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…
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 …
Retrocessos no contexto de terapia linguística de avaliação
O modelo de assimilacao e um modelo integrativo que pode ser aplicado a qualquer tipo de setting terapeutico para a descricao do processo de mudanca. A Escala de Assimilacao de Experiencias Problematicas (EAEP) descreve o processo de assimilacao de experiencias problematicas em terapia. Ainda que a EAEP apresente uma sequencia ordenada, estudos demonstram que o processo de assimilacao nao e continuo; contrariamente, o processo parece seguir um padrao de altos e baixos, com progressos seguidos de retrocessos, particularmente em psicoterapias cognitivas. Neste artigo, apresentamos uma analise dos retrocessos no processo de uma cliente com um bom prognostico, Maria, em tratamento com terapia l…
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 …
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...
Progress through the Early Stages of Assimilation in Play Therapy with a Traumatized Six-Year-Old Girl
We applied the assimilation of problematic experiences sequence (APES) to a six-year-old girl’s processing of traumatic experiences involving violence and death in play therapy. We analyzed the post-session notes from the first 34 sessions of a much longer treatment, during which the girl repeatedly enacted a drama we called the cottage play, involving characters assumed by the child and characters assigned to the therapist. We distinguished four phases based on changes in play themes. In phase 1, the girl expressed her need for safety in response to an overwhelming internal threat (APES stage 0, warded off/dissociated). In phase 2, she worked to escape and avoid the threat, referenced in t…
Hiding Shame – A Case Study of Developing Agency
Abstract The hiding aspect of shame makes the study of shame difficult. In this article we aim to show through Hanna’s case study how shame manifests and develops during the course of one psychotherapy process. This will be done using Assimilation analysis (APES) and Dialogical Sequence Analysis (DSA) to show in detail one idiosyncratic developmental path through which the relationship toward the problematic shame experience changes and develops in psychotherapy. Results show how the manifestation of shame toward the problematic experience of being seen was present in the first moments of the first meeting, but also how during the sequence of sessions 7 – 9 Hanna’s relationship toward shame…
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…
Vamos a Traducir los MRV(Let’s Translate the VRM): Linguistic and Cultural Inferences Drawn from Translating a Verbal Coding System from English into Spanish
Translating a verbal coding system from one language to another can yield unexpected insights into the process of communication in different cultures. This paper describes the problems and understandings we encountered as we translated a verbal response modes (VRM) taxonomy from English into Spanish. Standard translations of text (e.g., psychotherapeutic dialogue) systematically change the form of certain expressions, so supposedly equivalent expressions had different VRM codings in the two languages. Prominent examples of English forms whose translation had different codes in Spanish included tags, question forms, and "let's" expressions. Insofar as participants use such forms to convey nu…