Exceeding the therapeutic zone of proximal development as a clinical error.
Open accessAbstract
The Assimilation of Problematic Experiences Scale (APES) summarizes a developmental continuum along which psychological problems progress in successful psychotherapy. The therapeutic zone of proximal development (TZPD) is the segment of the APES continuum within which the clients can proceed from their current APES level to the next with the therapist's assistance. It is the therapeutic working zone for a particular problem. As the client makes progress on a problem, its TZPD shifts up the APES. Theoretically, so long as the therapist's interventions remain within the TZPD, the client feels safe enough to work. However, when an intervention aims beyond the upper limit, the client will find it too risky and will reject or avoid the proposal. In this sense, exceeding the TZPD can be considered as a clinical error. This article presents examples of exceeding the TZPD and ways the error can be repaired. (PsycINFO Database Record
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Pressure to disclose can be conceptualized within a zone of proximal development framework: too little or too much pressure is unhelpful, but a balance between safety and challenge facilitates growth.
“Pressure to disclose can be conceptualized within a zone of the proximal development framework.Too little or too much pressure is unhelpful, but when there is a balance between safety and challenge, the discloser can risk exploring new beliefs and previously problematic experiences can become enriching, thus facilitating growth (Stiles et al., 2016).”
From Feeling pressured to talk about trauma: How pressure to disclose alters the association between trauma disclosure and posttraumatic growth (2023) · cites this paper as Stiles et al., 2016
Cites
(1978) · Medical Entomology and Zoology · Cited by 53,488 · see citing works
Treatment Plans and Interventions for Depression and Anxiety Disorders
Leahy, R. L., Holland, S. J., & Butler, A. C. (2000) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.14.4.409 · Cited by 275 · see citing works
Assimilation of problematic experiences.
Stiles, W. B. (2001) · Psychotherapy · doi:10.1037/0033-3204.38.4.462 · Cited by 256 · see citing works
Self-citationLeiman, M., & Stiles, W. B. (2001) · Psychotherapy Research · doi:10.1080/713663986 · Cited by 209 · see citing works
Self-citationLongitudinal study of assimilation in exploratory psychotherapy.
Stiles, W. B., Morrison, L. A., Haw, S., Harper, H., Shapiro, D. A., & Firth‐Cozens, J. (1991) · Psychotherapy · doi:10.1037/0033-3204.28.2.195 · Cited by 164 · see citing works
Self-citationHow collaboration in therapy becomes therapeutic: The therapeutic collaboration coding system
Ribeiro, E., Ribeiro, A. P., Gonçalves, M. M., Horvath, A. O., & Stiles, W. B. (2012) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/j.2044-8341.2012.02066.x · Cited by 128 · see citing works
Self-citationStiles, W. B. (2011) · Psychotherapy Research · doi:10.1080/10503307.2011.582186 · Cited by 108 · see citing works
Self-citationTemporal patterns of improvement in client-centred therapy and cognitive-behaviour therapy
Osatuke, K., Brinegar, M. G., Stiles, W. B., Greenberg, L. S., Shapiro, D. A., & Barkham, M. (2005) · Counselling Psychology Quarterly · doi:10.1080/09515070500136900 · Cited by 57 · see citing works
Self-citationGabalda, I. C., & Stiles, W. B. (2012) · Psychotherapy Research · doi:10.1080/10503307.2012.721938 · Cited by 53 · see citing works
Self-citationMachado, P. P. P., & Fassnacht, D. B. (2014) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12048 · Cited by 53 · see citing works
Ribeiro, A. P., Ribeiro, E., Loura, J., Gonçalves, M. M., Stiles, W. B., Horvath, A. O., & Sousa, I. (2013) · Psychotherapy Research · doi:10.1080/10503307.2013.856042 · Cited by 51 · see citing works
Self-citationMendes, I., Rosa, C., Stiles, W. B., Gabalda, I. C., Gomes, P. V. T., Basto, I., & Salgado, J. (2016) · Psychotherapy Research · doi:10.1080/10503307.2015.1136443 · Cited by 29 · see citing works
Self-citationThe Linguistic Therapy of Evaluation: A Perspective on Language in Psychotherapy
Caro, I. (1996) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.10.2.83 · Cited by 26 · see citing works
Meystre, C., Kramer, U., de Roten, Y., Despland, J., & Stiles, W. B. (2013) · Counselling and Psychotherapy Research · doi:10.1080/14733145.2013.782056 · Cited by 22 · see citing works
Self-citationZonzi, A., Barkham, M., Hardy, G. E., Llewelyn, S. P., Stiles, W. B., & Leiman, M. (2014) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12022 · Cited by 19 · see citing works
Self-citationThe development of therapeutic collaboration in a good outcome case of person-centered therapy
Ribeiro, E., Fernandes, C., Santos, B., Ribeiro, A. P., Coutinho, J. F. P., Angus, L. E., & Greenberg, L. S. (2014) · Person-Centered & Experiential Psychotherapies · doi:10.1080/14779757.2014.893250 · Cited by 12 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Impact of confrontations by therapists on impairment and utilization of the therapeutic alliance
Moeseneder, L., Ribeiro, E., Muran, J. C., & Caspar, F. (2018) · Psychotherapy Research · doi:10.1080/10503307.2018.1502897 · Cited by 40 · see citing works
Self-citationYonatan‐Leus, R., Tishby, O., Shefler, G., & Wiseman, H. (2017) · Psychotherapy Research · doi:10.1080/10503307.2017.1292067 · Cited by 33 · see citing works
Metacognitively oriented psychotherapy for schizotypal personality disorder: A two‐case series
Cheli, S., Lysaker, P. H., & Dimaggio, G. (2019) · Personality and Mental Health · doi:10.1002/pmh.1447 · Cited by 34 · see citing works
One More Time on the Zone of Proximal Development
Zaretsky, V. K. (2021) · Cultural-Historical Psychology · doi:10.17759/chp.2021170204 · Cited by 31 · see citing works
Therapist interventions and client ambivalence in two cases of narrative therapy for depression
Ribeiro, A. P., Braga, C., Stiles, W. B., Teixeira, P., Gonçalves, M. M., & Ribeiro, E. (2016) · Psychotherapy Research · doi:10.1080/10503307.2016.1197439 · Cited by 26 · see citing works
Self-citationThe form of the story: Measuring formal aspects of narrative activity in psychotherapy†
Habermas, T., & Döll-Hentschker, S. (2017) · Psychotherapy Research · doi:10.1080/10503307.2016.1259534 · Cited by 14 · see citing works
Assimilation Setbacks as Switching Strands: A Theoretical and Methodological Conceptualization
Gabalda, I. C., & Stiles, W. B. (2018) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-018-9385-z · Cited by 15 · see citing works
Self-citationZone of Proximal Development: Evolution of the Concept
Zaretsky, V. K. (2024) · Cultural-Historical Psychology · doi:10.17759/chp.2024200305 · Cited by 12 · see citing works
The Therapeutic Collaboration in Dropout Cases of Narrative Therapy: An Exploratory Study
Pinto, D., Sousa, I., Pinheiro, A., Freitas, A. C., & Ribeiro, E. (2018) · Revista de Psicoterapia · doi:10.33898/rdp.v29i110.209 · Cited by 11 · see citing works
Self-citationColli, A., Gagliardini, G., & Gullo, S. (2021) · Psychotherapy Research · doi:10.1080/10503307.2021.1884768 · Cited by 11 · see citing works
Abargil, M., Schenkolewski, A., & Tishby, O. (2024) · Psychotherapy Research · doi:10.1080/10503307.2024.2403422 · Cited by 10 · see citing works
Kimbley, C. T., Cox, D. W., Kahn, J. H., & Renshaw, K. D. (2023) · Journal of Traumatic Stress · doi:10.1002/jts.22930 · Cited by 9 · see citing works
KOLLY-SHAMNE, A. (2022) · Scientific Bulletin of Mukachevo State University Series “Pedagogy and Psychology” · doi:10.52534/msu-pp.8(3).2022.81-95 · Cited by 8 · see citing works
Therapist’s actions after therapeutic collaboration breaks: a single case study
Cardoso, C., Pinto, D., & Ribeiro, E. (2019) · Psychotherapy Research · doi:10.1080/10503307.2019.1633483 · Cited by 9 · see citing works
Self-citationBasto, I., Stiles, W. B., Pinheiro, P., Mendes, I., Rijo, D., & Salgado, J. (2021) · Psychotherapy Research · doi:10.1080/10503307.2021.1892231 · Cited by 9 · see citing works
Self-citationTo err is human: An introduction to the special issue on clinical errors.
Budge, S. L. (2016) · Psychotherapy · doi:10.1037/pst0000084 · Cited by 8 · see citing works
Gabalda, I. C., & Stiles, W. B. (2020) · Psychotherapy Research · doi:10.1080/10503307.2020.1795292 · Cited by 8 · see citing works
Self-citationZaretsky, V. K., & Ageeva, A. A. (2021) · Counseling Psychology and Psychotherapy · doi:10.17759/cpp.2021290310 · Cited by 6 · see citing works
Therapeutic Collaboration in Career Construction Counseling: Case Studies of an Integrative Model
Silva, F., Taveira, M. D. C., Cardoso, P. M. D. S., Ribeiro, E., & Savickas, M. L. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.784854 · Cited by 6 · see citing works
Self-citationTherapist activities preceding therapy setbacks in a poor-outcome case
Gabalda, I. C., & Stiles, W. B. (2017) · Counselling Psychology Quarterly · doi:10.1080/09515070.2017.1355295 · Cited by 6 · see citing works
Self-citationGabalda, I. C., & Stiles, W. B. (2019) · Journal of Constructivist Psychology · doi:10.1080/10720537.2019.1689540 · Cited by 5 · see citing works
Self-citationPodolan, M. (2025) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-025-09683-9 · Cited by 5 · see citing works
On the system of categories of the Cultural-Historical Psychology
Maidansky, A. D., & Rubtsov, V. V. (2025) · Cultural-Historical Psychology · doi:10.17759/chp.2025000001 · Cited by 4 · see citing works
Hiding Shame – A Case Study of Developing Agency
Kivikkokangas, S., Leiman, M., Laitila, A. A., & Stiles, W. B. (2020) · Revue roumaine de psychanalyse · doi:10.2478/rjp-2020-0008 · Cited by 4 · see citing works
Self-citationWhy did she leave? Development of working alliance in a case of psychotherapy for depression
Doležal, P., Čevelíček, M., Řiháček, T., Roubal, J., Hytych, R., & Ukropová, L. (2019) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2019.354 · Cited by 4 · see citing works
Gelo, O. C. G., & Podolan, M. (2025) · European Psychologist · doi:10.1027/1016-9040/a000574 · Cited by 3 · see citing works
Ribeiro, E., Gonçalves, M. M., & Santos, B. (2018) · Journal of Humanistic Psychology · doi:10.1177/0022167818792123 · Cited by 3 · see citing works
Self-citationKnox, S., Callender, K. A., Mak, T. W., Skaistis, S. M., & Knowlton, G. (2020) · Counselling Psychology Quarterly · doi:10.1080/09515070.2020.1843004 · Cited by 3 · see citing works
Aro, T. I., Kuusinen, K., Stiles, W. B., & Laitila, A. A. (2021) · Journal of Infant Child and Adolescent Psychotherapy · doi:10.1080/15289168.2021.1916210 · Cited by 2 · see citing works
Self-citationTherapeutic activities after assimilation setbacks in the case of Alicia
Gabalda, I. C., & Stiles, W. B. (2022) · Counselling Psychology Quarterly · doi:10.1080/09515070.2021.2023467 · Cited by 2 · see citing works
Self-citationFacilitating the client change: A perspective from the therapeutic zone of proximal development
Dongmei, W. A. N. G., & XIANG, K. (2022) · Advances in Psychological Science · doi:10.3724/sp.j.1042.2022.00648 · Cited by 1 · see citing works
Prihandhika, A., Aiyub, A., Suryadi, D., & Prabawanto, S. (2022) · JNPM (Jurnal Nasional Pendidikan Matematika) · doi:10.33603/jnpm.v6i3.7073 · Cited by 1 · see citing works
El Modelo de Asimilación como un Modelo Integrador sobre el Cambio Terapéutico
Gabalda, I. C., Ruiz, S. P., & Vañó, R. (2017) · Revista de Psicoterapia · doi:10.33898/rdp.v28i108.204 · Cited by 1 · see citing works
Navigating Adventure Therapy: Using Existential Theory as a Guide
Brown, C. L., Christian, D. D., McMillion, P. L. R., & McLain, J. R. (2025) · The Journal of Humanistic Counseling · doi:10.1002/johc.12240
Responsively Navigating Breaks in Therapeutic Collaboration
Ribeiro, E., Cardoso, C., & Stiles, W. B. (2026) · CBT: science into practice · doi:10.1007/978-3-032-07140-8_6
Self-citation
- Authors
- Stiles, W. B., Caro Gabalda, I., & Ribeiro, E.
- Affiliations
- Miami University (US)
- University of Minho (PT)
- Venue
- Psychotherapy
- Published
- 2016-09
- Volume
- 53
- Issue
- 3
- Pages
- 268-272
- ISSN
- 0033-3204 (ISSN-L)
- 1939-1536
- OpenAlex
- W2520858491
- Cited by
- 36
- References
- 16
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 2 · 2023: 1 · 2022: 5 · 2021: 5 · 2020: 3 · 2019: 4 · 2018: 4 · 2017: 3 · 2016: 3
- FWCI
- 6.25
- Type
- journal article
- Language
- en
- Open access
- Licence
- cc-by-nc-nd
- Locations
- Psychotherapy (publishedVersion)
- PubMed (publishedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, cc-by-nc-nd)
- Funders
- University of Minho (UID/PSI/01662/2013)
- Portuguese Foundation for Science and Technology
- Portuguese Ministry of Science, Technology, and Higher Education
- FEDER (POCI-01-0145-FEDER-007653)
- BIAL Foundation
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Social Psychology › Counseling Practices and Supervision
- Keywords
- zone of proximal development, medical errors, client safety, error repair
- MeSH terms
- Adult, Awareness, Mental Disorders, Humans, Male, Problem Solving, Professional-Patient Relations, Psychotherapy, Psychotherapeutic Processes, Cognitive Behavioral Therapy, Treatment Outcome, Medical Errors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
