Elaborating the assimilation model: Introduction to a special section on case studies of setbacks within sessions and therapeutic collaboration

AbstractThis article introduces a Special Section of case studies that focus on therapeutic collaboration and setbacks in the process of assimilation with the aim of contributing to the evolution of the assimilation model of therapeutic change. The first study examined setbacks in two depression cases (a good vs. a poor outcome) treated with emotion-focused therapy. The second article traced how therapist activities and positions toward internal voices were associated with setbacks in a case treated with linguistic therapy of evaluation. The third article studied contributions of therapeutic collaboration for both advances and setbacks in assimilation in two contrasting cases treated with e…

La Base y el Origen Socio-cultural de las Psicoterapias Cognitivas

Este trabajo, de corte teórico, tiene como finalidad principal rastrear las bases y el origen socio-cultural de las psicoterapias cognitivas. Para ello, el trabajo comienza describiendo, brevemente, los elementos principales del modelo cognitivo y señalando, a continuación, las relaciones entre psicoterapia y marco occidental. Seguidamente, se procede a una comparación en mayor detalle entre las psicoterapias cognitivas y su particular origen socio-cultural. Elementos clave que se resaltan y relacionan con las psicoterapias cognitivas son el individualismo, la búsqueda de control y autonomía, un self individual autolimitado, y la consecución del racionalismo. El desarrollo de estos apartad…

Psychological consequences of rheumatic diseases in children and adolescents: A first exploratory study

The objective of our study was to make a first exploratory study about the psychological status of children and adolescents with rheumatic diseases exploring, also, the significant differences between girls and boys. A total of 123 children (81 girls and 42 boys) with rheumatic diseases, between the ages of 1 and 19 years old were assessed using different measures for evaluating behavioral and emotional problems. The results showed a picture of a mild or moderate degree of psychological problems in the different measures of anxiety, depression, general distress and behavioral problems. Girls, compared to boys, scored higher in most of the measures used, showing more internalizing than exter…

The Innovative Moments Coding System and the Assimilation of Problematic Experiences Scale: A case study comparing two methods to track change in psychotherapy

The Assimilation of Problematic Experiences Scale (APES) and the Innovative Moments Coding System were applied to transcripts of a successful case of linguistic therapy of evaluation independently by different research groups. Assimilation theory and research suggest that higher APES scores reflect therapeutic gains, with a level of approximately 4.0 separating good from poor outcome cases. The innovative moments (IMs) model suggests that IMs classified as reconceptualization and performing change occur mainly in good outcome cases, whereas action, reflection and protest occur in both good and poor outcome cases. Passages coded as reconceptualization and performing change were rare in this …

Irregular assimilation progress: Reasons for setbacks in the context of linguistic therapy of evaluation

The assimilation model suggests progress in psychotherapy follows an eight-stage sequence described by the Assimilation of Problematic Experiences Scale (APES). This study sought to reconcile this developmental stage model with the common but superficially contradictory clinical observation that therapeutic advances alternate with setbacks. Setbacks (n=466) were identified in therapy transcripts of two clients and classified using a preliminary nine-category list of possible alternative reasons for setbacks. Most of the setbacks involved switches among the multiple strands of a problem due to (a) therapists exceeding clients' therapeutic zone of proximal development, (b) therapists guiding …

A micro-analysis of the assimilation process in the linguistic therapy of evaluation

This paper reports a qualitative micro-analysis of the assimilation process in 18 events drawn from six patients treated in the linguistic therapy of evaluation. Each event began with a problematic situation introduced by the patient and ended with a marker showing either non-resolution or resolution of the problematic situation. These events all represented a common therapeutic task: The orders of abstraction technique, one of the main techniques of the linguistic therapy of evaluation. The non-resolved and resolved events tended to represent different levels on the Assimilation of Problematic Experiences Scale (APES). The non-resolved events tended to be associated with low APES levels, w…

Linguistic Therapy of Evaluation and the Assimilation Model

This theoretical article examines possible points of convergence between the assimilation model and linguistic therapy of evaluation (LTE), insofar as the former describes the process of change and the latter, as a form of cognitive therapy, considers the therapeutic conditions that facilitate it. In particular, the argument focuses first on why a voice becomes problematic from a LTE conceptualization. Second, the article explains how the therapeutic aims of LTE could contribute to a linguistic perspective on the assimilation model, focusing on how a dialogue between voices in the self could occur. Finally, the article will include a theoretical review of the assimilation stage of insight, …

Why setbacks are compatible with progress in assimilating problematic themes: Illustrations from the case of Alicia.

Objective: This theory-building case study investigated setbacks in assimilation, seeking to replicate and elaborate previous work, in which most setbacks were one of two types, balance strategy (B...

Therapist activities preceding therapy setbacks in a poor-outcome case

AbstractProgress in psychotherapy is typically irregular, as advances alternate with setbacks. This study investigated the therapist’s activities prior to two main types of setbacks, one involving the client following therapist proposals and one involving the client failing to follow from therapist proposals, in the case of a poor-outcome client treated with a linguistically-oriented kind of cognitive therapy. Setbacks were defined as decreases of at least one level on an index of therapeutic progress, the 8-level Assimilation of Problematic Experiences Scale (APES), in adjacent client passages. Therapist activities were coded in 361 setback episodes that each included a client pre-setback …

El Modelo de Asimilación como un Modelo Integrador sobre el Cambio Terapéutico


 
 
 Este trabajo se centra en el modelo de asimilación de experiencias problemáticas. Dicho modelo es un modelo de corte integrador que nos permite estudiar el proceso de cambio en cualquier enfoque terapéutico y con diversos tipos de pacientes y sujetos. Por ello, expondremos, en primer lugar, los principales conceptos y características del modelo, como por ejemplo, qué significa asimilar, el concepto de voz y de voz no dominante y voz dominante, junto con la descripción de la Escala de Asimilación de Experiencias Problemáticas. A continuación, se describirán los resultados más destacados alcanzados en tres áreas principales: el estudio del proceso de cambio en pacientes;…

Ética y psicoterapia: Una perspectiva sociocultural

La meta principal de este trabajo busca comprender la ética en psicoterapia desde una perspectiva sociocultural. Para conseguirla, la psicoterapia, al ser una práctica social de cura, se relacionará con los elementos socioculturales a su base. Esta perspectiva permite ofrecer a los terapeutas algunas reflexiones éticas sobre qué (y por qué) es correcto hacer, o no, en el campo de la psicoterapia. Ejemplificar y deconstruir tales elementos facilita la formación de los terapeutas, al igual que nos permite lograr la necesidad ética de pensadores más críticos. Este artículo desarrolla estas metas, situando, en primer lugar, a la psicoterapia en un contexto sociocultural y ejemplificando la infl…

Behavioural and Cognitive Psychotherapy: A Descriptive Review (2000 to July 2016)

Background: TheBehavioural and Cognitive Psychotherapy(BCP) Journal is the main academic publication of theBritish Association for Behavioural and Cognitive Psychotherapies. It publishes empirical studies, reviews and theoretical papers, brief reports and single cases.Aim: To describe the main areas of interest and focus in BCP papers.Method: All the papers published in BCP from 2000 to July 2016 were analysed. A categorization procedure was followed with 813 contributions in six main areas: main author country; main author gender; kind of contribution; kind of therapeutic approaches; kind of samples; kind of focus/topic.Results: Although the journal's scope is international, first authors …

Assimilation of Problematic Experiences in Linguistic Therapy of Evaluation: A Case Study

In this article the process of assimilation in the problematic experience of tiredness of one patient, Maria, is shown. Maria was treated with linguistic therapy of evaluation (LTE), a therapy midway between constructivist and cognitive therapies based on the theory of General Semantics, for 14 sessions. Maria was one of the most successful cases of LTE. Aims of the study were to show the process of assimilation in a case with good outcome and to explore if this process shows an irregular pattern, with setbacks or jumps between stages. This process is analyzed by the Assimilation of Problematic Experiences Scale (APES), an eight-stage scale that shows the process of assimilation from an exp…

The Case of Gabriel: A Linguistic Therapy of Evaluation Perspective

This article describes the treatment of Gabriel, 24, an undergraduate student suffering from performance anxiety. His main symptoms were heart palpitations, aching muscles, inability to relax, nervousness, worry, and negative anticipation about performance in various classes. The treatment applied was 13 sessions of linguistic therapy of evaluation (LTE), a variety of cognitive therapy based on the theory of general semantics. The main therapeutic techniques involved emphasizing the difference between words and “facts” (the “map” and the “territory”), general semantics debate, and the focusing on orders of abstraction. Across treatment Gabriel showed a clear shift from an intensional orient…

Insight en esquizofrenia desde el modelo de asimilación: un estudio cualitativo de caso a través de narraciones

El Insight es un elemento clave del proceso de asimilación, reflejando un nivel elevado y un progreso en la asimilación. En la esquizofrenia es, además, un elemento crucial relacionado con diferentes déficits metacognitivos. Por ello, la meta de este trabajo está en analizar, cualitativamente, los Insights alcanzados por un sujeto con esquizofrenia a lo largo de una serie de narraciones. Estos Insights, en un sujeto que no muestra un progreso en la asimilación de sus experiencias problemáticas, permiten reflexionar sobre el modelo de asimilación. Así, se plantea en la Discusión la necesidad de considerar a algunos de estos Insights, como “pseudo-insights”, que no reflejarían, a diferencia d…

El Estudio del Proceso del Cambio según el Modelo de Asimilación: Una Introducción Teórica y Metodológica

Con este trabajo se busca la descripción teórica y metodológica del modelo de asimilación y de algunos de los principales resultados. El modelo de asimilación se ha desarrollado como un modelo de procesos integrador que permite describir el proceso de cambio en cualquier enfoque de terapia. Este trabajo describe el modelo y cómo debe ser el procedimiento a seguir cara al desarrollo de estudios de asimilación. Define, además, sus conceptos principales, como asimilación, voces dominantes y no dominantes y puente de significado y se presenta la Escala de Asimilación de Experiencias Problemáticas (APES). Se resumen algunos de los principales resultados alcanzados, como por ejemplo, la relación …

The assimilation of problematic experiences in linguistic therapy of evaluation: How did maría assimilate the experience of dizziness?

Abstract The assimilation model proposes eight stages through which patients with problematic experiences pass during assimilation, ranging from suppression or dissociation to mastery. These are summarized in the Assimilation of Problematic Experiences Scale (APES). The assimilation model and the APES have been developed through intensive qualitative study of significant therapeutic events. This article describes the process of assimilation of the problematic experiences of dizziness in a patient, Maria, treated with linguistic therapy of evaluation. All treatment sessions were analyzed with the goals of describing the process of assimilation and connecting this process with the therapeutic…

Therapeutic activities and the assimilation model: A preliminary exploratory study on the Insight stage

The assimilation model describes the process of change assuming that the self is enriched when there is a dialogue between nondominant voices or problematic experiences and the dominant voices. This dialogue is best seen in the Insight stage. The aim of this paper is to study the Insight stage during the assimilation process in relation to the main therapeutic activities performed by the therapist. All the Insights from the assimilation process of a patient, Maria, were analysed. In assimilation terms, Maria could be described through the nondominant voices of “dizziness,” “tiredness,” and “inability to cope with daily demands,” and through the dominant voices of “control,” “overcome and so…

¿Es Posible la Integración en Psicoterapia?


 
 
 En este trabajo se hace una reflexión teórica sobre si es posible la integración en psicoterapia. Para ello se revisará el porqué del surgimiento de la integración en psicoterapia y se enmarcará al terapeuta integrador en relación a dos cuestiones básicas: las actitudes que debe tener, así como las posibilidades reales de formación en integración en psicoterapia. Todo ello supone considerar las dificultades y obstáculos para la integración y qué posibilidades tenemos para resolverlas. Destacados proponentes de la tendencia hacia la integración en psicoterapia han asumido que ésta es un proceso y no un producto. Dicha cuestión se ejemplificará en el campo de las psicote…

Convergences and Divergences Among Cognitive Models

Therapist activities preceding setbacks in the assimilation process

This study examined the therapist activities immediately preceding assimilation setbacks in the treatment of a good-outcome client treated with linguistic therapy of evaluation (LTE).Setbacks (N = 105) were defined as decreases of one or more assimilation stages from one passage to the next dealing with the same theme. The therapist activities immediately preceding those setbacks were classified using two kinds of codes: (a) therapist interventions and (b) positions the therapist took toward the client's internal voices.Preceding setbacks to early assimilation stages, where the problem was unformulated, the therapist was more often actively listening, and the setbacks were more often attrib…

Breaking the Dominance of Dominant Voices: How the Therapist Promotes Assimilation by Facilitating Dialogue with the Client’s Problematic Voices

Assimilation requires a dialogue between the client’s dominant and non-dominant internal voices, that is between the client’s usual self and his or her problematic experiences. This dialogue is est...

La teoría de la semántica general de A. Korzybski (1985)

The assimilation of problematic experiences in the context of a therapeutic failure

Abstract A negative case–a therapeutic dropout–was analyzed with the Assimilation of Problematic Experiences Scale (APES). The APES has been devised from the assimilation model developed by Stiles and colleagues, and it has proven useful for describing the process of change. The APES describes assimilation as a sequence of eight stages which range from an experience being warded off, through being avoided, in vague awareness, then clarified, understood and solutions applied and finally, resolved and integrated into the self. The current study focuses on the case of Ana, who was being treated for reactive depression in five sessions of linguistic therapy of evaluation. The aims of this study…

Theory and Practice in the Cognitive Psychotherapies: Convergence and Divergence

Cognitive therapy, linguistic therapy of evaluation, and constructivist psychotherapy display prominent points of both convergence and divergence at conceptual and practical levels. This article considers these comparisons and contrasts, focusing on their respective positions regarding their meta-theoretical models of human beings, science, and epistemology, as well as key aspects of their therapeutic stance, style, and strategic preferences. The resulting analysis suggests that these three contemporary approaches to cognitive therapy make distinctive contributions to clinical practice, adding to the richness of the field in different ways.

Setbacks in the process of assimilation of problematic experiences in two cases of emotion-focused therapy for depression

Research on the assimilation model has suggested that psychological change takes place in a sequence of stages punctuated by setbacks, that is, by transient reversals in the developmental course. This study analyzed such setbacks in one good outcome case and one poor outcome case of Emotion-focused therapy (EFT) for depression.Intensive analyses of five transcribed sessions from each case identified 26 setbacks in the good outcome case and 27 in the poor outcome case. The reason for each setback was classified into one of four categories: balance strategy, exceeding the therapeutic zone of proximal development either induced by the therapist (ZPD-T) or induced by the client (ZPD-C), or spon…

Constructivismo, psicoterapias cognitivas de reestructuración y enfoques contextuales

En este trabajo se establecen las diferencias y convergencias principales entre los modelos cognitivos de reestructuración, los constructivistas y los contextuales. Partiendo de una breve revisión histórica se podrá enmarcar el surgimiento de cada uno de estos enfoques e, igualmente, las diferencias epistemológicas y ontológicas entre ellos. Estos modelos se analizan, principalmente, haciendo hincapié en sus conceptos principales y en las técnicas desarrolladas que, en principio, serían coherentes con su marco teórico. Igualmente, la coherencia entre teoría y práctica se hace evidente mediante el desarrollo de un tipo concreto, y diferente, de relación terapéutica en cada modelo. La conclus…

Convergence of voices: assimilation in linguistic therapy of evaluation.

This paper shows the convergence of voices in psychotherapy in the context of the assimilation model. Convergence is the link between patients' voices within the community of voices. The main aim of the paper was to explore (a) how convergence (and divergence) is shown during sessions and the usefulness of convergence for the process of assimilation; (b) if a well-structured patient is able to track the sociohistorical antecedents of his/her main voices; and (c) if, at the end of the therapy, the self becomes richer and with more resources. For this aim to be realized, a case study of a patient, Maria, treated with linguistic therapy of evaluation for 14 sessions, was analysed by using the …