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This 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 emotion-focused therapy. The fourth and final article analyzed the therapeutic collaboration in episodes of ambivalence in two cases of narrative therapy (one good outcome, one poor outcome) reflecting on the implications for the assimilation model’s perspective on the therapeutic relationship. This Introduction conclude...

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 attributable to pushing a theme beyond the client's working zone. Preceding setbacks to later assimilation stages, where the problem was at least formulated, the therapist was more likely to be directing clients to consider alternatives, following the LTE agenda, and setbacks were more often attributable to the client following these directives shifting attention to less assimilated (but nevertheless formulated) aspects of the problem.At least in this case, setbacks followed systematically different therapist activities depending on the problem's stage of assimilation. Possible implications for the assimilation model's account of setbacks and for practice are discussed.

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 case, but 100% of them were rated at or above APES 4. By contrast, 63% passages coded as action, reflection or protest were rated below APES 4 (Chi-square = 28.62, p < .001). Implications for research are discussed.

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 clients to shift toward relatively problematic material (balance metaphor), or (c) spontaneous switches. Rather than contradicting the theory, this close examination of setbacks yielded elaborations of it.

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 were to describe the process of assimilation and to determine whether it showed the sawtooth pattern of progress found in other APES studies. Main results showed that Ana had difficulties in the process of assimilation, never reaching APES Stage 4 (insight). Ana remained at APES Stages 2 and 3. The sawtooth pattern was...

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 change. The results showed that the assimilation process includes setbacks within a general pattern of progress through the APES stages. The process of assimilation was associated with the changes in Maria's life. Zusammenfassung Die Assimilation problematischer Erfahrungen in linguistischer Bewertungstherapie: Wie hat...