Resolution of assimilation setbacks in the case of Alicia: the dance of strands

Abstract

ABSTRACT Objective According to assimilation theory, in successful therapy, the usual self, composed of dominant voices (DVs) comes to terms (establishes meaning bridges) with traces of problematic experiences, or nondominant voices (NDVs). Voices are composed of multiple strands, that is, traces of interrelated experiences. Setbacks typically involve a shift from a more-assimilated pre-setback strand of a problem to a less-assimilated setback strand. This qualitative theory-building case study investigated participants’ responsive processes as they resolved such setbacks. Methods Alicia was diagnosed with depression and treated with a cognitive therapy for 26 sessions. Setback episodes (N = 70) resolved to at least level 4 (Insight) on the 0 to 7 assimilation scale were identified, and the therapist's and client’s responsive actions were described as the different strands appeared and evolved during the post-setback resolution. Results Resolutions involved a dance of strands of the NDVs and DVs, facilitated by the introduction of therapeutic strands by the therapist. This entailed joint, mutually responsive work by client and therapist. This required tempering strands of the DV (responsively moderating their dominance) and opening the DV to strands of NDVs, which were reframed in ways that seemed to make them more understandable and less painful. Conclusion If both participants elicit and pursue many strands of conflicting voices--the dance of strands – their positions become mutually comprehended, facilitating assimilation and the resolution of setbacks. As clients resolve setbacks in this way, DV and NDV come to understand each other, establishing a meaning bridge.