PPRNet Clinical summary: Therapists' Difficulties with Emotion Regulation Affect Treatment Outcomes

There is significant variability in therapists' effectiveness – some therapists are more effective than others, and this has important implications for the patients they treat. We know little about what makes one therapist more effective than another. However, interpersonal skills may be among those variables (e.g., empathy, ability to express emotions verbally, ability to develop and maintain a therapeutic alliance). Among those important therapist skills might be emotion regulation, or the process through which individuals modulate the experience and expression of their emotions. Emotion regulation skills might include emotional awareness, emotional clarity, emotional acceptance, goal-directed behaviors, impulse control, and implementing regulation strategies. Navigating their emotional experiences may help therapists manage their own emotional reactions (countertransference), maintain their composure during emotionally charged sessions, remain empathic, and help patients regulate their in-session emotions. Little research examines therapists’ emotional regulation and its effect on patients’ ability to manage their emotions, patient outcomes, and the therapeutic alliance. In this study, Gwertzman and Tishby had 86 adult patients with depressive and anxiety symptoms treated by 57 graduate student therapists providing short-term psychodynamic therapy. The researchers were interested in the effects of therapists’ emotion regulation on change in patient emotion regulation, patient symptom outcomes, and the therapeutic alliance. Therapists completed a scale to measure difficulties in emotion regulation before each treatment, assessing awareness, clarity, acceptance, strategies, goals, and impulsivity. Patients completed the same measure of difficulties in emotion regulation after each session, a symptom outcome measure before each session, and a measure of therapeutic alliance after each session. Three main findings emerged. First, patients who had therapists with greater difficulty in accepting their emotions showed increases in emotion regulation difficulties. That is, these therapists were detrimental to their patients’ ability to regulate their emotions. Second, patients with therapists who had less difficulty with emotion regulation had the most symptom reduction. That is, therapists who were accepting and goal-directed in their approach to their emotions helped patients achieve better outcomes. Third, patients whose therapists had less difficulty with emotion regulation experienced the greatest improvement in the therapeutic alliance across sessions. That is, therapists who maintained their emotional equilibrium facilitated greater trust and collaboration among their patients. 

Practice Implications 

Therapists must maintain technical competence despite the emotional challenges they may face during a session. When therapists embrace and understand their emotional responses, they can work more effectively by staying mindful and using their feelings to benefit the therapeutic process. The results of this study highlight the importance of incorporating emotion regulation into therapist training and supervision. 

 

Gwertzman, G. & Tishby, O. (2025). Therapists' difficulties in emotion regulation and their association with treatment outcomes and alliance in short-term psychodynamic psychotherapy. Clinical Psychology & Psychotherapy, 32, e70189. https://doi.org/10.1002/cpp.70189