Journal of Contemporary Psychotherapy

, Volume 48, Issue 4, pp 205–214 | Cite as

Assimilation Setbacks as Switching Strands: A Theoretical and Methodological Conceptualization

  • Isabel Caro GabaldaEmail author
  • William B. Stiles
Original Paper


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.


Assimilation setbacks APES Therapeutic zone of proximal development Balance strategy Switching strands Voices Theme 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.


  1. Caro Gabalda, I. (1996). The linguistic therapy of evaluation: A perspective on language in psychotherapy. Journal of Cognitive Psychotherapy, 10, 83–104.CrossRefGoogle Scholar
  2. Caro Gabalda, I., & Stiles, W. B. (2009). Retrocesos no contexto de terapia linguística de avaliaçâo [Setbacks in the context of linguistic therapy of evaluation]. Análise Psicologica, 2(XXVII), 199–212.Google Scholar
  3. Caro Gabalda, I., & Stiles, W. B. (2013). Irregular assimilation progress: Reasons for setbacks in the context of linguistic therapy of evaluation. Psychotherapy Research, 23, 35–53.CrossRefGoogle Scholar
  4. Caro Gabalda, I., Stiles, W. B., & Pérez Ruiz, S. (2016). Therapist activities preceding setbacks in the assimilation process. Psychotherapy Research, 26, 653–664.CrossRefGoogle Scholar
  5. Georgaca, E. (2003). Exploring signs and voices in the therapeutic space. Theory & Psychology, 13, 541–560.CrossRefGoogle Scholar
  6. Goodridge, D., & Hardy, G. E. (2009). Patterns of change in psychotherapy: An investigation of sudden gains in cognitive therapy using the assimilation model. Psychotherapy Research, 19, 114–123.CrossRefGoogle Scholar
  7. Hermans, H. J. M. (1996). Voicing the self: From information processing to dialogical interchange. Psychological Bulletin, 119, 31–50.CrossRefGoogle Scholar
  8. Hermans, H. J. M. (2001). The dialogical self: Toward a theory of personal and cultural positioning. Culture & Psychology, 7, 243–281.CrossRefGoogle Scholar
  9. Hermans, H. J. M., Kempen, H. J. G., & Van Loon, R. P. P. (1992). The dialogical self: Beyond individualism and rationalism. American Psychologist, 47, 23–33.CrossRefGoogle Scholar
  10. Knox, S., Goldberg, J. L., Woodhouse, S. S., & Hill, C. E. (1999). Clients’ internal representations of their therapists. Journal of Counseling Psychology, 46, 244–256.CrossRefGoogle Scholar
  11. Kramer, U., Meystre, C., Imesch, C., & Kolly, S. (2016). Assimilative processes in a client with borderline personality disorder: Tracking internal multiplicity over the first ten sessions of therapy. Journal of Psychotherapy Integration, 26, 144–159.CrossRefGoogle Scholar
  12. Leiman, M., & Stiles, W. B. (2001). Dialogical sequence analysis and the zone of proximal development as conceptual enhancements to the assimilation model: The case of Jan revisited. Psychotherapy Research, 11, 311–330.CrossRefGoogle Scholar
  13. Mendes, I., Gomes, P., Rosa, C., Salgado, J., Basto, I., Caro Gabalda, I., & Stiles, W. B. (2016). Setbacks in the process of assimilation of problematic experiences in two cases of emotion-focused therapy for depression. Psychotherapy Research, 26, 638–652.CrossRefGoogle Scholar
  14. Meystre, C., Pascual-Leone, A., de Roten, Y., Despland, J. N., & Kramer, U. (2014). What interventions facilitate progress through the assimilation model? A task analysis of interventions in the psychodynamic treatment of depression. Psychotherapy Research, 25, 484–502.CrossRefGoogle Scholar
  15. Mosher, J. K., & Stiles, W. B. (2009). Clients’ assimilation of experiences of their therapists. Psychotherapy, 46, 432–447.CrossRefGoogle Scholar
  16. Osatuke, K., Glick, M. J., Stiles, W. B., Greenberg, L. S., Shapiro, D. A., & Barkham, M. (2005). Temporal patterns of improvement in client-centred therapy and cognitive-behaviour therapy. Counselling Psychology Quarterly, 18, 95–108.CrossRefGoogle Scholar
  17. Pascual-Leone, A. (2009). Dynamic emotional processing in experiential therapy: Two steps forward, one step back. Journal of Consulting and Clinical Psychology, 77, 113–126.CrossRefGoogle Scholar
  18. Raggatt, P. T. F. (2007). Forms of positioning in the dialogical self: A system of classification and the strange case of Dame Edna Everage. Theory & Psychology, 17, 355–382.CrossRefGoogle Scholar
  19. Smith, K. W., & Greenberg, L. S. (2007). Internal multiplicity in emotion-focused therapy. Journal of Clinical Psychology: In Session, 63, 175–186.CrossRefGoogle Scholar
  20. Stiles, W. B. (2005). Extending the assimilation of problematic experiences scale: Commentary on the special issue. Counselling Psychology Quarterly, 18, 85–94.CrossRefGoogle Scholar
  21. Stiles, W. B. (2006). Assimilation and the process of outcome: Introduction to a special section. Psychotherapy Research, 16(4), 389–392.CrossRefGoogle Scholar
  22. Stiles, W. B. (2009). Logical operations in theory-building case studies. Pragmatic Case Studies in Psychotherapy, 5(3), 9–22. Retrieved from
  23. Stiles, W. B. (2011). Coming to terms. Psychotherapy Research, 21, 367–384.CrossRefGoogle Scholar
  24. Stiles, W. B., & Angus, L. (2001). Qualitative research on client’s assimilation of problematic experiences in psychotherapy. In J. Frommer & D. L. Rennie (Eds.), Qualitative psychotherapy research: Methods and methodology (pp. 112–127). Lengerich: Pabst Science Publishers.Google Scholar
  25. Stiles, W. B., Caro Gabalda, I., & Ribeiro, E. (2016). Exceeding the therapeutic zone of proximal development as a clinical error. Psychotherapy, 53, 268–272.CrossRefGoogle Scholar
  26. Stiles, W. B., Elliott, R., Llewelyn, S., Firth-Cozens, J., Margison, F. R., Shapiro, D. A., & Hardy, G. (1990). Assimilation of problematic experiences by clients in psychotherapy. Psychotherapy, 27, 411–420.CrossRefGoogle Scholar
  27. Stiles, W. B., Morrison, L. A., Haw, S. K., Harper, H., Shapiro, D. A., & Firth-Cozens, J. (1991). Longitudinal study of assimilation in exploratory psychotherapy. Psychotherapy, 28, 105–206.CrossRefGoogle Scholar
  28. Vygotsky, L. S. (1978). Mind in society: the development of higher psychological processes. Cambridge: Harvard University Press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de PsicologíaUniversidad de ValenciaValenciaSpain
  2. 2.Miami UniversityOxfordUSA
  3. 3.Appalachian State UniversityBooneUSA

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