Assimilation Setbacks as Switching Strands: A Theoretical and Methodological Conceptualization

This paper offers a theoretical and methodological formulation of setbacks in the process of assimilation of problematic experiences in psychotherapy. It is based on a series of theory-building case studies, in which case observations were used to modify and confirm an evolving understanding. Assimilation typically follows a sawtoothed progression in which advances alternate with setbacks. Research has identified two main types of setbacks, called exceeding the therapeutic zone of proximal development, and the balance strategy, which occur under systematically different conditions. Both types of setbacks can be understood as switching strands within a problematic theme. This formulation defines and elaborates the methodological concepts of topic, theme, and strand, as well as the underlying theoretical concepts of internal voices and sub-voices. These are illustrated with examples from a clinical case. This elaboration of the assimilation model is related to other perspectives that emphasize people’s multiplicity of internal voices and used to suggest further studies.