Emotional Labour in Psychotherapy: A Scoping Review of How Therapists Regulate Emotions in Clinical Practice

Abstract

Emotional labour is an integral yet conceptually underexamined feature of psychotherapeutic work. This scoping review mapped how emotional labour has been conceptualized and operationalized among psychotherapists, along with the associated outcomes and factors linked to greater emotional burden, and potential protective resources. Following JBI and PRISMA-ScR guidance, PsycINFO, Web of Science and Scopus were searched in August 2025 and updated in April 2026 for peer-reviewed studies on emotional labour among professionals delivering psychotherapy published in English or Spanish. Two reviewers independently screened and charted records. Fourteen sources met inclusion criteria, comprising both quantitative and qualitative research. Emotional labour was most commonly conceptualized as the regulation of emotional experience and expression to meet professional expectations. Operationalizations ranged from surface and deep acting to multidimensional models incorporating emotional dissonance. Therapists described emotional labour as intrinsic, emotionally ambivalent and capable of extending beyond the therapy room. Surface acting and emotional dissonance were most consistently linked to exhaustion, burnout and secondary traumatic stress, whereas self-compassion, psychological flexibility and professional identity were associated with more favourable responses to emotional demands. Emotional labour thus appears structurally embedded in psychotherapeutic practice, although the predominantly cross-sectional evidence limits conclusions about temporal and causal relationships, underscoring the need for longitudinal and intervention research.