A.: Changing the subject a little bit, going to training and supervision. We would like to know how do you conceive it. Which are for you the main steps toward the making of a good coherence therapist?

 

B.: Well actually there are a number of important components that all work together that a trainee needs to develop skill for. Working experientially is one, a very important one and that is, again, very much about the difference between talking about the emotional themes of the client versus having the client actually drop into the live experience of those emotional themes in the room in the moment. Another important training area is the ability to stay coherence-focused throughout the session, and we mean something very specific by that. Coherence Therapy focuses from start to finish on guiding the client toward and into the direct experience of how a given symptom is actually emotionally necessary to have. So many therapies take a rather opposite strategy of trying to help a person get away from, disconnect from, avoid both the symptom as well as the underlying material generating the symptom and causing all the trouble. Coherence Therapy perhaps counterintuitively heads directly toward and into that underlying material requiring the symptom, and that’s what we mean by coherence-focused. And so, for a therapist to maintain that way of thinking and that way of listening all throughout a session turns out to be a special skill.

 

Along with that is the skill of communicating what we call coherence empathy to the client. The work needs to be empathic. Empathy can be focused in several different places. The empathy most familiar to therapists is empathy for the experience of having the symptom, the particular distress or hardship that comes in the experience of the symptom. Then there is also empathy for what we call the client’s anti-symptom position, the wish to be rid of the symptom, hatred of the symptom, the client’s wish to be rid of the suffering of having the symptom—that is anti-symptom empathy. Coherence empathy includes those two kinds of empathies, because it’s very important to join with the client’s terrible experience of a symptom and the wish to be rid of it. In addition the coherence therapist again and again expresses coherence empathy, which is empathy for how the symptom is actually very necessary to have, for reasons that emerge very clearly, despite the suffering that truly comes with it. A.: How mature or clinically educated should a coherence therapist be in order to accomplish good sessions? Do you believe we can teach Coherence Therapy to young psychotherapists or do we need more experienced ones?

 

 

B.: It’s learnable by therapists at every level of experience including graduate students who have little or no clinical experience yet, and we’ve seen this in various graduate programs. In fact we hear very inexperienced therapists reporting to us words such as “even though I’m fumbling around with Coherence Therapy and really don’t feel I’m doing this smoothly or know how to find my way, even this clumsy application of it is getting remarkable effects”.

 

A.: You and Laurel Hulley have put a lot of work into writing a Coherence Therapy practice manual and I think you did a very good job, however manuals sometimes have, as you know, the power to keep therapists distracted from clients, because they want to follow the manual and they forget the client, they forget that the map it is not the territory, since Korzybski. They get too focused on techniques and don’t see the bigger picture. How much does Coherence Therapy risk being misunderstood as a constructivist approach by being manualized?

 

B.: Any system can be misconstrued in all sorts of ways. Coherence Therapy is a fairly complex system and there’s never any guarantee of it being properly understood if someone is trying to learn it only from the manual without guidance. We emphasize when we are teaching Coherence Therapy that it is not defined by specific techniques. It is defined by a methodology, not a set of techniques, and within that methodology it’s open-ended in terms of what techniques can be used to carry out the methodology. We emphasize this and yet we have seen some people take one of the techniques that we teach and use that one technique over and over in a rather mechanical way, thinking this is Coherence Therapy. But therapists who get training in our program are soon guided out of such misunderstandings.

 

A.: I’d like to come back to your Carl Jung influence and ask you, does a good Coherence Therapy session require a “good client” in the sense of someone with emotional intelligence and able to follow his own emotional experience. And does it require the client to have a clear-cut, functional symptom? In these two ways, how much do you think Coherence Therapy needs special clients with specific problems? What is the applicability of this model?

 

B.: It’s applicable with a very wide range of people and client populations. It is completely applicable with people who are not self-aware, growth-oriented, or psychologically aware. The therapist guides the client into having experiences. The therapist is free to adjust his or her style and techniques to the individual client and has to come up with ways to apply the methodology with the individual. So two sessions that I do in my office, one after another, can look and feel very different in style and pace and ways of communicating, and yet I’m carrying out the same methodology. With someone who is very self-aware and growth-oriented I’ll work in rather different ways than with someone who is not, and yet both will be guided into the direct experiences of their own underlying material. Everyone is living from their own unconscious themes and purposes—they are right there in the room and we have to know how to get people in touch with these things. There are many ways of doing so.

 

A.: This leads us to the question of the symptom, the functional symptoms in a Jungian way too. In Coherence Therapy is there the assumption that every problem has its own pro-symptom position? Putting this in another way: do you believe every symptom is always functional? Don’t you believe in “accidentalism” which stands for the hypothesis that diseases are an accidental modification of the health condition?

 

B.E.: Coherence Therapy does not view all symptoms as functional. It identifies two broad types of symptoms: functional and functionless. Even functionless symptoms are coherent, however, in the following sense. A functionless symptom is a symptom that does not do something of value or get some need met. Every functionless symptom exists as a byproduct, an orderly byproduct of something else that is functional and is needed unconsciously according to some pro-symptom position of the client. The therapist cannot know initially whether the symptom has a function—is doing something needed—or is functionless. There is no way to deduce which type the symptom is, so the coherence therapist does not try to theoretically figure that out. What happens instead is that the experiential process of Coherence Therapy reveals the underlying material giving rise to the symptom and it becomes apparent which type it is, not speculated or theorized. 

A simple example is a client whose presenting symptom is an inability to fall asleep—insomnia—and the chronic fatigue this is causing. Then it gets revealed in therapy that all the time, all day long, she maintains either obsessive thinking or compulsive activity, which are needed because if she is quiet and sits still, she starts to feel intolerable feelings and body memory, stemming from what she suffered in being molested as a child. Her obsessive thinking and compulsive activity are functional symptoms that shield her from feeling her unresolved ordeals, and those symptoms in turn cause the byproduct of being unable to sleep, because sleep requires a quieting of the mind, which she must avoid. For her, staying awake and being tired were not meeting some need and had no function in themselves.  But for some other client, staying awake could have a function in itself, such as maintaining hypervigilance. It becomes directly apparent from the client’s revealed material whether the symptom is itself carrying out an important function that has great necessity or whether the symptom is a byproduct of something else which in itself has a function and is doing something necessary. What is called “accidentalism” we think corresponds to what we see as functionless symptoms produced as necessary byproducts of functional symptoms that clients might not present or even be aware of.