A method of rating assimilation in psychotherapy based on markers of change.

This article reports the development of a marker-based method for rating assimilation in psychotherapy with a case study of a woman Sarah, who was treated for depression with process-experiential psychotherapy. To increase the rigor of the qualitative case study methodology, independent judges rated passages—taken out of context and randomly ordered—from the qualitative analysis. The authors examined levels of training required to make quantitative judgments by comparing ratings from 4 graduate students and 4 undergraduate students. Pooled reliabilities of the 2 groups of raters were high (.90 and .84), and the estimated reliability of single graduate student raters was acceptable (.70). Consistent findings across a series of related case studies are reviewed to address the generalizability of the findings. The assimilation model describes clients’ incremental assimilation of problematic experiences as they make progress in therapy (Honos-Webb & Stiles, 1998). The purpose of the present article is to report progress in the development of a marker-based method for obtaining reliable judgments of assimilation stages and to examine the level of training required to make such judgments. An intensive qualitative case study of Sarah, who was treated for depression with process-experiential psychotherapy (PEP; Greenberg, Rice, & Elliott, 1993) is presented to demonstrate the marker-based methodology. Independent ratings are also presented to increase the rigor of the qualitative case study. The use of quantitative data to supplement interpretive conclusions represented a tentative step toward answering the call for the “necessity of developing the clinical case study, with its compelling power and obvious scientific limitations, into a disciplined research instrument” (Kvale, 1986, p. 171).