MIAMI UNIVERSITY The Graduate School Certificate for Approving the Dissertation We hereby approve the Dissertation of Meredith Glick Brinegar Candidate for the Degree: Doctor of Philosophy _______________________________ Chair William B. Stiles, Ph.D. ________________________________ Reader Roger M. Knudson, Ph.D. _________________________________ Reader Larry M. Leitner, Ph.D. ________________________________ Graduate School Representative Paul V. Anderson, Ph.D. ABSTRACT WHAT CLIENTS CAN TELL US ABOUT THE ASSIMILATION OF THEIR PROBLEMATIC EXPERIENCES: A MULTIPLE CASE STUDY by Meredith Glick Brinegar The assimilation model describes the process of change in psychotherapy. The model suggests that in successful therapy, clients’ problematic experiences progress through a series of developmental stages, referred to as the Assimilation of Problematic Experiences Sequence (APES). The model has been empirically supported and modified by a series of case studies, largely completed by observer-researchers. Relatively less attention has been paid to the client’s perspective on the process of assimilation. This study sought to incorporate clients’ phenomenological accounts about the assimilation of their problematic experiences and therapy, in general, into the model. The goals were to both honor clients’ experiences and inform a specific theory of change. Six client accounts were obtained using an interview strategy called Interpersonal Process Recall. Moments from recent therapy sessions that were related to assimilation constructs or which seemed salient to the client were identified and reflected on. Transcripts of these interviews were qualitatively analyzed by three co-investigators with the goal of creating a dialogue between clients and the assimilation model. They linked specific observations from the interviews with theoretical statements to elaborate the assimilation model, making it a richer account of psychotherapy. Primary areas of contact between the observations and the model were: client awareness of intrapersonal dialogue; secondary or derivative problems; client accounts of various APES stages, including somatic symptoms and behavioral changes; the role of the therapeutic relationship; the function of abrupt topic changes; and clients’ perception of progress. Modifications to general assimilation theory, the specific APES descriptions, and problems and questions raised by this study are discussed. WHAT CLIENTS CAN TELL US ABOUT THE ASSIMILATION OF THEIR PROBLEMATIC EXPERIENCES: A MULTIPLE CASE STUDY A DISSERTATION Submitted to the Faculty of Miami University in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Psychology by Meredith Glick Brinegar Miami University Oxford, Ohio 2006 Dissertation Chair: William B. Stiles, Ph.D. © Meredith Glick Brinegar 2006 List of Tables ................................................................................................................................. vi List of Figures............................................................................................................................... vii Acknowledgments........................................................................................................................viii Introduction..................................................................................................................................... 1 The Assimilation Model ............................................................................................................. 1 Assimilation is Largely a Researcher’s Account of Change ...................................................... 7 Lessons from Rashomon: Point of View Matters....................................................................... 7 Creating a Dialectical Tension Among Multiple Frames of Reference...................................... 8 The Client’s Frame of Reference.............................................................................................. 11 Interpersonal Process Recall..................................................................................................... 17 Client Perspectives on Assimilation ......................................................................................... 18 Method .......................................................................................................................................... 18 Participants................................................................................................................................ 18 Investigators.............................................................................................................................. 19 Measures ................................................................................................................................... 19 Procedure .................................................................................................................................. 22 Organization of Results............................................................................................................. 26 Results: The Case of Sabrina ........................................................................................................ 26 Background Information........................................................................................................... 26 PQ ............................................................................................................................................. 27 AQ............................................................................................................................................. 27 Process of IPR........................................................................................................................... 28 Analysis of IPR......................................................................................................................... 28 Discussion: The Case of Sabrina .................................................................................................. 46 Problems and Derivative Problems........................................................................................... 46 A “Back and Forth” .................................................................................................................. 47 “Don’t Look a Gift Horse in the Mouth”.................................................................................. 47 “A Little Therapist in My Head” .............................................................................................. 48 Results: The Case of Kyle............................................................................................................. 48 Background Information........................................................................................................... 48 PQ ............................................................................................................................................. 49 AQ............................................................................................................................................. 49 Process of IPR........................................................................................................................... 50 Analysis of IPR......................................................................................................................... 51 Discussion: The Case of Kyle....................................................................................................... 66 Avoiding Contact with the Problem ......................................................................................... 66 “Just Like Going Back in Time”............................................................................................... 68 Socialization of Client Role...................................................................................................... 68 The Therapeutic Alliance.......................................................................................................... 68 Results: The Case of Brian ........................................................................................................... 70 Background Information........................................................................................................... 70 PQ ............................................................................................................................................. 70 AQ............................................................................................................................................. 70 Process of IPR........................................................................................................................... 71 Analysis of IPR......................................................................................................................... 72 iii Discussion: The Case of Brian.................................................................................................... 104 “Aren’t My Feelings Obvious?”: Implications for APES 1 and 2.......................................... 104 Awareness of Defense Mechanisms ....................................................................................... 105 Maintaining a Sense of Control .............................................................................................. 105 Prelude to Insight 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