Below we will be describing and illustrating the therapeutic reconsolidation process in action. The steps of the process define essential experiences the client must have, without specifying methods or techniques for creating those experiences—just as a map does not impose a mode of travel when one is on a journey. This allows each therapist full freedom to choose and use preferred methods to fulfill the sequence of experiences required by the brain for shedding a targeted emotional learning. We show in Chapter 6 how several widely used systems of psychotherapy are well suited for this purpose.
In order to illustrate, for instructional purposes, the clinical use of the therapeutic reconsolidation process, its sequence of steps needs to be embodied in some chosen, concrete way. Best suited for this instructional demonstration is a therapy that implements the steps explicitly and recognizably. Across the various psychotherapies that are congenial to this process (see Table 1.1), there is a wide variance in the degree to which its steps are overtly apparent. In other words, if we were to observe such therapies being carried out successfully (as in Chapter 6), for most of them we would not easily recognize the steps of the therapeutic reconsolidation process occurring even when the client is, indeed, having the particular sequence of internal experiences that is the true essence of the process required by the brain.
To our knowledge, the only form of psychotherapy that has a
procedural map or methodology that explicitly calls for and guides every step of the therapeutic reconsolidation process is Coherence Therapy—the approach developed by Ecker and Hulley in discovering the process clinically. For that reason, in this chapter and the next, the non-theoretical system of Coherence Therapy will serve to demonstrate the unlocking of the emotional brain through the therapeutic reconsolidation process.
Table 3.1 maps the steps of the therapeutic reconsolidation process and shows how the phases of Coherence Therapy are in one-to-one correspondence with those steps. This chapter will give you a basic grounding in understanding those steps of process—the sequence of internal experiences—that erase the emotional learnings underlying a given presenting symptom.
Coherence Therapy (originally called Depth Oriented Brief Therapy or DOBT) was initially developed from 1986 to 1993 by Ecker and Hulley (1996, 2000a, 2008a, 2011). Clinical training in this process began in 1993—more than a decade before reconsolidation researchers arrived at the erasure process in the lab
—and it has been in use by psychotherapists since then (e.g., Ecker &
Table 3.1 Steps of clinical process for using new learning to nullify or update an existing emotional learning
Hulley, 2000a, 2008a; Martignetti & Jordan, 2001; Neimeyer, 2009;
Neimeyer & Bridges, 2003; Neimeyer, Burke, Mackay, & van Dyke Stringer, 2010; Neimeyer & Raskin, 2001; Thomson & Jordan, 2002) to dispel a broad range of symptoms, as listed in Table 3.2; for a listing of published case examples indexed by symptom, see the online supplement.
The steps of methodology of Coherence Therapy listed in Table 3.1 emerged as a result of culling from thousands of therapy sessions the outliers that contained the markers of profound, lasting change that later came to be associated distinctively with the erasure of an emotional learning. Those ultra-effective sessions were closely studied in order to identify the essential steps of process that they shared, across a wide range of symptoms and clients. Neuroscientists using the same markers of change identified the same steps of required process in research on memory reconsolidation published since 2004, as reviewed in Chapter 2; for readers who have bypassed that review of research, we note that brief, accessible accounts of reconsolidation research and its extension to psychotherapy are available online (Ecker, 2011; Van Nuys, 2010a).
Researchers determined that change consisting of those markers
corresponds on the neurological level to an unlocking of synapses, which allows the neural encoding of a well-established emotional learning to be erased from functioning memory through being rewritten and replaced by new learning.
Table 3.2 Symptoms observed that are dispelled by the therapeutic reconsolidation process through Coherence Therapy
Aggressive behavior Grief and bereavement
problems
Agoraphobia Guilt
Alcohol abuse Hallucinations
Anger and rage Inaction
Anxiety Indecision
Attachment-pattern behaviors & distress Low self-worth Attention deficit problems Panic attacks
Codependency Perfectionism
Complex trauma symptomology Post-traumatic symptoms Compulsive behaviors of many kinds Procrastination
Couples’ problems of
conflict/communication/closeness
Psychogenic/psychosomatic pain
Depression Sexual problems
Family and child problems Shame
Fidgeting Underachieving
Food/eating/weight problems Voice and speaking problems
Note: For a list of published case examples indexed by symptom, see online supplement.
The fact that the same process emerged independently through such different approaches as the neurological study of learning and memory in animals and the examination of psychotherapeutic process signifies progress toward a synthesis of the neurobiological (bottom-up) and holistic (top-down) understandings of therapeutic change.
The need for just such a binocular approach was emphasized by
neuroscientist Eric Kandel (2001, p. 605) toward the end of his Nobel address, when he commented regarding a range of challenging unknowns in brain science, “These systems problems of the brain will require more than the bottom-up approach of molecular biology.
They will also require the top-down approaches of cognitive psychology, neurology, and psychiatry. Finally, they will require a set of syntheses that bridge the two approaches.” The convergence described in this chapter appears to be a step in the direction of fulfilling this vision of unification.
Coherence Therapy equips the therapist with extensive guidance for carrying out the therapeutic reconsolidation process, as well as offering a set of versatile techniques for doing so. It is defined by both the methodology indicated in Table 3.1 and a guiding conceptual framework consisting of the research-based knowledge of emotional learning and unlearning in the Emotional Coherence Framework, described in Chapter 1. This includes the central concept of symptom coherence, which, as demonstrated below, serves as Coherence Therapy’s model of both symptom production and symptom cessation.
The limits of applicability of Coherence Therapy are the same as were detailed in Chapter 2 for the therapeutic reconsolidation process. Being entirely a respectful process of guiding the client to attend deeply to his or her own emotional learnings and attributed meanings, Coherence Therapy is naturally applicable cross-culturally and across sexual orientations, socioeconomic levels and age groups.
It can be conducted with individuals, couples and families, and with children, adolescents and adults.
In describing Coherence Therapy in the following case example, we assume that the therapist–reader already has sound skills of listening, communicating empathetic understanding authentically, attuning accurately, building emotional safety and trust, creating a good working alliance, and repairing ruptures. These relationship skills and qualities, known in the clinical field as “non-specific common factors,” certainly are prerequisites for carrying out Coherence Therapy successfully. However, Coherence Therapy is not defined in terms of these common factors, and its specific process of
profound change—the therapeutic reconsolidation process—is neither inherent in the common factors nor likely to result regularly from them alone (a point that is further discussed toward the end of Chapter 6).