title: Development and validation of a system of assimilation indices: A mixed method approach to understand change in psychotherapy.
abstract: OBJECTIVE
  Assimilation is an important process in understanding change in psychotherapy. Similar to other psychological processes, assimilation may be traceable in the speech of clients by attending to its signs or indices. In the present research, we aimed to build a system of indices of assimilation.
  
  
  METHODS
  This research follows a mixed method design. The indices were derived through qualitative analysis, using grounded theory. Subsequently, the indices were adjusted quantitatively and applied to 30 single psychotherapy sessions of adult clients with depression and 11 therapists. Forty-two indices were found and grouped into the following five process categories of assimilation: external distress, pain, noticing, decentring and action.
  
  
  RESULTS
  The indices showed good inter-rater reliability and internal consistency. Except for noticing, all process categories correlated significantly with each other according to conceptual proximity. The system of indices also showed convergent validity with an existing coding system of assimilation for two process categories.
  
  
  CONCLUSIONS
  The results suggest that the system of indices is a useful approach for understanding assimilation. The consideration of assimilation in a continuous fashion through sub-processes may help to extend our knowledge of this process and provide a tool for clinical practice.
  
  
  CONCLUSIONS
  Assimilation is an important process in understanding change in psychotherapy in the sense that it takes into account insight and action-related processes. Clients convey in their speech signs or indices of the assimilation process which can be observed both in the style and content of their utterances. Using these indices, therapists can continuously assess assimilation and use this information in choosing interventions. Limitations: This study follows a cross-sectional design and does not allow consideration of the predictive value of the indices. The outcome of the therapy was not taken into account, which restricts validity considerations to the comparison with an existing instrument and the observation of the relation between sub-processes of assimilation.
authors.affiliation: Faculdade de Psicologia, Universidade de Lisboa, Portugal; The School of Health and Related Research, University of Sheffield, UK.
authors.forename: David D
authors.initials: DD
authors.lastname: Neto
authors.forename: Telmo M
authors.initials: TM
authors.lastname: Baptista
authors.forename: Kim
authors.initials: K
authors.lastname: Dent-Brown
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000628:therapy*; D005260:Female; D006282:Health Personnel; D006801:Humans; D008960:Models, Psychological; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D063545:Personal Narratives as Topic; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics / Q000295:instrumentation; D011613:Psychotherapy / Q000379:methods* / Q000592:standards* / Q000639:trends; D036301:Qualitative Research; D015203:Reproducibility of Results
keywords: assimilation; assimilation indices; change processes; psychotherapy