We report the development of the Early Assimilation Research Scale (EARS), a measure of clients' ... more We report the development of the Early Assimilation Research Scale (EARS), a measure of clients' presentation of their problems during the first 20 minutes of their first psychotherapy session. Using an iterative group-based process in which we cycled between listening to first-session tape recordings and discussing our understandings, we identified the following dimensions of clients' presentations: specificity, internality, in-session distress, reported distress, richness of understanding, and openness of the negotiation. An application of the EARS to data from a large comparative psychotherapy research project yielded acceptable interrater reliability and preliminary but promising evidence of construct validity, based on correlations of EARS scales with measures of symptom intensity at intake and impact of the first session. This paper describes an instrument for rating how clients present their problems at the beginning of therapy. The instrument's content and structure were informed by a model of clients' assimilation of their problematic experiences (Stiles et al., 1990), and we call the instrument the Early Assimilation Research Scale (EARS). We explain how we identified a set of conceptual dimensions and scales that characterize presenting problems, and we report the interrater reliability and
Institutionalized responses to human care have been prone to developing unhelpful practices. Inqu... more Institutionalized responses to human care have been prone to developing unhelpful practices. Inquiries into malpractice often generate recommendations focusing on improving protocols or procedures, while neglecting the emotional experiences of both clients and ...
Following recent interest in this journal in building bridges between a psychoanalytic and system... more Following recent interest in this journal in building bridges between a psychoanalytic and systemic approach to family therapy (Vol. 19, 1997), the authors take up the debate. A clinical vignette from a recent article is used for discussion and, in order to describe further work from a psychoanalytic perspective, two case vignettes are presented. The comparisons are discussed with particular reference to the concepts of projective identification, transference/countertransference and internal object relations.
... Only one published qualitative study has explored both clients' and therapists&#... more ... Only one published qualitative study has explored both clients' and therapists' experiences of DBT (Araminta, 20002. Araminta , T. (2000) . ... Clients felt that therapist self-disclosure was highly salient, while therapists emphasised the value of techniques. ...
The study aimed to explore and synthesize stakeholders&am... more The study aimed to explore and synthesize stakeholders' conceptualizations and solutions concerning ADHD in the context of CAMHS. The participants were 28 stakeholders consisting of seven mental heath professionals, two teachers, seven parents/carers, five children referred for an ADHD assessment, two siblings and five peers. Individual, semi-structured interviews were held with all professionals and parents/carers. The children's interviews used methods tailored for junior age children and were semi-structured, individual and in a group format for the peers. All interviews were transcribed verbatim and the children's pictures were analysed. A thematic analysis was undertaken with ADHD thematically emerging as a confusing mess with conflicts reverberating across all levels of analysis from the intra-psychic world of the child to wider social contexts. Professionals attempt to make sense of this mess, parents experience the emotional impact of the mess and…
Service-user involvement is an essential component of mental health service provision. This revie... more Service-user involvement is an essential component of mental health service provision. This review aims to synthesise literature that has attempted to elicit children's experiences of mental health services with particular reference to looked-after children. The review is limited to qualitative research with study inclusion based on a synthesis of good quality criteria. Identification of gaps in the literature, directions for further research and implications for service developments are discussed.
This paper will provide theoretical and clinical evidence for the significance of relating to and... more This paper will provide theoretical and clinical evidence for the significance of relating to and dissociating from the object in the development of a regulatory function. A selective review examines psychoanalytic views concerning the interactive nature of innate and environmental factors in development. The role of trauma is also considered as a contributing factor in individual differences. Relevant clinical material is described from two sessions in the treatment of a traumatized young woman with bulimia, focusing on the regulatory function in the therapeutic relationship. The patient frequently dissociated from the therapist as object and substituted the resulting loss of regulation with a pendulous movement between over-indulgence and deprivation. This created significant implications for treatment. The clinical findings suggest that the inclusion of these different aspects may be necessary factors in understanding the developmental pathway from intolerable frustration/impulsivity to an internal sense of containment.
Assigning clients to treatments on the basis of their differential aptitudes for those treatments... more Assigning clients to treatments on the basis of their differential aptitudes for those treatments may reduce variability and improve the mean outcomes of psychotherapy. The assimilation model suggests that in time-limited treatments, clients with well-assimilated problems would do better in cognitive or behavioral therapies than in psychodynamic, experiential, or interpersonal therapies, whereas the reverse should be the case for clients with poorly assimilated problems. Results for high-, moderate-, and low-assimilation subgroups (based on rating the level of assimilation of problems presented in the first 20 min of first sessions) of clients (N = 112) randomly assigned to time-limited cognitivebehavioral or psychodynamic-interpersonal treatment supported the first suggestion but not the second (clients with poorly assimilated problems did equally well in both treatments). Most psychotherapies yield benefits for most clients (e.g., Lambert & Bergin, 1994; Lipsey & Wilson, 1993; Seligman, 1995), yet within each treatment there is variation in how well clients respond. Investigators have proposed to reduce the variability in outcome by finding bases-described as client aptitudes-for assigning clients to differentially appropriate treatments, although this strategy has yielded only sporadic success so far (Shoham-Salomon & Hannah, 1991; Snow, 1991). The assimilation model (Stiles et al., 1990) suggests a basis for treatment assignment that is based not on the client's diagnosis or global characteristics but on the degree to which the main
We report the development of the Early Assimilation Research Scale (EARS), a measure of clients' ... more We report the development of the Early Assimilation Research Scale (EARS), a measure of clients' presentation of their problems during the first 20 minutes of their first psychotherapy session. Using an iterative group-based process in which we cycled between listening to first-session tape recordings and discussing our understandings, we identified the following dimensions of clients' presentations: specificity, internality, in-session distress, reported distress, richness of understanding, and openness of the negotiation. An application of the EARS to data from a large comparative psychotherapy research project yielded acceptable interrater reliability and preliminary but promising evidence of construct validity, based on correlations of EARS scales with measures of symptom intensity at intake and impact of the first session. This paper describes an instrument for rating how clients present their problems at the beginning of therapy. The instrument's content and structure were informed by a model of clients' assimilation of their problematic experiences (Stiles et al., 1990), and we call the instrument the Early Assimilation Research Scale (EARS). We explain how we identified a set of conceptual dimensions and scales that characterize presenting problems, and we report the interrater reliability and
Institutionalized responses to human care have been prone to developing unhelpful practices. Inqu... more Institutionalized responses to human care have been prone to developing unhelpful practices. Inquiries into malpractice often generate recommendations focusing on improving protocols or procedures, while neglecting the emotional experiences of both clients and ...
Following recent interest in this journal in building bridges between a psychoanalytic and system... more Following recent interest in this journal in building bridges between a psychoanalytic and systemic approach to family therapy (Vol. 19, 1997), the authors take up the debate. A clinical vignette from a recent article is used for discussion and, in order to describe further work from a psychoanalytic perspective, two case vignettes are presented. The comparisons are discussed with particular reference to the concepts of projective identification, transference/countertransference and internal object relations.
... Only one published qualitative study has explored both clients' and therapists&#... more ... Only one published qualitative study has explored both clients' and therapists' experiences of DBT (Araminta, 20002. Araminta , T. (2000) . ... Clients felt that therapist self-disclosure was highly salient, while therapists emphasised the value of techniques. ...
The study aimed to explore and synthesize stakeholders&am... more The study aimed to explore and synthesize stakeholders' conceptualizations and solutions concerning ADHD in the context of CAMHS. The participants were 28 stakeholders consisting of seven mental heath professionals, two teachers, seven parents/carers, five children referred for an ADHD assessment, two siblings and five peers. Individual, semi-structured interviews were held with all professionals and parents/carers. The children's interviews used methods tailored for junior age children and were semi-structured, individual and in a group format for the peers. All interviews were transcribed verbatim and the children's pictures were analysed. A thematic analysis was undertaken with ADHD thematically emerging as a confusing mess with conflicts reverberating across all levels of analysis from the intra-psychic world of the child to wider social contexts. Professionals attempt to make sense of this mess, parents experience the emotional impact of the mess and…
Service-user involvement is an essential component of mental health service provision. This revie... more Service-user involvement is an essential component of mental health service provision. This review aims to synthesise literature that has attempted to elicit children's experiences of mental health services with particular reference to looked-after children. The review is limited to qualitative research with study inclusion based on a synthesis of good quality criteria. Identification of gaps in the literature, directions for further research and implications for service developments are discussed.
This paper will provide theoretical and clinical evidence for the significance of relating to and... more This paper will provide theoretical and clinical evidence for the significance of relating to and dissociating from the object in the development of a regulatory function. A selective review examines psychoanalytic views concerning the interactive nature of innate and environmental factors in development. The role of trauma is also considered as a contributing factor in individual differences. Relevant clinical material is described from two sessions in the treatment of a traumatized young woman with bulimia, focusing on the regulatory function in the therapeutic relationship. The patient frequently dissociated from the therapist as object and substituted the resulting loss of regulation with a pendulous movement between over-indulgence and deprivation. This created significant implications for treatment. The clinical findings suggest that the inclusion of these different aspects may be necessary factors in understanding the developmental pathway from intolerable frustration/impulsivity to an internal sense of containment.
Assigning clients to treatments on the basis of their differential aptitudes for those treatments... more Assigning clients to treatments on the basis of their differential aptitudes for those treatments may reduce variability and improve the mean outcomes of psychotherapy. The assimilation model suggests that in time-limited treatments, clients with well-assimilated problems would do better in cognitive or behavioral therapies than in psychodynamic, experiential, or interpersonal therapies, whereas the reverse should be the case for clients with poorly assimilated problems. Results for high-, moderate-, and low-assimilation subgroups (based on rating the level of assimilation of problems presented in the first 20 min of first sessions) of clients (N = 112) randomly assigned to time-limited cognitivebehavioral or psychodynamic-interpersonal treatment supported the first suggestion but not the second (clients with poorly assimilated problems did equally well in both treatments). Most psychotherapies yield benefits for most clients (e.g., Lambert & Bergin, 1994; Lipsey & Wilson, 1993; Seligman, 1995), yet within each treatment there is variation in how well clients respond. Investigators have proposed to reduce the variability in outcome by finding bases-described as client aptitudes-for assigning clients to differentially appropriate treatments, although this strategy has yielded only sporadic success so far (Shoham-Salomon & Hannah, 1991; Snow, 1991). The assimilation model (Stiles et al., 1990) suggests a basis for treatment assignment that is based not on the client's diagnosis or global characteristics but on the degree to which the main
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