Studies indicate that story-telling and emotional expression may be important therapeutic mechanisms. This study examined how they work together over 1 year of supportive-expressive group therapy (SET). Participants were 41 women randomized to SET. We coded emotional expression and story types (story vs. non-story) at the initial session, 4, 8, and 12 months. Women engaged in more storytelling in their initial than later sessions. In later sessions, women expressed significantly more emotion, specifically compassion and high-arousal positive affect. Direct communication (non-story) allowed more positive but also more defensive expression as women supported and challenged each other. Greater hostility in non-story and greater constrained anger during story were associated with increasing depression. Greater high-arousal positive affect in non-story and greater primary negative affect in story were associated with increasing social network size. These results inform clinicians about cues they might use to improve the effectiveness of cancer support groups.