Coherence therapy looks at the client’s symptoms of depression as a necessary expression of underlying, unconscious constructs which were learned in the past and are lived out in the present moment.
What to expect?
The dominant concept is that of symptom coherence, where adaptive schemas or constructions of reality turns certain symptoms necessary as part of how the individual strives to avoid suffering and attain well-being. From this point of view, the symptoms of depression depicts an adaptive, coherent expression of unconscious emotional learning. The critical bent and difference of this approach from cognitive approaches like CBT is the assumption that strong emotional implicit memories, which are laid down by the limbic system, are not indelible, but are transformable.
How does it work?
The therapist first learns from the client the specific behaviors, emotions, thoughts, somatics, and/or circumstances that constitute the unwanted pattern. When this symptom picture is clarified, the therapist then pursues a process of experiential discovery that elicits into explicit awareness the individual’s unique, implicit core schema(s) that compel production of those symptoms. This is a fully phenomenological process that reveals the underlying learned schemas or pro-symptom positions just as they are, without interpreting or theorizing, to both the client and the therapist. Schema verbalization and cognitive insight follow from the client’s direct, subjective experience of the material, rather than the other way around. In most cases, the newly explicit content of the learning makes apparent whether the schema was, or was not, learned in early attachment experiences.
The next step is the guiding of the unlearning and dissolution of some selected part of the symptomrequiring schema, resolving a core emotional issue and eliminating the emotional necessity for the symptom. Coherence Therapy identifies memory reconsolidation as the neurological process that accomplishes this true unlearning, and it follows the same brain-required process that reconsolidation researchers have identified. The needed ingredients are the target construct. Armed with this contradictory knowledge, the therapist brings the two memories simultaneously into conscious awareness with experiential vividness, creating a juxtaposition experience in which the now explicitly conscious target construct encounters a sharp mismatch or prediction error. It is in response to that juxtaposition that a target learning’s synapses unlock into a destabilized, revisable state, as described above. As attention is then guided again to the contradictory knowledge a few more times over the next several minutes, this new knowledge rewrites and thereby erases the target construct’s synaptic encoding. If the target learning is active in several different contexts, a separate juxtaposition experience for each context may be needed. Also, if unlearning and dissolution will bring a distressing emotional adjustment, it may be necessary to attend to that adjustment before the juxtaposition experience can be effective.
When is it used?
Coherence therapy is predominantly used with clients suffering from depression and other neurotic difficulties, where the cognition of the patient can be put to use to overcome the psychopathological symptoms.
Role of the therapist:
Coherence therapy capitalises on the recently found “key” to unlocking these implicit emotional memories, reconsolidation: the activation of targeted emotional learning into a de-consolidated state whereby the learning can be revised and re-encoded before the altered synapses relock. This effectively re-writes, or erases, that emotional learning while leaving any episodic/autobiographical memories intact. Factors such as building emotional safety, trust, attunement, and the ability to repair ruptures are essential. The therapist would first learn from the client what symptoms are problematic in order to define the “pro-symptom position” or core schema the symptoms are supporting.