How to be brief
when you were
trained to be deep
and vice versa...

The Essence of DOBT
A glimpse of DOBT in action

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A woman in her mid-forties was fearfully avoiding leaving home, a pattern widely labelled agoraphobia.
 
Asked what was frightening about going out, she was unclear. Looking more closely with the therapist's help, she retrieved a familiar sequence: 
 
When out and about she would soon "know" that her former therapist (a woman who had gone to live far away) is close by, watching her. She would then notice she was imagining this woman's presence and regarding it as real. Believing this meant she is going insane, she then felt intense anxiety. She would stay home, it emerged, to keep this highly disturbing experience from happening.
 
Having clarified this much, the stage is set for the central process of DOBT. The therapist now focused on bringing to light this woman's unconscious purpose for conjuring up the presence of her ex-therapist.
 
The DOBT technique of symptom deprivation accomplished this. She was asked to imagine, as if it were now happening, being out and about for an extended time without ever thinking her ex-therapist or anyone else she knew was watching her.
Immediately she began describing that perceiving herself as unaccompanied was bringing her into feeling alone and abandoned. An unresolved emotional reality consisting of early abandonment was surfacing.
 
Soon the therapist empathically mirrored what she was reporting by recapping, "So, if you don't imagine she's there, then you feel this painful feeling of being left all alone."
 
This added no new information or interpretation; it simply guided her to take stock of her own phenomenology. In the next moment an "Aha!" occurred for the client, who uttered, "Oh! And I don't feel all alone if she's there too--if I think she's there with me." She had experienced and realized her own purpose for imagining being accompanied.
 
It had taken about 25 minutes of DOBT to bring out enough of the unconscious basis of the problem to enable her to dispel it. The problem no longer occurred after two sessions. (For a more detailed account of this example, click here.)
 
Of course, the number of sessions required for resolution varies greatly. Skillfully applied, DOBT should always require a small fraction of the sessions needed in traditional in-depth systems.
The emotional truth of the symptom

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Depth-oriented brief therapy is a system for prompting the mind's native capacities for swift, deep change. It is a comprehensive, nonpathologizing methodology and conceptual framework.
 
As shown in the example above, the therapy client discovers--directly and experientially, not through interpretation from the therapist--that he or she harbors powerful personal themes and purposes, within which the presenting symptom or problem is necessary to have, despite the very real suffering or trouble incurred by having it.
 
The woman in the example found she was purposefully resorting to a delusion--the imagined presence of her former therapist--so that she would not go into feeling unbearably alone and abandoned when out on her own.
 
This symptom-requiring theme and purpose is the emotional truth of the symptom--the emotional truth of how the symptom is more necessary to have, than not to have. It is a particular construction of emotional reality previously formed in the course of life. 
Being an urgent emotional reality, it is created, preserved and activated in the limbic system of the brain and so is not effectively accessed by cognitive insights and interpretations. Experiential work is necessary. Once found, faced and felt, the symptom-maintaining formation can be revised or dissolved time-effectively if suitable experiential techniques are used.
 
A surprisingly wide range of clinical symptoms can be dispelled through this approach.
 
At the start of therapy, when the emotional truth of the symptom is still unconscious, the client regards the symptom as a form of irrationality or defectiveness, something involuntary and out of control, something to get rid of.
 
The therapist empathizes genuinely with this initial view and yet assumes that the client's mind is actually not out of control in producing the symptom. The therapist sets out to discover from the client the compelling themes and purposes that are making the symptom or problem necessary to have.
In a word, the presenting symptom is assumed to have coherence.
 
Symptom coherence is the view that a symptom is produced by a person because he or she harbors some construction of emotional reality--specific, compelling, unconscious personal themes and purposes--within which the symptom is necessary to have.
 
These specific themes and purposes necessitating the symptom are the emotional truth of the symptom. 
 
When there is no longer any formation of emotional reality necessitating the symptom, the person stops producing it. 
 
Symptom coherence is DOBT's paradigm of symptom production. More on this below.
 
DOBT's methodology focuses entirely on ushering clients into discovering and then revising the symptom-requiring themes and purposes they carry.
 
A more rigorous definition of "the emotional truth of the symptom" follows in the section below on the structure of emotional realities.
 
Methodology

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Carrying out DOBT has three main aspects:
 
Discovering the unconscious, symptom-generating construction of emotional reality
 
Integrating the specific themes and purposes constituting that reality, making them fully and routinely conscious
 
Transforming that now-conscious version of reality as needed for resolution (which may spontaneously occur upon integration or, if not, requires additional steps)
As already noted, the therapist does no interpreting and does not expect cognitive insights and explanations to have much potency at all.
 
The therapist's expertise lies in knowing how to prompt the client to actually bump into and experience his or her own emotional truths, so that these previously unrecognized yet passionate themes and purposes are felt directly and become unmistakably evident and nonspeculative to the client.
 
The therapist  learns from the client what the key themes and purposes are, not the other way around as in traditional in-depth therapies.
 
With the client experiencing the emotional truth of the symptom, change can occur at the root of the problem. 
The work goes back and forth between the three main steps listed above as needed until the presenting problem is no longer occurring.
 
DOBT is open-ended with respect to the experiential techniques that can be used to carry out these three activities. DOBT is defined not by techniques, but by this threefold methodology operating experientially within the assumption of symptom coherence. 
 
That said, it is also true that the therapist must have a repertoire of experiential techniques that are highly effective for this methodology. Techniques that have proven especially valuable are described in the DOBT book and articles.
Positions: The client's experience of agency

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When the agoraphobic woman described above directly and subjectively felt the emotional truth of her symptom, she was surprised to discover an ardent purpose that she carries out successfully by resorting to her delusion.
 
In a very real sense, she experienced having a position she didn't know she had--a wordless but nonetheless emotionally governing position which, cast into words, was, "When I'm all alone out in the world, I feel again abandoned, totally on my own, unable to survive, terrified. And I'm terrified of feeling that, so whenever I'm alone out there I've got to imagine and believe that someone who cares about me is with me."
 
DOBT encourages the therapist to view this purposefulness in resorting to a delusion as her own "position," a term used to emphasize that the client's own power and agency is very much involved in producing and maintaining the problem, albeit unconsciously.
People have many different positions. For referring specifically to a person's symptom-requiring position, DOBT uses the phrase pro-symptom position, meaning simply the position that is for having the symptom. This is really just another way of talking about the emotional truth of the symptom.
 
At the start of therapy the client of course expresses a position against having the symptom--his or her anti-symptom position. This is a very different emotional reality in which the symptom is construed as totally undesirable, irrational, out of control, and a sign of pathology or badness. 
 
When a therapy client makes the pro-symptom position fully conscious and experiences his or her unsuspected agency in relation to the problem, remarkable and swift therapeutic effects tend to occur--if the awareness is truly subjective and experiential, and not a merely cognitive insight coming from the therapist through interpretation or suggestion.
Symptom coherence

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Symptom coherence, introduced and defined above, does not mean that the client likes having the symptom.
 
It means she or he unconsciously expects not having the symptom to bring an even worse suffering than the familiar suffering with the symptom.
 
For the agoraphobic woman, the suffering of having an "insane" delusion when going about alone was preferable to the suffering of not having it and feeling abandoned.
 
Faced with this choice between these two sufferings--that with the symptom and that expected without it--the person unconsciously but coherently opts for the lesser misery--having the symptom!
 
For the client, the symptom truly seems involuntary and out of control as viewed in the narrow context of his or her conscious (anti-symptom) position, which contains no knowledge of how the symptom is
actually necessary to have. However, the unconscious mind--and in particular the person's pro-symptom position--is coherently in control of producing or not producing the symptom in each situation, and has full knowledge of why, when and how to do so.
 
Working phenomenologically, Ecker and Hulley, the originators of DOBT, have documented in their writings how symptom coherence proves to be the nature of the production of a vast array of symptoms encountered in therapy, including anxiety, panic, depression, attention problems, manic states and behavior, low self-esteem, procrastination, sexual problems, many sequelae of childhood abuse, and a wide range of couple and family problems.
 
Yet DOBT is not merely a function-of-the-symptom model, as symptom coherence fully accounts for both functional and functionless symptoms. Nor is it a secondary gain model, as coherence is a nonpathologizing, primary gain model.
The immediate accessibility of unconscious constructions

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It is axiomatic in DOBT that presently occurring symptoms are generated entirely by presently operating constructions of reality, conscious and unconscious.
 
These constructions--which in general are an inseparable amalgam of emotional, somatic, perceptual, and verbal-cognitive constructs--may well have been formed by the client far in the past, in the course of development, but they have continued to be part of the person's active knowledge structures and are carried and used in the present.
 
An assumption dominating the therapy world is that unconscious realities formed in the course of development and persisting for decades necessarily require much time to access and change. DOBT squarely challenges this view.
 
The fact that a potent construction of emotional reality has been fully unconscious for decades means not that it is inaccessible or remote, but only that it habitually goes unattended. The key unconscious material is actually always very close at hand, within arm's reach. After a lifetime of inattention to it, the client's attention can be brought to this material now, in this very session, in minutes.
 
What is required is not time, but a reliable methodology for bringing attention precisely into the particular unconscious constructions governing the production of the presenting symptom. 
 
This is what DOBT's methodology is designed to do. The pace of the work, the size of the steps at each point, should be limited not by the therapist's theoretical assumptions about how slowly in-depth work must always proceed, but by the client's actual capacities.
The experiential nature of the process is crucial; cognitive insight alone is completely inadequate and counterproductive. By definition it is experiential work that reaches into the nonverbally held themes and purposes making up so much of the unconscious emotional truths of symptoms.
 
Often these unconscious, limbic realities first emerge wordlessly in potent images or somatic sensations. This material becomes accurately, nonspeculatively known to the client only by subjectively experiencing it--being in it and speaking from it, not about it. In fact, an emotional construction is truly accessed and directly available for immediate change only while it is being subjectively experienced.
 
Interestingly, this experiential mode does not require clients to have high levels of conceptual insight or verbal or analytical skill. 
 
Everyone lives in their own emotional truths, their own constructions of experiential reality; and everyone, from every cultural and economic group, has the native ability to place attention in those emotional truths and experience them. This makes DOBT applicable with diverse populations.
 
Nor does experiential work necessarily involve evoking intense emotion or catharsis. Catharsis in itself does not reliably transform or dissolve the surfacing emotional reality. 
 
Whether or not such intensity develops, for success with DOBT the therapist must be unafraid of emotional process and skilled in guiding it. DOBT provides clear principles and methods for reaching an authentic and lasting resolution.
Constructions of reality and the mind's ability to revise them

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Whatever "objective" reality might "actually" be, we directly perceive and experience only the subjective realities constructed by our mind, in or out of consensus with other minds (the postmodern view of human knowledge). Even physical objects are not at all what they appear to be through our senses, as modern physics makes astoundingly clear.
 
Because the mind's activity of reality-construction is unconscious, the constructed realities we find ourselves experiencing seem externally real and objectively self-existing.
 
DOBT is extremely respectful of the client's psyche as the ruling creator, preserver and dissolver of experiential realities. The therapist's job in this approach largely consists of skillfully prompting the client to use her or his inherent abilities to access and alter the key constructions governing the presenting problem.
 
Utilization of people's native powers as architects of experiential reality characterizes constructivism as a paradigm of psychotherapy. (For recommended readings on psychological constructivism, click here.) Among the many different types of constructivist therapy, DOBT's approach is distinguished by these elements:
* Articulation of symptom coherence as the principle of symptom production
 
* Articulation of the mind's native processes for accessing and changing unconscious emotional realities
 
* Provision of a complete methodology for rapidly and with high accuracy creating fundamental change in unconscious, symptom-generating emotional realities
 
* Mapping of the pattern of constructs making up any emotional reality--a universal pattern used by the mind
 
It is noteworthy that the client's pre-existing, symptom-generating constructions are discovered in DOBT, not invented or "co-constructed" with the therapist.
 
Other constructivist therapies--such as strategic, solution-focused and narrative approaches--attempt to invent or co-construct a symptom-free state without discovering or dispelling the symptom-necessitating root constructs. The client's emotionally powerful and still-unconscious pro-symptom position is left intact. In DOBT the symptom-free state develops often by itself once the symptom-necessitating constructions are dissolved.
The structure of emotional realities

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DOBT, as just mentioned, provides a clear map of the structure of emotional realities.
 
This core ordering pattern has been identified phenomenologically by Ecker and Hulley. It appears to be a universal scheme used by the human mind for organizing personal reality. It consists of a four-level hierarchy of constructs, each level a different qualitative type from the others. Awareness of this pattern aids the therapist significantly.
 
The example of the agoraphobic woman can illustrate the four-level pattern. One way of diagramming it shows the client's symptoms as the top, visible layer of a four-layer cake of constructs:
 
ORDER OF CONSTRUCT CONSTRUCT
1st Order
Concrete thoughts, feelings, behaviors
PRESENTING SYMPTOMS
Imagines presence of caring person
Construes herself "insane"
Fearfully stays home to avoid being/going insane
2nd Order (UNCONSCIOUS)
Meaning of the concrete situation
I am out in the world alone!  I am in immediate danger of feeling abandoned, unable to survive, and terrified. I've got to make myself think I'm not alone and uncared-for here!
3rd Order (UNCONSCIOUS)
Broad purposes and strategies
I must never let the horror and danger of being abandoned start to happen ever again.
4th Order (UNCONSCIOUS)
Nature of self/others/world (ontology)
They've gone away, they don't want me; I am a little child alone and on my own and helpless to survive.
Clients' presenting symptoms are 1st-order constructs, defined as overt, manifested thoughts, feelings and behaviors. In this example the therapist's initial inquiry revealed the key symptom: the image and the kinesthetic sensation of her former therapist's presence nearby. The other symptoms derived in turn from this: the thought that this imagined presence means "insanity," the fear over this meaning, and the behavior of staying home.
 
Let's see how each layer is the basis and source of the layer above it. Keep in mind that each construct is an emotional reality, not merely a "belief" in the verbal-cognitive sense. For each construct the table gives a verbalized rendition of the reality created by the construct.
 
The bottom or 4th-order construct is the core and basis of the entire formation. It defines the essential nature or condition of self, others, or world (an ontological construct) approximated verbally here as, "They've gone away, they don't want me; I am a little child alone and on my own and helpless to survive."
 
From this core theme arises a 3rd-order construct of compelling purpose and plan for having safety, 
well-being, or justice: "I must never let the horror and danger of being abandoned start to happen ever again."
 
This in turn gives rise to her 2nd-order construct, which is how she frames the immediate, perceived situation when out and about: "I am out in the world alone!  I am in immediate danger of feeling abandoned, unable to survive, and terrified. I've got to make myself think I'm not alone and uncared-for here!"
 
Finally, based on this construal of the immediate situation she accordingly produces her main 1st-order symptom: the delusion of her former therapist being nearby, watching her. This delusion successfully avoids the experience of feeling alone, though it produces its own peripheral distress in the form of thinking she is insane and staying home to avoid the situation that makes her seeming insanity emerge.
 
The 1st order is usually the only level that is conscious at the start of therapy. 
 
The three deeper, unconscious levels constitute the emotional truth of the symptom.
Psychotherapy systems can be usefully compared in terms of the construct levels they seek to change. 
 
Those that address only level 1 seek to stop symptoms by straightforwardly counteracting and replacing them with different thoughts, feelings or behaviors, such as by teaching a couple better communication skills. These are 1st-order change therapies. 
 
Those that address level 2 seek to change how the client construes or frames the situation in which the symptom occurs. These are 2nd-order change therapies. Examples are strategic and solution-focused therapies that rely heavily on reframing techniques.
 
DOBT is a therapy of 3rd- and 4th-order change. It targets the client's unconscious purpose driving symptom production and the ontological construct maintaining that purpose.
 
The agoraphobic woman's purpose for producing her delusion was to avoid triggering an unresolved emotional reality -- that of being an abandoned, terrified child incapable of surviving on her own.
 
However, she was completely unconscious of this purpose and of carrying it out by producing the delusion of a caring companion standing nearby. The therapy rendered those 3rd- and 4th-order constructs conscious, then integrated, then largely dissolved. She stopped producing her symptoms because she no longer held an emotional reality that required them.
Beyond symptom relief

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Working at the level of the unconscious emotional truth of the symptom produces resolution and healing of a deeper kind than is the norm or aim in the brief therapy field.
 
The client's view of self as powerless to stop the symptom is dissolved in the experience of powerfully holding a position that necessitates the symptom. This is not a superficial positive reframe applied by the therapist, but rather a direct and genuine discovery of emotional truth on the part of the client. The client recognizes the great sense hidden in what had seemed his or her worst nonsense.
The woman in the example didn't just get rid of her presenting symptom of fear of going away from her home. What she thought was insanity--a profound defectiveness in her being--turned out to be full of sense and personal meaning.
 
This is a healing of her core self-worth, quite beyond merely getting rid of a painful symptom. Once symptoms fall away, people generally do not think of them any longer, and even forget they ever had them. But what therapy clients gain through the realization of their governing, pro-symptom position, their emotional truth, is a discovery of the coherence and cogency of their own inner being. That makes a deep and lasting impression.

Copyright © 2001 Bruce Ecker and Laurel Hulley
Email <website@dobt.com>