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?
Background
How Ecker came to his present clinical perspective.
He began by looking at his therapeutic breakthroughs, where something remarkable had happened.
(sounds similar to how Focusing was discovered, does it not!)
Bruce and Laura are both "effectiveness junkies." 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. For over 5 years, they began scrutinizing what happened inside the client, and what happened in the interaction in the room.
They were looking for "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 sequences 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, they changed the name to Coherence Therapy.
Memory Reconsolidation
In 2005, they studied neuroscience, to see if there was something there that matched what they were finding clinically. Their findings were anecdotal; they had not done a controlled study. So, they checked out neuroscience research on this topic.
They found research findings in Memory Reconsolidation that identified the same sequence that Ecker had found in his clinical work.
Memory Reconsolidation: When a memory first forms, it 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 could be undone. This discovery 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, which remains intact. However, after the undoing, the memory no longer triggers the strong emotional reactions. These changes follow from successful memory reconsolidation.
Attachment or Something Else?
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 and sequence:
This case will involve Coherence Therapy. However, memory reconsolidation is not limited to Coherence Therapy. This same sequence can happen also in other processes, such as EMDR, IPNB, AEDP, EFT and more....
It is engaged intentionally and consciously in Coherence Therapy, and also often happens in other effective modalities.
Case One
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 affects his own self-respect and his relationship with his fiance.
At this point, this situation 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 this initially. But, he 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.
Retrieval Work
A few different ways that, in a first session, the retrieval work could be done:
Hearing what the problem or symptom is made of- the 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, that 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? (All of this helps 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.
The process starts with the principle of Coherence ( that 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 the work of drawing out the emotional necessity of taking this, rather than scanning for something better or 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 something like [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 we have him say it mechanically. Then repeat it 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 "It looks like that has some emotional resonance for you. Is that right? IS that something that you feel 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. It might be words, images, or other sensations. They all move along the linkage from the symptom to the underlying emotional learning.
[This is compatible with Ann Weiser Cornell's teaching in Focusing that anything that arises either is a felt sense, or can lead to one.]
- 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.
- 4- Symptom deprivation. (this is what Ecker used in this case). If the symptom is emotionally necessary, then having an imaginal experience of not having it will bring some distress or difficulty. When that happens, have the client identify this discomfort. Then, that can be used as the point of accessing the emotional learning. By bringing this out, the emotional necessity of the belief is seen in the avoidance of that distress or difficulty.
In this particular case, Ecker had the client imagine going out and looking out for jobs in other companies, lining up a few possibilities, and making contact. And what that would feel like. This acted as symptom deprivation - in the imagining, the client would have to feel whatever it was that he was protecting himself from.
Ecker noticed that client began squirming with this, then the client's hand went to his 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.
Then 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, just 25 min into the first session, he was about to learn something that would make total sense for why this client was staying in this situation, that it was possible for him to access the constellation of the experience that led the client to stay there.
The experience happened for the client near the end of high school. The client was a track and field star. He had already won a scholarship for this in college, and was looking forward to the glory as collegiate athlete. In the process of training for his final high school meet, something happened that required medical evaluation. It was found that he had a bone disease of a type that ended his athletic career.
The client was detached when he described this. He was describing loss of identity, plans, and a sense of the 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."
The client did that. "It is related to 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 could see it, but it needed more work in order for the client to see it. This was done with verbalization - finding words that really represented what it meant to him.
Coherence therapy involves connecting with emotions that were blocked and with mental models, the emotional meanings, that operate in life separately 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 them.
How would Ecker do this part of the process with something like this new piece the client just referred to:
He might ask the client: "How would you say that in words?
When the client responds, Ecker reflects and asks the client to resonate and check with that, just like in Focusing reflecting. The 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 inside.
Ecker feels that 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 ... and the therapist can see it in their response.
So, Ecker wrote the following on a card, and had client read it, to check if it really fit or not, as his emotional truth around all this:
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, or 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!"
Process Summary of this case:
It is important to connect "down" - into the bodily felt experience under the symptoms, as the client did in first part of his work.
Then one needs 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. 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 the two of them work on this, as the client reads this. Same with therapist, who lets the client know that 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?" This is 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 in this particular case, it was not an attachment issue at play, but an existential learning, related to the unpredictability and uncontrollability of the fabric of life.
Reconsolidation Sequence and Implications
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, it requires two key ingredients. Once you have them, things can go quickly. But you do need to have them, and you need to do the prep work.
The prep work is:
- The retrieval work
- An experience of a very contradictory nature to the makeup of the symptom requiring emotional learning. This needs to be a living experience, an emotional experience that contradicts (disconfirms) at least some key piece of the earlier emotional learning.
So, the therapist helps the client to find a contradictory visceral experience. Then he helps design a juxtapositioning, some kind of mismatch that disconfirms the expectation, predications, the model of reality of the initial emotional learning.
The new learning then operates as the eraser of the target learning. The kind of new learning depends on the make-up of the earlier learning. If the initial learning was an attachment experience, then the contradictory one should also be attachment-based.
Now, if instead, this client's symptoms were due to an early childhood experience that set this up initially, what might Ecker have done in looking for a contradictory experience?
Ecker replied that there is a nice range of possibilities. This question opens up a wide range of choices:
Many therapists 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. From the perspective of this reconsolidation framework, the experience of the therapist's empathy can be the contradictory experience to being unloved, disconnected, abandoned, etc.
If the clients have beliefs such as "I am not a person who anyone would treat that way (deserving of love, respect, etc)" or "I am never listened to, understood..." then the positive experience with the therapist can disconfirm those earlier emotional meanings.
Reconsolidation reveals 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.
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, and also that an attachment injury might be positively influenced by another sort of intervention as well.
Here are two situations where this applies:
A) When a client's revealed attachments learning can be dissolved by the therapist's empathy. While reparative attachment can be used in these situations, the therapist can 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.
B) Where the revealed material shows how the therapeutic experience could not possibly be used as a disconfirming experience. Case Two is an example of this.
Case Two
A woman came to therapy because she feels no sexual desire or pleasure with husband. They are emotionally close, but no sexual desire.
She suffered from exhibitionistic and voyeuristic abuse from her parents. Her mom found her masturbating, and responded to her daughter with delight and joy. Her mother felt "How wonderful!" and went off, called all the family friends and members and told them about the client doing this. The client was mortified and felt very exposed at this.
In terms of attachment, the mother's demand for no sexual privacy was completely woven into the attachment fabric in the family. This was how the client could be most special to her mom, to get her mom's best attention, praise, and cherishing.
In this particular case, using the attachment to the therapist to access a disconfirming experience would not be helpful - it could easily 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 client, it turns out that she was expecting her sexuality to have precisely the same effect on her own teenage daughter, as her mom's had on her. "When a mom is sexual, it affects her 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 that powerful emotional expectation into language.
In her second session, a contradictory experience spontaneously came to here awareness:
Wait, my sexuality is different from my mom's. I have my sexuality; it is really different from hers!"
In this case, the client's brain did its own searching for living knowledge, and didn't need Ecker's help. She said"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, to help it land more deeply.
Going back to the first client, in his case, there was not already some existent knowledge. So, we had to go try to find it.
Sometimes one cannot find a contradictory personal experience. If so, another option, which I did with the first client, is the Unacceptable Costs method.
In our second session, the client reported that it was still there. Because there had been no contradiction, so no juxtaposition and reconsolidation, he still felt the original way about his job.
Ecker was looking for disconfirmation here. To Ecker, it seemed that his present solution of never wanting, or trying for something that he might want, wipes out the rest of his life for him and his fiance. And, Ecker could tell that client didn't notice this yet.
In this first case, he tried this:
"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 fiance might want together, for the rest of your life?
Then he was quiet, let this register with the client.
After a while, the client said: "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 of these sentences/beliefs/ learnings. This 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?
The client looked at Ecker for a while, and then " What was I thinking?!" as it integrated. The deep potentiation of emotional realness was happening.
After this, Ecker did a verification step, trying to re-evoke the original emotional learning. This is what the neuroscientists also do in their research. If it cannot be re-evoked, that is a marker for erasure of the emotional learning..
Ecker had the client read the declarative statement on his card again. The client read it - twice, and then said "Well, I sure can see why I would have reacted that way. But, now it is like hearing about somebody else!"
Resources
Materials about Coherence Therapy and memory reconsolidation and about the new book, "Unlocking the Emotional Brain"
Excellent article on memory reconsolidation with very useful tips and relevant research findings.