Sampling patients’ interpersonal perceptions and affects in psychotherapy: an update

Perceived interpersonal interactions with the therapist are strongly intertwined with patients’ emotional experiences during the sessions, and both represent key targets for treatment in personality pathology. This longitudinal experience sampling study investigates how traits of pathological narcissism and interpersonal perceptions of dominance shape patients’ emotions during individual psychotherapy. Psychotherapy patients (N = 157; 136 female; M age = 25.27) were assessed on their traits of grandiose (GN) and vulnerable narcissism (VN). Then, they were asked to report their emotions and perceptions of dominance in each psychotherapy session for 17 weeks, providing a total number of 1,619 observations (M observations per patient = 10.31). Multilevel models adjusting for the linear effect of time revealed that: (a) perceiving the therapist as more dominant than oneself was related to experiencing more shame and boredom, and less pride during the sessions; (b) patients high in GN and VN reported more shame, more scorn, and more boredom during treatment sessions, while VN also predicted anger and GN also predicted pride and envy; (c) high narcissistic traits (both GN and VN) strengthened the link between perceiving the therapist as more dominant than oneself and concurrently experiencing more boredom during the sessions; (d) high traits of GN amplified the link between perceptions of dominance and concurrent experiences of envy during the sessions. Results suggest that both dispositional (i.e., narcissism) and relational (i.e., interpersonal perceptions) factors contribute to shaping patients’ emotions, “colouring” the therapeutic relationship with several possible meanings.