How is the assimilation of problematic experiences associated with the long-term psychotherapeutic outcomes in depression? A contrasting case study

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ABSTRACT The Assimilation Model describes therapeutic change as a gradual integration of problematic experiences into the self. Previous studies associated higher assimilation levels with a reduction of depressive symptoms throughout therapy and better therapeutic outcomes at the end. We explored the relation between the assimilation of problematic experiences during therapy and the maintenance of therapeutic gains after the therapeutic process. Three depressed clients were studied: one remained asymptomatic throughout the follow-up; one relapsed after the end of therapy; and one become asymptomatic during the follow-up. The assimilation process was assessed through the Assimilation of Problematic Experiences Scale (APES) and depressive symptoms through the Beck Depression Inventory-II (BDI-II). Higher APES levels were associated with lower intensity of symptoms across sessions. The client who maintained gains and the client who recovered during follow-up achieved higher APES levels during treatment than did the client who relapsed. APES levels of at least 4 were associated with good outcomes during therapy and further improvement after therapy and levels of at least 6 were associated with maintenance of therapeutic gains. These results suggest that a more thorough assimilation of problematic experiences may help clients maintain therapeutic gains and/or recover after therapy, thereby reducing the likelihood of relapse.