Listening to elaboration in psychotherapy: The understanding of assimilation using narrative indices

How do clients elaborate throughout therapy? This was the question that broadly framed this research and situated it in the field of psychotherapy process research. The process chosen was assimilation which was conceived as a global process of change focused on the client. To study this process, this research used narrative indices which are elements of the narrative that are considered to represent particular processes. The use of indices depends on the understanding of language not as a rigid signal system to denote psychological concepts; but as an interactional process of communication in which narrative processes are represented. This research was divided into two studies. The first study sough to develop the system of indices based on a qualitative analysis and then adjust it to meet the reliability standards with respect to consistency and interrater reliability. To this end, 30 single sessions of adult clients with depression were recorded and analysed. After the system of indices had been developed it was analysed and contrasted with an existing coding system. Study I resulted in a system of indices grouped into five dimensions – external distress, pain, noticing, decentring and action – which showed acceptable interrater reliability, internal consistency and convergent validity. The second study was a longitudinal application of the system of indices. The goal was to contrast the cases with regard to their success status as defined by the pre-post variation of the depression level. Nine psychotherapies were recorded and analysed. Of these nine cases, only three showed a non-straightforward relation between the success status and the dimensions. The in-depth analysis of these three cases showed the usefulness of using the system of indices to understand the complexity of the psychotherapy and the non-linear relationship between psychotherapy and symptom change. The results suggest the importance of the indices in understanding assimilation and are discussed with emphasis on the practical implications that can be derived.