Abstract
Objective: Research on the assimilation model has suggested that psychological change takes place in a sequence of stages punctuated by setbacks, that is, by transient reversals in the developmental course. This study analyzed such setbacks in one good outcome case and one poor outcome case of Emotion-focused therapy (EFT) for depression. Method: Intensive analyses of five transcribed sessions from each case identified 26 setbacks in the good outcome case and 27 in the poor outcome case. The reason for each setback was classified into one of four categories: balance strategy, exceeding the therapeutic zone of proximal development either induced by the therapist (ZPD-T) or induced by the client (ZPD-C), or spontaneous switches. Results: In the good outcome case the most frequent reasons for setbacks were balance strategy and spontaneous switches, whereas in the poor outcome case the most frequent reason for setbacks was ZPD-T. Conclusions: As in previously studied therapies, setbacks in EFT, usually represent productive work on relatively less advanced strands of the client's major problems. Results point to the importance of the therapist attending to the limits of the client's therapeutic ZPD.
Highlights
The Assimilation of Problematic Experiences Scale (APES) sequence is continuous, at stage 4, the feelings engendered by encountering the nondominant voice shift from primarily negative to primarily positive (Stiles et al, 2004)
Towards the end of therapy, many passages were rated at APES stage 6, indicating a successful resolution of the problems and the integration of the previously nondominant voice of asserting her own needs into the community of voices (“I cannot care so much about what others may think in order to feel good”)
Setbacks in the Good Outcome Case We identified 26 setbacks in Alice's sessions (Table 2), of which 46% were coded as balance strategy, 46% were coded as spontaneous switch, and only 8% were coded as ZPD induced by therapist (ZPD-T)
Summary
We studied two cases treated with EFT for depression at Instituto Universitário da Maia (ISMAI) in Portugal. These two cases were randomly selected from a set of 10 goodoutcome and 10 poor-outcome cases from the EFT treatment group, which had complete transcripts for intensive process analyses Both clients underwent an assessment that included the Structural Clinical Interview for the DSM-IV axis I (First, Spitzer, Gibbon & Williams, 1996) and axis II (First, Sptizer, Gibbon, Williams & Benjamin, 1997) as well as standard self-report measures of symptom severity and met diagnostic criteria for Major Depressive Disorder (MDD). They each received 16 weekly sessions of EFT in the ISMAI project
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