The Impact of Resistance on Empathy in Cognitive - Behavioural Therapy

The present study sought to explore the impact of resistance on client perceptions of therapist empathy, and examine client-rated empathy as a mediator of the impact of resistance on therapy outcomes in the context of 44 therapist-client dyads receiving cognitive-behavioural therapy for generalized anxiety disorder. Trained observer ratings of resistance were utilized to identify the level of resistance present in an early therapy session, and corresponding client post-session ratings of therapist empathy were used. Treatment outcome was measured via client-rated worry severity at posttreatment and one-year posttreatment. Higher levels of resistance were significantly associated with lower client post-session ratings of therapist empathy, beyond clients’ baseline empathy ratings. Client post-session ratings of therapist empathy did not mediate the relationship between resistance and treatment outcomes. This study underscores the link between resistance and client perceived empathy, and highlights the need to enhance therapist in-session responsivity to resistance in psychotherapy research and training.