Therapists' Difficulties in Emotion Regulation and Their Association With Treatment Outcomes and Alliance in Short-Term Psychodynamic Psychotherapy

Background: The impact of therapists' emotion regulation abilities on therapeutic processes and outcomes remains understudied despite its theoretical significance. This study examined how therapists' difficulties in emotion regulation are associated with treatment outcomes, patients' emotion regulation development and therapeutic alliance in short-term psychodynamic psychotherapy. Method: Fifty-seven therapists treated 86 patients in 16-session short-term psychodynamic psychotherapy. Therapists completed the Difficulties in Emotion Regulation Scale (DERS-18). Patients completed the Outcome Questionnaire-45 (OQ-45), DERS-18 and Working Alliance Inventory (WAI). Results: Different therapist emotion regulation abilities were associated with distinct therapeutic processes. Better therapist emotion regulation (fewer overall difficulties, greater acceptance of negative emotions and stronger goal-directed behaviour) contributed to increased symptom reduction, while difficulties in emotional acceptance led to deterioration in patients' emotion regulation capabilities. Therapists' use of emotion regulation strategies predicted a stronger therapeutic alliance, while greater emotional awareness difficulties were unexpectedly associated with larger improvements in alliance. Conclusion: These findings demonstrate that specific therapist emotion regulation abilities are differentially associated with parallel therapeutic processes in short-term psychodynamic psychotherapy. They highlight the need for targeted training and supervision in maintaining therapeutic goals while managing emotional responses.