Mapping Good Therapy Sessions: A Pilot Study of Within-Session Client Affect

The purpose of the present study was to measure client affect over small timescales within therapy sessions, in order to identify affective patterns that might distinguish good versus poor sessions. Toward this end, patterns of affect were observed across 15-s intervals throughout one therapy session for each of four different clients being treated for generalized anxiety disorder using cognitive-behavioral therapy. The primary hypothesis was that during “good” therapy sessions (as defined by high session alliance scores and good therapy outcomes), clients would exhibit a pattern of positive–negative–positive (PNP) affect during the course of the session, reflecting prolonged periods of negative affect consistent with productive therapeutic work, situated between periods of positive feeling. Clients in “poor” sessions were not expected to show this pattern. The findings were consistent with predictions. There was also a non-significant trend suggesting that clients in good sessions demonstrated a greater frequency of very small PNPs—as brief as 45 s—suggesting a potentially greater number of “micro-episodes” of therapeutic work. Implications of the findings are discussed.