Emotions and Symptom Change in Psychodynamic Psychotherapy: A Longitudinal Study

The aim of this study is to study the level, range, and trend of experiencing certain emotions in open-ended psychodynamic psychotherapy, and their association with symptomatic improvement. For this aim, pre- and post-therapy symptoms were assessed for 54 clients and 12 intern therapists and emotion ratings were collected for 899 sessions. Emotions with the highest averages were happiness, sadness, relief, and surprise; whereas emotions with the lowest averages were contempt, disgust, fear, and envy. Linear Mixed Modeling revealed that higher ranges of clients' guilt and lower levels of therapists' anger predicted symptom improvement. It was discussed that sadness and guilt of the client might point to a capacity to grieve and to take responsibility; and anger of the therapist might have instigated indifference and rupture. Emotion trends were studied using Multi-level Modeling, and linear trends were observed for clients' surprise, and therapists' happiness and relief. This finding was interpreted in relation to the type of termination. The associations between clients' and therapists' emotion trends were analyzed by Multi-Level Vector Autoregression; and a strong association between the contemporaneous happiness and sadness of the client and the therapist was found. This state of "laugh together cry together" was considered as mutual attunement. Results were supportive of emotion literature and psychodynamic literature as well as promising in terms of the longitudinal study of the process experience of the client and the therapist as a dyad.