Labadie, D. (1990). Memory-enhancing characteristics of clientrecalled important events in cognitive and experiential therapy: Integrating cognitive and experiential and therapeutic psychology. Counseling Psychology Quarterly, 3, 239–256.
Morrow-Bradley, C.,& Elliott, R. (1986). The utilization of psychotherapy research by practicing psychotherapists. American Psychologist, 41, 188–197.
Orlinsky, D. E., & Howard, K. I. (1986). Process and outcome in psychotherapy. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of psychotherapy and behavioral change (3rd ed., pp. 311–381). New York: Wiley.
Pennebaker, J. W. (1990). Opening up: The healing power of expressing emotions. New York: Guilford.
Raue, P. J., & Goldfried, M. R. (1994). The therapeutic alliance in cognitive-behavior therapy. New York: Guilford.
Reandeau, S. G.,& Wampold, B. E. (1991). Relationship of power and involvement to working alliance: A multiple-case sequential analysis of brief therapy. Journal of Counseling Psychology, 38, 107–114.
Reich, W. (1949). Character analysis. New York: Noonday.
Rhodes, R. H., Hill, C. E., Thompson, B. J., & Elliott, R. (1994). Client retrospective recall of resolved and unresolved misunderstanding events. Journal of Counseling Psychology, 41, 473–483.
Rice, L. N., & Greenberg, L. S. (1984). Future research directions. In L. N. Rice & L. S. Greenberg (Eds.), Patterns of change: Intensive analysis of psychotherapy process (pp. 289–300). New York: Guilford.
Rogers, C. R. (1959). A theory of therapy, personality, and interpersonal relationships, as developed in the client-centered framework. In S. Koch (Ed.), Psychology: A study of a science: Vol. 3 (pp. 184–256). New York: Basic Books.
Rogers, C. R. (1961). On becoming a person. Boston: Houghton Mifflin.
Rosner, R. (1996). The relationship between emotional expression, treatment and outcome in psychotherapy: An empirical study. Frankfurt am Main, Germany: Peter Lang.
Safran, J. D. (1993). The therapeutic alliance rupture as a transtheoretical phenomenon: Definitional and conceptual issues. Journal of Psychotherapy Integration, 3, 33–49.
Safran, J. D., McMain, S., Crocker, P., & Murray, P. (1990). Therapeutic alliance rupture as a therapy event for empirical investigation. Psychotherapy, 27, 154–165.
Safran, J. D., & Segal, Z. V. (1990). Interpersonal process in cognitive therapy. New York: Basic Books.
Sexton, H. C., Hembre, K., & Kvarme, G. (1996). The interaction of the alliance and therapy microprocesses: A sequential analysis. Journal of Consulting and Clinical Psychology, 64, 471–480.
Shostrom, E. L. (Producer). (1966). Three approaches to psychotherapy. Santa Ana, CA: Psychological Films.
Stiles, W. (1997). Consensual qualitative research: Some cautions. TheCounseling Psychologist, 25, 586–598.
Tichenor, V., & Hill, C. E. (1989). A comparison of six measures of working alliance. Psychotherapy, 26, 195–199.
Walborn, F. S. (1996). Four variables: Four common elements of counseling and psychotherapy. Pacific Grove, CA: Brooks/Cole.
Watson, J. C., & Greenberg, L. S. (1994). The alliance in experiential therapy: Enacting the relationship conditions. In A. O. Horvath & L. S. Greenberg (Eds.), The working alliance: theory, research, and practice (pp. 153–172). New York: Wiley.
Wiser, S., & Goldfried, M. R. (1993). Comparative study of emotional experiencing in psychodynamic-interpersonal and cognitive-behavioral therapies. Journal of Consulting and Clinical Psychology, 61, 892–895.
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Iwakabe, S., Rogan, K. & Stalikas, A. The Relationship Between Client Emotional Expressions, Therapist Interventions, and the Working Alliance: An Exploration of Eight Emotional Expression Events. Journal of Psychotherapy Integration 10, 375–401 (2000). https://doi.org/10.1023/A:1009479100305
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DOI: https://doi.org/10.1023/A:1009479100305