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Therapist's Compass Changes That Last, Changes That Don’t: What Makes The Difference? Bruce Ecker, LMFT Therapist’s Compass Case Example 1 in Coherence Therapy • Symptom is necessary to have according to coherent knowings, meanings and feelings in implicit memory. • Head for the symptom-requiring implicit schema experientially. Questions Two Strategies for Change • What would be your strategy of change? • Change through counteracting the symptom • Need to know something more? What? • Change through transformation • What model of change is your strategy of change based upon? Common Counteractive Techniques The Counteractive Reflex • Relaxation techniques The use of methods that attempt to • Thought stopping/Positive thinking get rid of the symptom by… • Behavioral prescriptions • Resource development Replacing Educating Controlling Fixing Encouraging Outmaneuvering • Forming rational beliefs Blocking Interrupting Suppressing • Anger management techniques Avoiding Opposing Subjugating • Reframing Overriding Eradicating Subordinating • Communication skills training Correcting Persuading Disconnecting from Motivating Tricking Getting away from • Prescribing medications Psychotherapy Networker Symposium East © 2007 Bruce Ecker 1 Washington, DC · March 2007 Changes That Last, Changes That Don’t: What Makes The Difference? Bruce Ecker, LMFT Case Example 1 The Emotional Truth of the Symptom Client: “… I’m not going to be a talk show host because I’m afraid of your rage. There’s nothing worse than it—that rage, coming from nowhere! …I’d rather cut short my possibilities, make my life into a stump, rather than deal with that rage that scares me so.” Experiential deepening via “overt statement” Symptom Coherence Client’s Symptom-Requiring Knowings, Meanings, Feelings Model of symptom production in coherence therapy • Mom will rage if I do anything unfamiliar • Terror of that rage • Symptom is produced because it is • Urgent purpose: avoid that rage necessary to have according to some • Tactic: avoid unfamiliar actions schema (constructs) in implicit memory • Willingness to lose possibilities • Symptom ceases when those constructs Module of Part, Conditioned no longer exist (without counteracting personal Schema Ego-state, response the symptom!) constructs Subpersonality The emotional truth of the symptom Case Example 1 Definition of Implicit Memory Implicit memory is stored knowledge, formed in previous experiences, that generates behaviors, moods and thoughts without conscious awareness of the knowledge or the experiences “I’m still your daughter, and that’s what’s most—ahm—well, that created it. see, it’s not most important to me.” “Mom, it’s not most important to me to be your daughter. It’s most important to me to be myself.” Psychotherapy Networker Symposium East © 2007 Bruce Ecker 2 Washington, DC · March 2007 Changes That Last, Changes That Don’t: What Makes The Difference? Bruce Ecker, LMFT Case Example 1 Case Example 1 Testing for depotentiation: Can the symptom-requiring schema be re-evoked? Spontaneous Juxtaposition Staying familiar Being myself is most important. is most important. Mom’s rage is Mom getting unbearable. upset is workable. Depotentiated schema seems implausible, lifeless, silly, absurd, or laughable Clinical Strategy of Coherence Therapy Key Ideas for Profound, Lasting Change 1. Find the symptom-requiring, 1. For each symptom, an underlying, unconscious schema (Discovery) symptom-requiring schema is findable. 2. Steep the client in conscious 2. For lasting symptom cessation, experiencing of that schema (Integration) transform that schema via juxtaposition. 3. Depotentiate that schema through a dis- confirming juxtaposition (Transformation) Case Example 2 Case Example 2 Couples Therapy Deliberate Juxtaposition His withdrawal His withdrawal means he doesn’t means he’s terrified really love me. that I don’t want him any more. Psychotherapy Networker Symposium East © 2007 Bruce Ecker 3 Washington, DC · March 2007 Changes That Last, Changes That Don’t: What Makes The Difference? Bruce Ecker, LMFT Why Juxtaposition Is Case Example 3 The use of reenactment to juxtapose and Non-Counteractive depotentiate a traumatic implicit memory • Client stays fully in touch with symptom-requiring schema • Therapist favors neither knowing, empathizes with both • No attempt to build up desired condition or quash the unwanted condition Case Example 3 Sources of Knowings Deliberate Juxtaposition for Juxtaposition I’m helplessly I’m able to get • Already in client’s possession trapped in a out of the car • Received from external source death car. and be safe. • Created by new experience in session (reenactment, role play, sculpting, psychodrama, etc.) How an Emotional Schema in Key Ideas Implicit Memory Gets Depotentiated 1. Find and experience the symptom-requiring 1. For each symptom, an underlying, schema vividly, emotionally, bodily. symptom-requiring schema is findable. 2. Find and experience vividly some other, contradictory living knowledge. 2. For lasting symptom cessation, 3. Juxtaposition: Experience 1 & 2 simultaneously. transform that schema via juxtaposition. Both feel real, but both cannot be true. 4. Symptom-requiring schema is now depotentiated, lacks realness, cannot be re-evoked; symptom ceases. Psychotherapy Networker Symposium East © 2007 Bruce Ecker 4 Washington, DC · March 2007 Changes That Last, Changes That Don’t: What Makes The Difference? Bruce Ecker, LMFT Case Example 4 Case Example 4 Obsessive attachment to former lover Spontaneous Juxtaposition I want to be you. No boundaries Merging is well- equals death. being. Examples of Implicit Memory The of • Attachment “patterns” neuro- • Unresolved emotional “issues” biology change • Family of origin “rules & roles” • “Automatic behavior” response to a “trigger” • Phobias • Traumatic memory & PTSD • Unconscious memory of childhood abuse • And many more Neuroscience Before 2000 Current Evidence That Juxtaposition Recruits Reconsolidation and Depotentiates • Implicit memory believed indelible Symptom-Generating Implicit Memory • Implication for therapy: • Immediate symptom cessation Strategy of counteracting is the best that therapy can do • Formerly intense symptom-requiring schema cannot be re-evoked (build up desired response that • Matching steps of reconsolidation competes against & overrides the and the juxtaposition process of unwanted response) coherence therapy Psychotherapy Networker Symposium East © 2007 Bruce Ecker 5 Washington, DC · March 2007 Changes That Last, Changes That Don’t: What Makes The Difference? Bruce Ecker, LMFT The Transformation of Emotional Case Example 5 Knowledge Structures in Implicit Memory Just “teasing” Human phenomenological Neurological process Animal learning process process (Coherence therapy) (Reconsolidation studies) (Behavioral studies) 1. Reactivation Subjective immersion in Firing of the synaptic circuit Memory reactivation via presentation pro-symptom constructs that encodes the memory of conditioned stimulus (discovery/integration work) 2. Labilization Experience of an incompatible Synapses are unlocked and Termination of conditioned stimulus living knowledge rendered labile by an with no unconditioned stimulus after experience that mismatches short period (long period triggers what the memory predicts extinction, not reconsolidation) 3. Mutative influence Juxtaposition: Simultaneous exper- Alters synapses, strengthening, Blockade or enhancement of molecular ience of pro-symptom position and weakening, or remodeling the pathways by pharmaceuticals, incompatible knowledge (steps 1 stored schema endogenous biochemical effects, and 2 combined) or electroconvulsive shock 4. Reconsolidation Symptom cessation; pro-symptom Synapses re-lock in their Irretrievable disappearance of constructs seem unreal and are altered condition. conditioned response or permanent non-evocable by former triggers amnesia for a task Case Example 5 Symptoms Dispelled Spontaneous Juxtaposition Depression Grieving Anxiety Underachievement Feeling my sadness Feeling my sadness Panic Compulsive behaviors brings disaster: brings well-being: Agoraphobia Codependency I’d be boring and It fills the big hole Low self-worth Fidgeting alone, and it would and makes me feel Attachment problems Food/eating/weight last forever. solid and strong. Sexual problems Childhood abuse sequelae Rage Interpersonal, couple & Attention deficit family problems Procrastination Lasting Change: A Unified View of Mind and Brain 1. Reactivation www.coherencetherapy.org Discovery of schema 2. Labilization for coherence therapy learning resources… Integration Online Courses of schema 3. Mutative Practice Manual influence Demonstration Videos Transformation Email Discussion & Consultation Community of schema 4. Reconsolidation Psychotherapy Networker Symposium East © 2007 Bruce Ecker 6 Washington, DC · March 2007 Changes That Last, Changes That Don’t: What Makes The Difference? Bruce Ecker, LMFT Coherence Trilogy: Upcoming series of articles in the Journal of Constructivist Psychology, 2007 Article 1 OF NEURONS AND KNOWINGS: CONSTRUCTIVISM, COHERENCE PSYCHOLOGY AND THEIR NEURODYNAMIC SUBSTRATES Brian Toomey and Bruce Ecker Abstract. This first of three articles creates a framework for bringing the phenomenology of psychotherapy into fruitful coordination with neuroscientific knowledge. We suggest that constructivism is a conceptual paradigm adequate to this task. An examination of the main features of psychological constructivism and of neural constructivism serves to demonstrate their strong convergence.
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