Keep calm and alert and carry on: therapist calmness and fatigue in relation to session process

Abstract

ABSTRACTWe examined whether therapist calmness and fatigue were associated with session process. Data were collected from 15 therapists and 51 clients over 1172 sessions at a university training clinic providing psychodynamic psychotherapy. Therapists rated their levels of calmness and fatigue before and after each session; clients and therapists rated session quality and working alliance after each session. Multilevel modeling was used to examine therapist pre-session calmness and fatigue, and pre- to post-session change in calmness and fatigue, in relation to post-session ratings of session quality and working alliance. Higher therapist pre-session calmness and increase of therapist calmness from pre- to post-session were associated with better client- and therapist-rated session quality and working alliance. Therapist pre-session fatigue was not associated with client-rated session quality or working alliance. However, a decrease in therapist fatigue was associated with better client-rated session quality and better therapist-rated session quality and working alliance. Thus, therapists who felt fatigued at the beginning of sessions could still have good sessions as perceived by clients. In contrast, therapists who entered session not feeling calm were less effective. Strategies to enhance therapist calmness and to reduce therapist fatigue should be investigated.