Coherence therapy

Coherence Therapy is a system of psychotherapy based in the theory that symptoms of mood, thought and behavior are produced coherently according to the person's current models of reality, most of which are implicit and unconscious. It was founded by Bruce Ecker and Laurel Hulley in the 1990s. It is currently considered among the most well respected postmodern/constructivist therapies.

General Description


The basis of coherence therapy is the theory of symptom coherence. This is the view that all activity of the brain-mind-body system consists of the formation, use and revision of coherent personal constructs. Therefore, a therapy client’s presenting symptoms are understood as an activation and enactment of specific constructs.

The theory of symptom coherence maintains that an individual's seemingly irrational, out-of-control symptoms are actually sensible, cogent, orderly expressions of the person’s existing constructions of self and world, rather than a disorder or pathology.

Coherence therapy is considered a type of psychological constructivism. It differs from other forms of constructivism in that the principle of coherence is fully explicit and rigorously operationalized, guiding and informing the entire methodology. The process of coherence therapy is experiential rather than analytic, and is similar to Gestalt therapy, focusing or Hakomi in this regard. The aim is to come into direct experience of the unconscious personal constructs producing an unwanted symptom and undergo a natural process of change, ending the existence of the symptom. Adherents claim that entire process often requires a dozen sessions or less, although it can take longer when the themes and emotions underlying the symptom are particularly complex or intense.

Symptom Coherence
Symptom coherence is defined by Ecker and Hulley as follows:
 * (a) A person produces a particular symptom because, despite the suffering it entails, the symptom is compellingly necessary to have, according to at least one unconscious, nonverbal, emotionally potent construction of reality.
 * (b) Each symptom-requiring construction is cogent—a sensible, meaningful, well-knit, well-defined schema that was formed adaptively in response to earlier experiences and is still carried and applied in the present.
 * (c) The person ceases producing the symptom as soon as there no longer exists any construction of reality in which the symptom is necessary to have, with no other symptom-stopping measures needed.

There are several forms of symptom coherence. For example, some symptoms are necessary because they serve a crucial function (such as depression that protects against feeling and expressing anger), while others have no function but are necessary in the sense of being an inevitable effect, or by-product, caused by some other adaptive, coherent but unconscious response (such as depression resulting from isolation, which itself is a strategy for feeling safe). Both functional and functionless symptoms are theorized to be coherent, according to the client's own material.

In other words, the theory states that symptoms are produced by how the individual strives, without conscious awareness, to carry out self-protecting or self-affirming purposes formed in the course of living. This model of symptom production is fits into the broader category of psychological constructivism, which views of the self as having profound, if unrecognized, agency in shaping experience and behavior.

History
Coherence therapy was developed in the 1980s and 1990s as Bruce Ecker and Laurel Hulley investigated why certain psychotherapy sessions seemed to produce deep, lasting personal change and symptom cessation, while most sessions did not. Studying many such transformative sessions for several years, they concluded that in these sessions, the therapist had desisted from doing anything to oppose or counteract the symptom, and the client had a powerful, felt experience of some previously unrecognized 'emotional truth' that was making the symptom necessary to have.

Ecker and Hulley began exploring experiential methods to intentionally facilitate this process. They found that a majority of their clients were able to have an experience of the coherence of their symptoms from the first session. Due the swiftness of change they began experiencing in many of their clients, they initially named this new system Depth-Oriented Brief Therapy (DOBT).

In 2005, Ecker and Hulley began calling their modality coherence therapy, partly in order for the name to more clearly reflect the central principle of the approach, and partly because many therapists have come to associate the phrase 'brief therapy' with depth-avoidant methods that they regard as superficial.

Evidence from Neuroscience
In a series of three articles to be published in the Journal of Constructivist Psychology, Bruce Ecker and Brian Toomey present evidence that coherence therapy may be the system of psychotherapy which, according to current neuroscience, makes fullest use of the brain's built-in capacities for change.

Ecker and Toomey argue that the mechanism of change in coherence therapy uniquely correlates with a newly discovered neural process called 'memory reconsolidation', a process that can actually unwire longstanding emotional conditioning held in implicit memory. If this proves to be true, it would constitute the removal of the very basis of a symptom's existence, making it distinct from the counteractive strategy of most therapies, in which new, preferred patterns are built up to compete against and hopefully override the unwanted ones. The counteractive process, like the 'extinction' of conditioned responses in animals, is known to be inherently unstable and prone to relapse, because the neural circuit of the unwanted pattern continues to exist even when the unwanted pattern is in abeyance. Through reconsolidation, the unwanted neural circuits are unwired and cannot relapse.