Patients’ response to moments of disappointment with their therapist: the roles of disappointment experience, emotional abilities, and perceived alliance negotiation

Objective: Disappointment has not received sufficient attention in psychotherapy research. I examined how patients experience and respond to disappointment events with their therapist, as a function of patients’ emotional abilities and perceived alliance negotiation in their therapy. Method: A sample of 119 patients reported their emotional abilities (i.e., emotion dysregulation and alexithymia), perceived level of alliance negotiation, their experience during a specific disappointment event with their therapist and their responses to that event. Responses were conceptualized according to Rusbult’s model as exit, voice, loyalty, and neglect, and by whether the therapy was ended following the event. Results: Moments of disappointment were associated with premature termination. Patients’ responses were related to the quality of their experience. Alexithymia and emotion dysregulation were positively correlated with passive and destructive responses to disappointment. Patients with high levels of emotion dysregulation or alexithymia perceived the therapeutic alliance as less negotiable and responded passively and destructively in moments of disappointment with their therapist. Discussion: Patients’ responses to disappointment moments depend on their emotional experience, emotional abilities, as well as on their perception of the therapist’s willingness to discuss the different aspects of the therapeutic relationship. The theoretical and clinical implications of these results are discussed.