Treating Affect Phobias: Therapeutic Alliance as a Moderator of the Emotional Experience Effect on Outcomes

ABSTRACT

Psychodynamic-oriented psychotherapies have demonstrated their efficacy in emotional disorders’treatment. However, it remains unclear what are the specific mechanisms accounting for change. Inpsychodynamic psychotherapeutic models as the Affect Phobia Therapy (APT), emphasis is placedon therapeutic relationship and the ability of clients to regain adaptive contact with their emotions.Specifically, it is argued that there must be a high therapeutic alliance for the emotions’ exposure tolead to positive outcomes. This exploratory study aimed to examine whether the level of therapeuticalliance (high vs. low) moderates the contribution of emotional experience to outcomes. Twenty-sixclients (65% females; Mage= 25; SD= 7.26) with depressive and/or anxiety symptoms undergoing apsychodynamic psychotherapy on a university counselling centre were included. After each weeklysession, clients answered measures of therapeutic alliance, emotional experience, and outcomes(Psychological Well-Being and Subjective Discomfort). Data were analysed using Hierarchical LinearModels for longitudinal data. Results indicated that effect of emotional experience on outcomesdepends on levels of therapeutic alliance. In clients with low therapeutic alliance, higher levelsof emotional experience contributed to a decrease in Psychological Well-Being and an increasein Subjective Discomfort across sessions. In clients with higher levels of alliance, both outcomesdecreased significantly between sessions, regardless of the emotional experience effect. Our findingshighlight that it is important to consider that exposure to adaptive emotions may have adverse effectswhen a strong alliance is not established (AU)