Therapist Expressed Empathy Across Experiential Treatment for Depression: Its Growth and Relationship to Other Psychotherapy Processes
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Objective: This study examined whether the provision of expressed empathy by therapists increases from the beginning to the working phase of experiential therapy for depression. It also tested relationships among working phase therapist expressed empathy, the working phase alliance, and clients working phase emotional processing, as well as tested the relationship between therapist expressed empathy and outcome at termination. Method: Therapist expressed empathy was assessed using The Measure of Expressed Empathy, a valid and reliable observer-rated measure. The Working Alliance Inventory, Experiencing Scale, and Beck Depression Inventory were used to measure the alliance, emotional processing and outcome respectively. Results: A paired samples t-test determined that therapists significantly increased their provision of expressed empathy from session one to the first working phase therapy session. A linear regression determined that improvements in therapist empathy were associated with improvements in the working alliance between these sessions. A path analysis found that working phase therapist empathy indirectly predicted outcome by contributing to more favourable working phase alliances, and a trend was found for therapist empathy to indirectly predict working phase emotional processing through the working phase alliance. Conclusion: Therapists do increase in their expression of empathy over the course of experiential therapy. When therapist empathy increases across therapy sessions working alliances tend to improve. Further, higher working phase therapist empathy appears to indirectly contribute to more reductions in depressive symptoms at termination by improving the working phase alliance.