The impact of early empathy on alliance building, emotional processing, and outcome during experiential treatment of depression

Objective: This study examined the relationships among the therapist process of expressed empathy during first sessions, clients' post-session one alliance reports, clients' later working phase emotional processing, and clients' final reductions in depressive symptoms for 30 clients receiving short-term experiential therapy for depression. Method: The therapist process of expressed empathy was assessed using a new observer-rated measure: the measure of expressed empathy, which was demonstrated to be valid and reliable. Results: Results indicate that therapist expressed empathy in session one significantly affected the outcome, albeit indirectly. This indirect effect occurred through two direct effects on other important therapy processes that did directly predict client outcomes: (i) Therapist expressed empathy in first sessions directly and positively predicted client reports of first-session alliances; and (ii) therapist expressed empathy directly predicted observer-rated deepened client emotional processing in the working phase of therapy. Conclusions: Empirical support was provided for the theorized relationships in experiential theory amongst the variables examined.