Fluctuation in the Assimilation of Problematic Experiences: A Case Study of Dynamic Systems Analysis

Abstract

Dynamic systems theory suggests that instability can be a key element in the promotion of human change processes. Several studies have confirmed an association between unstable patterns and successful psychotherapeutic outcome. Somewhat similarly, the assimilation model of psychotherapeutic change argues that clinical change occurs through the integration of problematic experiences that initially threaten the stability of the self. This study examined how instability in assimilation levels was related to assimilation progress and change in symptom intensity, within and across sessions, in a good-outcome case of Emotion Focused Therapy. We used the assimilation of problematic experiences scales (APES) to measure assimilation and the outcome-questionnaire (OQ-10) to measure clinical symptom intensity. To assess assimilation instability, we used a fluctuation measure that calculated the amplitude and the frequency of changes in assimilation levels. To analyze the structural relationships between variables we used a dynamic factor model. The results showed that APES level and APES fluctuation tended to increase across treatment, while OQ-10 scores tended to decrease. However, contrary to expectations, the dynamic factor model showed no significant associations between APES fluctuation and OQ-10 scores either within sessions or between adjacent sessions.

The Assimilation Process of Problematic Experiences and Long-Term Outcomes in Psychotherapy for Depression: Comparing a Relapsed and a Non-Relapsed Case

“…The setbacks seem to corroborate this idea: the client appears to be in a change phase, where the problematic voice assimilation and consequent reorganization of the community of voices has not yet been finalized. The setbacks arise as a result of the voices confrontation and it doesn't result as a problem for the process, indicating that the client is in the active phase of the assimilation process (Basto et al, 2018;Caro-Gabalda & Stiles, 2016).…”

“…Elizabeth corresponds to a successful case during and after the end of therapy, having APES 6 levels have been identified either in the acute phase of treatment or during follow-up sessions. This may indicate that APES 6 may be associated with a more structural and sustained change, as reflected by the maintenance of gains after the end of the therapeutic process (Basto et al, 2017(Basto et al, , 2018). An explanatory hypothesis for the present results may be related to the fact that reaching level 6 in terms of assimilation can act as an important mark in preventing relapse and allowing the maintenance of gains.…”

“…Training (Basto et al, 2017;2018) on the APES procedures lasted approximately four months, with weekly meetings of approximately one hour each. First, papers about the assimilation model were analyzed, as well as the coding manual.…”

“…According to this model, change occurs through the integration of problematic experiences into the self, over eight stages, measured using the Assimilation of Problematic Experiences Scale (APES; Caro-Gabalda & Stiles, 2009). Previous studies demonstrated the relation between success in therapy and an increase in terms of assimilation of problematic experiences (Basto et al, 2018;Stiles, Shapiro, Harper & Morrison, 1995), but there are few studies analyzing the relation between assimilation and relapse prevention. In this sense, we aimed to understand how assimilation grows during and after the therapeutic process and consequently, to explore what is the relation between this therapeutic process and the maintenance of gains after the end of the therapy.…”

Digital images as meaning bridges: Case study of assimilation using avatar software in counselling with a 14‐year‐old boy

“…In successful psychotherapy, clients build meaning bridges to such problematic experiences, first with the therapist and then with his or her own community of voices, reducing distress and allowing smooth access. A series of theory‐building case studies has suggested that assimilation follows a developmental course summarised in the assimilation of problematic experiences sequence (APES; Basto et al, ; Brinegar, Salvi, Stiles, & Greenberg, ; Stiles, ; Stiles & Glick, ), described later.…”