What is coherence therapy and how does it work?

Often, we enter therapy and bring with us a list of all of our problems – things we want to change about ourselves or things that are easily pathologized as some kind of disorder. Coherence Therapy (CT) leans on the premise that these “problems” are often well-designed solutions to some other pain or suffering that is rooted in the past. Viewed through the lens of Coherence Therapy, our problematic symptoms are functional and adaptive, serving some kind of protective purpose, even if that function is unconscious. 

What is the main focus of coherence therapy?

The focus of Coherence Therapy is to:

• Help discover what makes these “problems” emotionally necessary,

• Identify the unconscious cost of not having these “problems,” and

• Find contradictory knowledge that can eliminate the need for such suffering. 

This can generate profound change and even completely remove problematic ways of thinking, feeling, and behaving! 

What is Coherence Therapy?

Coherence Therapy was developed over the last 30 years by Bruce Ecker and Laurell Hulley. The methodology guides people to uncover- for themselves and alongside their therapist- the implicit (outside of awareness) emotional learnings that underpin their current problematic ways of thinking, feeling, or behaving.

Emotional learnings are mental models we hold about how the world works. We often learn these at a very young age, and they are often unconscious. We usually don’t think about them, but they guide how we move through the world. And, they are often the root cause of problematic emotional experiences such as depression, anxiety, low self-worth, anger, and guilt, etc.

For example, an emotional learning that could lead to depression could look like this: a young boy, in expressing his emotional world to his father, was repeatedly told “boys don't cry, showing emotion means you're weak.” This could be internalized as “if I show emotion, I will be rejected, not only by my father but by everyone. In order to stay connected to people, I'd better not express myself.” In an attempt to avoid expressing himself, this young man held in all of his emotions all the time, of course, leading to depression.

Once unconscious emotional learnings are felt, at a deep level, and brought to consciousness, there is a window of opportunity to update these knowings, which can eliminate symptoms altogether. This is known as memory reconsolidation, which is the brain's natural way of updating or changing deeply held unconscious beliefs, and guides the work of a CT therapist. Emotional learnings can be updated with contradictory knowledge which in turn eliminates the necessity of the symptom.

We often have many experiences that directly contradict emotional learnings, but they aren’t fully taken in as such, so don’t naturally update until the original mental model is felt and experienced, thus making room for new knowledge to take hold.

What is an example of memory reconsolidation?

If we consider the young man above, once his emotional learning has been fully retrieved, brought into consciousness and integrated – “I have to never express any feelings, to anyone, to keep me safe from rejection. I know that if I express myself, I'll be seen as weak. It’s safer not to express any emotions than it is to risk being rejected like I was with my dad, and I have to assume everybody is like him” – we can start to look for disconfirming knowledge. Disconfirming knowledge is evidence that our previously held beliefs are not true, or at least not as global/black or white.

In the case of the young man with depression, disconfirming knowledge could be found by simply asking if, in his life, he had experienced anyone inviting him to speak deeply and freely about his emotions, in a way that felt safe and wasn’t rejected.

Once contradictory knowledge is found and felt at a deep level (as was the case with the target emotional learning), the therapist guides the client back and forth between the original knowing and the new knowing, allowing the brain to update the original emotional learning with the new knowledge. 

Coherence therapy steps

An initial session in CT would look at understanding what difference the client would like to make in their life. Often this involves fleshing out a particular problem someone may be facing in daily life, such as anxiety or depression. Time is spent clarifying what this means for the client and how it shows up in their life on an experiential level, getting as specific as possible- every person's experience of a symptom is entirely unique to them, and no assumptions can be made.

This means rather than just discussing the problem, the client is guided to connect with what it feels like to experience the problem in the moment it is occurring. This is often accomplished by recalling recent moments where the problem has been particularly potent. Rather than trying to counteract or push away a problem, the therapist leans on the sense that the problem is emotionally necessary to have on some level.

From there, the therapist will discover, along with the client, why it is emotionally necessary to maintain this problem and what suffering comes if this problem doesn’t exist. This is referred to as the “pro-symptom position” (PSP), meaning that somewhere inside us, the problem is actually protective and functional. There are a number of ways to guide this discovery work, and much of this is based on the therapist being attuned to any statements made by the client that hint at a PSP, and deepening into these experientially.  

Once the client has fully embraced and integrated the discovered emotional learning, and is fully conscious of the pro-symptom position (why the symptom is necessary), the therapist can explore and guide the client to reveal some kind of contradictory knowledge. Essentially, has the client had any experience that directly contradicts the emotional learning generating the problem pattern (the symptom)?

As mentioned, contradictory knowledge can be found in past experiences the client has already had but not integrated, in experiences the client has between sessions, or even generated through internal work that the client does to connect with themselves in a new way – for example, inner child work or structured revisiting of a traumatic memory. The client’s relationship with the therapist could also provide a disconfirming experience that can help update emotional learning if juxtaposed with the original emotional learning.

In order for CT to be effective, we have to be speaking “in” and “from” the experience, rather than talking “about” it. Experiences are what generate emotional learning in the first place, and an experience is what is required to update these knowings.

Throughout the entire process, the clinician works on the basis of emotional coherence – that is, assuming that all clients’ symptoms make sense on a deep and personal level, and that on some level, these symptoms developed as solutions. 

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