Therapeutic activities and the assimilation model: A preliminary exploratory study on the Insight stage

Does assimilation of problematic experiences predict a decrease in symptom intensity?

The assimilation model describes therapeutic change as an integration of experiences that had previously been problematic, distressing, avoided, or warded off. This study assessed whether assimilation was associated with treatment outcome in a sample of psychotherapeutic treatments for depression. Further, it assessed the direction of the association—whether increasing assimilation predicted decreases in symptom intensity or decreasing symptom intensity predicted increases in assimilation.

Method

Participants were 22 clients with mild to moderate depression drawn from a clinical trial comparing cognitive behavioral therapy with emotion‐focused therapy. The direction of prediction between assimilation progress and changes in self‐reported symptom intensity was assessed.

Results

The assimilation progress was shown to be a better predictor of decreases in symptom intensity than the reverse.

Conclusion

The results supported the assimilation model's suggestion that assimilation progress promotes decreases in symptom intensity in the treatment of clients with major depressive disorder.

Therapist activities preceding setbacks in the assimilation process

OBJECTIVE

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).

METHOD

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.

RESULTS

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.

CONCLUSIONS

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.