Clients' assessment of the affective environment of the psychotherapy session: Relationship to session quality and treatment effectiveness

Abstract

This study investigated clients' affective experience during therapy. Clients (N= 268) completed Therapy Session Reports (TSR) in an early session of treatment. The two sections of the TSR that assess how the client felt and how the client perceived the therapist to be feeling were combined and factor analyzed. Six stable and meaningful factors were derived (Client Distressed, Client Remoralized, Reciprocal Intimacy, Therapist Confident Involvement, Client Inhibited, and Therapist Distracted). Affect scale scores were created and compared to session quality and treatment effectiveness. Clients' affective experience was highly correlated with patient-rated session quality. The association between clients' affective experience during the session and treatment effectiveness was fairly strong for relatively brief therapy but insignificant for relatively lengthy treatment. The implications for practitioners, who--in contrast to most measures of therapeutic process--have easy access to clients' in-session emotional experiences, are discussed.

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