Coherence therapy

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Coherence therapy is a system of psychotherapy based in the theory that symptoms of mood, thought and behavior are produced coherently according to the person's current models of reality, most of which are implicit and unconscious. It was founded by Bruce Ecker and Laurel Hulley in the 1990s. It is currently considered among the most well respected postmodern/constructivist therapies.[1]

General description

The basis of coherence therapy is the principle of symptom coherence. This is the view that any response of the brain-mind-body system is an expression of coherent personal constructs and schemas, which are nonverbal, emotional, perceptual and somatic knowings, not verbal-cognitive beliefs. A therapy client’s presenting symptoms are understood as an activation and enactment of specific constructs.[2]

The principle of symptom coherence maintains that an individual's seemingly irrational, out-of-control symptoms are actually sensible, cogent, orderly expressions of the person’s existing constructions of self and world, rather than a disorder or pathology.

Coherence therapy is considered a type of psychological constructivism. It differs from other forms of constructivism in that the principle of symptom coherence is fully explicit and rigorously operationalized, guiding and informing the entire methodology. The process of coherence therapy is experiential rather than analytic, and in this regard is similar to Gestalt therapy, focusing or Hakomi. The aim is for the client to come into direct, emotional experience of the unconscious personal constructs producing an unwanted symptom and undergo a natural process of revising or dissolving these constructs, ending the existence of the symptom. Practitioners claim that the entire process often requires a dozen sessions or less, although it can take longer when the themes and emotions underlying the symptom are particularly complex or intense.[3]

Symptom coherence

Symptom coherence is defined by Ecker and Hulley as follows:

  • (a) A person produces a particular symptom because, despite the suffering it entails, the symptom is compellingly necessary to have, according to at least one unconscious, nonverbal, emotionally potent schema or construction of reality.
  • (b) Each symptom-requiring construction is cogent—a sensible, meaningful, well-knit, well-defined schema that was formed adaptively in response to earlier experiences and is still carried and applied in the present.
  • (c) The person ceases producing the symptom as soon as there no longer exists any construction of reality in which the symptom is necessary to have, with no other symptom-stopping measures needed.[4]

There are several forms of symptom coherence. For example, some symptoms are necessary because they serve a crucial function (such as depression that protects against feeling and expressing anger), while others have no function but are necessary in the sense of being an inevitable effect, or by-product, caused by some other adaptive, coherent but unconscious response (such as depression resulting from isolation, which itself is a strategy for feeling safe). Both functional and functionless symptoms are coherent, according to the client's own material.[5]

In other words, the theory states that symptoms are produced by how the individual strives, without conscious awareness, to carry out self-protecting or self-affirming purposes formed in the course of living. This model of symptom production fits into the broader category of psychological constructivism, which views of the self as having profound, if unrecognized, agency in shaping experience and behavior.


Coherence therapy was developed in the late 1980s and early 1990s as Bruce Ecker and Laurel Hulley investigated why certain psychotherapy sessions seemed to produce deep transformations of emotional meaning and immediate symptom cessation, while most sessions did not. Studying many such transformative sessions for several years, they concluded that in these sessions, the therapist had desisted from doing anything to oppose or counteract the symptom, and the client had a powerful, felt experience of some previously unrecognized 'emotional truth' that was making the symptom necessary to have.

Ecker and Hulley began developing experiential methods to intentionally facilitate this process. They found that a majority of their clients could begin having experiences of the underlying coherence of their symptoms from the first session. In addition to creating a methodology for swift retrieval of the emotional schemas driving symptom production, they also identified the process by which retrieved schemas then undergo profound change or dissolution: the retrieved emotional schema must be richly activated while concurrently the individual vividly experiences something that sharply contradicts it. Neuroscientists subsequently determined 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.

Due the swiftness of change that Ecker and Hulley began experiencing with many of their clients, they initially named this new system Depth-Oriented Brief Therapy (DOBT).

In 2005, Ecker and Hulley began calling the system coherence therapy in order for the name to more clearly reflect the central principle of the approach, and also because many therapists had come to associate the phrase 'brief therapy' with depth-avoidant methods that they regard as superficial.

Evidence from neuroscience

In a series of three articles published in the Journal of Constructivist Psychology, Bruce Ecker and Brian Toomey present evidence that coherence therapy may be the system of psychotherapy which, according to current neuroscience, makes fullest use of the brain's built-in capacities for change.

Ecker and Toomey argue that the mechanism of change in coherence therapy uniquely correlates with the recently discovered neural process of 'memory reconsolidation', a process that can actually unwire and delete longstanding emotional conditioning held in implicit memory.[6] The indications that coherence therapy achieves implicit memory deletion are circumstantial but significant: (a) procedural steps match those identified by neuroscientists for reconsolidation, (b) immediate, effortless symptom cessation, and (c) the emotional experience of the retrieved, symptom-generating schema can no longer be evoked by cues that formerly evoked it strongly. The actual removal of the emotional and neural basis of a symptom's existence is a fundamentally different process than the counteractive strategy of most therapies, in which new, preferred patterns are built up to compete against and hopefully override the unwanted ones. The counteractive process, like the 'extinction' of conditioned responses in animals, is known to be inherently unstable and prone to relapse, because the neural circuit of the unwanted pattern continues to exist even when the unwanted pattern is in abeyance.[7] Through reconsolidation, the unwanted neural circuits are unwired and cannot relapse.[8]

See also


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External links

  • Gurman, A. & Messer, S. (2005). Essential Psychotherapies: Theories and Practice. New York: Guilford Press. 
  • Neimeyer, R. & Raskin, J. (2000). Constructions of Disorder: Meaning-Making Frameworks for Psychotherapy. Washington, D.C.: American Psychological Association Press. 
  • Carson, J. & Sperry, L. (2000). Brief Therapy with Individuals and Couples. Phoenix, AZ: Zieg, Tucker & Theisen. 
  • Ecker, B. & Hulley, L. (1996). Depth oriented brief therapy: How to be brief when you were trained to be deep, and vice versa. San Francisco: Jossey-Bass. 
  • Ecker, B. & Hulley, L. (2006). Coherence therapy practice manual and training guide. Oakland, CA: Pacific Seminars. 
  • Nader, K., Schafe, G. E., & LeDoux, J. E. (2000). "Fear memories require protein synthesis in the amygdala for reconsolidation after retrieval". Nature. 406 (6797): 722–726. doi:10.1038/35021052. PMID 10963596. 
  • Myers, K.M. & Davis, M. (2002). "Behavioral and neural analysis of extinction". Neuron. 36: 567. doi:10.1016/S0896-6273(02)01064-4. 
  • Duvarci, S. & Nader, K. (2004). "Characterization of fear memory reconsolidation". Journal of Neuroscience. 24 (42): 9269. doi:10.1523/JNEUROSCI.2971-04.2004. PMID 15496662.