Coherence Therapy 
 

This Interview took place in Lisbon, the 20 May 2009, at the International Seminar & Workshop on Coherence Therapy, and to be published at Psiquilibrios Editions April 2010

Part II

 
 


 
 
A.: Do you see any risk that Coherence Therapy loses its power as a method, as a system of therapy and a methodology as people get familiar or educated in it, or on the contrary? How do you see this?

B.E.: If you are asking whether Coherence Therapy in some way loses its effectiveness because clients become familiar with how it works, no, definitely not. I’ve had many clients who get quite familiar with Coherence Therapy and come back after months or years to work on something else, as well as clients who stay with me, with no gap, and work on some new problem or symptom after the present one is finished. And I see no diminishing of the effectiveness as a result of their familiarity with it. In fact, one of the nice features of Coherence Therapy is that the therapist is free to be quite transparent and revealing to the client about how the therapy works and why the therapist is doing what he or she is doing, if the client has a need to know or to have an explanation.

A.: This would never be unproductive to them. It would never be unproductive for the process to reveal…

B.E.: It’s perfectly ok. It does not weaken the process to reveal it. It can even help, because some clients respond to the counterintuitive quality of Coherence Therapy and say “Hey, wait a minute! You’re bringing me right toward the stuff causing all the trouble, or pain, or distress, or grief, or fear. Why are you doing that?” You know? “Don’t I want to get rid of all this?” Right? Very sensible type of conscious resistance. And what I find to be very reliable for handling that question is to give a short, transparent explanation that this actually turns out to be the most effective way to dispel the stuff causing all the trouble. I’ve said to some clients, “You know, for years you’ve been trying to get away from that material, or to avoid it, or suppress it, or cut it off, or counteract it and it hasn’t worked, has it? And it turns out that it hasn’t worked not because you have failed to counteract well enough, but because counteracting doesn’t work to really solve or transform this stuff. And what does work is to go toward it and get very familiar with it, and then a process of change will open up that will be effective.” And almost without exception clients hear that and are quite satisfied and ready to cooperate.

A.: Would you say Coherence Therapy is totally ineffective with some problems?

B.E.: Well, among client populations at the extreme end of the spectrum of what is often called character disorder (either borderline, narcissistic, schizoid and others) Coherence Therapy may either be ineffective or the work becomes as slow as any other in-depth therapy, because these are people who are so powerfully organized around not accessing their vulnerable, underlying emotional materia—powerfully organized around never, ever opening up to that. And again, all the power is in the client so if the client’s power is that fully against going there, then the client is more powerful than the therapist and the therapist cannot get the client to do Coherence Therapy. There are methods that can be used to foster even such a client to do the wor,k but the work becomes very slow, gradual.

A.: Do you believe Coherence Therapy is possible with children and adolescents, and if yes, what does it require?
 
B.E.: The answer is yes. It is very nicely effective with children and adolescents. I’ve had that experience myself many times. And what it requires is, once again, the use of ways of communicating that are attuned to that individual child or adolescent. So again it comes down to the therapist’s freedom to adapt or adjust a style of communication, style of interaction and specific techniques that will meet and work with the individual. But yes, I’ve seen powerful transformational effects with children and adolescents.

A.: How much do you believe they are capable of this movement of changing positions from cortical to limbic in a metacognitive way as we adults are able, and children maybe not so much? How do you see this movement that enables the change process, the transformation process?

B.E.:  Are you asking about how to understand children and adolescents in Coherence Therapy from the point of view of the brain?

A.: Of the brain and these movements that Coherence Therapy is so skilled to promote. This movement between a cortical view, a limbic view, a cognitive view, an emotional view, the juxtaposition—Hhow much can these shifts and connections happen in an immature brain?

B.E.: And you’re asking about how that happens in children?
 
A.: Yes. Aren’t children less capable than an adult?
 
B.E.: On the one hand, in my experience it’s true that adolescents and children are generally less willing, I’m tempted to say. Less inclined, less willing to go into emotional states that are underlying a given pattern or symptom during a session. Whereas with many adults they are willing to revisit a situation, imagine a person, say or do experiential work that gets them in touch with certain emotions that are underneath. And often in working with children and adolescents one encounters a resistance to cooperating with that kind of process. Nevertheless I’ve been consistently able to find ways to engage a child or adolescent in a focus to that same underlying material. A shared recognition that it’s there. I might for example, say to an eight year old girl, “I see, I see you’re really mad at grandma for making the car crash... I see!…”, in such a way that the child feels that I’m not judgmental, it’s safe and it’s ok with me that she’s mad with grandma. The child may not be going directly into the experience of that anger in those moments, and yet there is enough internal accessing of the anger at grandma for Coherence Therapy to happen effectively and for big shifts to happen.
 
A.: This leads us perhaps to the final topic and theme: Coherence Therapy’s future developments. How would you like to see it being researched besides going under brainimaging, that I know you would love? Coherence Therapy applied to what kind of psychological problems would you like the most being researched, besides procrastination which I understand has been studied?
 
B.E.: A small pilot study, a initial look at the how to do Coherence Therapy research was done at the University of Florida by Greg Neimeyer and Ken Rice, comparing Coherence Therapy with treatment as usual for procrastination. Very small study that got very interesting results, very encouraging results. So hopefully they’ll do a bigger study where the statistics allow for reliability of the numbers. What’s most important for Coherence Therapy right now is simply a large enough study that shows a strong effect size with statistical reliability and gets Coherence Therapy on the map as an empirically verified therapy, whatever symptom area is chosen. Procrastination is a very good one for that purpose. But what specially interests me, beyond that basic initial need, is research that would examine what we believe may be the ability of Coherence Therapy to have a specific treatment effect. In other words a therapeutic effect that goes significantly beyond the common factors. An effect separate from the therapeutic effects of the common factors.
  
 


And here is why we believe that Coherence Therapy may prove to have such an effect. As you know, in Coherence Therapy the client gets directly in touch with a previously unconscious emotional schema, a powerful theme and purpose in which the presenting symptom is actually necessary to have, whether it’s a behavioural symptom or a mood symptom or a thought symptom. What we observe again and again is that this deep new awareness of the underlying necessity for the symptom does not in itself put an end to either the schema or the symptom, no matter how much the common factors are well supplied, session after session. But then, as soon as we create a juxtaposition experience, abruptly the schema dissolves—it loses its emotional realness—and the symptom stops happening. It’s  so clear clinically that the specific process that we call juxtaposition has a major therapeutic effect beyond what the common factors alone can do. If I can give you an example it may make the point clearer. A client of mine wanted therapy for the lack of confidence and the self-doubt that he always felt at work. He doubted his own knowledge so much that he felt insecure and anxious, and he usually stopped himself from speaking up and offering his ideas. And yet in fact he did excellent work and had many successful projects under his belt and was well respected by colleagues. So how come he is plagued by self-doubt? Well, we found how come, because that’s what Coherence Therapy does. And what he got in touch with was that his self-doubt is how he makes sure he is not a know-it-all like his father, not an arrogant, dominating, hated know-it-all. In other words, as a child he formed the schema, the emotional knowledge, that to speak with any authority or confidence is being the same as Dad, and he’ll be hated for it like Dad is. That’s an all-or-nothing schema, which children so often form. Well, he made all that conscious, and it felt like a powerful and very meaningful realization, but nothing changed. For weeks it continued to feel true and he kept doubting himself at work. Then an incident happened at work. In a meeting, somebody suggested a key idea that solved a big problem, an idea that my client had just then thought of too, but he had suppressed it as usual. This was upsetting, and he looked around and saw that no one seemed put off—quite the opposite—and then he was annoyed and critical with himself, and nothing really changed. In our next session I used that incident to create a juxtaposition experience, and as often happens, in his responses I could actually see the moments when the old emotional reality lost its realness. After that he no longer felt that speaking with confidence made him the same as Dad or would get him hated for it. His self-doubting simply stopped and he was speaking his ideas comfortably, and this felt like no big deal, he said. It was immediately upon having the juxtaposition experience that it all shifted, even though the common factors were in good supply all along. That’s a very representative sequence that happens consistently with Coherence Therapy clients. We think it’s the juxtaposition experience that creates these profound, lasting shifts that end symptoms permanently.
A.: So you would like to see that specific aspect researched?
B.E.: Yes. We’d like to see rigorous research verify this clinical observation which seems to indicate a treatment effect, namely the transformational effect of what we define as a juxtaposition experience. In other words the big changes that we see as a result of Coherence Therapy observably do not result from the common factors alone. You can give those common factors of empathy, attunement, good working alliance, etcetera, session after session after session and the symptom-requiring emotional schema does not change. It keeps its emotional realness and its grip, and the symptom that it generates keeps happening. All of the sudden finally there’s a juxtaposition experience and it all shifts and releases powerfully. So that’s the clinical indication that Coherence Therapy creates this specific treatment effect that’s beyond what the common factors can do. I would love to see a study identify that in a controlled manner and confirm that. The field has come to believe that the specifics of methodology don’t matter much and that it’s the common factors that create nearly all of the change. We think we have something that goes beyond that. That would be very significant to confirm.
A.: This is not mainstream now, this suggestion you are making.
B.E.: Right. Not at all mainstream. It is quite revolutionary really, relative to the assumptions of the field currently. It’s heretical, in fact, to suggest that a powerful specific treatment effect exists.
(Maybe at the end,  but a final question came up )
T.: How do you define a symptom? What’s a symptom?
B.E.: We define the symptom as whatever the client identifies as the experience or situation or repeating pattern that is unwanted and the client wishes it to stop. And to tell you the truth, even though we use the word symptom we wished we had another one-word way to refer to the unwanted, repeating pattern that the client wants to stop, because “symptom” does have a pathologizing connotations and we like the whole system of Coherence Therapy to be free of pathologyzing. It is a non-pathologyzing system so it’s unfortunate that we’re stuck with this word that has pathologizing connotations. And I’ve actually spent many minutes or even hours trying to find a different word and cannot! So if you can help us find one that seems as natural to use, you know, I would appreciate it.
T.: I’ve found that many concepts of Coherence Therapy don’t have the translation to Portuguese. Like “knowings”—we don’t have a word to say it.
B.E.: That’s interesting. Even in English, “knowings” is not in widespread use and sometimes people don’t understand right away what we mean by it. I began using it because it seems to be the word that best describes what’s—its phenomenological—
T.: Because it’s the action of knowing.
B.E.: That’s right. All constructs are used as knowings by the brain and the mind. Knowings of how reality is going to behave. Some therapists just immediately understand and others are quite confused.
T.: I think it’s very like the “structural coupling” of Maturana.
A.: It’s the concept closest to the knowings as Maturana sees it.
B.E.: I think that within the constructivist framework or paradigm, constructivists tend to know what knowings means. Maturana’s framework certainly fits right in to thinking that way. But I think knowings is a natural idea to the constructivist sensibility widely.
A.: Thank you so much!
B.E.: You’re welcome. Thank you.

 

 

 

 

 

 

 

 

 

 

 

 

 

Transcription: T. Alfama & A. Ganho