write:Thecurrentstudyutilizedsuchfine-grainedsession-levelanal-ysestoaddressseveralunresolvedissuesregardingthelinksbe-tweenemotionalexperience therapeuticalliance andoutcomes:(a)Doesast

moststudiesexaminingthesevariableshaveusedalimitednumberofsessionsandratings(typicallytwotothree)
whichreflectphaseswithintherapyratherthanchangesfromsessiontosession.However
thetemporalassociationsbetweenin-sessionemotionalexperienceandsymptomchangesaswellasthemorecomplexsession-by-sessionassociationsbetweenemotionalexperience
al-liance
andsymptomaticchangehaveyettobestudied.Exploringpsychotherapyprocessesatthisfine-grainedlevelisacentralchallengeposedbyleadingpsychotherapyresearchers(e.g.
Crits-Christoph
ConnollyGibbons
&Mukherjee
2013;Emmelkampetal.
2014).Suchanalyseshavebeenusedtoexploretheassociationbetweenallianceandsymptomsatthesessionlevel
withresultsrevealingcomplexreciprocalassociations.Specifi-cally
researchershaveshownthatclientratingsofthetherapeuticalliancepredictednext-sessionreductioninsymptomsandviceversa(Crits-Christoph
Gibbons
Hamilton
Ring-Kurtz
&Gallop
2011;Falkenström
Granström
&Holmqvist
2013).Thecurrentstudyutilizedsuchfine-grainedsession-levelanal-ysestoaddressseveralunresolvedissuesregardingthelinksbe-tweenemotionalexperience
therapeuticalliance
andoutcomes:(a)Doesastrongalliancefacilitateclients’emotionalexperience
oristhedirectionofinfluencereversed?Alternatively
isthereabidirectionalinfluence?(b)Doesgreateremotionalexperiencepromotealleviationofsymptoms
orviceversa?(c)Istheassoci-ationbetweenastrongallianceandsymptomalleviationmediatedbyclients’emotionalexperience?APsychodynamicViewofEmotionsinTherapyIntwocomparativereviewsofpsychotherapyapproaches
BlagysandHilsenroth(2000
2002)arguedthataffectiveemphasiswasamaincharacteristicofpsychodynamictherapyandcouldreliablydistinguishthisformoftherapyfrombothCBTandinterpersonalapproaches.Severalmeta-analyticreviewshavere-portedstrongandpositiveassociationsbetweentreatmentout-comesandpsychodynamicinterventionsthatfocusonevocationofemotions(cf.Diener&Hilsenroth
2009;Diener&Pierson
2013).However
clients’emotionalexperienceshavereceivedrelativelylittleempiricalattentioninpsychodynamictherapy(especiallycomparedtotheconsiderableattentiontheyhavereceivedinexperientialandcognitive–behavioraltreatment).Nevertheless
theprominenceofemotionalexperienceinpsychodynamictheo-ries(cf.Shedler
2010)suggeststhatsuchexperiencecouldplayanimportantroleinresearchhypothesesinthisfield.BreuerandFreud(1895/1955)werethefirsttoemphasizetheimportanceofemotionalexperienceduringtreatment.Theyhy-pothesizedthattheinabilitytoexpressemotionatthetimeoftraumawasthecauseofhysteria(nowknownasconversiondisorder).Symptomswoulddisappearoncethepreviouslyunex-pressedfeelingswerebroughttoawarenessandrelived.However
thepioneersofthepsychodynamicapproachincludingFreudtendedtoemphasizeinsightasthemainmechanismofchange.AlexanderandFrench(1946)departedradicallyfromthistradi-tionalviewandsuggestedthatthefundamentaltherapeuticprin-cipleiswhattheytermedthe“correctiveemotionalexperience.”Intheirdefinition
itmeanttoreexposetheclienttopastemotionalconflictsundermorefavorablecircumstances.Thisconcepthasbeenoverlookedforyearsbuthasrecentlyattractedgrowinginterestinthedynamicliterature(Castonguay&Hill
2012;Ra-chman
2007).Winnicott(1965)andothersfromtheobjectrela-tionsschool(forareview
seeSummers&Barber
2010)empha-sizedtheimportanceofexperiencingpainfulemotionsinthepresenceofthetherapist
andborrowinghisorherstrengthandabilitytocontaintheseemotions
whichmayleadtoincreasedtoleranceonthepartoftheclientfortheseemotions.Inspiredbytheseideasaswellasbyattachmenttheoriesandexperientialapproaches
contemporaryintegrativeandpsychodynamicwriterssuchasFosha(2002)maintainthatthemechanismofchangeindynamictherapyresidesinfacilitatingnewemotionalexperiencesandhandlingthemtogetherwithsignificantothers.McCulloughetal.(2003)andWachtel(1993)highlightedthetherapeuticeffectofexposingclientstopainfulemotionswhoseavoidancehascontrib-utedtopsychopathologyandproblemsinlife.Fromtheseperspec-tives
psychotherapyisanopportunitytopromoteandmaintainpsychologicalhealthbyusingemotionallysignificantrelationshipstoreexperienceemotionsthataretoointenseorpainfulforanindividualtomanagealone(Fosha
2001
2005;McCullough&Magill
2009).Specifically
agoodtherapeuticrelationshipshouldfirstbeestablishedtoenableclientstofeelsafeinreexperiencingandregulatingpainfuloroverwhelmingemotionsandthusachievesymptomaticrelief.ResearchQuestionsandHypothesesThepresentstudyexploredtheroleofemotionalexperienceanditsassociationswithallianceandsymptomaticreliefonasession-by-sessionbasisoverthecourseofpsychodynamictherapy.Thestudystructurewasbasedonthefollowingthreehypotheses:Hypothesis1:(a)Wepredictedthathighertherapeuticalliancescoresattheendofeachsessionwouldpredictgreateremo-tionalexperiencesinthenextsession.(b)Inaddition
weexpectedthatemotionalexperienceswouldpredictsubsequentlevelsofalliance.ThefirstpartofthispredictionisbasedonthemodelsofFosha(2001)andMcCulloughetal.(2003)andonfindingsindicatingthatastrongertherapeuticalliancepredictsdeeperemotionalexperiences(Posetal.
2009).Al-thoughthetheoreticalmodelspresentedaboveprimarilyrefertotheformerassociationratherthantothesecondpartoftheprediction
Beutleretal.(2000)arguedthatoneofthefeaturesofemotionalexperienceisitsabilitytostrengthenthethera-peuticrelationship.Hypothesis2:(a)Weexpectedthathigheremotionalexperi-encescoresattheendofeachsessionwouldpredictbetterfunctioninginthenextsession.(b)Inaddition
higherlevelsoffunctioningatthebeginningofeachsessionwereexpectedtopredicthigherexperiencescoresattheendofthesession.Thefirstpartofthehypothesis(emotionalexperiencepredictssymptoms)wasbasedonstudiesthatreportedthisassociationatthetreatmentlevel(Missirlianetal.
2005);however
nostudyhasexploredthishypothesisatthesessionlevel.Al-thoughnostudieshaveexaminedthereverseassociation(symptomspredictemotionalexperience)
thiscanbeinferredfromstudiesthathavenotedreciprocalassociationsbetweenThisdocumentiscopyrightedbytheAmericanPsychologicalAssociationoroneofitsalliedpublishers.Thisarticleisintendedsolelyforthepersonaluseoftheindividualuserandisnottobedisseminatedbroadly.106FISHERETAL.