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.

Whilst therapy impasse has been analysed by a number of clinicians based on their interpretations from case studies, there has been a lack of research studies investigating this phenomenon. The clinical literature points to different aspects of the therapy frame and contract, individual client and therapist factors, the alliance and therapeutic interaction which combine in an idiosyncratic way in each case of impasse. The aims of this research was to examine the accounts of a small number of therapists currently experiencing therapy impasse in order to understand the role that these or other factors play in individual cases of impasse as well as to investigate the meaning and effects of an impasse experience for the therapist. A qualitative methodology was chosen in order to undertake a more in-depth analysis, and four participating therapists were interviewed on two separate occasions. The principles of Interpretative Phenomenological Analysis informed both the design of the study and its analysis. The analysis identified that the early development of problematic transferential patterns of relating was associated with impasse. In these cases of impasse therapists appeared to have a powerful personal engagement with their clients and they experienced strong affect in relation to the therapy process. The role of the therapists' ideal self which comes under threat during impasse was highlighted and the management of impasse was associated with therapists' regaining their therapeutic stance and attending to the therapy process. The implications of the study, in terms o f how clinicians may recognise and respond to cases of impasse at an early stage, are addressed, along with a theoretical discussion of how we might define and understand therapy impasse. A critical analysis of the study is included and suggestions for further research are offered.

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