Abstract
Two central dimensions in psychotherapeutic work are a therapist’s empathy with clients and challenging their judgments. We investigated how they influence psychophysiological responses in the participants. Data were from psychodynamic therapy sessions, 24 sessions from 5 dyads, from which 694 therapist’s interventions were coded. Heart rate and electrodermal activity (EDA) of the participants were used to index emotional arousal. Facial muscle activity (electromyography) was used to index positive and negative emotional facial expressions. Electrophysiological data were analyzed in two time frames: (a) during the therapists’ interventions and (b) across the whole psychotherapy session. Both empathy and challenge had an effect on psychophysiological responses in the participants. Therapists’ empathy decreased clients’ and increased their own EDA across the session. Therapists’ challenge increased their own EDA in response to the interventions, but not across the sessions. Clients, on the other hand, did not respond to challenges during interventions, but challenges tended to increase EDA across a session. Furthermore, there was an interaction effect between empathy and challenge. Heart rate decreased and positive facial expressions increased in sessions where empathy and challenge were coupled, i.e., the amount of both empathy and challenge was either high or low. This suggests that these two variables work together. The results highlight the therapeutic functions and interrelation of empathy and challenge, and in line with the dyadic system theory by Beebe and Lachmann (2002), the systemic linkage between interactional expression and individual regulation of emotion.
Highlights
The results confirmed our hypotheses in four respects: (a) empathy increased the therapist’s and decreased the client’s skin conductance over the session, (b) empathy increased orbicularis oculi EMG activity indexing positive emotional expressions in both the therapists and the client across the sessions, (c) challenge increased heart rate of both the therapist and client across the sessions, and (d) challenge increased the therapist’s skin conductance during the very intervention
The hypotheses were not confirmed in all respects, the results support our general hypothesis that the therapist’s empathy is connected to positive valence and decrease in arousal in the client, and that the therapist’s challenge is connected to increase in physiological arousal in the participants
Our study offers clear evidence that therapists and clients orient to empathy and challenge in the verbal level of interaction, and physiologically
Summary
While the form and content of therapists’ responses to their clients’ experience may vary greatly, among other possible distinctions, psychotherapist’s attitudes toward the client can be divided to two basic orientations or facets: empathy and challenge (Bänninger-Huber and Widmer, 1999; Voutilainen et al, 2010; Ribeiro et al, 2013; Weiste and Peräkylä, 2014). Despite the difference in conceptualizations, both empathy and challenge are observable in the actual interaction across different psychotherapy approaches (Bänninger-Huber and Widmer, 1999; Voutilainen et al, 2010; Ribeiro et al, 2013; Weiste and Peräkylä, 2014) and both have positive association with therapeutic outcome (Orlinsky and Howard, 1986; Keijsers et al, 2000; Elliot et al, 2011). Empathy and challenge can be seen as diverging orientations, in reality they often co-exist (Bänninger-Huber and Widmer, 1999; Voutilainen et al, 2010; Ribeiro et al, 2016)
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