Psychotherapists can help us make breakthroughs in dealing with depression, but often the insights gained during a session don’t lead to permanent change. Why is it that we can’t always put the new insight into daily use and sometimes forget it as soon as we’re out of the room? That’s the problem that a new approach, called coherence therapy, tries to solve.
Like the work that led to focusing oriented therapy, the coherence concept came from the investigation of two therapists, in this case, Bruce Ecker and Laurel Hulley, trying to find out why it was that some of their clients could achieve profound and permanent change in a brief period while most did not. What set these successes apart?
A Pattern of Profound Change
They found a pattern common to all the breakthrough experiences across a wide variety of cases and conditions. Later they found evidence supporting their approach in neuroscience research on the ways the mind could undo emotional memory patterns that had long been thought to be permanent. They summarize this research as well as the steps in coherence therapy in their new book, Unlocking the Emotional Brain.
The first steps in the process they identified sound familiar enough. Clients come in with deep depression or other disorder and feel completely controlled by it. The first step is to work with the client to get them to reproduce the experience of depression by stepping into a typical situation that seems to trigger the problem, or simply relive a moment to capture the full effect of depression if there is no triggering mechanism.
Reliving rather than talking about the symptoms is important to bring the client into the deepest feelings of the experience and to allow the therapist to see behaviorally, emotionally and intellectually exactly what happens.
The idea is that the depression is part of a well-defined pattern of response that the client developed in early life as a protective mechanism to deal with emotional pain, rejection, abuse, isolation or whatever the situation might have been. That’s a familiar concept in my own therapy, but the difference is that I usually describe my depression in a detached way rather than reproduce and relive the experience.
By working with clients in re-entering the dramatic experience of the problem, the therapist tries to drive home why this behavior feels so inevitable. What purpose does it serve? What greater problem is avoided by the intervention of depression and all its debilitating symptoms?
How Depression Can Serve a Purpose
The first breakthroughs come when clients can grasp on an emotional level that this is purposeful behavior, a coherent, well-constructed response to a type of situation and potential danger that first arose in early years. The pattern established itself spontaneously without conscious effort and entered a deep level of implicit memory below ordinary awareness.
That is why it seems so overwhelming, as if it were imposed from without, a force the person can’t control. Now they can see that there is a form and point to the pattern. The benefit of protection from whatever the threat might be, however, comes at the high price of crippling life in many other ways.
In one case, Ecker describes a woman who had shut down completely in deep depression and no longer felt any connection to her family. He worked with her through three or four sessions to relive a series of experiences until she could uncover the core purpose of this behavior going back to early life. At first, shutting down emotionally seemed to be a response to protect her from the hostile reactions of her parents. It was a way of keeping herself safe, and realizing this marked a turning point for her. Yet there was a lot more to it than that.
By revisiting other memories and also testing her reactions to sensitive situations in the present, she went deeper until confronting the basic problem of having no boundaries with her parents. Her mother seemed to take anything of emotional value from her and appropriate it as her own. It wasn’t until she hit that ultimate problem of protecting her sense of who she was as a person that something shifted in a lasting way.
To be able to see depression as a coherent strategy for protecting her selfhood made sense of the behavior but also made it unnecessary. She had achieved a distance from depressive behavior so that she could plainly observe how and why it had served her but also see the unacceptable loss of satisfaction in life that the strategy entailed.
Change Takes More than Talk
The way therapists usually try to change a pattern like this is to help the client develop a counteracting one that is much more beneficial. The idea is that with practice these new patterns can take the place of the old. However, this approach often doesn’t hold up over time. Relapse is common because the old pattern, still present and deeply embedded in implicit memory, reasserts itself and seems to obliterate even the recollection of the new strategy.
Ecker found that the necessary step was to help the client have experiences that prove on an emotional level to the client that the old schema is no longer necessary or helpful, that disproves its value completely. In that way, and only in that way, can the implicit memory link that unconsciously drives behavior be erased.
It’s like the memory reprocessing in EMDR, and Ecker sees coherence therapy as a framework that can be applied through a number of other therapeutic methods that have emerged in the last twenty years, including EMDR.
Ecker describes in several case studies that clients like the depressed woman may have to go through many breakthrough experiences before reaching the deepest pattern that reveals the original motive for a protective strategy. Then the client, with the new understanding of the behavior, needs to have new experiences, whether in the therapist’s office or in daily life situations, that dramatically bring home the realization that the pattern is pointless.
Ecker believes that most breakthroughs in therapy don’t last because they lack the necessary follow-up to reprocess the deeply embedded memories they challenge. They take place initially during an altered state of heightened consciousness and awareness, arrived at with the help of a therapist. To take a deeper hold by erasing old remembered patterns, clients need to experience the change as part of everyday life as well.
He also emphasizes the importance of imprinting the new knowledge by having the client come up with phrases that make emotional sense to him and repeat them several times. He has clients write down these phrases to keep them visible during the day so they can be repeated and referred to often. We’ve all had the experience of forgetting something of this sort that was so powerful when grasped in a therapy session. Ecker’s methods address that problem.
When the deepest breakthroughs occur and are reinforced by everyday experience, then clients see the old patterns as completely meaningless, bizarre, even funny. Those behaviors have completely lost their links to the deepest levels of emotional remembrance and no longer have an unconscious hold on their lives.
This is powerful stuff that makes a lot of sense to me. I continue to be plagued, even now, with behavior patterns that seem to control me and go directly counter to the values I hold about the life I want to lead. The coherence approach may be another powerful tool for gaining a greater sense of self-mastery, the feeling that I am choosing what I do rather than being driven by unconscious forces.
To what extent do you feel locked into patterns of behavior that never change? How have you been able to deal with them?