The role of pre-treatment interpersonal problems for in-session emotional processing and long-term outcome in emotion-focused psychotherapy

Objective: Interpersonal problems may lead to, uphold, or follow from depression. However, we know little of how depressed patients' different interpersonal problems are associated with patients' emotional processing during psychotherapy and whether distinct processes are helpful for their long-term reduction. Method: 23 adult outpatients who received emotion-focused therapies lasting 16–20 sessions filled the Inventory of Interpersonal Problems at pre- and post-treatment and 18-month follow-up. These problems were related to emotional processing in two mid-therapy sessions, rated by observers with the Classification of Affective-Meaning States. Results: All pre-treatment interpersonal problems were clearly associated with patients' negative evaluations of themselves during therapy. Self-experiences of vindictiveness were most pronouncedly linked to in-session emotional expressions of rejecting anger, and self-experiences of social inhibition to expressions of fear and shame, following a circumplex model. In the long-term reduction of interpersonal problems, especially reaching emotional states of hurt and grief seemed beneficial for patients who experienced themselves as socially inhibited, non-assertive, self-sacrificing, or overly accommodating. Conclusions: For clients suffering from particular interpersonal problems, accessing particularly beneficial emotional processes, such as hurt and grief, may form specific therapeutic process goals. Further studies should verify these findings, which link interpersonal theory with research on emotional processing in psychotherapy.