Patients’ emotional experiences in psychotherapy: An experience sampling study targeting the role of narcissism and interpersonal dominance

Patients’ emotions in the here-and-now of psychotherapy sessions are a key target for treatment in personality disorders. This study investigates the underpinnings of patients’ emotions during therapy sessions, with a focus on traits of pathological narcissism and interpersonal perceptions of dominance. After assessment of their traits of grandiose (GN) and vulnerable narcissism (VN), patients enrolled in weekly individual psychotherapy entered a 17-week experience sampling (ES) procedure collecting their emotions and perceptions of dominance in each psychotherapy session (event-contingent design). Preliminary data (N = 157; 136 female; M age = 25.27; number of observations = 1,619; M observations per patient = 10.31) were analyzed via multilevel models, controlling for the linear effect of time. Patient’s perceptions of interpersonal dominance affected some in-session emotional experiences, such that perceiving the therapist as more dominant than oneself was related to reporting more shame, more boredom, and less pride during the sessions. Patients high in both GN and VN reported experiencing more shame, more scorn, and more boredom during treatment sessions. Also, in-session anger was uniquely predicted by VN, while in-session pride and envy were uniquely predicted by GN. Finally, both GN and VN interacted with perceptions of dominance in predicting specific emotions. For instance, high narcissistic traits (both GN and VN) amplified the link between perceiving the therapist as more dominant than oneself and concurrently experiencing more boredom during the sessions; while high traits of GN amplified the link between such perceptions of dominance and concurrent in-session experiences of envy.