3. Brief vs. Deep
“For therapy to be brief, depth must be
sacrificed….”
4. Brief vs. Deep
“For therapy to be brief, depth must be
sacrificed….”
“Coherence therapy is a complete,
versatile modality in which theory and
practice are completely aligned for
achieving the new level of
effectiveness that is needed if therapy
is to be deep and brief.”
5. Brief vs. Deep
“For therapy to be brief, depth must be
sacrificed….”
“Coherence therapy is a complete,
versatile modality in which theory and
practice are completely aligned for
achieving the new level of
effectiveness that is needed if therapy
is to be deep and brief.”
(Ecker & Hulley, 2002)
8. History
1960s: progressive,
nonpathologizing
brief therapies
(emphasis on
speed)
Backlash against
longstanding
Freudian/psycho-
analytic monopoly
on in-depth therapy
9. History
1960s: progressive,
nonpathologizing
brief therapies
(emphasis on
speed)
Backlash against
longstanding “The Unconscious”—
Freudian/psycho- only recently (1990s)
analytic monopoly liberated from the
on in-depth therapy psychoanalytic school
of thought
11. History: DOBT
1980s & 1990s: Bruce Ecker and Laurel
Hulley, “Why do certain sessions produce
deep, lasting change and symptom
cessation, while most do not?”
12. History: DOBT
1980s & 1990s: Bruce Ecker and Laurel
Hulley, “Why do certain sessions produce
deep, lasting change and symptom
cessation, while most do not?”
Transformative sessions = experiential + pro-
symptom attitude + emotional truth
13. History: DOBT
1980s & 1990s: Bruce Ecker and Laurel
Hulley, “Why do certain sessions produce
deep, lasting change and symptom
cessation, while most do not?”
Transformative sessions = experiential + pro-
symptom attitude + emotional truth
Swift occurrence = Depth-Oriented Brief
Therapy (DOBT)
14. History: DOBT
1980s & 1990s: Bruce Ecker and Laurel
Hulley, “Why do certain sessions produce
deep, lasting change and symptom
cessation, while most do not?”
Transformative sessions = experiential + pro-
symptom attitude + emotional truth
Swift occurrence = Depth-Oriented Brief
Therapy (DOBT)
2005: Coherence Therapy
25. Emotional Truth
Definition
“the underlying, unconscious emotional schema
that compellingly requires the client’s symptom
or problem, despite the suffering entailed in
having it” (Ecker, 2008)
26. Emotional Truth
Definition
“the underlying, unconscious emotional schema
that compellingly requires the client’s symptom
or problem, despite the suffering entailed in
having it” (Ecker, 2008)
“specific, unconscious personal themes,
knowings and purposes that, in one way or
another, powerfully and passionately require
having the presenting symptom, even though
consciously the client wants so much not to have
it.” (Ecker & Hully, 2002)
27. Emotional Truths: Example
“Adam” from video
Symptom: yearly depression (end of August),
irritability at work
ET #1: It was so awful for me [in Sweden] that, to
this day, I get very unhappy at the end of
summer.
ET #2: “I’m really not what you [parents] think I
am, and I dread that you’ll find out, be
disappointed in me, give up on me and cut off
from me. To keep that from happening, I’ll do
anything, including faking it.
28. What Coherence Therapy
Is Not
Other brief therapies attempt to prevent
the client’s debilitating symptom with:
Override
Counteract
More rational beliefs
Insightful interpretations
Better narratives
Clever reframes
29. The Science of Depth Therapy
Depth therapies
— engage the
limbic system.
vs.
Surface work—
engages the
neocortex.
30. Current Brain Research
The old biology: Consolidation (Ecker, 2008)
1997–2000: Stimulation + implicit memory
triggered + synapses unlock + can be
disrupted + erasure of implicit memory = old
responses/BHs can’t be re-evoked.
(Cozolino, 2006; Lipton, 2005;
Siegel, 2007)
31. Cultural and Ethical Issues
“Everyone, from every cultural and
economic group, has the native ability
to place attention in those emotional
truths and experience them. This
makes CT applicable with diverse
populations.”
(Coherence Psychology Institute, 2009)
32. Side Effects
Clients with trauma/PTSD: therapist must be
prepared to deal with possible traumatic
memories.
Client determination: Never push a client
who is not ready or willing to go into the
unconscious. Use of the unconscious can be
a powerful tool, and therapists must remain
sensitive to that.
36. Boundary Spanning
Littrell, 2008:
Psychotherapy enhances the body’s
ability to combat disease.
Stress suppresses a body’s ability to fight
illnesses of all sorts (i.e., cancer).
37. Boundary Spanning
Littrell, 2008:
Psychotherapy enhances the body’s
ability to combat disease.
Stress suppresses a body’s ability to fight
illnesses of all sorts (i.e., cancer).
Psychological distress slows a person’s
ability to heal physically.
38. Boundary Spanning
Littrell, 2008:
Psychotherapy enhances the body’s
ability to combat disease.
Stress suppresses a body’s ability to fight
illnesses of all sorts (i.e., cancer).
Psychological distress slows a person’s
ability to heal physically.
Vaccinations are less effective in
individuals dealing with mental distress.
39. Boundary Spanning (cont’d)
Health
Work
Relationships
Spirituality
Case Studies
Albert’s chronic tension (Ecker, 2003)
Adrienne’s musculature, weight, optimism
(Ecker & Hulley, 2002)
40. How to Become
a Coherence Therapist
Online short courses
Training & certification
program
Case consultation
Graduate degrees highly
encouraged but not
required
www.coherencetherapy.org
41. Coherence Psychology Institute (2009). What Is Coherence
Therapy? Retrieved March 14, 2009, from http://
www.coherencetherapy.org/discover/what.htm
Cozolino, L. (2008). The Neuroscience of Human
Relationships: Attachment and the Developing Brain. New
York, NY: W. W. Norton & Co.
Ecker. B. (2008, Sep/Oct). Unlocking the Emotional Brain.
Psychotherapy Networker, 32, 42–47.
Ecker, B. (2006, October). Teaming up with the brain’s hidden
rules for change. Psychotherapy Networker Symposium West,
San Franciso, CA.
Ecker, B. (2003, Nov/Dec). The hidden logic of anxiety: look for
the emotional truth behind the symptom. Psychotherapy
Networker, 27, 38–43.
42. References
Coherence Psychology Institute (2009). What Is Coherence
Therapy? Retrieved March 14, 2009, from http://
www.coherencetherapy.org/discover/what.htm
Cozolino, L. (2008). The Neuroscience of Human
Relationships: Attachment and the Developing Brain. New
York, NY: W. W. Norton & Co.
Ecker. B. (2008, Sep/Oct). Unlocking the Emotional Brain.
Psychotherapy Networker, 32, 42–47.
Ecker, B. (2006, October). Teaming up with the brain’s hidden
rules for change. Psychotherapy Networker Symposium West,
San Franciso, CA.
Ecker, B. (2003, Nov/Dec). The hidden logic of anxiety: look for
the emotional truth behind the symptom. Psychotherapy
Networker, 27, 38–43.
43. Ecker, B., & Hulley, L. (2002, July/Aug). DOBT toolkit for in-
depth effectiveness: methods & concepts of depth-oriented
brief therapy. New Therapist, 20, 24–29.
Ecker, B. & Hulley, L. (2002, Jan/Feb). Deep from the start:
profound change in brief therapy is a real possibility.
Psychotherapy Networker, 26, 46–51.
Ecker, B. & Hulley, L. (2000). A new effectiveness for
psychotherapy. New Therapist, 6, 31–33.
Ecker, B. & Hulley, L. (1996). Depth Oriented Brief Therapy:
How to Be Brief When You Were Trained to Be Deep, and Vice
Versa. San Francisco: Jossey-Bass.
Ecker, B. & Toomey, B. (2008). Depotentiation of symptom-
producing implicit memory in coherence therapy. Journal of
Constructionist Psychology, 21, 87–150.
Lipton, B. (2005). The Biology of Belief: Unleashing the Power
of Consciousness, Matter, & Miracles. Santa Rosa, CA:
Mountain of Love / Elite Books.
44. Littrell, J. (2008). The mind-body connection: not just a theory
anymore. Social Work in Health Care, 46, 17–30.
Siegel, D. J. (2007). New York, NY: W. W. Norton & Co.
Toomey, B. & Ecker, B. (2009). Competing visions of the
implications of neuroscience in psychotherapy. Journal of
Constructionist Psychology, 22, 95–140.
Toomey, B. & Ecker, B. (2007). Of neurons and knowings:
Constructivism, coherence psychology, and their neurodynamic
substrates. Journal of Constructionist Psychology, 20, 201–
245.
Editor's Notes
\n
“For therapy to be brief, depth must be sacrificed--according to assumptions that have prevailed in the world of psychotherapy for almost a century. Under managed care, on the staff of a counseling center, or in private practice, most brief therapist avoid clients’ deeper, unconscious themes. Consequently many clinicians feel a serious deterioration in both the quality of services rendered and in professional satisfaction. \n\nSwift, focused, in-depth therapy with individuals, couples, and families turns out to be a very real option, however. The approach described here, Coherence Therapy, is a complete, versatile modality in which theory and practice are completely aligned for achieving the new level of effectiveness that is needed if therapy is to be deep and brief.”\n
“For therapy to be brief, depth must be sacrificed--according to assumptions that have prevailed in the world of psychotherapy for almost a century. Under managed care, on the staff of a counseling center, or in private practice, most brief therapist avoid clients’ deeper, unconscious themes. Consequently many clinicians feel a serious deterioration in both the quality of services rendered and in professional satisfaction. \n\nSwift, focused, in-depth therapy with individuals, couples, and families turns out to be a very real option, however. The approach described here, Coherence Therapy, is a complete, versatile modality in which theory and practice are completely aligned for achieving the new level of effectiveness that is needed if therapy is to be deep and brief.”\n
“For therapy to be brief, depth must be sacrificed--according to assumptions that have prevailed in the world of psychotherapy for almost a century. Under managed care, on the staff of a counseling center, or in private practice, most brief therapist avoid clients’ deeper, unconscious themes. Consequently many clinicians feel a serious deterioration in both the quality of services rendered and in professional satisfaction. \n\nSwift, focused, in-depth therapy with individuals, couples, and families turns out to be a very real option, however. The approach described here, Coherence Therapy, is a complete, versatile modality in which theory and practice are completely aligned for achieving the new level of effectiveness that is needed if therapy is to be deep and brief.”\n
1960s: progressive movement; more client-centered, shunned “the unconscious”\n\nThe new breed of therapists during this time railed against working with unconscious, intra-psychic process, unverifiable interpretations, the therapist as authoritarian, pathologizing, preoccupation with the past, monumental goals, the “snail’s pace of change,” and “dubious effectiveness.\n
1960s: progressive movement; more client-centered, shunned “the unconscious”\n\nThe new breed of therapists during this time railed against working with unconscious, intra-psychic process, unverifiable interpretations, the therapist as authoritarian, pathologizing, preoccupation with the past, monumental goals, the “snail’s pace of change,” and “dubious effectiveness.\n
1960s: progressive movement; more client-centered, shunned “the unconscious”\n\nThe new breed of therapists during this time railed against working with unconscious, intra-psychic process, unverifiable interpretations, the therapist as authoritarian, pathologizing, preoccupation with the past, monumental goals, the “snail’s pace of change,” and “dubious effectiveness.\n
In the 1980s and 1990s, Ecker and Hulley began to ask of themselves, why do certain sessions produce deep, lasting personal change and symptom cessation, while others do not? They studied recordings and transcripts from their own sessions for about a decade and began to notice that, in the most transformative sessions, the therapist has NOT done anything to oppose or counteract the symptom, and that the mode of the session was more experiential (felt experience), so that some previously unrecognized “emotional truth” became evident, which was making the symptom necessary to have.\n\nThey found that the majority of their clients were able to get to their “emotional truth” and experience the coherence of their symptoms in just the first session. So they named it DOBT.\n\nIn 2005, Ecker and Hulley renamed it Coherence Therapy, to reflect the central principle of the approach, and because of the association of the phrase 'brief therapy' with depth-avoidant methods\n\n*** PLAY VIDEO!\n\nTherapist training: a man volunteers for demo. His presenting problem is that at the same time every year, end of summer, this man experiences depression. He also notices that he becomes irritable at work and doubts his abilities as an employee. He becomes short, impatient, and gets into power plays with coworkers and his boss. Bruce asks him if anything traumatic ever happened to him at this time of year, and the client remembers that when he was 10 years old, his parents sent him off to Sweden to visit relatives then to attend board school. \n
In the 1980s and 1990s, Ecker and Hulley began to ask of themselves, why do certain sessions produce deep, lasting personal change and symptom cessation, while others do not? They studied recordings and transcripts from their own sessions for about a decade and began to notice that, in the most transformative sessions, the therapist has NOT done anything to oppose or counteract the symptom, and that the mode of the session was more experiential (felt experience), so that some previously unrecognized “emotional truth” became evident, which was making the symptom necessary to have.\n\nThey found that the majority of their clients were able to get to their “emotional truth” and experience the coherence of their symptoms in just the first session. So they named it DOBT.\n\nIn 2005, Ecker and Hulley renamed it Coherence Therapy, to reflect the central principle of the approach, and because of the association of the phrase 'brief therapy' with depth-avoidant methods\n\n*** PLAY VIDEO!\n\nTherapist training: a man volunteers for demo. His presenting problem is that at the same time every year, end of summer, this man experiences depression. He also notices that he becomes irritable at work and doubts his abilities as an employee. He becomes short, impatient, and gets into power plays with coworkers and his boss. Bruce asks him if anything traumatic ever happened to him at this time of year, and the client remembers that when he was 10 years old, his parents sent him off to Sweden to visit relatives then to attend board school. \n
In the 1980s and 1990s, Ecker and Hulley began to ask of themselves, why do certain sessions produce deep, lasting personal change and symptom cessation, while others do not? They studied recordings and transcripts from their own sessions for about a decade and began to notice that, in the most transformative sessions, the therapist has NOT done anything to oppose or counteract the symptom, and that the mode of the session was more experiential (felt experience), so that some previously unrecognized “emotional truth” became evident, which was making the symptom necessary to have.\n\nThey found that the majority of their clients were able to get to their “emotional truth” and experience the coherence of their symptoms in just the first session. So they named it DOBT.\n\nIn 2005, Ecker and Hulley renamed it Coherence Therapy, to reflect the central principle of the approach, and because of the association of the phrase 'brief therapy' with depth-avoidant methods\n\n*** PLAY VIDEO!\n\nTherapist training: a man volunteers for demo. His presenting problem is that at the same time every year, end of summer, this man experiences depression. He also notices that he becomes irritable at work and doubts his abilities as an employee. He becomes short, impatient, and gets into power plays with coworkers and his boss. Bruce asks him if anything traumatic ever happened to him at this time of year, and the client remembers that when he was 10 years old, his parents sent him off to Sweden to visit relatives then to attend board school. \n
In the 1980s and 1990s, Ecker and Hulley began to ask of themselves, why do certain sessions produce deep, lasting personal change and symptom cessation, while others do not? They studied recordings and transcripts from their own sessions for about a decade and began to notice that, in the most transformative sessions, the therapist has NOT done anything to oppose or counteract the symptom, and that the mode of the session was more experiential (felt experience), so that some previously unrecognized “emotional truth” became evident, which was making the symptom necessary to have.\n\nThey found that the majority of their clients were able to get to their “emotional truth” and experience the coherence of their symptoms in just the first session. So they named it DOBT.\n\nIn 2005, Ecker and Hulley renamed it Coherence Therapy, to reflect the central principle of the approach, and because of the association of the phrase 'brief therapy' with depth-avoidant methods\n\n*** PLAY VIDEO!\n\nTherapist training: a man volunteers for demo. His presenting problem is that at the same time every year, end of summer, this man experiences depression. He also notices that he becomes irritable at work and doubts his abilities as an employee. He becomes short, impatient, and gets into power plays with coworkers and his boss. Bruce asks him if anything traumatic ever happened to him at this time of year, and the client remembers that when he was 10 years old, his parents sent him off to Sweden to visit relatives then to attend board school. \n
VIDEO!!!!\n
Theoretical underpinnings:\n\n1. The symptom is necessary--despite the suffering it enduces, it is necessary in order to disguise or cope with an unconscious reality that may feel, to the unconscious, far more painful.\n2. The symptom is cogent--it makes complete sense when you uncover the reason for the symptom. It was formed as a way to adapt or respond to an earlier, painful experience.\n3. Once the client no longer experiences the “reality” in which the symptom was necessary to have, the symptom dissipates.\n
Theoretical underpinnings:\n\n1. The symptom is necessary--despite the suffering it enduces, it is necessary in order to disguise or cope with an unconscious reality that may feel, to the unconscious, far more painful.\n2. The symptom is cogent--it makes complete sense when you uncover the reason for the symptom. It was formed as a way to adapt or respond to an earlier, painful experience.\n3. Once the client no longer experiences the “reality” in which the symptom was necessary to have, the symptom dissipates.\n
Theoretical underpinnings:\n\n1. The symptom is necessary--despite the suffering it enduces, it is necessary in order to disguise or cope with an unconscious reality that may feel, to the unconscious, far more painful.\n2. The symptom is cogent--it makes complete sense when you uncover the reason for the symptom. It was formed as a way to adapt or respond to an earlier, painful experience.\n3. Once the client no longer experiences the “reality” in which the symptom was necessary to have, the symptom dissipates.\n
Theoretical underpinnings:\n\n1. The symptom is necessary--despite the suffering it enduces, it is necessary in order to disguise or cope with an unconscious reality that may feel, to the unconscious, far more painful.\n2. The symptom is cogent--it makes complete sense when you uncover the reason for the symptom. It was formed as a way to adapt or respond to an earlier, painful experience.\n3. Once the client no longer experiences the “reality” in which the symptom was necessary to have, the symptom dissipates.\n
In session, instead of talking ABOUT an experience the client had during the week, she will speak of the experience IN THE MOMENT.She will re-experience it in session, subjectively. The client brings to mind any recent moment in which she experienced the troubling/presenting symptom, and imagine being again in the one of the most recent scenes where it occurred. The client can close her eyes and visualize being in the scene. Typically, the symptom (panic, depression, etc) will then emerge in the session.\n\n“Bruce first asked Tina to reenter a recent situation in which se had felt depressed. Rather than merely getting her to talk “about” her symptoms, Bruce guided her toward directly experiencing them so that the underlying themes and constructs sustaining them could more readily be brought into awareness. He asked questions rich in concrete cues: ‘Where are you sitting? What time of day is it? What are you wearing? How does your body feel on the chair?’” (Ecker & Hulley, 2002)\n
Emotional truth: “the underlying, unconscious emotional schema that compellingly requires the client’s symptom or problem, despite the suffering entailed in having it”\n\n“specific, unconscious personal themes, knowings and purposes that, in one way or another, powerfully and passionately require having the presenting symptom, event though consciously the client wants so much not to have it.”\n
Emotional truth: “the underlying, unconscious emotional schema that compellingly requires the client’s symptom or problem, despite the suffering entailed in having it”\n\n“specific, unconscious personal themes, knowings and purposes that, in one way or another, powerfully and passionately require having the presenting symptom, event though consciously the client wants so much not to have it.”\n
Emotional truth: “the underlying, unconscious emotional schema that compellingly requires the client’s symptom or problem, despite the suffering entailed in having it”\n\n“specific, unconscious personal themes, knowings and purposes that, in one way or another, powerfully and passionately require having the presenting symptom, event though consciously the client wants so much not to have it.”\n
\n
These methods treat the symptom like a demon we are trying to drive out of the client. CT focuses instead on learning from the client why their depression, panic attacks, story relationships, or obsessions are somehow necessary.\n\nBrief psychotherapists want to reduce unwanted behaviors, moods, or thoughts that arise from emotional learnings by suppressing them or counteracting them--building up new separate learnings and responses. COUNTERACTING, a characteristic common to CBT, includes any direct attempt to make a symptom happen less and some preferred pattern happen more.\n\nBUT, this pits the conscious self and its resources against an underlying self and its implicit symptom-inducing knowledge. This increases internal conflict and the sense of having a divided self, still leaving the person vulnerable to having old responses re-evoked. \n
Unconscious, core material is stored in the limbic system. Until the limbic system and this core material is accessed, beliefs and behaviors remain in the unconscious, which puts the client at risk for slipping back into patterned behavior. \n
There currently are no peer-reviewed empirical articles in existence regarding Coherence Therapy. However, current brain research seems to support the claims that Eckert and Hulley are making about how Coherence Therapy works.\n\nUntil a few years ago, it was believed that truly dissolving schemas in the unconscious was impossible. It was believed that when a new emotional learning was first installed in stable, long-term (consolidation), its neural circuits in the limbic system are there permanently. Experts believed the synapses forming the circuits were locked in place. \n\nFrom 1997 to 2000, studies demonstrated that when an implicit scheme gets triggered by an event in the present environment, synapses holding the schema in place can unlock for a brief period of time. Then they relock, reconsolidating memory circuits. While these synapses are unclocked, however, they can be disrupted (by experiential therapy, for example) so that relocking is prevented. As a result, the implicit memory and behavioral responses to the memory are erased and can never be re-evoked.\n
Read quote.\n\nHowever, I would like to urge you to remain sensitive to ethnic and cultural differences, as we have been taught in this MSW program. Ask your clients what they’re comfortable with. Assess how they feel doing depth work. Hispanic populations, for example, may not appreciate this type of therapy due to stigma in their society regarding mental illness.\n
Tell anecdote of my client who got antsy every time I invited him to become experiential.\n
\n
\n
\n
\n
\n
Albert: “Banned from awareness, Albert’s anxieties found expression in his body. He described bands of chronic tension throughout his torso and neck.”\n\nAdrienne: Post-intervention, “she indicated the degree of her change in mood by pointing out that she had to readjust her car’s rear-view mirror because her posture and walk had changed and become more upright. A friend was struck by the new look of vitality she saw in Adrienne’s face. This kind of neuromuscular release in the body is an important indicator of the real depth of the psychological work.\n“I’ve lost 25 pounds, and even my handwriting has changed. And perhaps more important, I find I am now basically an optimist.”\n\n***The research I’ve done has yielded no information regarding side effects except for the positive ones I’ve just described.\n
Online short courses--session video segments and interactive training exercises; online pages, videos with transcripts; each course varies in level of difficulty (beginner vs. advanced/more challenging)\nTraining & certification--includes two units of individual practicum (55-minute sessions by phone), two units of group practicum (which can be conference calls), two additional units of either individual or group practicum, and an assessment of an hour’s worth of one or several recorded sessions; go at your own pace; must be trained by at least 3 certified trainers; manual and textbook\n
