Therapeutic collaboration and the assimilation of problematic experiences in emotion-focused therapy for depression: Comparison of two cases

Abstract

Aims: The Assimilation model argues that therapists should work responsively within the client's therapeutic zone of proximal development (TZPD). This study analyzed the association between the collaborative processes assessed by the Therapeutic Collaboration Coding System (TCCS) and advances in assimilation, as assessed by the Assimilation of Problematic Experiences Scale (APES).Method: Sessions 1, 4, 8, 12, and 16 of two contrasting cases, Julia and Afonso (pseudonyms), drawn from a clinical trial of 16-sessions emotion-focused therapy (EFT) for depression, were coded according to the APES and the TCCS. Julia met criteria for reliable and clinically significant improvement, whereas Afonso did not.Results: As expected, Julia advanced farther along the APES than did Afonso. Both therapists worked mainly within their client's TZPD. However, Julia's therapist used a balance of supporting and challenging interventions, whereas Afonso's therapist used mainly supporting interventions. Setbacks were common in both cases.

Self-narrative reconstruction in emotion-focused therapy: A preliminary task analysis

“…Regarding the present task of self-narrative reconstruction we can say that therapeutic activity appeared as a collaborative effort that was constant across the several steps of the model. This is congruent with the emotion-focused therapeutic stance, which has been evidenced in other studies with EFT for depression (e.g., Ribeiro et al, 2016). Moreover, several instances of dyadic interaction also evidenced tangential processes (defined as moments of dyadic activity appearing in the form of if-then contingent actions-if the client does X, then the therapist does Y; cf., Bennett et al, 2006) that become explicit at specific junctures of the therapeutic conversation.…”

“…The study of these cases suggests that the therapeutic strategies are essentially related with a collaborative style from therapists characterized by non-directive, empathic, and exploratory interventions expected at this phase Greenberg, 1984Greenberg, , 1991Greenberg et al, 1993;Ribeiro et al, 2016). Furthermore, exploratory interventions have also been related to reconceptualization and performing change IMs in a previous study with this sample (Cunha, Gonçalves, Hill, et al, 2012), suggesting their key role in the productivity of EFT.…”

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

“…A series of intensive case studies of assimilation progress in different therapeutic models has shown that good outcome clients, as assessed by standard symptom intensity measures, progress toward high APES levels across their sessions (e.g., Brinegar, Salvi, & Stiles, 2008;Caro Gabalda, 2011;Caro Gabalda, Stiles, & Pérez Ruiz, 2016;Gray & Stiles, 2011;Honos-Webb, Stiles, & Greenberg, 2003;Knobloch, Endres, Stiles, & Silberschatz, 2001;Mendes et al, 2016;Osatuke et al, 2007;Ribeiro, Braga et al, 2016a;Ribeiro, Cunha et al, 2016b). For example, in a study of one good outcome client, Basto et al (2016) found a strong negative correlation across 16 sessions of CBT between APES level and symptom intensity.…”

Setbacks in the process of assimilation of problematic experiences in two cases of emotion-focused therapy for depression

“…The therapeutic ZPD may be different for each problem and will move as the client makes progress on the problem. In order to promote novelty and progress in the assimilation process the therapist may press the client higher within the ZPD, but if the client feels this movement as too risky (exceeding the ZPD), he or she will move back into a less challenging stage of assimilation (Ribeiro, Ribeiro, Gonçalves, Horvath, & Stiles, 2013;Ribeiro et al, 2015). Therapeutic work occurs within the therapeutic ZPD developed between client and therapist under joint collaboration.…”