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Publication Date


Document Type

Honors Project




Psychotherapy-Outpatient assessment, Psychotherapy-Case studies, Single subject research, Emotion-focused therapy, Emotions, Facial expression, Emotion, Psychotherapy, Single-case research, Facial and behavioral coding


Naturalistic systematic case studies are a valid form of evidence undervalued in scientific research. They are particularly suited to answering questions about how change unfolds in psychotherapy sessions. The current study examined the therapeutic process in two clinical cases through coding clients’ facial expressions during therapists’ verbalizations that introduced new perspectives (i.e. interventions). The results indicated that clients’ facial responses to therapists’ interventions, as measured by the key facial codes (acceptance, rejection, novelty, pleasantness, arousal), were significantly associated with psychophysiological responses and psychotherapy progress. Specifically, novelty was found to produce the same psychophysiological activation in both cases (i.e., skin conductance increases) and to result in sessions with better global ratings in both cases. However, we also found results that suggested the opposite to what we theorized. For example, in both cases therapeutic alliance seemed to be worsened by acceptance, novelty, or low rejection. We also found mixed support for our predictions concerning the relationship of novelty and immediate therapeutic progress. Our study confirmed the importance of studying clients’ facial responses in psychotherapeutic contexts. The complex results necessitated a fuller understanding of the underlying mechanisms of therapeutic change. The new findings precipitated by the case-based microanalytic methodology have led us to believe that with systematic and rigorous study designs, case studies have great potential to contribute to the knowledge base for evidence-based practice and inform clinical decisions.




61 pages : color illustrations. Honors project, Smith College, 2016. Includes bibliographical references (pages 37-44)