Bruce Ecker Video Nov 6 2012

Lead Question:

Is there a danger that attachment theory becomes a Procrustean bed? How does one make meaningful distinctions about when attachment is the key issue, and when it is not.

How Ecker came to his present clinical perspective.

Began by looking at his therapeutic breakthroughs, where something remarkable had happened.

(sounds similar to Focusing’s discovery, no?)

Bruce and Laura are both ‘effectiveness junkies’. They saw that breakthroughs happened only occasionally with their clients.

It did happen at times, so they knew it was possible. They began studying sessions in which lasting change occurred, where some previous long-standing symptoms went away. They began scrutinizing what happened inside the client, and what happened in the interaction in the room. Did this for about 5-6 years….

Is there an identifiable process or sequence of events that always accompanies this?

Once they identified the key sequences, they organized the therapy AROUND those sequence of events, for each client.

They saw a huge increase in their effectiveness and in their capacity to guide powerful change. They called this “Depth-Oriented Brief Therapy”. In 2005, changed the name to Coherence Therapy.

In 2005, they studied neuroscience, to see if there was something there that matched what they were finding clinically. They had not done a controlled study, this was anecdotal, so they studied neuroscience.

They found “Memory Reconsolidation” research findings. THIS IDENTIFIED THE SAME SEQUENCE THERE that Ecker had found in his clinical work.

Memory Reconsolidation – when a memory first forms, is established in memory, that is the initial consolidation. Until more recently, there was a belief that, once an emotional memory was formed, any memory formed in the presence of strong emotion, set up a situation that was not reversible.

In 2000, it was discovered that there were conditions under which, even the synapses and connections of emotionally learned memories can be undone. Could lead to a rigorous understanding of how deep lasting change can actually occur.

There is a sequence of experiences that can undo deeply held emotional learning.

This “undoing” does not affect autobiographical memory, but now does not trigger the strong emotional reactions. These are changes that follow from successful memory reconsolidation,

How do we distinguish between cases when the prime issues are attachment injury, and when it is some other kind of emotional distress?

A case example, to get a sense of Ecker’s model, sequence:

This case will be Coherence Therapy. But the memory reconsolidation is NOT limited to Coherence Therapy. This same sequence can happen also in other processes, such as EMDR, IPMB, AEDP, EFT.

So, it happens intentionally and consciously in Coherence Therapy, but also often happens in others.

EXAMPLE

Man, mid -30s, abused by his boss, staying in that situation. Gets yelled at, does overtime without pay.

In spite of this, he does NOT look for another job. This all affects his own self-respect and his relationship with his own fiancé.

At this point, it surely has the look of attachment issues; it covers attachment territory. One could see how this may be his familiar role from his family of origin, maybe he has core beliefs that he deserves to be treated this way..

All of this makes sense, and Ecker was thinking that. BUT, Ecker has learned to not hang onto his presumptions. Instead, he trusts what comes to him when doing the “retrieval work” – the experiential retrieval process. In it, one brings the underlying emotional issues out, the move from implicit knowledge to explicit knowledge, so that one lays bare the specific emotional learnings maintaining the behavior of him staying in his job.

Then, one can SEE whether or not the issues are attachment issues.

A few different ways that, in a first session, the retrieval work could be done:

Hearing what the problem or symptom is made of. Experiential particulars of it.

He might ask:

-“at what point in your years of working there, did it start to feel that you might need to leave, it was hurting your self-respect?”
- “what was going on in your life that you didn’t choose to change?”

What, where, and when:

-What do you experience?

-In what situations do you experience the problem?

-What is going on inside of you when you experience the problem? Thoughts, feelings, body sensations

-How do you know when this problem is happening?,( to elicit these specifics.)

In this case, the problem was clear enough:

He is in an abusive situation. That is clear. He is getting that feedback, and he still stays.

That was enough for Ecker to begin the process.

It starts with the principle of Coherence (the symptom or belief must be there for some good reason). In other words, every emotional learning is adaptive. Whenever an emotional learning comes into awareness, what you see is an adaptive striving for safety, well being, justice,

And, the make up of emotional learning completely makes sense with respect to the experiences where they occurred

The work of the retrieval is drawing out the emotional necessity of taking this, rather than scanning for something better, trying to replace beliefs. One honors the “rightness” of what has been chosen, from its point of view…

There are specific “techniques” used:

1) Direct empathic eliciting. “I wonder if there might be something you know… in your life, about how just staying put is what is best for you…, not heading for something better… Does some part of you know something about that?

This is a direct invitation for a felt knowing.

2) An overt statement. Inviting client to try on a simple statement that captures this emotional necessity, It asserts it as a declarative statement, has client say: [as a kind of reflection of the belief]:

“Even though it is so clear to me and to everyone who cares about me that I should leave this job and head for something better, no. I had better not do that.”

The client might feel self conscious, but they have him say it mechanically. Then again, and maybe again. Something often starts to bubble up, as it gives the implicit emotional necessity a voice.

If something is happening, then, therapist might say “looks like that has some emotional resonance for you. Is that right? IS that something you feel that in your body somewhere?”. . . . .

So, focus on that part. Maybe internally say to that area, ‘yes I am aware of you. is there something that you want to add to that.’”

Something will come – might be words, images, other sensations…. They all move along the linkage from the symptom to the underlying emotional learning [anything IS a felt sense, or can lead to one, as Ann teaches]

3) Sentence completion. Unconscious implicit learnings often want to complete well formed sentences.

“My job is not healthy for me, But, if I try to leave it, and find something better, then . . . “and let it complete itself.

This is done over and over with same stem. This is another way to access it

4) Symptom deprivation. (this is the one Ecker used in this case). If the symptom is emotionally necessary, then having the imaginal experience of NOT having it, will bring some distress or difficulty. Have the client identify this discomfort, identify it, and now THAT is now the point of access. By bringing this out, the emotional necessity is the avoidance of that thing.

In this particular case, Ecker had him imagine going out and looking out for jobs in other companies, lining up a few possibilities, and making contact. And, feeling it. This acted AS symptom deprivation, now he would have to feel whatever it was that he was protecting himself from.

Ecker noticed that client began squirming with this, then client’s hand went to knee and squeezed. Within a few seconds, he said that he forgot what he was asked. This is a good sign that something is happening.

So, Ecker asked “is something happening that is distracting you?”

“Yes, I don’t know why, but a memory is coming up. A memory of the worst time in my life”

Ecker realized that, he was about to hear/learn [about 25 min into the first session], something that would make total sense for why this client was staying in this situation. One can access the constellation of the experience that led him to stay here.

Experience was end of high school. The client was a track and field star. Was heading for the last of his track meets, had already won a scholarship in college. Was looking forward to that glory as collegiate athlete. In the process of training for his final meet, something happened that required medical evaluation. It was found that he had a bone disease, which ended his athletic career.

The client was detached when he described this. He was describing loss of identity, plans, and a sense of colossal unfairness after all the years of working so hard, ripped away arbitrarily…

After this, trying to stay on track with coherence, Ecker asked:

“Your memory of that terrible loss came up as you imagined looking for a better job. There seems to be a connection between those two things. See if you can feel what the connection is. Go back and forth, and see if you can feel a connection.”

Client did that. Then “it is thinking that soon I am going to have something better that I really want.”

Ecker replied “you got SO hurt, when you were thinking that you were about to have a wonderful life you really want in college”

Now, Ecker can see it, but needed more work for client to see it. Done with verbalization, finding words that really represent what it meant to him.

Coherence therapy involves connecting with emotions that were blocked AND with mental models, the emotional meanings, that get used in life separate from those emotional experiences. These are then used by emotional brain to vigilantly watch out for that kind of thing ever happening.

So, we look for the beliefs, the mental models, the conclusions, that came from that.

The emotional brain is always on duty, trying to make sense of these things, watching out for it.

How he does the process, like a new piece the client just referred to:

Ecker might ask “How would you say that in words?”

Then client says, then Ecker reflects and asks client to resonate – just like in Focusing reflecting. Client might then say “no, it is more like….” Ecker might sensitively offer some of his own thoughts, but very deferentially, having the client check…

Ecker “People are amazingly sensitive to the accuracy of the words fitting the emotional material. If it is off just a little bit, people feel that.. You can see it in their response.”

They came to this, and Ecker wrote it on a card, and had client read it, to check it for fit, so it really fit or not, as their emotional truth:

“Life suddenly took away and crushed, the top notch life that I worked so hard for, and deserved, and was going to have. I’ve got to never again really want anything, try for anything I want, because then life will crush me again. If I try for a better job, it could happen to me again, and, no thank you!”

It is important to connect down, as he did in first part of his work.

Then to connect back up, to the specific presenting symptoms. That is why the sentences on the card end with the specific problem, the staying in the present job.

The client now becomes aware of their adaptive coherence for what seemed irrational earlier, then the sense of emotional agency dawns. Then, instead of feeling a victim, that this was something happening to them, one realizes their agency, and the context in which this made sense. This transforms the negative self-talk.

As soon as clients retrieve these coherent poignant meaningful understandings of these symptoms, the negative self-pathologizing talk simply evaporates.

At this point, the client is getting this connection. Tears stream as they work on this, as he reads this. Same with therapist, letting client know he feels moved listening.

Ecker might ask “how is it for you, suddenly to feel, how staying in this job is so connected with this meaningful experience in your life?” Making the meta-connection.

This is where can return to the question of attachment. Once one has the specifics of the emotional learnings that created this, one can see that this was NOT attachment at play, but an existential learning. The unpredictability and uncontrollability of the fabric of life.

What is the decision point here? What if this would have turned out to be attachment based? If it had come from parent competing with the child, keeping him back, etc?

The answer to that question is provided by the reconsolidation sequence of experiences.

The sequence of experiences that will dissolve an existing emotional learning, is simple. But, requires TWO KEY INGREDIENTS. Once you have them, things can go quickly. But, need to have them, need to do the prep work.

The prep work is

1) The retrieval work

2) An experience of a very contradictory nature to the makeup of the symptom requiring emotional learning. A living experience, emotional experience that contradicts, disconfirms, at least some key piece of the earlier emotional learning.

So, therapist helps client find a contradictory visceral experience. Then helps design a juxtapositioning, some kind of mismatch that disconfirms the expectation, predications, model of reality, of the initial emotional learning.

The new learning that operates as ‘the eraser’ of the target learning. This depends on the make-up. If the initial was an attachment experience, then the contradictory one should also be attachment based.

So, if this was an early childhood experience that set this up initially, and looking for a contradictory one, what concretely might Ecker have done?

Nice range of possibilities. It opens up a wide range of choices.

Most therapist who are attachment focused assume that the way to do deep change, is to use the client-therapist relationship to do reparative work, to heal the emotional wounds. Within the reconsolidation framework, the experience of the therapist’s empathy CAN BE the contradictory experience to being unloved, disconnected, abandoned, etc…

Such as a client’s belief of “I am not a person who anyone would treat that way (deserving of love, respect, etc).” Or “I am never listened to, understood”

The positive experience with the therapist CAN disconfirm those earlier emotional meanings.

What reconsolidation reveals, is that, once you understand the nature of the client’s learning, you are not limited to the therapy setting to find disconfirming instances. There are a whole realm of possibilities, within the client’s experience.

Yes, there is great importance in presencing secure attachment in the therapy room, to provide corrective emotional experiences. Ecker would say that these secure attachment experiences can be corrective, but an attachment injury might be positively influenced by another sort of intervention.

2 situations

a) clients revealed attachments learning CAN be dissolved by therapist’s empathy. Even while reparative attachment CAN be used, therapist can also find something else besides a positive experience of the therapist as a disconfirming experience.

The therapeutic relationship is always important, but not have to be the disconfirming experience. It doesn’t have to be from early childhood

B) Where the revealed material shows how the therapeutic experience COULD NOT POSSIBLY be used as a disconfirming experience.

Case Two-

A woman came to therapy because she feels no sexual desire or pleasure with husband. They are emotionally close, but not sexual desire.

Suffered from exhibitionistic and voyeuristic abuse from her parents. Mom found her masturbating, and found her doing this. Mom responded by delight and joy, how wonderful! So Mom went off, called all the family friends and members and told them. Client was mortified and felt very exposed at this…

In terms of attachment, the demand for no privacy sexually was completely woven into the attachment fabric in the family. This was how she would be most special to mom, to get mom’s best attention, praise, and cherishing. In this particular case, using the attachment to the therapist WOULD NOT be helpful – it could be too triggering. One might need to have the client find a disconfirmatory experience outside of the therapy interaction, given this history in this case….

For this second case history, it turns out that this woman was expecting her sexuality to have precisely the same effect on HER teenage daughter, as her mom’s had on her. “When a mom is sexual, it affects the child in the way I suffer here.” The emotional necessity to not harm her daughter is what was the blocking issue.

Then, Ecker helped her put it into language, etc… the powerful emotional expectation…

In her second session, a contradictory experience spontaneously came to awareness. “Wait, my sexuality is different from my mom’s – I have MY sexuality; it is really different from hers!” here, the client’s brain did its own searching for living knowledge, didn’t need Ecker’s help. “you know, that thing I believed, it seems SILLY now.”

When you hear “silly”, that is a good sign that the old schema is dissolving. When this becomes explicit, the more mature self can now observe and interact with it, it does not stay so insulated, and can become integrated.

Once that happens, the therapist guides the experience of contradiction even more than the client had already had it…

Back to the first client, there was not already existent knowledge. So, had to go try to find it.

They are working on a manual of how to search for contradictory experiences.

Used the “unacceptable costs” method.

Sometimes one cannot find a contradictory personal experience. If so, this is another option:

Ecker did this with first client.

The second session, the client reported that it was still there (because there had been no contradiction, so no juxtaposition and reconsolidation), still felt that way about his job.

Ecker was looking for disconfirmation here. To Ecker, seemed that his solution of never wanting, or trying for a want, wipes out the rest of his life – for him and his fiancé. And, Ecker could tell that client didn’t notice it yet.

In this case, he tried:

“I have a question for you. How is it for you to recognize, so clearly now, that this solution of yours for protecting yourself, from being crushed like you were in high school – effectively rules out, for the rest of your life, ever again heading for something you really want, or something you and your fiancé might want together, for the rest of your life?”

Then was quiet, let this register

Then, after a while “I hadn’t thought of it that way! Whoa!” Now the client had a metacognitive understanding of this.

Over next 15 minutes, Ecker kept repeating the juxtaposition, in naturalistic ways, expressing his own amazement. Empathically referring to one, and then to another, which led to dissonance

“So how is it for you now, to be in touch with these two opposite experiences of how you protect yourself?”

Client looked at Ecker for a while, and then “What was I thinking?!” as it integrated. That deep potentiation of emotional realness was happening.

Then, a verification step – try to re-evoke the original emotional learning. This is what the neuroscientists also do, in their research, to tell that it is a marker for erasure.

Had client read the declarative statement on his card again. He read it, twice.Then client said “well, I sure can see why I would have reacted that way. But, now it is like hearing about somebody else!”

www.coherenceinstitute.org

materials about reconsolidation, about the new book,

online courses “Obsessive attachment to former lover”