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Clients' Experience of Exploring Pro-Symptom Positions In Clients’ experience of exploring pro-symptom positions in integrative counselling Jodie Hawkey Diploma for Professional Studies Counselling, University West of England, UK. Abstract Coherence therapy identifies three specific steps that need to occur in sequence for transformational change to occur in therapy. These steps coincide with the neurological processes involved in memory reconsolidation. The present study explores one of the techniques utilised in step one; through the eyes and experience of the client. Four counselling students took part in a skills practice setting where the technique of ‘symptom deprivation’ was employed. Experience was recorded through semi-structured questionnaires and the qualitative data was thematically analysed. Four themes emerged from the data. The most poignant was the effect of honing in to a specific element of the client’s symptom. Results suggest that this tight focus allows clients to drop into their unconscious and access more global constructs that are influencing multiple areas of their life. This is explored with reference to the literature and implications regarding accessibility of the technique are considered. Introduction Coherence therapy is an approach in counselling that claims to have identified neurological processes that link with memory reconsolidation which are believed to accompany deep and lasting change in therapy as experienced by clients (Ecker et al., 2012). Coherence therapy sits within a framework of constructivism, believing that individuals each construct their own personal ‘knowings’ about the world through their own experiences and perceptions of those experiences. Although the majority of these knowings about the world are implicit and so not readily accessible to conscious thought, they actively guide an individual’s expectation of the world and so guide thoughts, emotional responses, somatic responses and behaviour (Held, et al. 2006 cited in Ecker et al. 2012). Coherence therapy suggests that these constructs, or knowings, once accessed, are potentially revisable (Ecker & Toomey, 2008). Coherence therapy identifies three specific steps that need to occur in sequence for memory reconsolidation to take place. The first step is known as the discovery stage. Counsellors work with the client to identify specifically what the client feels is the presenting symptom and then to work 1 to uncover the ‘pro-symptom’ position; what personal implicit constructs have led the client to feel like they require this symptom; what coherent emotional need is being served by having the symptom. Toomey & Ecker (2007) cite various psychotherapeutic systems that entail the conscious retrieval of unconscious, unresolved emotional themes (implicit schemas); psychodynamic psychotherapy (Crits-Christoph, Luborsky, & Barber, 1990), psychoanalysis (Curtis & Hirsch, 2003), and existential– humanistic therapies (Schneider, 2003). However, Toomey & Ecker (2007) propose a concise method that appears to access the ‘pro-symptom’ position, the adaptive implicit knowledge behind the symptom, in a direct way. One technique involves guiding the client towards an embodied experience of their symptom, and then asking them to imagine that same experience but with the symptom removed. This can help access a greater fear that their symptom is in fact protecting them from. The principle of ‘symptom coherence’ maintains that an individual's seemingly irrational symptoms are actually meaningful, orderly expressions of the person's existing constructions of self and world, rather than a disorder or pathology. So a client's presenting symptoms are understood as an activation and enactment of specific constructs. The second step needed for memory reconsolidation involves fully integrating the newly accessed implicit knowledge into conscious awareness. Part of this work in coherence therapy involves writing the new knowledge on a card that the client is invited to read several times a day between sessions. There is no attempt to counteract the new knowledge. This stage of the process resonates with Carl Rogers’ (1967) statement; “The curious paradox is that when I accept myself just as I am, then I can change” and is similarly aligned to the ‘paradoxical theory of change’ (Beisser, 1970). The final step required for memory reconsolidation is the process by which retrieved schemas then undergo profound change or dissolution: the retrieved emotional construct must be experientially activated while concurrently the individual vividly experiences something that sharply contradicts it. Neuroscientists have confirmed that these same steps are precisely what unlocks and deletes the neural circuit in implicit memory that stores an emotional learning—the process of reconsolidation. “Reconsolidation is the only known neural mechanism capable of dissolving an existing emotional learning” (Ecker et al. 2012) My initial interest in this approach came from an article I read in Therapy Today (Sibson & Ticic, March 2014). I have a clear memory of reading the article and a sense of excitement building; I felt like I was reading something that intuitively made sense. I was attracted by the depth of the work, and also by the potential of working in this way in brief therapy. I liked the need for a deep level of empathic attunement, alongside phenomenologically assisting a client to uncover their unconscious meaning making constructs. I also like the emphasis on validating rather than counteracting. In this way I feel that the approach de-pathologises constructs that might otherwise be seen as defences that need to be ‘got rid of’. I was also attracted 2 by the convergence between the findings of therapeutic transformation and neurological function (Toomey and Ecker, 2007). Having attended a coherence therapy workshop and experienced, as a ‘client’, the process of uncovering implicit memories through experiential work, I have become familiar with the ‘tingle’ I experience when a piece of consciously unknown, and at the same time, implicitly known information is brought into conscious awareness. I had the experience of working briefly with one of the trainers and I was really struck by his approach. He was so inquisitive and I felt like there was an absolute belief that whatever came forth from my unconscious would be wholly acceptable, and somehow, objectively so. I feel that the expectation of there being a coherence to the discovery work, brings an added dimension and it was this that I became interested in. The question I asked myself was; what is it about this expectation that allowed me to access these previously unknown ‘knowings’? The idea of personal constructs, or ‘inner working models’ were originally developed by Bowlby (1969) to explain how a child’s attachment relationship with their primary caregiver leads to a framework from which subsequent relationship expectations will be based. Maronne (1998) suggests that the term ‘working model’ can be used “to denote all the representations we have about the world around us that we have built out of our individual experience.” Maronne explains the importance of the earliest attachment models in that they are likely to influence the way the child subsequently experiences the world and so may influence the construction of later models. Through accessing these inner working models using coherence therapy techniques, I have come more into contact with these hidden aspects of myself, recognising that they are originally rooted in either attachment and/or survival needs. I am therefore much more ready to accept and validate these parts of me. I feel like I’m much more willing to meet my unconscious. Interest in the unconscious has expanded significantly in recent years as it has come to be explored within neuroscience with much interest generated in uncovering the areas of the brain responsible for our unconscious. Schore (2003) asserts that “the right hemisphere is the biological substrate of the human unconscious and it is it’s homeostatic-survival and affect regulation functions that are truly dominant in human existence”. He states however that because the left hemisphere has the capacity for explicit language, this hemisphere is often seen as dominant. Schore (2005) has shown that early emotional experiences are stored in our right hemisphere, pre-verbal implicit memory systems. He suggests that these implicit or unconscious systems must be reached in psychotherapy in order for any lasting change to take place. He also cites Bowlby (1988) who asserted that; restoring into consciousness, and the reassessment of internal working models, is the essential task of therapy. 3 Toomey & Ecker (2007) argue that the mechanism of change in coherence therapy is centred around the brain's built-in capacities for change. They have mapped out the processes that they have observed across hundreds of therapeutic sessions where transformative change has been observed, and found that these converge with the steps needed for the brain to undergo memory reconsolidation; a recently discovered neural process that can actually unwire and delete longstanding emotional conditioning held in implicit memory (Schiller et al. 2010, Xue et al. 2012) The assertions that coherence therapy achieves implicit memory deletion are unproven but Ecker et al. (2012) assert that the process aligns with the growing body of evidence supporting memory reconsolidation. (Duvarci and Nader, 2004). In all of the literature I have read about coherence therapy, I have not found any inquiry into the experience
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