Markers of assimilation of problematic experiences in dementia within the LivDem project.

Richard Cheston,Peter Coleman,John H Spreadbury,Lauren Gatting,Ann Marshall

doi:10.1177/1471301215602473

Abstract

This study aimed to determine whether the Markers of Assimilation of Problematic Experiences in Dementia scale (MAPED) can be used to identify whether the way in which participants talk about dementia changed during the group. All eight sessions of a LivDem group, which were attended by participants were recorded and transcribed. An initial analysis identified 160 extracts, which were then rated using the MAPED system. Inter-rater reliability was 61% and following a resolution meeting, 35 extracts were discarded, leaving 125 extracts with an agreed marker code. All of the participants were identified as producing a speech marker relating to dementia, and these varied between 0 (warding off) to 6 (problem solution). Examples of these markers are provided. The proportion of emergence markers (indicating the initial stages of assimilation) compared to later markers changed significantly between the first four sessions and the final sessions. This difference was still significant even when the markers produced by the most verbal participant, Graham, were excluded. The use of process measures within psychotherapy complements more conventional outcome measures and has both theoretical and clinical implications.

Highlights

The Assimilation Model of psychotherapeutic change (Honos-Webb & Stiles, 1998; Stiles, 1999; 2001; Stiles et al, 1999) is a transtheoretical model of the process of change that occurs in psychotherapy
It has been used to analyse the process of change within psychotherapy sessions with clients with a wide variety of mental health needs (e.g. Varvin & Stiles, 1999), as well as people with learning disabilities (Newman & Beail, 2002) and people affected by dementia (Watkins et al, 2006)
The assimilation analysis of recordings collected during the Living well with Dementia (LivDem) study falls into two parts: first of all, the analysis presented here of all eight of the sessions attended by one of the seven groups; and secondly, the analysis of a randomly selected sample of sessions from the remaining six groups, which will be reported separately

Summary

Introduction

The Assimilation Model of psychotherapeutic change (Honos-Webb & Stiles, 1998; Stiles, 1999; 2001; Stiles et al, 1999) is a transtheoretical model of the process of change that occurs in psychotherapy. The assimilation model represents the self not as a single, unified entity but instead as contextdependent, shifting and multiple selves. This is consistent with post modern or social constructionist theories of the self which describe a “community of voices” Hermans & Kempen, 1992; Mair, 1989; Gergen & Kaye, 1992). These different voices are referred to as the Dominant Voice (the voice of continuity, or the preservation of the status quo) and the Problematic Voice (the voice of the emotional consequences of change including fear, anger, sadness and loss). Within the Assimilation Model, most experiences in a person’s life are seen to be unproblematic and can be assimilated relatively routinely into that person’s existing self

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