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, María, were analysed. In assimilation terms, María 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 solve,” and “why something is happening.” María showed a successful assimilation of her problematic experiences. The therapeutic context was the Linguistic Therapy of Evaluation (LTE), a kind of cognitive therapy based on the theory of General Semantics. María was considered a good outcome case in the LTE sample. Results showed that there were some general therapeutic activities related to these Insights. A high percentage of activities pointed to one of the main issues of LTE: the development of an extensional orientation. At the same time, some of these activities were related to María’s voices. Results are discussed in relation to the relevance of the development of an extensional orientation for the assimilation process; how voices are recognized or challenged in therapy, and to the importance of considering relationship issues during the assimilation process.     

Therapist activities preceding therapy setbacks in a poor-outcome case

Progress 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 passage, a therapist passage, and a client setback passage; both client passages had been previously rated on the APES. The main categories of therapist activities showed distinctive patterns in relation to the two main types of setbacks, the therapeutic zone of proximal development and the balance strategy. The two main patterns were described as an exploratory and a challenging configuration. These patterns of therapist activities and setbacks showed how the therapist seemed to persevere with approach-guided interventions while this poor-outcome client continued to have setbacks to low APES levels.