The Relationships Among Growth, Emotion Schematic Change and Long-Term Outcomes After Experiential Treatment for Depression

This study empirically examined whether clients with strong alliance growth (SAG) versus weak alliance growth (WAG) trajectories, and good versus poor long-term outcomes engage in differential emotional change processes during experiential therapy for depression. Using Classification of Affective Meaning States (CAMS), emotional processing was coded during all emotion episodes that occurred in 2 working and 2 termination phase sessions for 14 clients from the York I and York II depression projects who had provided 18-month follow-up outcomes (7 SAG and 7 WAG clients). Cross-sectional analysis (independent and repeated measure t-tests) examined emotional processing differences between the groups across and within therapy phases. Sequences or patterns of CAMS rated emotion episodes were also explored using THEME time sequential analysis. Results found that compared to clients with a WAG trajectory, the SAG trajectory clients expressed: 1) significantly greater proportions of primary adaptive emotions states within both phases of therapy (specifically acceptance and agency, assertive anger, and relief), 2) greater proportions of need expression in the working phase, and 3) significantly less proportions of secondary and maladaptive emotions across both therapy phases (specifically global distress and rejecting anger). Also from the working to the termination phase of therapy, SAG clients expressed 4) significant increases in acceptance and agency, and decreases in expression of fear/shame, need expression, and overall primary adaptive emotion. Alternatively, WAG clients showed 5) significance increases in global distress and relief from their working to termination therapy sessions. THEME results showed that SAG clients had significantly more instances of need expression linked with the expression of hurt/grief, and repeated expression of relief, while WAG clients showed significantly more repeated expressions of global distress, rejecting anger leading to global distress, and global distress leading to fear/shame. Future directions of this research are discussed.