Tracking Patients’ Affective Activation in Individual Psychotherapy Using Experience Sampling: The Role of Narcissism and Interpersonal Perceptions

Patients’ emotions in the here-and-now of psychotherapy sessions guide clinical interventions in personality pathology. This study investigates patients’ emotions during therapy sessions, and their associations with both patients’ individual differences (i.e., traits of grandiose and vulnerable narcissism) and features of the interpersonal therapeutic context (i.e., patients’ perceptions of dominance during sessions). Patients enrolled in weekly individual psychotherapy entered a 17-week experience sampling (ES) protocol and rated their emotional and interpersonal experience after each psychotherapy session. Preliminary data (N = 166; 144 females; M age = 25.22; number of observations = 1,936; M observations per patient = 11.66) were analyzed via random-intercept models, controlling for the linear effect of time and for between-person effects. Perceiving the therapist as more dominant than oneself in a specific session was related to concurrently reporting more shame, more boredom, less pride, and more envy in the same session. 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, 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 traits of GN amplified the link between such perceptions of dominance and concurrent in-session experiences of envy.