Is empathic accuracy enough? The role of therapists' interventions in the associations between empathic accuracy and session outcome.

Therapists' ability to accurately assess their clients' emotions is a critical clinical skill across various therapeutic approaches. However, little is understood about the contexts that facilitate or interfere with the effects of this accuracy on therapeutic outcomes. This study investigated the relationship between therapists' empathic accuracy (EA) concerning their clients' emotions and session outcomes, and whether this relationship is moderated by the therapists' use of different intervention types. A sample of 81 clients treated by 50 therapists in a university setting was used for the study. Following each session, clients rated the emotions they experienced during the session, as well as the quality of the session, while therapists rated their perception of their clients' emotions. Findings revealed that therapists' EA for negative emotions (but not positive ones) positively correlated with higher client evaluations of the session. Furthermore, the frequency of exploratory interventions (but not directive ones) moderated this relationship. The results highlight that merely being empathically accurate in assessing clients' negative emotions may not be sufficient; therapists who employ an exploratory approach while being empathically accurate can better facilitate emotional processing, potentially leading to improved outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Modes: Cohesive personality states and their interrelationships as organizing concepts in psychopathology.

We propose a transdiagnostic approach that centers on modes, state-like manifestations of personality that function as cohesive organizational units. Modes are characterized by specific profiles of affects, behaviors, cognitions, and desires that tend to be coactivated. Each mode is typically experienced as having its own distinct experiential and agentic qualities. A mode-based approach to psychopathology builds on recent analytic and methodological developments which demonstrate the value of modeling personality states dynamically, as well as on longstanding theoretical and empirical traditions that highlight the pragmatic clinical utility of such conceptualizations. We seek to illustrate how the conceptualization of psychopathology in terms of modes and their dynamic interrelations holds considerable transdiagnostic promise. As background, we review both theory and research from philosophical accounts of selfhood, developmental psychology, social and personality psychology, and diverse psychotherapy models that lay the foundation for this mode-based approach to psychopathology. We elaborate on this foundation and (in Section 1 of our online supplemental materials) provide examples of the approach's explicit or implicit relevance to several classes of psychopathology, including dissociative, trauma-related, mood, anxiety, obsessional, substance, psychotic, and personality disorders. After addressing the clinical utility of mode-based conceptualizations, we lay out a research blueprint for assessing and modeling modes, and (in Section 2 of the online supplemental materials) present a broader research agenda highlighting intriguing empirical questions regarding modes in psychopathology. We conclude by noting that the time seems ripe for modes to be (re-)introduced as an organizing construct for understanding psychopathology and personality. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Silent voices that must be heard - women's perceptions of gynecologic examinations.

PURPOSE: To analyze the perception of gynecologic examination from the patients' point of view. MATERIALS AND METHODS: This anonymous electronic cross-sectional survey aimed to evaluate the subjective experiences of women during gynecologic examinations (levels of pain, embarrassment and trauma), the manner the examination was conducted, and women's suggestions for improving their experience. RESULTS: Overall, 6,508 women answered the survey. The examination was considered an embarrassing event by 47%, painful by 35% and traumatic by 19%. Importantly, only 43% of the respondents stated they would notify the gynecologist in case of physical discomfort or pain during the examination. The quality of physician-to-patient communication was rated as the most important aspect of gynecologic examination, and showed a significant association with the general quality of the experience (levels of pain, embarrassment, and trauma). Matters relating to women's privacy during gynecologic examination were also considered important. An option for a companion was rated as important by 64% of the respondents. Significant differences with large effect-sizes were found between the respondents' preferences and their reports of the observed situation. CONCLUSION: The findings highlight the need for establishing guidelines for gynecologic examinations, according to a patient-centered care approach. This study constitutes a first discourse on the subject of gynecologic examinations in Israel in order to provide an overview and initial insights, serving as a starting point for further specific and more in-depth research.

Negative Emotion Differentiation Predicts Psychotherapy Outcome: Preliminary Findings.

Emotion differentiation (ED), the extent to which same-valenced emotions are experienced as distinct, is considered a valuable ability in various contexts owing to the essential affect-related information it provides. This information can help individuals understand and regulate their emotional and motivational states. In this study, we sought to examine the extent to which ED can be beneficial in psychotherapy context and specifically for predicting treatment response. Thirty-two prospective patients with mood and anxiety disorders completed four daily assessments of negative and positive emotions for 30 days before receiving cognitive-behavioral treatment. Depression, stress, and anxiety symptoms severity were assessed pre- and post-treatment using self-reports and clinical interviews. We conducted a series of hierarchical regression models in which symptoms change scores were predicted by ED while adjusting for the mean and variability. We found that negative ED was associated with greater self-reported treatment response (except for anxiety) when negative emotional variability (EV) was included in the models. Probing negative ED and EV's interactive effects suggested that negative ED was associated with greater treatment response (except for anxiety) for individuals with lower EV levels. Results were obtained while controlling for mean negative affect. Our findings suggest that negative ED can benefit psychotherapy patients whose negative emotions are relatively less variable. We discuss the meaning of suppression and interactive effects between affect dynamics and consider possible clinical implications.

When to disclose and to whom? examining within- and between-client moderators of therapist self disclosure-outcome associations in psychodynamic psychotherapy.

Objective: While previous studies have indicated that therapists' self-disclosure (TSD) can have curative effects, the contextual variables that may moderate the link between TSD and treatment outcome have not been sufficiently explored. Using session-by-session psychotherapy data, we examined the extent to which within-client distress and between-clients emotion regulation difficulties moderated the associations between TSD and session outcomes.Method: The sample comprised 68 clients treated according to the principles of psychodynamic psychotherapy by 47 therapists in a university clinic. Emotion regulation difficulties were assessed at the beginning of treatment, and functioning and distress levels as well as symptoms were assessed at the beginning of each session. After each session, therapists completed a measure of frequency and centrality of their immediate and non- immediate self-disclosure interventions during the session.Results: At the within-client level, in sessions marked by high pre-session client distress, immediate TSD was associated with a better next session outcome. At the between-clients level, for clients who had low emotion regulation difficulties, immediate TSD was marginally associated with better outcomes.Conclusion: These findings highlight the importance of considering within-client level as well as between-clients level variables when deciding upon self-disclosure.

Using computerized text analysis to examine associations between linguistic features and clients' distress during psychotherapy.

Raw linguistic data within psychotherapy sessions may provide important information about clients' progress and well-being. In the current study, computerized text analytic techniques were applied to examine whether linguistic features were associated with clients' experiences of distress within and between clients and whether changes in linguistic features were associated with changes in treatment outcome. Transcripts of 729 psychotherapy sessions from 58 clients treated by 52 therapists were analyzed. Prior to each session, clients reported their distress level. Linguistic features were extracted automatically by using natural language parser for first-person singular identification and using positive and negative emotion words lexicon. The association between linguistic features and levels of distress was examined using multilevel models. At the within-client level, fewer first-person singular words, fewer negative emotional words and more positive emotional words were associated with lower distress in the same session; and fewer negative emotion words were associated with lower next session distress (rather small f2 effect sizes = 0.011 < f2 < 0.022). At the between-client level, only first session use of positive emotion words was associated with first session distress (ηp2 effect size = 0.08). A drop in the use of first-person singular words was associated with improved outcome from pre- to posttreatment (small ηp2 effect size = 0.05). The findings provide preliminary support for the association between clients' linguistic features and their fluctuating experience of distress. They point to the potential value of computerized linguistic measures to track therapeutic outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Machine learning uncovers the most robust self-report predictors of relationship quality across 43 longitudinal couples studies.

Given the powerful implications of relationship quality for health and well-being, a central mission of relationship science is explaining why some romantic relationships thrive more than others. This large-scale project used machine learning (i.e., Random Forests) to 1) quantify the extent to which relationship quality is predictable and 2) identify which constructs reliably predict relationship quality. Across 43 dyadic longitudinal datasets from 29 laboratories, the top relationship-specific predictors of relationship quality were perceived-partner commitment, appreciation, sexual satisfaction, perceived-partner satisfaction, and conflict. The top individual-difference predictors were life satisfaction, negative affect, depression, attachment avoidance, and attachment anxiety. Overall, relationship-specific variables predicted up to 45% of variance at baseline, and up to 18% of variance at the end of each study. Individual differences also performed well (21% and 12%, respectively). Actor-reported variables (i.e., own relationship-specific and individual-difference variables) predicted two to four times more variance than partner-reported variables (i.e., the partner's ratings on those variables). Importantly, individual differences and partner reports had no predictive effects beyond actor-reported relationship-specific variables alone. These findings imply that the sum of all individual differences and partner experiences exert their influence on relationship quality via a person's own relationship-specific experiences, and effects due to moderation by individual differences and moderation by partner-reports may be quite small. Finally, relationship-quality change (i.e., increases or decreases in relationship quality over the course of a study) was largely unpredictable from any combination of self-report variables. This collective effort should guide future models of relationships.

Relational events are more consequential when accompanied by emotional similarity.

Shared experience - i.e. commonality in inner states such as feelings, beliefs, or concerns - plays an important role in establishing and maintaining close relationships. Emotional Similarity (ES) can be thought of as one type of shared experience, but the exact role it plays in our responses to specific contexts (objects, events, circumstances) is not well understood. We sought to examine the day-level context-dependent roles of romantic partners' ES. We hypothesised that relational events (i.e. conflict and sexual activity) occurring on days with high ES would be more consequential. Two samples (N = 44, N = 80) of committed couples completed daily diaries for three and five weeks, respectively. Each evening, partners reported their currently-felt moods, relationship quality, and the occurrence of conflict and/or sex in the preceding 24 h. ES was operationalised as the profile similarity between the partners' moods on each day. Generally, ES moderated the associations between conflict or sex and relational outcomes: on days marked by greater ES, conflict and sex had stronger negative/positive outcomes, respectively. These findings highlight the importance of considering ES on a momentary basis and suggest that it may function as an amplifier of charged relational events.

Therapists' empathic accuracy toward their clients' emotions.

OBJECTIVE: Therapists' empathic accuracy (EA) toward their clients' fluctuating emotions is a crucial clinical skill that underlies many therapeutic interventions. In contrast to the subjective components of empathy, limited empirical work has addressed EA or its effect on the outcomes of psychotherapy. Here, we differentiate between the components of EA (tracking accuracy, directional discrepancy) as well as the valence of the target emotions (positive vs. negative). We also investigated the relative contribution of cognitive and emotional processes to therapists' EA and examined the associations between EA and treatment outcomes. METHOD: The sample comprised 93 clients treated by 62 therapists in a university setting. Prior to each session, clients self-reported their symptoms. Following each session, clients rated their positive (PE) and negative (NE) emotions during the session and therapists rated their own emotions, as well as their assessment of their clients' emotions. RESULTS: Therapists accurately tracked their clients' PE and NE and were more accurate for NE. Therapists tended to overestimate their clients' NE and underestimate their clients' PE. Therapists' emotions were associated with their clients' emotions (real similarity). Therapists' emotions were also associated with their assessments of their clients' emotions (assumed similarity). Therapists' own emotions partially mediated the association between clients' emotions and therapists' assessments. Therapists' inaccuracy in assessing their clients' PE was associated with higher reported symptoms in the next session. CONCLUSION: These findings help provide a better understanding of the specific characteristics associated with more EA and underscore the importance of EA in facilitating clients' emotional well-being. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Clients' emotional instability and therapists' inferential flexibility predict therapists' session-by-session empathic accuracy.

Clients' emotions often serve as a major focus for therapists' attention. Interestingly, little is known about the factors that facilitate or hinder therapists' accurate assessment of these emotions. We hypothesized that therapists' accuracy would be negatively tied to their clients' emotional fluctuation (i.e., instability) and positively tied to the therapists' own inferential fluctuation (i.e., flexibility) as well as to the clients' emotional intensity. Clients (N = 98/N = 76) received weekly psychodynamic psychotherapy at a university-based clinic. Following each session, clients reported their within-session emotions, and therapists provided their own assessment of their clients' emotions. As expected, when clients' emotions were more unstable, therapists were less accurate in tracking these emotions. Additionally, when therapists' assessments of their clients' emotions were more flexible, they were more accurate in tracking them. Our results help identify factors that predict accurate emotion perception within psychotherapy and may translate into actionable ideas for enhancing this accuracy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Accurate where it counts: Empathic accuracy on conflict and no-conflict days.

When we are accurate regarding our partners' negative moods, are we seen as more responsive (and do we see them as such) as a function of the presence/absence of conflict? In 2 daily diary studies, empathic accuracy (EA) was assessed by comparing targets' daily negative moods with perceivers' inferences of these moods. We hypothesized that conflict will be associated with reductions in perceived partner responsiveness (PPR) for both parties; that on no-conflict days, EA will be positively associated with both parties' PPR; that on conflict days, this positive association will be stronger for targets but will become negative for perceivers; and that regardless of conflict, overestimation (vs. underestimation) of negative moods will be tied with higher PPR for targets but with lower PPR for perceivers. Thirty-six (Sample 1) and 77 (Sample 2) committed couples completed daily diaries (for 21 or 35 days, respectively). We utilized multilevel polynomial regression with response surface analyses, a sophisticated approach for studying multisource data of this sort (Edwards & Parry, 1993). Results partially supported our hypotheses: conflict was tied to reduced PPR; on no-conflict days, EA was not consistently predictive of target or perceiver PPR; on conflict days, EA predicted increased target PPR but decreased perceiver PPR; finally, overestimation predicted increased target PPR on no-conflict days and decreased perceiver PPR regardless of conflict. These results highlight the double-edged effects of EA on conflict days, and the importance of investigating dyadic EA in a context-sensitive approach. (PsycINFO Database Record

Empathic accuracy and relationship satisfaction: A meta-analytic review.

Empathic accuracy (EA; Ickes & Hodges, 2013) is the extent to which people accurately perceive their peers' thoughts, feelings, and other inner mental states. EA has particularly interested researchers in the context of romantic couples. Reviews of the literature suggest a possible link between romantic partners' EA and their relationship satisfaction (Ickes & Simpson, 2001; Sillars & Scott, 1983). To assess the magnitude of this association and examine possible moderators, we performed a meta-analytic review of 21 studies (total N = 2,739 participants) that examined the association between EA and satisfaction. We limited our review to studies measuring EA using the dyadic interaction paradigm (Ickes, Stinson, Bissonnette, & Garcia, 1990). We found a small but significant association between the two (r = .134, p < .05). Subsequent moderation analyses demonstrated that EA for negative emotions (one's accuracy when assessing a partner's negative emotions) was more closely related to satisfaction (r = .171, p < .05) than EA for positive ones (r = .068, p > .1). The association was also stronger in relationships of moderate length, suggesting that EA may be more meaningful when relationships are consolidating but before they become stable. Gender and procedural variations on the dyadic interaction paradigm did not moderate the association, and there was no difference depending on whether the association was between EA and perceivers' or targets' satisfaction (i.e., actor or partner effects). We discuss the implications of these findings and offer recommendations for future EA studies. (PsycINFO Database Record