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Coherence Therapy was formerly known as Depth Oriented Brief Therapy.

Coherence Therapy Online Training
Course 700
Transformation of Core Emotional Schemas:
Client With Obsessive Attachment to Former Lover

Introduction to Coherence Therapy

Links to this course's other parts:  Part A  ·  Part B  ·  Part C

For full coverage of Coherence Therapy methodology, see the Practice Manual and Training Guide.

Coherence Therapy is a unified set of methods and concepts for consistently dispelling problems and symptoms at their roots in far fewer sessions than conventional in-depth therapies require.

Coherence Therapy is an experiential and focused in-depth therapy. It holds that in the vast majority of cases, non-conscious, adaptive emotional learning plays a primary role in maintaining the presenting symptom or problem. This approach uses advanced methods for efficiently finding the client's symptom-generating learnings or schemas, shifting them experientially from implicit (non-conscious) form into explicit awareness, and then deeply unlearning and dissolving them through the brain's built-in process for doing so -- the process of memory reconsolidation.

The approach can dispel a very wide range of symptoms along with the less visible, often lifelong emotional wounds associated with them. It was developed by psychotherapists Bruce Ecker and Laurel Hulley.

Symptom coherence -- the guiding principle in Coherence Therapy -- is the nonpathologizing view that a therapy client's presenting symptom occurs only because of emotional necessity, according to at least one non-conscious emotional learning or schema, held in implicit memory, that strives to avoid a particular suffering. The suffering or hardship due to having the symptom is very real, but the emotional necessity driving production of the symptom prevails because it is urgent and powerful, though not conscious.

The coherent, symptom-necessitating themes and purposes are the emotional truth of the symptom -- the emotional truth of how, in the client's non-conscious world of implicit knowledge, the symptom is actually necessary to have. Psychobiological research has shown that transformational change of these underlying emotional learnings occurs not through cognitive insights, but through a special sequence of experiences custom-tailored for the target learning. Coherence Therapy is a complete system for shaping those transformational experiences, using the principle of coherence as an effective guide.

At the start of therapy the client, unaware of how the symptom is necessary, naturally regards it as a form of irrationality or defectiveness, something involuntary and out of control, something to get rid of. The therapist empathizes genuinely with the client's pain or hardship, yet assumes that his or her brain and mind produce the symptom adaptively, according to urgent emotional learnings formed earlier in life, and sets out to guide the client into discovering the emotional truth or deep personal sense in having the symptom. The aim is to prompt the client's own native capacities to find and then to transform the symptom-requiring material.

Coherence-focused therapy ushers clients into deep experiences of the hidden sense and necessity present within seemingly senseless symptoms. Clients embrace the disowned, underlying, passionate themes, purposes and parts that have control over their anxiety, depression, insecure attachment, low self-worth, and many other problems. The client's subjective embrace of this material gives true access to it, setting the stage for its transformation.

A symptom ceases immediately and permanently when a person no longer has any emotional schemas necessitating it. Then, no symptom-counteracting measures or efforts are needed for remaining symptom-free. This is the meaning of symptom coherence. In fact, throughout its methodology, Coherence Therapy is transformative without being counteractive of the symptom in any way. It is devoid of methods that come across to the client as preventing, opposing, overriding, fixing or regulating the presenting symptom or problem.

As a basic example to illustrate these ideas, consider Craig, a high-level corporate executive whose presenting symptom was chronic anxiety at work, which liberal doses of Celexa and BuSpar did little to relieve. He described always feeling in danger interpersonally, as if he were "not doing things right" and would "get into trouble."

The therapist asked Craig to revisit in imagination one or two recent anxiety-producing incidents with coworkers and to notice and put into words his own feelings and aims in the midst of these interactions. This exercise soon led to a realization that surprised him: He was essentially always trying to draw his fellow executives into a personal friendship rather than a professional relationship "so they will like me and not want to attack me." It was a powerful experience for this up-in-the-head fellow to connect consciously with the emotional truth of this pervasive strategy that he was following.

It also became apparent that in business contacts outside his company, it was different -- Craig did not expect customers, suppliers or executives at partner companies to relate to him as friends. But inside his company, he always assumed he had successfully converted his own teammates into being friends. He said this new realization suddenly made sense of why he had felt deeply "betrayed" on many past occasions when a teammate jockeyed against him for a promotion or competed with him for work projects or didn't return a phone call. Another "betrayal" by an exec "friend" could occur suddenly at any time, an expectation maintaining continual anxiety for Craig.

His homework after session one was simply to stay aware of trying for safety-by-befriending as he interacted with coworkers. In session two he expressed with some sadness a recognition that between upper management coworkers it's business first, not friendship, despite friendly appearances. As a result of holding his strategy consciously, he had begun to notice that actually, his world of fellow execs didn't work that way. He was clearly beginning to accept the loss of his longstanding fantasy and strategy. The post-session task now was defined as, "Just look over at your exec coworkers once or twice each day and ask yourself: 'How willing or unwilling am I to see them through the same lens I already use with people outside the company, the lens of 'this is business, not friendship'?" Craig left the session carrying an index card on which that question was written.

In the third session, Craig reported that being aware of the question changed the way he regarded his fellow execs. Now he no more expected family loyalty from them than he would from any other business contacts. By staying conscious of his befriending-for-safety strategy, he was able to experience contradictory knowledge and hold that disconfirming knowledge in juxtaposition with his now conscious expectation that co-execs could and would become his friends.

That is the experiential process required for memory reconsolidation, the brain's innate process for unlocking an emotional learning at the synaptic level and allowing that target learning to be re-written, and thereby erased, by other, disconfirming knowledge. How reconsolidation works and how therapists can utilize it is the subject of Unlocking the Emotional Brain by Bruce Ecker, Robin Ticic and Laurel Hulley.

As a direct result of no longer expecting and assuming friendship with his co-workers, Craig's sense of vulnerability to betrayal of friendship fell away, along with its ripple effect, the anxiety for which he began therapy. He said, "It's pretty dramatic, like a switch has been thrown. I'm much more able to say what I think or ask for what I need. That old desperation is just lifted, it's gone. I had no idea how much my anxiety was muddying the waters."

It was unnecessary with Craig to go into the historical origins of his befriending for safety, because that pattern and the anxiety it was generating ceased without doing so. However, in many cases focusing on experiences from early in life does greatly help carry out the implicit-to-explicit retrieval work and/or the subsequent transformation process. A Coherence Therapy practitioner has wide latitude of choice in that regard and in many other aspects of the work, such as specific techniques to use for carrying out each steps of the process. Craig's therapist certainly was free to point out to him, at the end of work described above, that his expectation of aggression and his self-protective befriending probably were learned much earlier in life, perhaps in his family, and to ask him whether he wishes to follow the thread into those areas. Undoubtedly, additional fruitful work would result if the client opts for this.

This man became aware of his own knowledge of a particular problem -- the competitive aggression of members of his own group -- and of a particular solution that he was always striving to carry out -- preventing such actions by getting each person to see their relationship with him as one of "friends" and assuming he had succeeded in that.

That problem-and-solution was the learned emotional schema that was necessitating Craig's presenting symptom of anxiety. Seeing as friends people who weren't caused him to experience betrayal -- a deeply hurtful wounding -- whenever these people pursued their jobs and careers in ordinary ways that diverged sharply from that of a "friend." And Craig knew that could happen again at any time, generating his continual anxiety.

The client's symptom-generating emotional schema is referred to using a number of different phrases in Coherence Therapy writings: either as the symptom-requiring schema, the emotional truth of the symptom, the target emotional learning or the client's pro-symptom position. The latter phrase, pro-symptom position, is used for highlighting the purposefulness and agency that are inherent in emotional learnings and that are experienced by the client after retrieval into awareness as his or her own purposefulness and agency, as Craig had experienced his tactic of befriending others for safety.

Note that the therapist had done nothing to counteract, prevent or eliminate Craig's symptom of chronic anxiety. The work consisted entirely of having Craig subjectively experience and "own" his position of making himself feel safe from attack by making teammates feel they're his friends, and then believing they truly were. Making this conscious allow it to be dissolved by Craig's own current experiences that disconfirmed it.

The methodology of Coherence Therapy has the following phases, which begin after the presenting symptom or problem has been identified in its experiential particulars:

Retrieval of the symptom-requiring schema into awareness, which comprises both the discovery and the integration of it as distinct milestones, making the material routinely conscious in day-to-day life. All of this work is experiential.

Transformation of the schema through the memory reconsolidation process, which fundamentally unlearns, dissolves and revises the schema, in part or whole, such that the symptom is no longer an emotional necessity.

Each of those processes follows well-defined principles and can be carried out using a wide range of techniques. Coherence Therapy is defined not by a particular set of techniques, but by this methodology of discovery, integration and transformation of the client's coherent symptom-requiring schemas, using any suitable experiential techniques. A basic set of versatile techniques is described in the Coherence Therapy Practice Manual and Training Guide. The experiential nature of the work is essential, because it is only by subjectively experiencing an implicit emotional learning that it becomes accurately known and genuinely accessed and made available for transformational change. With the client experiencing the emotional truth of the symptom, change can occur at the very root of the problem.

The coherence principle of symptom production is not a theoretical construct. On the contrary, it is readily verifiable empirically with every client by using the phenomenological methodology of Coherence Therapy. That is, the process of therapy itself concretely demonstrates symptom coherence as the essential nature of the production of a vast array of presenting symptoms.