William B. Stiles

• Ph.D.
• Professor Emeritus at Miami University

The Assimilation Model describes therapeutic change as a gradual integration of problematic experiences into the self. Previous studies associated higher assimilation levels with a reduction of depressive symptoms throughout therapy and better therapeutic outcomes at the end. We explored the relation between the assimilation of problematic experien...

Objective: How are collaborative interactions associated with clients' progress in therapy? This study addressed this question, by assessing the quality of therapeutic collaboration and comparing it passage by passage with the clients' assimilation of problematic experiences in two cases of major depression treated with Cognitive Behavioral Therap...

This theory-building case study examined the relational transactional analysis concept of empathic transactions (ETs) developed by Hargaden and Sills. The researchers analyzed the transactions between a 28-year-old woman and her therapist during their 26-session therapy. Client progress was assessed using the Assimilation of Problematic Experiences...

In transactional analysis theory, life script themes are archaic patterns of experience and interaction, which can emerge during clinical work and impact practice. This study examined whether a newly qualified therapist’s problematic life script themes were detectable in supervision, how they were addressed, and whether addressing them led to assim...

This case study addressed what therapists do after assimilation setbacks. Previous research has shown that most setbacks reflect the client switching between strands of the problem and that most setbacks can be classified as balance strategy setbacks (BS) or setbacks due to the therapist exceeding the client’s zone of proximal development (TZPD). A...

Objectives Life script is a transactional analysis concept describing a pattern of human experience, interaction and meaning making developed in childhood that can be activated in adulthood, sometimes creating problems. Problematic life script themes can impact a therapist's experience and interaction during clinical work and interfere with therape...

This theory-building case study examined an application of the Assimilation of Grief Experiences Scale (AGES), a conceptual account of a bereaved person’s process of change in grief recovery, in a case study of a 40-year old woman in bereavement counselling. An assessment session and 44 counselling sessions were analysed intensively, comparing the...

Aims This study describes the outcomes of clients treated by therapists in their first placement who were undergoing training in a range of humanistic and other relational approaches: Transactional Analysis, Gestalt, Integrative, Humanistic, Person Centred and Counselling Psychology. Method All clients seen by 179 trainee therapists over a 2-year...

Ambivalence toward change is a patient variable characterized by an inner tension that results in movements towards and away from change and in a subjective feeling of inability to change coupled with distress. In session, it should be successfully managed by the therapist otherwise ambivalence can result in resistance/reactance to therapist’s inte...

We applied the assimilation of problematic experiences sequence (APES) to a six-year-old girl’s processing of traumatic experiences involving violence and death in play therapy. We analyzed the post-session notes from the first 34 sessions of a much longer treatment, during which the girl repeatedly enacted a drama we called the cottage play, invol...

"Over the years, research has demonstrated that psychotherapy is an effective treatment in different psychopathological conditions. However, which are the mechanisms or processes involved in therapeutic change that could explain its efficacy are not yet clear. The Assimilation of Problematic Experiences Model describes change in therapy as a proces...

The assimilation model suggests that therapeutic change occurs through a gradual assimilation of problematic experiences. Previous case studies have suggested that both good-and poor-outcome cases exhibit a fluctuating pattern of assimilation progress, characterized by advances and setbacks. Our study examined more closely how this fluctuating patt...

This study aimed to investigate (a) what clients’ within-treatment activity preferences were; (b) whether match between preferences and psychotherapy approach predicted outcomes and alliance; (c) whether scores on preference dimensions, per se, predicted outcomes and alliance. Participants were 470 clients engaging in one of five approaches with tr...

This study aimed to investigate (a) what clients’ within-treatment activity preferences were; (b) whether match between preferences and psychotherapy approach predicted outcomes and alliance; (c) whether scores on preference dimensions, per se, predicted outcomes and alliance. Participants were 470 clients engaging in one of five approaches with tr...

Assimilation requires a dialogue between the client’s dominant and non-dominant internal voices, that is between the client’s usual self and his or her problematic experiences. This dialogue is established through conjoint work between therapist and client. This article seeks to consolidate some developments in the assimilation model by reviewing h...

Objective: This theory-building case study investigated setbacks in assimilation, seeking to replicate and elaborate previous work, in which most setbacks were one of two types, balance strategy (BS) or exceeding the therapeutic zone of proximal development (TZPD). Method: We studied the case of Alicia, a 26 year-old woman, treated successfully for...

In his extended critique Smedslund suggested that scientific theory and research on psychotherapy are not feasible because (1) people respond to myriad, constantly shifting determinants, and their behavior, (2) evolves in ever-compounding sequences that are not precisely predictable, (3) is never precisely repeated, and (4) is deeply enmeshed in in...

The hiding aspect of shame makes the study of shame difficult. In this article we aim to show through Hanna's case study how shame manifests and develops during the course of one psychotherapy process. This will be done using Assimilation analysis (APES) and Dialogical Sequence Analysis (DSA) to show in detail one idiosyncratic developmental path t...

Psychological intervention outcomes depend in part on the therapist who provides the intervention (a therapist effect). However, recent reviews suggest that therapist effects may vary as a function of the context in which care is provided, and therefore should not be generalised beyond that context. This study statistically analysed therapist effec...

Objectives According to the assimilation model, psychotherapeutic progress involves building semiotic meaning bridges between disconnected parts of the person. Previous research with a young male client, who was diagnosed with ASP, showed that digital imagery can serve to build inter and intrapersonal relating during counselling. This project aimed...

Objectives According to the assimilation model, psychotherapeutic progress involves building semiotic meaning bridges between disconnected parts of the person. Previous research has focused on verbal meaning bridges; this case study investigated whether and how digital imagery might serve as well. Design This was a qualitative theory‐building case...

Objective: The study aimed to (a) investigate the effect of treatment location on clinical outcomes for patients receiving psychological therapy (a clinic effect, akin to the concept of a therapist effect) and (b) assess the impact of explanatory individual and aggregate demographic and process variables on the clinic and therapist effects. Metho...

Progress in psychotherapy is typically irregular, as advances alternate with setbacks. This study investigated the therapist’s activities prior to two main types of setbacks, one involving the client following therapist proposals and one involving the client failing to follow from therapist proposals, in the case of a poor-outcome client treated wi...

This paper offers a theoretical and methodological formulation of setbacks in the process of assimilation of problematic experiences in psychotherapy. It is based on a series of theory-building case studies, in which case observations were used to modify and confirm an evolving understanding. Assimilation typically follows a sawtoothed progression...

This commentary suggests that discursive methods offer valuable tools for psychotherapy research and that discursive research on psychotherapy is ripe for synthesis. It suggests that the source and persistence of discourses can be understood as reflecting the historicity of signs: the distinctive language of a particular discourse accumulates and r...

Dynamic systems theory suggests that instability can be a key element in the promotion of human change processes. Several studies have confirmed an association between unstable patterns and successful psychotherapeutic outcome. Somewhat similarly, the assimilation model of psychotherapeutic change argues that clinical change occurs through the inte...

Method: Participants were 22 clients with mild to moderate depression drawn from a clinical trial comparing cognitive behavioral therapy with emotion-focused therapy. The direction of prediction between assimilation progress and changes in self-reported symptom intensity was assessed. Results: The assimilation progress was shown to be a better p...

The verbal response modes (VRM) taxonomy is a general-purpose classification of speech acts. It concerns what people do when they say something rather than the content of what they say. Grammatical form and interpersonal intent of each utterance are each coded as Disclosure, Edification, Question, Acknowledgment, Advisement, Confirmation, Interpret...

Much of therapy, particularly person-centered therapy, is devoted to finding words to accurately symbolize the experiences the client chooses to share. Accurately symbolizing clients’ problematic experiences allows them to be assimilated and transformed into personal resources. Words are used to share experience. Word meanings grow by accumulating...

The Assimilation of Problematic Experiences Scale (APES) summarizes a developmental continuum along which psychological problems progress in successful psychotherapy. The therapeutic zone of proximal development (TZPD) is the segment of the APES continuum within which the clients can proceed from their current APES level to the next with the therap...

Aim: We understand ambivalence as a cycle of opposing expressions by two internal voices. The emergence of a suppressed voice produces an innovative moment (IM), challenging the dominant voice, which represents the client's problematic self-narrative. The emergence of the IM is opposed by the dominant voice, leading to a return to the problematic...

Objective: The Assimilation model argues that therapists should work responsively within the client's therapeutic zone of proximal development (TZPD). This study analyzed the association between the collaborative processes assessed by the Therapeutic Collaboration Coding System (TCCS) and advances in assimilation, as assessed by the Assimilation o...

Objective: Some studies have suggested that a decrease in immersion (egocentric perspective on personal experiences) and an increase in distancing (observer perspective on personal experiences) are associated with the resolution of clinical problems and positive outcome in psychotherapy for depression. To help clarify how this change in perspective...

The assimilation model describes the change process in psychotherapy. In this study we analyzed the relation of assimilation with changes in symptom intensity, measured session by session, and changes in emotional valence, measured for each emotional episode, in the case of a 33-year-old woman treated for depression with cognitive-behavioral therap...

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:...

This article describes the Clinical Outcomes in Routine Evaluation (CORE) System and reports on its scientific yield and practice impact. First, we describe the suite of CORE measures, including the centerpiece CORE-Outcome Measure (CORE-OM), its short forms, special purpose forms, translations, and psychometric properties, along with the pretreatm...

Objective: This study examined the therapist activities immediately preceding assimilation setbacks in the treatment of a good-outcome client treated with linguistic therapy of evaluation (LTE). Method: Setbacks (N = 105) were defined as decreases of one or more assimilation stages from one passage to the next dealing with the same theme. The th...

In this chapter, I draw distinctions among three classes of research purposes: theory building, enriching, and fact gathering. Theory-building research seeks to test, improve, and extend a particular theory. Enriching research seeks to deepen and enrich people’s appreciation or understanding of a phenomenon. Factgathering research seeks to discover...

Aim: We understand ambivalence as a cyclical movement between two opposing parts of the self. The emergence of a novel part produces an innovative moment, challenging the current maladaptive self-narrative. However, the novel part is subsequently attenuated by a return to the maladaptive self-narrative. This study focused on the analysis of the the...

Therapist responsiveness is defined as therapist behavior being influenced by emerging context. Responsiveness is ubiquitous and creates serious problems for a ballistic, cause–effect understanding of how psychotherapy works. This conceptual literature review examines ways psychotherapy researchers have constructively engaged the responsiveness pro...

Our aim was to examine client mood in the initial and final sessions of cognitive-behavioral therapy (CBT) and psychodynamic-interpersonal therapy (PIT) and to determine how client mood is related to therapy outcomes. Hierarchical linear modeling was applied to data from a clinical trial comparing CBT with PIT. In this trial, client mood was assess...

Background Previous studies have reported similar recovery and improvement rates regardless of treatment duration among patients receiving National Health Service (NHS) primary care mental health psychological therapy. Aims To investigate whether this pattern would replicate and extend to other service sectors, including secondary care, university...

Unlabelled: Randomized controlled trials (RCTs) are currently the dominant methodology for evaluating psychological treatments. They are widely regarded as the gold standard, and in the current climate, it is unlikely that any particular psychotherapy would be considered evidence-based unless it had been subjected to at least one, and usually more...

Abstract On the occasion of the 25th anniversary of the journal, Psychotherapy Research, three former editors first look back at: (i) the controversial persistence of the Dodo verdict (i.e., the observation that all bona fide therapies seem equally effective); (ii) the connection between process and outcome; (iii) the move toward methodological plu...

Objective: Ambivalence can be understood as a cyclical movement between an emerging narrative novelty-an Innovative Moment (IM)-and a return to a problematically dominant self-narrative. The return implies that the IM, with its potential for change is devalued right after its emergence. Our goal is to test the hypothesis that the probability of th...

Objectives: This theory-building case study examined the zone of proximal development (ZPD) in psychotherapy within the assimilation model. Theoretically, the ZPD is the segment of the continuum of therapeutic development within which assimilation of problematic experiences can take place. Work within a problem's current ZPD may be manifested as a...

Objectives: The Assimilation of Problematic Experiences Scale (APES) describes eight levels that a problematic experience passes through en route to becoming part of the person's self. Theoretically, progress along this continuum may be facilitated by therapist interventions that are appropriately responsive to the problem's current APES level, in...

Objectives: We understand ambivalence as a cyclical movement between two opposing parts of the self. The emergence of a novel part produces an innovative moment, challenging the current maladaptive self-narrative. However, the novel part is subsequently attenuated by a return to the maladaptive self-narrative. This study focused on the analysis of...

Patient-led appointment scheduling is a form of responsive regulation in which patients schedule their own psychotherapy appointments within the constraints of available resources. Of 92 patients referred to a clinical psychology clinic in the public mental health service of a remote country town in Australia, 51 attended more than 1 appointment (M...

Abstract The Assimilation of Problematic Experiences Scale (APES) and the Innovative Moments Coding System were applied to transcripts of a successful case of linguistic therapy of evaluation independently by different research groups. Assimilation theory and research suggest that higher APES scores reflect therapeutic gains, with a level of approx...

Background. The quality and strength of the therapeutic collaboration, the core of the alliance, is reliably associated with positive therapy outcomes. The urgent challenge for clinicians and researchers is constructing a conceptual framework to integrate the dialectical work that fosters collaboration, with a model of how clients make progress in...

Using Case Studies to build theories of psychotherapy In this paper, I want to make the case for case studies as scientific evidence. I will argue that case studies are appropriate in the context of justification as well as in the context of discovery. I have been developing this argument in papers written over a number of years (Stiles, 2003, 2005...

The impact of exchanges and client-therapist alliance of online therapy text exchanges were compared to previously published results in face-to-face therapy, and the moderating effects of four participant factors found significant in previously published face-to-face studies were investigated using statistical mixed-effect modeling analytic techniq...

In this journal's first article, Strupp (1963) pointed to problems specifying independent and dependent variables as a source of slow progress in psychotherapy outcome research. This commentary agrees, shows how the concept of variable loses its meaning in psychotherapy research because of participants' responsiveness, and notes an alternative rese...

In this paper, I want to make the case for case studies as scientific evidence. I will argue that case studies are appropriate in the context of justification as well as in the context of discovery. I have been developing this argument in papers written over a number of years (Stiles, 2003, 2005, 2007, 2009, 2010), and this paper repeats much of wh...

The assimilation model is an integrative model that can be applied to any kind of therapeutic setting for describing the process of change. The Assimilation of Problematic Experiences Scale (APES) describes the process of assimilation of problematic experiences in therapy. Although the APES presents an orderly sequence, studies have shown that assi...

Abstract This study examined a client's therapeutic progress within one session of an 18-session child neurological assessment. The analysis focused on a parent-psychologist dialogue in one session of the assessment process. Dialogical sequence analysis (DSA; Leiman, 2004, 2012) was used as a micro-analytic method to examine the developing discours...

The Session Evaluation Questionnaire (SEQ) was translated into German. It measures the impact of a therapy session from the perspectives of patients and therapists. The primary aim of this investigation was the replication of the factor structure of the English language version of the SEQ. Secondary was to assess the correspondence between therapis...

This chapter addresses principles and practices useful in designing and evaluating studies aimed at determining how well a particular psychotherapy method works. The authors' focus is on controlled research designs. Topics include: choice of comparison conditions (wait-list or no-treatment comparisons, treatment-as-usual comparisons, placebo comp...

Abstract The assimilation model suggests progress in psychotherapy follows an eight-stage sequence described by the Assimilation of Problematic Experiences Scale (APES). This study sought to reconcile this developmental stage model with the common but superficially contradictory clinical observation that therapeutic advances alternate with setbacks...

This study compared participants' speech acts in low-hostile versus moderate-hostile interpersonal episodes in time-limited psychodynamic psychotherapy. Sixty-two cases from the Vanderbilt II psychotherapy project were categorized as low or moderate in interpersonal hostility based on ratings of interpersonal process using Structural Analysis of So...

The question of how effective therapies are in routine practice is crucial. The answer depends on how we define effectiveness. Both the definition of who was treated and the index chosen to represent outcome can affect estimates dramatically. We used data from the Clinical Outcomes in Routine Evaluation (CORE) Primary Care National Practice-Based E...

This study sought an understanding of clients' experiences with psychotherapy from clients' own points of view. Eleven 18–23-year-old clients or former clients participated in in-depth, semi-structured interviews about their experiences and opinions of therapy. The interviews were transcribed, and themes were extracted, drawing on techniques from G...

Background. The quality and strength of the therapeutic collaboration, the core of the alliance, is reliably associated with positive therapy outcomes. The urgent challenge for clinicians and researchers is constructing a conceptual framework to integrate the dialectical work that fosters collaboration, with a model of how clients make progress in...

After 5 years of conceptualizing, investigating, and writing about corrective experiences (CEs), we (the authors of this chapter) met to talk about what we learned. In this chapter, we summarize our joint understanding of (a) the definition of CEs; (b) the contexts in which CEs occur; (c) client, therapist, and external factors that facilitate CEs;...

The professional development of student psychotherapists can be understood as a dialogical process, observable, in part, in the interaction of the students with their therapy supervisors. This paper applies the assimilation model (Stiles, 1999; Stiles, et al., 1990), which is a theory of the dialogical, or multivoiced self, and of psychological cha...

This article reports the development and psychometric properties of two short forms of the 28-item Agnew Relationship Measure, the ARM-12 and ARM-5. For the ARM-12, results of previous research were used together with conceptual considerations to select three items to represent each of four ARM subscales: Bond, Partnership, Confidence, and Openness...

The assimilation model of therapeutic change describes the self as comprised of multiple internal voices (mental states), and tracks the development of understanding and joint action between those voices in successful psychotherapies. This model has been constructed from studies of individual therapy, and has generally focused on intrapersonal chan...

This theory-building case study aimed to elaborate an account of anxiety and its treatment within an assimilation model of therapeutic change (e.g., Stiles, 2002). A team consisting of the senior author and two other co-investigators independently reviewed the case of Robert, a 52 year-old man who was successfully treated for generalized anxiety di...

Child neurological diagnostic procedures involve extensive encounters with a multi-professional team and may have therapeutic effects. This study explored the therapeutic potential of the diagnostic process using the assimilation model as the conceptual frame of reference. The process of assimilation was tracked across nine consecutive encounters d...

An utterance's intended meaning may be the same or different at six conceptually distinct levels. Level 0 is the speaker's literal meaning – the conventional meaning of the words as used by the speaker. Level 1 is the speaker's occasion meaning – the pragmatic, on-record intended meaning. Level 2 is the hint level – intended to be recognized as int...

The assimilation model is a theory of psychological change that depicts the self as a community of internal voices, composed of traces of the person's experiences. The model suggests that disconnection of certain voices from the community underlies many forms of psychopathology and psychological distress. Such problematic voices may be assimilated...

We describe the assimilation model, a developmental theory of psychological change that focuses on interpretive study of people’s experience in therapy. Assimilation research relies on methods that are simultaneously interpretive and quantitative, and uses them in mutually complementary ways. We explain how quantitative techniques have been useful...

This case study applied the assimilation model to examine the changing narrative of an outpatient with schizophrenia and symptoms of depression across a successful pharmacotherapy. The assimilation model describes how clients assimilate painful, problematic experiences. Therapeutic progress is understood to reflect increasing assimilation, measured...

Narrative accounts of psychotherapy may contribute usefully to scientists as well as practitioners' tacit knowledge.

Warded off traumatic experiences can have pathological effects by impinging on consciousness (e.g., recurrent nightmares), on behavior (e.g., avoidance of intimacy), or on the body (e.g., pains). Assimilation or integration of these problematic experiences is a common goal for different psychotherapies. In this article, we describe the psychoanalyt...