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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 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 mai...

In this research process, Stiles’ assimilation of problematic experiences scale is used to study Olivia’s process of change. The objectives of this study are: first, to describe Olivia’s therapeutically successful assimilation of the problematic experience of fear of dying, treated with brief strategic therapy; and second, to study how that pattern of assimilation unfolded. We can conclude that Olivia assimilated her problematic experience of fear of dying by following a fluctuating and irregular pattern.

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.

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, explaining the influence of the development of an extensional orientation on the dialogue and the establishment of meaning bridges.

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 solve,” and “why something is happening.” Maria 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. Maria was considered a good outcome case in the LTE sample. Results ...

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.

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.

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 orientation to an extensional orientation, which for Gabriel meant stopping anticipating and instead focusing on the here and now and dealing with uncertainty. At the end of therapy and at two-year follow-up, Gabriel showed a complete recovery.

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 externalizing kinds of symptoms. The results suggest the importance of making a more detailed study of these children, comparing them with matched controls and making prospective, longitudinal studies in order to detect psychological problems, and to explore the influence of predictive variables.

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 experience being warded off, avoided, in vague awareness, clarified, understood, solutions applied, and finally resolved and integrated into the self. Results showed, first, that the process of assimilation reaches APES Stages 5 (application) and 6 (problem solution), and, second, that the process of assimilation showed a ...

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...

This paper introduces the Special Symposium Issue on the Assimilation of Problematic Experiences and on the Assimilation Model. The main context of these studies is the process research trend in psychotherapy. Process research keeps a direct connection with outcome research and it tries to explore (in many different ways) how patients and therapists are involved and related in therapy and what kind of therapeutic activities, operations or variables are influencing the therapeutic change. In this process context qualitative studies are contributing greatly to give a more detailed explanation of the process of change. The Assimilation Scale and the Model developed by Stiles and his group are embbeded in this qualitative stance. So, in this introduction some of the main concepts and theoretical foundations of the Assimilation Model will be addressed as well the main conclusions of the papers edited.

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, whereas the resolved events tended to include higher APES levels. The process of assimilation showed a sawtoothed pattern characteristic of directive therapies. To illustrate the process of assimilation, qualitative data—passages, excerpted from one patient, Silvia—are shown. The results are discussed in terms of the ass...