Coherence Therapy- a way forward with emotional & chronic pain.
This is an approach to psychotherapy which has come out of the ‘brief-therapy’ arena, in that it suggests that therapeutic change can occur in a short time frame. The people who developed the approach, Bruce Ecker and Laurel Hulley titled their first book ‘Depth Oriented Brief Therapy’, and have since changed the title of their approach to ‘Coherence Therapy’. As its original title implies, Coherence Therapy is very much a depth-psychology approach, however it rejects the notion that people need to be in therapy for years to achieve desired results.
Being a depth-psychology approach, Coherence Therapy recognizes the roles of both the conscious and the unconscious minds. In this, it is in total accord with current neuroscience which reveals that most of what goes on in the mind/brain is in fact unconscious. As it is not a self-help approach, information about Coherence Therapy should not be read with an expectation of it being a healing experience- although, like the The Mind/Body Syndrome (TMS) model of chronic pain (see my home page), learning about it can afford you a greater level of knowledge as to what is going on within your psyche, and this alone can be very helpful. Coherence Therapy is essentially an experiential approach, in that clients are brought into contact with their immediate emotional/psychological realities which are operating on several different levels. Despite this, Ecker and Hully do acknowledge that to “encounter and own a predominantly cognitive construct, such as a previously unrecognised “belief”, is an experiential event, because any such belief is not a dry, impersonal fact but is seeped with personal meaning and emotional significance”. It is possible, through reading and thinking about the ideas presented here, to obtain an awareness on a cognitive (thinking) level, and for this awareness to be a step towards recovery from problems such as emotional issues and chronic pain. You may also try the self-help Coherence Therapy link at the bottom of this page.
Coherence Therapy suggests that all of the symptoms which people bring to therapy (including anxiety/panic, depression, self-harm, mania, low self-esteem, etc, and chronic pain) are problems on a conscious level. We tend to have a conscious anti-symptom stance, as the symptom causes us difficulties and pain which we would prefer to live without. However, as people familiar with the TMS model already know, there is another level of psychological functioning- that of the unconscious mind/brain, which can be at total odds with the conscious level and with what the self-aware “I” would prefer. Where the anti-symptom position is generally a function of the conscious mind/brain, the unconscious can have a very different agenda. It is often confusing and perplexing to the conscious “I” that a different level of the psyche could have a totally different take on reality, and a different position in regards to the symptoms. Within the unconscious is the pro-symptom position, as well as the 'emotional truth' which this position is highly related to. The goal of the therapy is to assist the unconscious pro-symptom stance to become conscious- we can only change what we are conscious of.
Examples of typical anti-symptom stances include:- I hate being depressed; my life would be so much easier and rewarding if I were not feeling anxious all the time; this pain is stopping me from living my life. All of these statements are completely true and understandable- most people who are suffering genuinely dont want to be suffering. However, at the same time, usually at a deep unconscious level, are the pro-symptom stances, such as:- I need to remain anxious so that I am ready to respond to danger at all times; the only way for me to get supportive attention is through being depressed; as long as I keep messing up in life, then my parents will be exposed as having done a lousy job in raising me. Most people are unaware of these types of positions (or 'schemas') most of the time, but these are often present nevertheless. They can be felt with the common experience of when a person becomes aware that 'a part of me.... likes having this problem.... undermines my successes..... enjoys the drama', ie. views things differently. Such deep and unconscious positions have usually been created in the context of bad experiences, and result from some kind of 'emotional learning'. What is learnt in such a context is referred to as an 'emotional truth'- that is, it feels true on an emotional level, regardless of its factual truth value.
The emotional truth is a learning which the person had, often during childhood, and in a distressing context. For example, a child growing up with abuse from a parent may ‘learn’ from this experience that they are of no value, that those in positions of authority are abusive, and that the world is a dangerous place. This learning is undergone in an emotionally stressful circumstance, and therefore remains highly resistant to change on a neurological level. As an adult, they may experience the symptom of lacking confidence and never being able to speak up when needed to defend themselves. Their emotional truth (as opposed to ‘actual’ truth) is that they are still of no value as a human being, and that to open their mouth is to invite abuse from others. To the extent that this emotional truth remains unacknowledged in the conscious awareness, the unconscious mind/brain is able to create symptoms which make sense (i.e are coherent) in the context of the emotional truth.
The symptoms therefore represent a ‘solution’ to the problem which is represented by the emotional truth. The symptom can therefore be both necessary and meaningful to the unconscious mind/brain, and is pursued regardless of the pain these solutions cause the conscious personality- eg. keeping one’s mouth shut and feeling unworthy makes one a smaller target for further abuse (even though thie results of keeping quiet may be painful). This symptom is felt to be a problem in the conscious awareness, a deficit or ‘pathology’, but it is generated by the unconscious as a solution in light of the painful learning which results in the emotional truth. As such, the unconscious tends to take a pro-symptom position entirely independently from the conscious anti-symptom position. Symptoms can be generated by this unconscious 'stance' or position as a means of protecting the person from what is believed would happen, were the symptoms not present. Rather than being signs of pathology or deficiencies, such symptoms can be seen as purposeful, meaningful (coherent) and often even smart responses which the unconscious mind creates in response to bad situations- this is not the mind failing to work properly, but is evidence of the mind working very well (which becomes clear once we know what the emotional truth and the pro-symptom position is).
As already stated, Coherence Therapy is an experiential approach. As such, we can only expect limited value from talking about what happens in it. However, some of its approach can be useful to create a level of cognitive change, which can be an important component to recovery. The essential question in Coherence Therapy (asked in many different ways) is:-
What would be the bad thing, the dangerous thing, the scary thing, the difficulty you would have to face if you let go of the ......(eg. depression, anxiety, substance abuse, pain)...?
- Review your psychological history, and see if you can identify significantly distressing events in your past (use the self-analysis questions in Ch 9 of ‘The Hidden Psychology of Pain’ to assist with this).
- Begin thinking about what were the learnings about yourself, other people and the world in general which you picked up from those experiences (note: these need not be positive learnings, although some may have been).
- What are the emotional truths (not necessarily factually true) which these learnings have led you to? eg. I am ......... Others are ........ The world is .............
- In what way did your symptom represent an actual or potential solution to these emotional truths in the context in which they originated?
- In what way does your symptom still serve you, in order to protect you from dangers and pain inherent in the emotional truths?
Living as though the symptom’s emotional truth is not the case is what generates the symptoms. In order to get better, we need to become aware of the unconscious emotional truths, and begin to see how the symptoms are actually in the service of these truths- in order to protect us from a perceived threat. Obviously, chronic pain, like other problems such as depression and anxiety, is a very good protective strategy in that it will dominate our awareness and prevent us from becoming aware of painful emotional truths- these are the threats to our conscious equilibrium. As long as we fail to see how the symptom (pain of one form or another) is serving us, and in fact is more important to have than not to have, the symptom will last.
In our normal daily experiences, one unconscious position after another is activated by our experiences, and brings its particular set of meanings, feelings and responses to the fore. Neuroscience demonstrates that a large number of brain modules or components operate without conscious awareness and can feel emotions, act, compute and remember independently.
The difficulty with attempting this process of psychological discovery on one’s own is that emotional truths are hard to find without assistance of someone skilled in this- we can easily think about and discuss possible emotional truths, but these are just speculations. Coherence Therapy, in order to be effective, needs to be experiential rather than a mental exercise or speculative; and there is often a natural resistance from the unconscious in staying with a new awareness of the emotional truths. Self-analysis can result in cognitive changes, and these may be sufficient for some people. However, other people will require the experiential changes which face to face therapy is good at providing and maintaining. As such, I would recommend self-help as an ideal starting point for anyone suffering. If this is sufficient, as it clearly is for many people who read books about the TMS approach, excellent. If it is not sufficient to radically reduce or eradicate the problem, then I would suggest psychotherapy. Practitioners who use Coherence Therapy have a very broad range of experiential strategies with which they help people to become aware of their emotional truths, their pro-symptom positions, and ultimately, to help them transition from suffering to non-suffering.
Free On-Line self-help Coherence Therapy is available on the following website. Doing therapy for yourself is like cutting your own hair- it can be done to a certain extent, but with a level of potential complication and difficulty which you wont get with seeing a therapist. But, there are circumstances in which it simply isn't possible to access a quality therapist, and a self-help approach may be all that is available and up to the task for less extreme problems. Give it a go!
http://www.psychresources.net/free-online-counseling/
Another excellent resource is psychotherapist Courtney Armstrong's memory reconsolidation process for traumatic memories, available from the following link:-
http://armstrongpdfs.s3.amazonaws.com/5-steps-to-heal-a-traumatic-memory.pdf
We already know, from the Rusk Institute, that brief psychoanalytic therapy works at addressing chronic pain. Eye Movement Desensitization & Reprocessing (see the EMDR link on the home page) also works at treating chronic pain, especially when it is derived from emotional trauma. And I would now add Coherence Therapy to the list of helpful psychotherapies. Learn more about it via three podcast interviews which can be downloaded here. You can contact the Coherence Psychology Institute via:- http://www.coherencetherapy.org/index.htm
and you can request contact details about practitioners in your part of the world. Some practitioners are very comfortable with conducting therapy sessions over Skype to any part of the world.
the following is a link to some excellent video presentations by Dr Niall Geoghegan, a trainer with the Coherence Psychology Institute on the nature of memory reconsolidation (the process of therapeutic change used in this therapy) and Coherence Therapy.
http://www.sensemaking.com.au/coherencetherapy
An excellent Psychotherapy Networker article about Coherence Therapy by the authors of 'Unlocking the Emotional Brain' is available via the following link:-
http://www.coherencetherapy.org/files/ecker-ticic-hulley-networker-2013.pdf
Audio Interview with Bruce Ecker in 2009
http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=29647
Audio Interview with Bruce Ecker in 2010
http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=36397
Audio Interview with Bruce Ecker in 2012
http://www.shrinkrapradio.com/2012/12/13/330-unlocking-the-emotional-brain-with-bruce-ecker-m-a/
http://www.neuropsychotherapist.com/bruceeckerinterview/
Bruce Ecker provides a very good description of the neuroscience of memory reconsolidation in this recent presentation
https://www.youtube.com/watch?v=_V_rI2N6Fco&feature=youtu.be
For the technically oriented reader, the attached article presents some neuroscience research on memory reconsolidation. Bruce Ecker comments: "This study is one of the most decisive re-confirmations yet that when we dissolve and erase an emotional learning through reconsolidation via juxtaposition experiences, the merely suppressive mechanism of extinction (and its various counteractive cousins) isn't engaged at all on the neurological level. This study adds significant weight to the distinction between transformational and counteractive processes, which is so central in Coherence Therapy and in the Emotional Coherence Framework."