Acknowledging problematic voices: processes occurring at early stages of conflict assimilation in patients with functional somatic disorder

Abstract

Objectives: This study elaborates the assimilation model's account of client processes at an early stage (Level I). This model describes therapeutic change as a gradual assimilation of problematic experiences, or voices, into the client's personality. The Assimilation of Problematic Experiences Scale (APES; Stiles et al., 1991) measures client's increasing ability to recognize, accept and utilize these previously avoided voices.

Design and methodology: Two researchers rated session excerpts from two psychotherapy cases, where the 'problematic voice' (PV) was initially unassimilated. Passages rated at APES Level I, along with their verbal assimilation descriptions, were later scrutinized for change processes. Voice dynamics within each passage were detailed and reviewed, to hypothesize substage processes representing movement. Both procedures involved a convergence process: raters first independently analysed, then shared their findings over successive rounds.

Conclusions: Across cases, shifts in the quality of negative affect were evident. Anxiety increased throughout this stage, as clients began to sustain exposure to intrusive problematic experiences. Later, Level I substages also showed an increase in conscious apperception of dominant voice characteristics including its resistance to experiencing PVs. Together, these relatively subtle changes indicated clients' increasing ability to familiarize themselves with PV qualities and recognize their historic defences against them, prior to identifying and accepting them as part of their personalities.