The impact of resistance on empathy in CBT for generalized anxiety disorder

OBJECTIVE: Client resistance has been shown to relate to poorer therapy outcomes, thus making it important to better understand the mechanisms underlying this association. Given observational research suggesting that therapist empathy decreases during moments of resistance, the present study examined client-rated therapist empathy as a potential mediator of the resistance-outcome association. METHOD: Participants included 44 therapist-client dyads receiving cognitive-behavioral therapy for generalized anxiety disorder. Trained observers rated an early therapy session for the level of client resistance, and clients completed a corresponding postsession measure of therapist empathy. Posttreatment outcome was measured via client-rated worry severity. RESULTS: Higher client resistance was significantly associated with poorer treatment outcome and lower client postsession ratings of therapist empathy; however, therapist empathy was not observed to mediate the relationship between resistance and treatment outcomes. CONCLUSIONS: As empathy did not mediate the association between resistance and outcome, future research is needed to uncover other potential mechanisms of this association. However, the current results underscore an important link between resistance and client perceived therapist empathy. As empathy has been shown to relate positively to therapy outcomes, our result highlights the need to enhance therapist in-session responsivity to resistance in psychotherapy research and training.