Session-by-session client feeling and clarification processes over the course of emotion-focused therapy.

BACKGROUND: Emotion-Focused Therapy (EFT) is an effective form of psychotherapy for a range of psychological problems. While earlier research demonstrated the effect of in-session processes as being central for explaining the effects of EFT, it is unclear what the role of clients' self-reported quality of emotional processing assessed right after each therapy session is for the prediction of therapy outcome. Specifically, we are assuming that session-by-session trajectories of clients' self-assessed clarification processes and treatment outcome are moderated by their self-reported post-session feelings. METHODS: A total of N = 48 clients with a variety of psychological problems and undergoing EFT within a naturalistic context have been included in the present study. Symptom change was assessed using CORE-10 after each therapy session, in addition to pre- and post-therapy. After each session, the client self-assessed a range of session feelings and the quality of clarification experienced in the session. Longitudinal trajectory analyses with moderation effects and exploratory dynamic network analyses were conducted. RESULTS: The post-session client experience of sadness or grief and joy moderate the trajectory of clarification depth over the course of EFT. Post-session feelings influenced the trajectory of symptom levels over the course of therapy (clarification was non-significant in the model). Specific emotion-based dynamic pathways to clarification and symptom load were explored. CONCLUSIONS: The session-by-session interplay between session feelings (sadness and joy), as self-rated by the client after each session, was a moderator of self-rated clarification and symptom-level trajectories across Emotion-Focused Therapy. This study adds to the understanding of the client's self-perceived mechanisms of change in EFT as it is conducted in a naturalistic context.