Therapist skills associated with client emotional expression in psychodynamic psychotherapy.

Objective: We wanted to determine whether four therapist skills were differentially associated with emotional expression. Method: We compared paraphrases (restatements and reflections of feelings) and open questions (focused on thoughts or feelings) in relation to antecedent and subsequent client emotional expression and client attachment style for 36 clients and 22 therapists in psychodynamic psychotherapy. Results: Therapists gave more paraphrases when clients were expressing more emotions, but more open questions when clients were expressing fewer emotions. Regardless of attachment style, subsequent emotional expression was highest when therapists used open questions for feelings, and intermediate when therapists used reflections of feelings or open questions for thoughts. Subsequent client emotional expression was lowest when therapists used restatements with clients who were low in attachment avoidance, and at about the same level as other skills for clients who were high in attachment avoidance. Conclusions: Therapists differentially used the skills based on how much emotion clients were expressing. Clients expressed emotions differentially depending on antecedent client emotional expression, therapist skills used, and client avoidant attachment style.