Client subgroups in emotion-focussed therapy: Exploring profiles in observable emotion

Objective

The present study examined client profiles in observed emotion to explore possible subgroups among clients given that there is substantial heterogeneity in clients' expression of emotion in therapy. Subgroups were identified using the sequential model of emotional processing, which posits that global distress, shame/fear and rejecting anger represent ‘early expressions of distress’, whereas assertive anger, self-compassion and grief/hurt are conceptualised to be ‘adaptive states’ that predict good outcomes. The present study also offers a unique strategy for studying differences in clients' emotional presentation with implications for within-session assessment by therapists.

Method

Sections of videotaped therapy sessions for 34 participants in emotion-focussed therapy were coded for each emotional state. Through cluster analysis, participants were grouped based on the relative magnitude of each emotion state in the model.

Results

In the first set of analyses, two naturalistic groups were formed: Cluster 2 had higher levels of adaptive emotion and rejecting anger than Cluster 1. There was a significantly greater proportion of good within-session outcomes in Cluster 2 than in Cluster 1. In the second set of analyses, a separate cluster analysis categorised participants based on their early expressions of distress. Four groups were described as follows: Distressed, Protesters, Fearful & Ashamed and Minimally Distressed. Only the Minimally Distressed group showed significantly higher rates of good within-session outcome.

Discussion

These findings provide support for the emotional processing model by using novel methods and analyses. Although the findings are preliminary, they have implications for clinicians' assessments of clients' emotional needs and characteristic presentations.