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El Insight es un elemento clave del proceso de asimilación, reflejando un nivel elevado y un progreso en la asimilación. En la esquizofrenia es, además, un elemento crucial relacionado con diferentes déficits metacognitivos. Por ello, la meta de este trabajo está en analizar, cualitativamente, los Insights alcanzados por un sujeto con esquizofrenia a lo largo de una serie de narraciones. Estos Insights, en un sujeto que no muestra un progreso en la asimilación de sus experiencias problemáticas, permiten reflexionar sobre el modelo de asimilación. Así, se plantea en la Discusión la necesidad de considerar a algunos de estos Insights, como “pseudo-insights”, que no reflejarían, a diferencia de la formulación inicial del modelo, un progreso en la asimilación. Reaching an Insight is a key element of the assimilation process. It reflects a high level and progress in assimilation. In relation to schizophrenia, the Insight is a key issue, as it may be related with different meta-cognitive impairments. Therefore, the aim of this paper is to qualitatively analyze, through narratives, the Insights of a schizophrenic subject. Those Insights, in a subject who showed no progress in the assimilation of his problematic experiences, may facilitate making some reflections about the assimilation model. Therefore, as it is emphasized in the Discussion, some of those Insights could be considered as “pseudo-insights”, which will not reflect, contrary to the initial model formulation, a progress in assimilation. Sin financiación No data JCR 2020 No data SJR 2020 UEV

En este trabajo se establecen las diferencias y convergencias principales entre los modelos cognitivos de reestructuración, los constructivistas y los contextuales. Partiendo de una breve revisión histórica se podrá enmarcar el surgimiento de cada uno de estos enfoques e, igualmente, las diferencias epistemológicas y ontológicas entre ellos. Estos modelos se analizan, principalmente, haciendo hincapié en sus conceptos principales y en las técnicas desarrolladas que, en principio, serían coherentes con su marco teórico. Igualmente, la coherencia entre teoría y práctica se hace evidente mediante el desarrollo de un tipo concreto, y diferente, de relación terapéutica en cada modelo. La conclusión principal sería que, aunque las terapias evolucionan, pudiéndose integrar y combinar, es saludable y conveniente mantener las diferencias entre ellas, dando la bienvenida a las distintas maneras de abordar los problemas psicológicos y de enfocar su tratamiento. Reducirlo todo a un único prisma empobrece nuestro campo de trabajo y su posible evolución.

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...

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...

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.

En este trabajo se hace una reflexión teórica sobre si es posible la integración en psicoterapia. Para ello se revisará el porqué del surgimiento de la integración en psicoterapia y se enmarcará al terapeuta integrador en relación a dos cuestiones básicas: las actitudes que debe tener, así como las posibilidades reales de formación en integración en psicoterapia. Todo ello supone considerar las dificultades y obstáculos para la integración y qué posibilidades tenemos para resolverlas. Destacados proponentes de la tendencia hacia la integración en psicoterapia han asumido que ésta es un proceso y no un producto. Dicha cuestión se ejemplificará en el campo de las psicoterapias cognitivas y con la actitud frente a ellas desde una falsa perspectiva integradora. Finalmente, el trabajo concluirá con una reflexión sobre cómo llevar a la práctica la promesa de la integración.

Este trabajo se centra en el modelo de asimilación de experiencias problemáticas. Dicho modelo es un modelo de corte integrador que nos permite estudiar el proceso de cambio en cualquier enfoque terapéutico y con diversos tipos de pacientes y sujetos. Por ello, expondremos, en primer lugar, los principales conceptos y características del modelo, como por ejemplo, qué significa asimilar, el concepto de voz y de voz no dominante y voz dominante, junto con la descripción de la Escala de Asimilación de Experiencias Problemáticas. A continuación, se describirán los resultados más destacados alcanzados en tres áreas principales: el estudio del proceso de cambio en pacientes; el proceso irregular y dentado de asimilación y el papel que tiene el terapeuta en dicho proceso. Esta última cuestión se relaciona con el concepto de responsividad y con el concepto de integración asimilativa.

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...

Este trabajo, de corte teórico, tiene como finalidad principal rastrear las bases y el origen socio-cultural de las psicoterapias cognitivas. Para ello, el trabajo comienza describiendo, brevemente, los elementos principales del modelo cognitivo y señalando, a continuación, las relaciones entre psicoterapia y marco occidental. Seguidamente, se procede a una comparación en mayor detalle entre las psicoterapias cognitivas y su particular origen socio-cultural. Elementos clave que se resaltan y relacionan con las psicoterapias cognitivas son el individualismo, la búsqueda de control y autonomía, un self individual autolimitado, y la consecución del racionalismo. El desarrollo de estos apartados tiene en cuenta a las principales terapias cognitivas, de corte clásico, o de corte constructivista. Finalmente, el trabajo termina haciendo una reflexión de todo ello desde la perspectiva del sujeto cognitivo.

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 paper discusses the various subjects embedded in cognitive psychotherapy. The cognitive model developed by Beck, considered as a rationalist and modernist model, will exemplify these subjects. Cognitive therapy should be placed in the modernist historical context and related to a subject characterized as having rationality and the ability to observe and detect cognitions, emotions and behaviors. The paper develops this background introducing three main subject types. The first is the introspective and conscious subject, who is able to observe what is within oneself, has free access, and is conscious of one’s cognitive world. The second is the cognitive miser that describes the subject who enters into therapy. The final subject identified, is the trained scientist who is able to develop a more objective knowledge, changing faulty schemas and cognitive distortions. This subject is the one most looked for in cognitive therapy. We could connect these subjects to some of the main elements of cognitive therapy such as the concept of ABC, assessment procedures, cognitive techniques or the relevance of schemas. Finally, the paper suggests some issues for study that could contribute to the theoretical and clinical evolution of cognitive psychotherapy

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.

The Assimilation of Problematic Experiences Scale (APES) summarizes a developmental continuum along which psychological problems progress in successful psychotherapy. The therapeutic zone of proximal development (TZPD) is the segment of the APES continuum within which the clients can proceed from their current APES level to the next with the therapist's assistance. It is the therapeutic working zone for a particular problem. As the client makes progress on a problem, its TZPD shifts up the APES. Theoretically, so long as the therapist's interventions remain within the TZPD, the client feels safe enough to work. However, when an intervention aims beyond the upper limit, the client will find it too risky and will reject or avoid the proposal. In this sense, exceeding the TZPD can be considered as a clinical error. This article presents examples of exceeding the TZPD and ways the error can be repaired., A part of this research was conducted at the Psychology Research Centre (UID/PSI/01662/2013), University of Minho, and was supported in part by the Portuguese Foundation for Science and Technology, the Portuguese Ministry of Science, Technology, and Higher Education, and FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653). This study was also partially supported by the BIAL Foundation., info:eu-repo/semantics/publishedVersion

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...

The assimilation model describes therapeutic change through APES (Assimilation of Problematic Experiences Scale) trying to reconcile the study of change through a pre-/post-test comparison with studying moment-by-moment change. Two processes of assimilation are described and compared from two clinical cases treated with the linguistic therapy of evaluation. A sample of 2,211 passages was coded with the APES. The good outcome case showed, at the end of treatment and at different moments of the therapeutic process, high stages of assimilation in its four proble- matic experiences. The poor outcome case showed, at the end of treatment and at different moments of the therapeutic process, the assimilation of some of its five problematic experiences. In both cases, the assimilation pattern was sawtoothed, with jumps and returns between APES stages.

Con este trabajo se busca la descripción teórica y metodológica del modelo de asimilación y de algunos de los principales resultados. El modelo de asimilación se ha desarrollado como un modelo de procesos integrador que permite describir el proceso de cambio en cualquier enfoque de terapia. Este trabajo describe el modelo y cómo debe ser el procedimiento a seguir cara al desarrollo de estudios de asimilación. Define, además, sus conceptos principales, como asimilación, voces dominantes y no dominantes y puente de significado y se presenta la Escala de Asimilación de Experiencias Problemáticas (APES). Se resumen algunos de los principales resultados alcanzados, como por ejemplo, la relación entre asimilación y cambio terapéutico, la relación entre no asimilación y ausencia de cambio terapéutico. Se hace mención, igualmente, al patrón característico de asimilación encontrado en terapias de corte cognitivo, es decir, un patrón de tipo dentado.

This paper shows the convergence of voices in psychotherapy in the context of the assimilation model. Convergence is the link between patients' voices within the community of voices. The main aim of the paper was to explore (a) how convergence (and divergence) is shown during sessions and the usefulness of convergence for the process of assimilation; (b) if a well-structured patient is able to track the sociohistorical antecedents of his/her main voices; and (c) if, at the end of the therapy, the self becomes richer and with more resources. For this aim to be realized, a case study of a patient, Maria, treated with linguistic therapy of evaluation for 14 sessions, was analysed by using the Assimilation of Problematic Experiences Scale (APES). Three main problematic experiences or non-dominant voices were identified with the APES: inability to do things, dizziness and tiredness. Maria's main dominant voices were to cure, solve and overcome problems, to be always doing things and to cope. Results showed a convergence but no divergence of voices as early as session 3. Results also showed how continuity-benevolence assumptions were broken and that, at the end of therapy, the patient's self became richer due to assimilation through the dialogue between non-dominant and dominant voices. Discussion emphasized these results, which are especially representative of a well-integrated patient who showed a healthy multiplicity. Copyright © 2009 John Wiley & Sons, Ltd.

En este trabajo seguimos la perspectiva linguistica de la semantica general, aplicada a la conceptualizacion y analisis de parte de la experiencia depresiva a traves de la terapia linguistica de evaluacion. Articulamos todo el trabajo alrededor de la conceptualizacion y cambio en el proceso evaluador de una paciente diagnosticada con "depresion mayor". Se hace un especial hincapie en las consecuencias para nuestra sanidad de seguir una orientacion intensional y en las ventajas de desarrollar otra de tipo extensional. Para exponer el cambio en las evaluaciones se utilizo la metodologia del analisis de tareas, muy empleada dentro del paradigma de investigacion de procesos para analizar de forma intensiva acontecimientos significativos de cambio.

This paper examines, in a first exploration, the psychological condition of adolescents with rheumatic diseases, and investigates the differences between boys and girls. Forty adolescents (31 girls and 9 boys), patients of the Pediatric Rheumatology Unit at Children’s Hospital La Fe in Valencia, ranging from 13 to 19 years old, were assessed using different methods as to their psychological condition and emotional problems. The results point at several problems in the psychosocial functioning of adoles-cents with rheumatic diseases. The results from the psychological tests indicate that this is especially so where girls are concerned. The sample presents more problems related to absence of the capacity to experience joy, fun and happiness than problems related to depression. Boys, although to a lesser extent, also have problems with psychosocial functioning. In their case hostility stands out.

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 spontaneous switches.In the good outcome case the most frequent reasons for setbacks were balance strategy and spontaneous switches, whereas in the poor outcome case the most frequent reason for setbacks was ZPD-T.As in previously studied therapies, setbacks in EFT, usually represent productive work on relatively less advanced strands of the client's major problems. Results point to the importance of the therapist attending to the limits of the client's therapeutic ZPD.