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An Interview with Bruce Ecker, M.A., L.M.F.T., on Coherence Therapy

David Van Nuys, Ph.D.

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Bruce Ecker, M.A., L.M.F.T.In this edition of the Wise Counsel Podcast, Dr. Van Nuys interviews Bruce Ecker, M.A., L.M.F.T. on the topic of Coherence Therapy.

For many psychotherapists, the peak of satisfaction occurs during breakthrough sessions in which a client experiences a deeply felt shift and then is free of an entrenched behavioral reaction, a mood problem, an attachment pattern, an emotional wound or obsessive cognitions. However, the alchemy that produces such a fundamental shift has been something of a mystery, so they come unpredictably, typically after many months or years of sessions with a client.

The guiding principle of Coherence Therapy is that an individual's symptom, normally regarded as pathology or disorder, is actually the sensible expression of an adaptive, unconscious emotional schema learned earlier in life. On an emotional level, symptoms make deep sense.

By offering clinicians a clear, explicit map of how profound change occurs, Coherence Therapy helps catalyze the therapeutic process so that genuine client breakthroughs become a more regular and predictable therapeutic outcome.

David Van Nuys: Welcome to Wise Counsel, a podcast interview series sponsored by Mentalhelp.net, covering topics in mental health, wellness, and psychotherapy. My name is Dr. David Van Nuys. I'm a clinical psychologist and your host.

On today's show we'll be talking with Bruce Ecker about coherence therapy, an approach that was previously known as Depth Oriented Brief Therapy. Bruce Ecker, MA and Licensed Marriage Family Therapist, is codirector of the Coherence Psychology Institute, co-author of many clinical publications, including Depth Oriented Brief Therapy: How to Be Brief When You Were Trained to Be Deep and Vice Versa, a frequent presenter at major psychotherapy conferences, and an internationally sought clinical trainer who has taught in graduate programs for many years. He's been in independent private practice in the San Francisco area for over 20 years.

Now, here's the interview.

Bruce Ecker, welcome to Wise Counsel.

Bruce Ecker: Thanks for the invitation. I appreciate it very much.

David: Well, some time back, one of my listeners contacted me suggesting that you'd be a good person to interview. Now, I'm under the impression that you and your wife, Laurel Hulley, are the originators of an approach called coherence therapy. Is that right?

Bruce Ecker: That's right.

David: And I understand it was originally called Depth Oriented Brief Therapy, which in a way seems more descriptive. Why the name change?

Bruce Ecker: Well, there were two main reasons. One was that after quite a few years with the first name, we felt we wanted a name that somewhat more substantively refers to the nature of the approach. And the other reason is that the field had changed since we first named the approach, and the phrase "brief therapy", which is the first name, Depth Oriented Brief Therapy, came to have a strong connotation or meaning of superficial work, of depth avoiding work.

David: Oh, that's too bad.

Bruce Ecker: We also felt it was better for the name to reflect the central principle of this approach, which is the coherence of the mind, even in producing symptoms..

David: Now, I didn't ask you about your background so maybe that would be something for us to touch upon - a little bit about your training and experience - and then how you and your wife came to develop this approach.

Bruce Ecker: Well, in the relatively early years of our clinical careers, we noticed that very occasionally a client would have a very deep liberating shift happen in a session. And we got very interested in that and it so happened that we also each had a mentor, Dr. Robert Shaw, who founded the Family Institute of Berkeley and who just very recently a few months ago passed away, sadly. He emphasized the possibility of a rapid, focused restructuring of the personal constructs involved in producing a given symptom. So with that background, with that vision of how effective therapy can be, when we then began to see people occasionally have profound change events happen before our eyes in therapy sessions, we got very interested in how can we bring those about right from the start of therapy, because at that point we had no idea how to bring them about promptly and reliably. They happened to happen sometimes; more often than not, didn't happen.

David: How did you describe those experiences? I missed one of the words.

Bruce Ecker: I grasp for different phrases for that kind of experience because it really eludes words: profound change events, a deep liberating shift. The client reports a deeply felt experience that has a very freeing up quality and some long-standing symptom abruptly ceases to happen anymore.

David: Okay, shift was the word I had missed before. Now, I ask this next question somewhat tongue-in-cheek, which is there are so many psychotherapy approaches out there, why do we need another one?

Bruce Ecker: Good question and I'm sure there are a lot of answers to that, but here's my answer. The field has hit a ceiling on effectiveness, as you probably know. The affectionate term for this ceiling is the "dodo bird verdict". Now the dodo bird in Alice in Wonderland shouted, "All have won," this race that the dodo bird staged. "All have won and all should receive prizes." And the therapy field is very much in that situation.

For 70 years the outcome research keeps measuring the same level of efficacy across virtually all - in fact, to my knowledge, all different types and forms of psychotherapy. And that, as you know, has led to this very widespread belief in our field that it's the "common factors" of empathy, trust, good working alliance, and so on, that control the measured effectiveness of therapy, and that the specific techniques and theories really don't have much to with it.

Well, that's all well and good but, frankly, the level of effectiveness is kind of mild, and when in those occasional sessions we saw remarkable effectiveness happen, we got very interested in why isn't the field calibrating to this? Why hasn't anybody taught us how to make this happen from the first sessions with a given client? And that's what excited us and formed our vision and really shaped our careers.

And it took quite a few years of closely studying these profound change events when they happened to happen before we culled, I want to say, specific processes that turned out to be present whenever those profound shifts happened, whatever the client's presenting symptom or personality style. And once we identified the key ingredients of those profound shifts, we figured, well, let's form a therapy that's made of nothing but this and see what happens. And, again, that took some years of development and resulted in coherence therapy.

And now we've had about 15 years of teaching it to the field and we consistently hear from therapists who learn this approach that they feel they experience a dramatic enhancement of effectiveness; they see this kind of profound change happen as a regular event in their day to day clinical practice, rather than something few and far between.

David: Well, that's got to be very gratifying for you. In other words, they were able to reproduce the experience that you were having.

Bruce Ecker: Yes, they were, and just to find that it was teachable and that other therapists get the same results we do when they use this approach was a huge hurdle to get over, initially. When we began teaching this and we - I think 1993 was the first workshop - we weren't sure at all that it was teachable, but happily it turns out to be and satisfying is exactly the word, David. We see this approach as being just as important for the therapists as for the clients.

David: Yes, it's very discouraging, as I'm sure you know, to work therapeutically and feel like you're not being all that helpful, which many times is the case.

Bruce Ecker: Yes, absolutely.

David: So, I think we're far enough into this topic that it's time for us to get some kind of an overview of what you mean by coherence therapy. Just what is it?

Bruce Ecker: Well, coherence therapy is based on this clinical observation and confirmation and reconfirmation that most any given symptom exists because it's actually necessary to have according to some unconscious emotional theme and purpose that the person carries, what we call the emotional truth of the symptom. What we found is that the vast majority of symptoms and problems that people have and come to therapy for exist as an expression of some currently held, ingrained emotional schema, you could call it, some well-defined but unconscious theme and purpose that the person formed adaptively earlier in life. And once retrieved, the person experiences a deep sense, real coherence, a deeply connection with important personal life meaning directly underlying the symptom that had been unconscious all along.

David: Now, isn't it kind of widely accepted, though, that symptoms may trace back to some survival strategy or decision that a person made a long time ago?

Bruce Ecker: Yes, that's absolutely right. It's nothing new in the field that there can be these underlying emotional themes associated with symptoms. What's distinctive with coherence therapy is creating a methodology that enables a therapist to guide a client to retrieve the symptom-requiring schemas very, very efficiently, usually in a few sessions. And that's done not as a cognitive insight but experientially, so the client bumps into the underlying material and the client has his and her own direct, certain recognition and knowledge of it; it's not an interpretation imparted from the therapist. In fact, it's quite the other way around; the therapist literally learns from the client what the material is made of.

David: Okay, so you emphasize that it's experiential. Is this something that might, say, differentiate it from something like cognitive behavioral therapy, where there would be an attempt, maybe, to understand an original meaning of the symptom from the past?

Bruce Ecker: Yeah, very much so. That distinction is a big one for us, the experiential quality of this approach, in contrast to cognitive behavioral therapy in particular. Surprisingly for us, as we were developing this approach, we found that the key steps, the key processes that occur when profound change happens, involved no counteracting. And what I mean by that is counteracting is the activity of trying to build up a preferred condition in order to replace or avoid or suppress the undesired condition.

David: So in other words you're not attacking the symptom, you're not trying to quash the symptom in any way directly, or substitute something else for the symptom.

Bruce Ecker: That's right, exactly, and we're very careful not to say or do anything that comes across to the client as a counteractive move. In fact, it's quite the opposite, and some clients are initially taken aback when they notice that the movement of the work is toward and into the very stuff causing all the trouble. And we have various ways of helping clients understand why that's going to be effective and to feel comfortable and cooperative with that process. But the counteractive reflex, as we call it, is so widespread both among lay people and therapists that it's really taken for granted as the way to create change, very widely. And, in fact, for a large fraction of therapists learning coherence therapy unlearning their counteractive reflex is initially a big part of the learning curve.

David: Yes, I read one of your early articles and, in fact, you mentioned that that was something that, even at that time, you were still struggling with that reflex.

Bruce Ecker: Yeah, it's deep set, it's very deep set, and it's crucial to not go counteractive if you're trying to do coherence therapy, because the moment you start counteracting, you're actually fostering the opposite process that coherence therapy seeks to bring about; you're helping suppress and disconnect from the very material that in coherence therapy is necessary to move toward, into, directly experience and then subject to a transformational process, that even then is not counteractive.

David: Okay, now maybe we need to understand a little bit more about symptom formation itself, and you have theorized about cortical processes that are involved in that and, of course, these days with all the imaging technology and so on, it seems like everybody is able to talk somewhat more explicitly about the brain and the nervous system and so on. Give us your view of that.

Bruce Ecker: Well, these unconscious emotional schemas or learnings, that are the very basis and root of such a wide range of symptoms, exist in memory systems of the brain that are what neuroscientists call, and nowadays more and more therapists recognize as, implicit memory. It's very, very different than the explicit memory that we're all familiar with in the course of living; the memory of facts, the memory of incidents in our own lives.

Implicit memory is actually very peculiar compared to the ordinary experience of memory. Implicit memory is stored knowledge that was formed in previous experiences, knowledge that generates behaviors, moods, and thoughts but without any conscious awareness of the knowledge or of the experiences that created it. And I think the best glimpse or sense of implicit memory that most of us have is when we think about what's called conditioned responses, Psych 101. An animal that learns a red light is associated with a foot shock or a terrible smell, and then when the red light comes on alone, the animal goes into the fear response. So that response to the red light is not a mechanical process, that's a knowing, that's the animal's knowledge about that red light, but it's the knowledge of the implicit memory systems of the brain. It's not thoughtful, conceptual, verbal knowledge.

And so the emotional schemas that humans have, likewise, exist in the implicit memory systems of the brain and, curiously, the way the brain evolved over so many hundreds of millions of years, those circuits in implicit memory that store emotional learnings are formed with remarkable durability. In fact, they will last a lifetime unless very special processes get the brain to use its ability to erase even those circuits.

But those implicit memory circuits are so durable that, right up until 1997, the neuroscience field ever since Pavlov had formed the view that implicit memory circuits are intrinsically indelible. That's how durable they are. You know, all the research on extinction - thousands of publications on extinction from Pavlov up to the end of the 20th century - all made it seem as though those implicit memory circuits, well, you can suppress them really well but, even after complete extinction, where they look like they're gone, they can be retriggered very easily, much more easily than the original conditioning that set up the conditioned response. So it was well understood that conditioned response circuits, implicit memory learnings, just don't fade away; they stay there even when extinction has been done.

David: Now, would an everyday example be something like learning to ride a bike or drive a car and you're kind of on automatic and you're driving the car but you're not thinking about it? Would that be an example of implicit memory?

Bruce Ecker: Yes, those are implicit memory knowledges in probably the cerebellum and brain stem, the physical kind of knowledge. Then there's the implicit memory of knowing how to form your next sentence, and that's in yet a different area of implicit memory. The implicit memory that is most usually involved in psychotherapy is emotional implicit memory.

David: Yes.

Bruce Ecker: Which is the limbic system and not only, but largely, the amygdala and a few other structures in the limbic system. An example there is a client I once had who came into therapy describing extreme lack of confidence at work. And this is a man who was actually very successful at work; he was an expert, he was well thought of and had a great track record, but on a day to day, hour to hour basis he feels this grueling lack of confidence and insecurity. We did coherence therapy and what surfaced for him, what he bumped into, was all about his father and, you know, at the start of therapy, hearing his problem, it's a dark mystery, right? It's like whoa, who knows what's generating that. Well, his father was, well, to be blunt, a severe narcissist, very heavy handed, know-it-all, dominating, tyrannical. And my client, as a little boy, formed the emotional learning that, to speak with firmness and confidence is to be mean and tyrannical like Dad.

David: And so, of course, he didn't want to do that.

Bruce Ecker: Exactly, he was fully pitched against ever being anything like that and he felt such anger and even at times hatred toward his father that he also assumed, implicitly, that if you talk with confidence and firmness you'll not only look like that, you'll be hated like that by other people. So it was a very scary way to be. And he avoided it very, very powerfully. In fact, his lack of confidence at work was his unconscious success at making sure he never gets anywhere near being like Dad. That's a good example of how these unconscious schemas operate; it's emotional knowledge, emotional and perceptual knowledge in the limbic system, that is actually a success for the client, although the costs show up consciously and it looks like a problem or a symptom.

David: In other words, it was adaptive at the time. Some people would say, maybe, that he made a decision, would you agree with that? That a decision was made as a child?

Bruce Ecker: You know, it's strictly true but I think, usually, the word decision to most of us connotes a conscious, thoughtful choice. And this is definitely not conscious, thoughtful choice when we talk about implicit memory and unconscious emotional schemas. The whole point about these implicit emotional schemas or learnings is that they form completely without any explicit thoughts or words or conscious awareness.

David: Yes, isn't there an approach called decision therapy or re-decision therapy or something like that?

Bruce Ecker: Yeah, re-decision therapy, which has some significant overlap with coherence therapy and, in the strict sense, if you think in terms of the whole psyche or the whole self then, yes, even the original formation of an emotional schema and its strategy, such as my client's strategy of making sure he's never, never confident or assertive in order not to be like Dad and be hated like Dad. You can see in that material, that example of that client, how specific the knowings are, how specific a model of reality that is. And yet it exists; that very well-defined model of reality exists without any words or explicit conscious ideas.

Now, just to complete the neuroscience question you were asking, to come to the full circle on that. The neuroscience field regarded these implicit memory circuits as intrinsically indelible for the lifetime of the individual. But then, starting in 1997 for the next few years, a handful of neuroscience research papers got published which turned that almost century long tenet really on its head, because a number of labs demonstrated the actual erasure of implicit memory circuits. I won't go into the details. Actually there are references and papers cited on the coherence therapy website for anyone who's interested, coherencetherapy.org.

And when we came across this revolution in neuroscience understanding several years ago, and studied closely what they had found, we were amazed and delighted to find that the specific steps of the process that actually unwires implicit memory circuits matches point for point the series of steps that we had come up with 10 years earlier in phenomenologically creating coherence therapy.

David: Wow.

Bruce Ecker: Yeah, we're very excited to think that we have something that gets such support from rigorous research. The evidence is just circumstantial so far, but we're hoping for some point in the future to get neuroscientific studies of people undergoing coherence therapy to nail that.

David: Well, that's very exciting. So what are those steps?

Bruce Ecker: Well, first is what we call the retrieval of the unconscious emotional schema, the unconscious emotional truth of the symptom. And in the example that we've been using here, that consisted of having this man actually feel and experience and emotionally register and then give words to his powerful position that he was so completely living by without any awareness of it; that in words, once he was putting words on it: "I better not ever say anything with my own conviction, my own authority, firmness, confidence because that'll make me the same as Dad and I don't want to be anything like that and people will hate me." Well, we came to that kind of verbalization while he's in the material feeling it, the work was experiential. And at the end of the session he leaves with an index card on which those words are written, so he can look at that card daily between sessions and stay very closely in touch with this emotional truth that feels very, very real to him.

David: And the words, again, would be…?

Bruce Ecker: It was something like - and this is what we call limbic language - we've learned that the phrasing needs to have a certain style that fosters emotional experience rather than going up into the head with ideas. You know, there's no one phrasing, it just happens to capture the gist with that limbic language, so it could be something like, "If I'm in a meeting in work and I say what I know with any confidence or authority, that will make me the same as Dad, and I'll be insensitive and dominating to others and they'll hate me for it. So no way, no way will I speak up with any confidence."

David: I see.

Bruce Ecker: And those were the words on the card and he's to actually take out that card discreetly while in a meeting at work, and actually get in touch with that emotional truth right in the situation where it's happening.

David: But you're not - I'm going back to what you said earlier about not counteracting - so you're not asking him to dispute that idea, say, in the way that a cognitive behavioral therapist might, is that right?

Bruce Ecker: Not at all, not one drop. That's the retrieval, that's the first stage of the process, and it consists of the initial discovery work and then the integration, sustained awareness in life step that I was just describing. That's the full retrieval. We learned that a client can bump into this kind of thing right in the session and it can be very lucid and very clear, but it isn't yet integrated at that point. The client leaves the office at the end of the session and the material evaporates the way a dream evaporates.

David: Yes, right.

Bruce Ecker: It's gone because, really, it's an altered state in its first encounter with the material. So we learned we have to very deliberately create a sustained experience of the exact material found, repeated experiences. Client comes back in the next session; I'll start the session saying, "How was it for you to live being in touch with what we put on that card?" And check the degree of integration that I hear from the client and perhaps craft additional integration experiences until the material is very, very well wired into the routine day to day personal reality.

So that's the first of the two major steps of coherence therapy. And the second is a specialized experience that we found has the power, I might say, to actually dissolve these ingrained lifelong emotional schemas. But the schema has be first retrieved and very stably held as a conscious personal reality. That makes it susceptible to the second stage, and that experience works in the following way; I'll use the same example to illustrate it.

In the course of a few weeks of living in touch with that emotional truth and being in touch with it during meetings at work, about roughly three weeks later he came into a session and he said a weird thing had happened. What's that? Well, he said, he was in a meeting at work where a challenging problem was being tackled and discussed, and in the course of the meeting he came up with what he thought was a pretty good idea for the solution, but he didn't speak up, in his usual way of not coming forth with his knowings. And he was aware, as per our work, what was going on. He no longer felt, what's wrong with me? I have a lack of confidence. He now knew his own purpose in keeping quiet, you see?

So just the retrieval work alone, even before the transformational next step, is very beautifully depathologizing for clients because now he's in touch with his own very coherent purpose and his agency in not speaking up. It looks like "lack of confidence" from the outside, but from the inside its truer name is "making sure I'm not a narcissistic tyrant like Dad." Oh, he was in a meeting; he squelched this very good idea that he felt would solve this important problem; and seconds later the fellow next to him expressed the same solution.

David: Great.

Bruce Ecker: Yeah, often life helps us along in just this kind of beautiful way.

David: I didn't know I would see that as helpful. I would think he might be kicking himself, "Oh my God, I should have spoken up."

Bruce Ecker: Ah, well, watch what happens. What he described to me about this weird experience is that he hears the words come out of this fellow's mouth, and he looks around the room, and to his amazement he sees that everybody is good natured, welcoming and happy to have this contributed.

David: Ah hah, so in other words, his catastrophic expectation of what would happen is disconfirmed.

Bruce Ecker: Perfectly put, David, exactly it. And back in the session with me he described this and he was still sort of puzzled and what he called the weirdness of it was still with him. I could see from his description that we now had all of the ingredients needed for this second kind of experience that can dissolve the ingrained schema. And it just took a few minutes for me to walk him through it and it went something like this: I said, "Let's revisit those moments when this weird thing happened. Could you visualize the situation and sort of be back in it, and I'm going to sort of guide you in a process here." So spontaneously he closed his eyes, he was back in the scene and I said, "Okay, you're at the moment where you are looking around and you're seeing something very different than you expected. You're seeing that this person confidently expressed the same idea and it's going fine; people are relaxed, friendly, no problem. All your life…" and now I'm speaking to him as he's immersed in this re-experiencing, with his eyes closed. "All your life one part of you has known that to speak something so confidently will definitely make you or anyone be like Dad, and now you have this other knowing, right alongside that old knowing, you have this other new knowing that's so different, a knowing that a person can say what they know very confidently and it doesn't come across like Dad at all, and others are fine with it." Then I pause a little bit, and I've done the set-up. And the set-up is what we call a juxtaposition experience. Notice that I'm still not counteracting the old knowing at all. In fact, I need him to be fully in touch with it, so I'm literally empathizing with both.

David: Yeah, that's interesting.

Bruce Ecker: And that's key for a successful juxtaposition experience to dissolve the old schema. The therapist empathizes with both, never gives any indication of which is the preferred or the correct reality. So he's immersed in this side-by-side, odd experience, where both feel very real and yet both cannot possibly be true. That's it. That's the defining feature of juxtaposition experiences. The old and the new both feel real, yet both cannot possibly be true and experientially felt.

David: Okay, now in this particular example, the guy very conveniently has this other guy who speaks out the idea and he sees the guy doesn't get slammed for it. That's not going to happen in every situation, so what do you do when there isn't that sort of fortunate happenstance?

Bruce Ecker: Yeah, that's right. Well, there are quite a few different ways that the therapist can deliberately help orchestrate juxtaposition experiences. I'm not sure it's going to work here in this phone interview for me to try to get into that in specifics other than to say that, yes, you're right, it won't always go that way and there are numerous angles of approach to set it up and bring it about. Beautifully, however, more than half the time we find the juxtaposition experience does fully happen spontaneously by itself on the heels of good retrieval because people often happen to have their own living knowledge that is utterly in contradiction to the symptom-requiring schema. It's such a curious feature of the human mind that we can harbor any number of knowings or realities that are completely incompatible as long as they are in separate bubbles, dissociated. And once the symptom-requiring knowledge is conscious, it's wide open to making this juxtapositional contact with some other knowledge that's at odds and that happens spontaneously a little more than half the time, we estimate.

David: Interesting. And if people want more details you've probably spelled them out in your book, right?

Bruce Ecker: Yeah, the book has full details. Really, the website is the place to go for more information. Coherencetherapy.org has all the learning resources including a practice manual and DVDs of some real sessions I've done. We have a training program now, too, that's fully described on the website.

David: Oh, that's great. Now, you know, before we started this conversation based on a couple of articles that you sent me, I had the impression that you did a lot of reframing and I know you started off calling it short-term therapy and I know Jay Haley was very influential in that movement, particularly here in the Bay Area and I think reframing was something that he talked about a lot. But now that I hear you saying that you don't do anything to directly go against it, reframing sounds like maybe that's a bit too active.

Bruce Ecker: That's right. The way it's usually done is counteractive and we don't do any reframing. In other words, we don't try to get the client to take in our way of understanding the symptom or any situation. The retrieval process, in a very organic and natural and spontaneous way, brings about a reframing but it's from inside the client.

David: It's got to be spontaneous.

Bruce Ecker: It's completely spontaneous and natural. Just think of that man who felt a lack of confidence at work; he got in touch with his own emotional truth of why it's important never to speak confidently, and so the meaning of his symptom of never feeling confidence changed fundamentally to him. The meaning was no longer, what's wrong with me; the meaning is I'm lying low purposefully; I'm using my power in this exact way, keeping myself from speaking up so that I won't seem like Dad. So the meaning of the symptom changed because he retrieved his own emotional truth, not because the therapist decided what's the preferred meaning. So there's no reframing in the usual way that reframing is thought of in the field.

David: Yeah, that's interesting because a lot of us therapists have given at least lip service to the notion that you can't just give an interpretation, that the person has got to discover it for themselves. And it sounds like you really believe that and that you've developed a very specific approach that helps you hew to that.

Bruce Ecker: Exactly right, yes.

David: I'm wondering about that first step. You said that you want to lead the person into the experience, not to have it be a cognitive thing, but to somehow experientially contact that implicit knowledge, that implicit "decision" that they made so long ago. Are you able to talk briefly about some of the techniques that you would use to guide a person experientially or bring that about?

Bruce Ecker: Yes, we can get a glimpse of that here, I think. Let's see, yeah, in fact I think the same example could serve us nicely for that. I'll tell you how I did it with this man. First, there are really quite a number of techniques that can be used to guide a person along the linkage from the symptom to the underlying emotional knowings. And that's a real linkage and it exists and whatever techniques or methods we use, really, are all different ways to bring conscious attention starting at the symptom, along the linkage to the underlying material. It's like the symptom is almost like a trailhead, where we start.

And what I did with this fellow is a technique that we call symptom deprivation, and it worked like this with him. I asked him to imagine a typical situation, a recent situation at work, at a meeting, and a situation where the symptom happened, where he didn't speak up even though he might have had something good to say and he felt that lack of confidence. So he brought that to mind, he described it to me with the shape of the table and where people were sitting. So he's getting rather engaged in the subjective experience, visualized. And I then guided him to try out being without the symptom - symptom deprivation. He's going to be without the symptom in the situation where the symptom actually happened.

Now, the logic of this technique is simply that, well, if the symptom really is emotionally necessarily in some way, then what does necessarily mean? It means that being without the symptom is going to create some trouble of some kind, and the therapist has no idea what's going to be found; the therapist in this approach has no way to know what's underneath until actually doing this work. So the therapist never tries to figure out what the underlying material is according to some theoretical map or a typology of schemas.

So what I did with him is I had him imagine actually saying what he had in mind, with confidence, knowing that this would bump him into some distress, something uncomfortable. And sure enough, he starts to fidget and he said something like, boy, this doesn't feel so good. And I can see that the discomfort in his metaverbals and I said, "Okay, just stay in touch with this discomfort. We'll move through it quickly, but stay in touch with it and see what the discomfort feels like. What's it made of? Does it want to say something?" And he was quiet for a moment and then said, "I just saw my dad." So the linkage is happening. An image of his father shot to mind and then words sort of stammered out. Let's see, I wish I could remember the exact words, but a sentence spoken one or two words at a time, in staccato, "Now… I'm… an asshole… like Dad." Something like that. It was seeping into awareness; you could actually watch the material link into his conscious attention right before my eyes.

David: Wow.

Bruce Ecker: And that's very typical of how the discovery work occurred. You know, this is very rich work; it's very poignant work as people retrieve these very meaningful, life-shaping themes in their world.

David: Yes, now originally you called this a brief therapy. What's the average length of treatment, do you have a sense of that?

Bruce Ecker: I have a sense that my personal average is probably around eight sessions. I think probably, maybe, half of my clients are around eight. There's a smaller fraction that's three or four. There's some that are 12, 16, and there's a tail of the bell curve that goes out to many, many sessions even with this approach. Some people have such numerous, heavy duty underlying schemas, numerous symptoms, very complex work, still takes many sessions even this way, although I feel it still takes far fewer sessions this way than conventional in-depth approaches.

David: And you've written that you treat, and find it effective, for quite a range of conditions, including depression, anxiety, panic, agoraphobia, low self-worth, attachment problems, sequelae of childhood abuse, sexual problems, food, eating, weight problems, rage, attention deficit, complicated bereavement, codependency, underachievement, procrastination, fidgeting. That's quite a list.

Bruce Ecker: I see you must have one of our lists in front of you, I'm glad you had it.

David: Yeah, I didn't commit that to memory, I must confess.

Bruce Ecker: Yeah, a very wide range of symptoms and problems turn out to be arising from these kinds of well-defined, unconscious, emotional knowings, yes.

David: Well, we might have some listeners who would want to be clients for this kind of work, and you've told us how therapists can get more information and training and so on. What about potential clients, how would they find a practitioner in their area?

Bruce Ecker: Good question, David. We are currently beginning the project of creating a referral directory on the coherencetherapy.org website.

David: Oh, good.

Bruce Ecker: But it's not there yet. In the meantime the way to do it is to send an email to simply info@coherenceinstitute.org. Really, that's the easiest way to get in touch for that. We're the Coherence Psychology Institute. We formed the institute as the home of the training program that we now run, a couple of years ago, and I'm co-director of the institute along with Dr. Sara Bridges of the University of Memphis.

David: Okay, well, as we wind down here, I wonder if there are any final thoughts you'd like to leave our audience with, or anything that maybe you were hoping to say that you didn't get a chance to get out.

Bruce Ecker: Thanks, but no. I think you really gave me a good workout here, got me to say pretty much everything. I just want to encourage all therapists to follow your instincts or your yearning for the kind of meaningful effectiveness that you know ought to be possible in therapy, because it is.

David: Wow, well Bruce Ecker, thanks so much for being my guest today on Wise Counsel.

Bruce Ecker: Thank you so much for inviting me, David.

David: Well, this is yet another fascinating approach. I hope you enjoyed listening to this interview as much as I did speaking with Bruce Ecker. I saw many parallels to other approaches and, at the same time, Bruce seems to have found a uniquely powerful point of leverage for the therapeutic process. With today's emphasis on evidence-based therapies, I hope that Bruce or someone else will undertake some research that will further establish the efficacy of this approach. More on coherence therapy can be found at www.coherencetherapy.org/ and you can write Bruce directly by sending your email to info@coherenceinstitute.org.

You've been listening to Wise Counsel, a podcast interview series sponsored by Mentalhelp.net. If you found today's show interesting, we encourage you to visit Mentalhelp.net, where you can add a comment or question to this show's web page, view other shows in the series, or simply page through the site, which is full of interesting mental health and wellness content. Access the show's page and show archive information via the podcast box on the Mentalhelp.net home page.

If you like Wise Counsel, you might also like ShrinkRapRadio, my other interview podcast series, which is available online at www.shrinkrapradio.com. Until next time, this is Dr. David Van Nuys, and you've been listening to Wise Counsel.

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About Bruce Ecker, M.A., L.M.F.T.

Bruce Ecker, M.A., L.M.F.T.Bruce Ecker, M.A., L.M.F.T., is co-originator of Coherence Therapy, co-director of the Coherence Psychology Institute, coauthor of many clinical publications including Depth Oriented Brief Therapy: How To Be Brief When You Were Trained To Be Deep and Vice Versa, a frequent presenter at major psychotherapy conferences, and an internationally sought clinical trainer who has taught extensively in graduate programs. He has been in independent practice in the San Francisco area for over 20 years. More on Coherence Therapy can be found at www.coherencetherapy.org.