Narrative processes in the assimilation of a problematic experience: qualitative analysis of a single case

Zusammenfassung Increasing attention has been given to the Assimilation Model as an integrative framework for understanding the change process in psychotherapy. This paper contributes to the development of the model by identifying ways in which narrative and discursive practices are involved in the transition to the „problem statement“ stage of assimilation of a problematic experience. The study uses a method of qualitative narrative analysis to construct an interpretive account of the change process occurring in a single case of experiential psychotherapy. The overall process of change in this case is described in terms of two broad phases: building a storyworld and coconstruction of a new narrative. The shift to „naming“ the problem is discussed in terms of the operation of a number of narrative micro-processes, including positioning, symbolisation and the co-construction of metaphor themes. The implications of this analysis are discussed. Narrative Prozesse in der Assimilation einer problematischen Erfahrung: eine qualitative Einzelfallstudie Das Assimilation Model als integrativer Rahmen fur das Verstandnis von Veranderungsprozessen in der Psychotherapie stost zunehmend auf breites Interesse. Durch die Identifikation von narrativen und diskursiven Aspekten beim Ubergang zum Stadium der Problemerkenntnis im Verlauf der Assimilation einer problematischen Erfahrung tragt der vorliegende Aufsatz zur Weiterentwicklung dieses Modells bei. Die vorgelegte Einzelfallstudie nutzt die Methode der qualitativen Narrativanalyse zur Konstruktion eines interpretativen Ansatzes uber den Veranderungsprozess bei einer erfahrungsorientierten psychotherapeutischen Behandlung. Der Veranderungsprozess in diesem Fallbeispiel wird in zwei Phasen beschrieben: Explikation einer personlichen Geschichte und gemeinsame Konstruktion eines neuen Narrativs. Die Entwicklung zur „Namengebung” fur das Problem wird verstanden als Abfolge narrativer Mikroprozesse, einschlieslich Positionierung, Symbolisation und gemeinsamer Metaphernkonstruktion. Die Implikationen dieser Methodik werden diskutiert. 284 ZBBS Heft 2/2000, S. 283-302 The development of better ways of understanding the change process has comprised one of the primary goals of psychotherapy research in recent years. Although a substantial amount of research has been carried out into the process of therapeutic change (see, for example, Toukmanian/Rennie 1992), it can be argued that this body of work has been informed by a diversity of theoretical perspectives, and as a result may lacks conceptual cohesion. The fragmented and contested nature of much psychotherapy process has made it difficult for practitioners to make use of research findings in guiding practice. Stiles and colleagues (Stiles et al. 1990, 1992) have developed an integrationist model for understanding the process of change in psychotherapy. This model conceives of therapy as an activity through which the client becomes able to master or „assimilate“ problematic or difficult experiences. The „Assimilation Model“ comprises 8 stages through which the client moves in his or her efforts to explore and understand the problematic issue which has brought them to therapy: Stage 0: Warded off; 1: Unwanted thoughts; 2: Vague awareness/emergence; 3: Problem statement/clarification; 4: Understanding/insight; 5: Application/working through; 6: Problem solution; 7: Mastery. The basic structure of the Assimilation Model has been supported in series of research studies (Stiles 1999; Stiles et al. 1991, 1995; Varvin/Stiles 1999). Recently, Honos-Webb and Stiles (1998) have presented a reconceptualisation of the Assimilation Model in terms of voices. Typically, in therapy a „warded off“ or „unheard“ voice of the client, which expresses a painful or unconscious aspect of the experiential world of the person, struggles to be heard in the face of stronger, dominant voices. The process of assimilation involves this emergent voice coming to take its place in the „community of voices“ (Honos-Webb/ Stiles 1998). Notions of „voice“ and „assimilation“ provide integrationist conceptual tools which enable the contribution of a broad range of theoretical approaches to psychotherapy to be brought to bear on the task of producing a more differentiated, elaborated and practically useful understanding of the change process. The narrative social constructionist approach to psychotherapy (McLeod 1997, 1999a, b) is a theoretical perspective which may potentially represent a valuable means of extending the scope of the Assimilation Model. The narrative social constructionist perspective on psychotherapy has developed from the work of White and Epston (1990) and Gergen (1985, 1999). It is an approach to psychotherapy which emphasises the social, historical and cultural construction of identity, and the collaborative co-construction of meaning between therapist and client. Narrative social constructionist inquiry pays particular attention to the uses of language within therapy, with a specific focus on the ways in which the telling of stories creates and conveys meaning and locates teller and listener within a cultural context. Experiential psychotherapy can be defined as a contemporary rendering of an approach to therapy which originated in the work of Carl Rogers and other humanistic psychologists in the 1950s. There are many current versions of experiential therapy in use, for example process-experiential therapy (Greenberg/Rice/Elliott 1993) person-centred therapy (Mearns/Thorne 1999), „secondgeneration“ person-centred therapy (Rennie 1998) and Gestalt Therapy. A review of recent developments in experiential psychotherapy can be found in J. McLeod/S.Balamoutsou: Narrative processes 285 Greenberg, Lietaer and Watson (1998). Some of the basic features of all experiential approaches to psychotherapy are an emphasis on an accepting, respectful empathic relationship between therapist and client, therapist willingness to be congruent and authentic, and active engagement in processing of current emotions and feelings. The aim of the present paper is to identify some of the narrative processes which may be involved in the therapeutic co-construction of assimilation of a problematic experience. The paper forms part of a series of research reports based on analysis of narrative processes in single cases of experiential psychotherapy (McLeod/Balamoutsou 1996; McLeod 1997; Grafanaki/McLeod 1999). The methodological assumption underpinning this series of case reports is that the complexity of narrative process can only be appreciated within the context of a whole case. As in the work of Murray (1938), findings from a series of case studies are used as means of building towards a generalisable model.