Gabalda (2006) examines the case of a forty two year old woman, Ana who was suffering from depression. Ana had sought treatment but eventually discontinued her visits to her psychologist. The study examines the role of assimilation of nondominant voices of negative experiences that a patient is having difficulty with. Dominant voices are described as basic beliefs and schema that make up our feelings and thought processes. Nondominant voices are those that challenge us and cause difficulty in processing into our schema (Stiles, Elliott, Llewelyn, Margison, Shapiro and Hardy 1990).
Gabalda (2006) provides a strong literature review built on the concept of nondominant voices which is based on the work of Stiles and his colleagues. The concept of nondominant voices and the assimilation process is clearly described and an example used for clarification. Honos-Webb and Stiles (1998) define the assimilation process as new thoughts and feelings that are in dialog with our existing schema and emotions. Through this dialog the new feelings eventually become accepted and a part of our schema (Honos-Webb and Stiles 1998). The author provided the appropriate literature to base the current study on, however most of the research was based on the work of the same two researchers and their colleagues: Stiles and Honos-Webb (Gabalda 2006).
The Assimilation of Problematic Experiences Scale (APES) was the tool used for measurement in this case study. The scale divides problematic experiences that are experienced into eight categories of assimilation: warded off; unwanted thoughts; vague awareness; problem statement; understanding; application; problem solution and mastery (Honos-Webb, Surko, Stiles and Greenberg 1999). This tool is used primarily in case studies as it will be used in this case study. A negative case was selected by the author in order to determine how the APES and assimilation model would be applied (Gabalda 2006). The hypothesis was clearly stated and based on the literature review. The purpose of the study was implied by the author as a learning experience for therapists.
In this qualitative study, one participant is used (Gabalda 2006). Ana is described as a forty two year old woman who had sought treatment for depression after a medical mishap left her daughter with alopecia (Gabalda 2006). The daughter is described as having accepted her condition, but Ana was depressed and anxious over the situation. Ana’s relationships with her husband and children is described as good. Ana had sought treatment for her condition but dropped out, her family supported her decision (Gabalda 2006). The author was thorough in describing the participant and her history.
Ana’s treatment used a cognitive therapy known as LTE in which patients change their language in addressing their issue. This approach is based on the work of Korzybski, a linguist (Lahman 2013). Al of Ana’s sessions were recorded. The author employed four other psychologists to also code and analyze the transcripts of the session. The problem they looked for was Ana’s discussions of the medical mishap and her feelings about her daughter’s alopecia (Gabalda 2006). By collaborating with four other professionals in analyzing the data, bias is removed.
The coding was clearly described. The raters identified Ana’s beliefs about her mothering skills as her dominant voice and any mention of her daughter’s medical problem as the negative voice (Gabalda 2006). Excerpts and examples from each session are presented. The data was graphed to indicate Ana’s levels on the APES scale (Gabalda 2006). Gabalda (2006) clearly defines what type of comments are considered at what level of the APES scale. For example, when she says she wants to change this is considered Stage 2 on APES and represented awareness (Gabalda 2006).
The discussion is thorough. The author stresses that a negative outcome case was chosen because of the benefit of learning that results in failed therapy (Gabalda 2006). The LTE therapy did not help Ana to master the negative voice of her daughter’s medical condition. Ana made some process, but was unable to completely assimilate this negative experience into her skills and perceptions as a mother (Gabalda 2006). Gabalda (2006) discusses that previous research using APES and LTE therapy were generally successful. In the case of Ana however, this method of therapy did not work well because her dominant voice was very strong and she simply could not accept the medical issue in any way (Gabalda 2006). The author also mentions that the five session therapy was not length enough to successfully treat Ana (Gabalda 2006). Ana, and other patients who have a severe negative experience that they cannot assimilate would benefit from the LTE therapy over a longer period that includes more sessions.
This case study was well researchers and conducted. The author enlisted the cooperation of four other psychologists in the coding process to keep the case study fair and impartial. By examining the response of one patient in a deep manner to pinpoint the success or failure of a treatment therapy can guide other professionals in selecting and executing a particular therapy, in this case LTE cognitive therapy. The basis of the study was very narrow, the literature review was based on the work of a limited number of researchers. The LTE therapy was not clearly addressed in the literature review but was a major component of the study. The transcripts of the sessions, examples of the coding were thorough and well presented. The discussion provided insight into the case and offered suggestions for future therapy and examined the implications for this failure of therapy for the client.
References
Gabalda, I.C. (2006). The assimilation of problematic experiences in the context of a
therapeutic failure. Psychotherapy Research, 16(4), 436-452.
DOI: 10.1080/10503300600743897
Honos-Webb, L., & Stiles, W. B. (1998). Reformulation of assimilation analysis in terms of voices. Psychotherapy, 35, 23-33.
Honos-Webb, L., Surko, M., Stiles, W. B., & Greenberg, L. S. (1999). Assimilation of voices in psychotherapy: The case of Jan. Journal of Counseling Psychology, 46, 448_460.
Lahman, M. (2013). General semantics: Understanding Korzybski’s formulations. ETC: A
Review of General Semantics, 70(2), 111-119.
Stiles, W. B., Elliott, R., Llewelyn, S., Firth-Cozens, J., Margison, F. R., Shapiro, D. A., &
Hardy, G. (1990). Assimilation of problematic experiences by clients in psychotherapy.
Psychotherapy, 27, 411-420.
