To illustrate symptom generation by underlying emotional learnings and how such learnings are unlearned and erased through MR, producing transformational change, consider Tina, 33, who began her first therapy session by saying, “I’ve been feeling depressed and lousy for years. I have a black cloud around me all the time.” She described a total absence of motivation, low energy, thorough social isolation, great difficulty doing her part-time, at-home work of writing grant proposals, and much self-denigration and self-pathologizing. She said, “I’m a vegetable. I’m a worthless nothing that nobody could possibly find interesting.” She had previously tried therapy, self-help groups, and Prozac, and was now taking Wellbutrin, but none of those had helped. More as an expression of hopelessness than curiosity she said, “I just don’t know why I can’t be happy.” There was indeed a definite reason, but it was in her implicit emotional learnings, outside of awareness. Bringing that underlying emotional learning into direct, explicit awareness as a subjectively felt emotional truth would set it up as a target of change through MR. (For reviews of the neurobiology subserving the implicit and explicit memory systems, see, e.g., LaBar and Cabeza 2006; Squire 2004.)
Different therapy systems provide many different techniques for that retrieval from implicit to explicit knowing. In this case, the therapist was using Coherence Therapy (Bridges 2015; Ecker and Hulley 2019), which holds that a given symptom exists because, according to at least one adaptive emotional learning that is outside of conscious awareness, the symptom is compellingly necessary to have, even with the suffering entailed in having it. That is termed the principle of symptom coherence, and it guides the experiential process of finding and revealing the symptom’s underlying emotional learning(s) or schema(s). Once revealed and brought into awareness, each schema generating the symptom is then subjected to the memory reconsolidation process of profound unlearning and erasure. Finally, observation of the markers of transformational change, verifying complete elimination of the symptom and its underlying core theme of emotional distress, is the last stage of Coherence Therapy for a given symptom. If the client also wants therapy to address other symptoms, the same process is carried out for them.
Here the therapist first enquired about Tina’s experience in her family of origin. She described painful memories of several incidents, then in summary said flatly, “Saying what I’m really feeling or caring about gets me mowed down—so I don’t go there.”
The therapist then asked, “And how do you keep yourself from ‘going there’?” That question arose from the therapist’s assumption of symptom coherence, and it brought Tina’s awareness deeper into an area where awareness had never gone. Her eyes darted around as she recognized and voiced with animation, “By being dead, apathetic, and telling myself I have nothing interesting to say!”
That began Tina’s retrieval into awareness of emotional learnings that she had formed in response to the hostility that surrounded, endangered, and actually assaulted her in her family after almost every expression of her feelings, needs, thoughts and interests. Her autobiographical memory and conscious narratives already contained a great deal of what she had suffered and learned to expect in her family, but nothing about her own self-protective tactics that were urgently needed to avoid those assaults as much as possible. It was new, surprising awareness for her to recognize that for safety she had resorted to eliminating her own self-expression by deadening herself.
With that shift from implicit to explicit knowing of why and how she had learned to protect herself, and from seeing for herself the fully coherent and adaptive nature of her solution to the problem of family hostility, her state of depression, lack of motivation and futility suddenly made deep sense to her in an entirely new way. Instead of viewing those symptoms as mystifying, out-of-control personal defects and pathology, she now recognized that they were urgently needed, purposeful, and effective tactics for keeping to a minimum the suffering that her family members were always ready to inflict.
That recognition of her agency and that de-pathologizing of her condition happened by becoming aware of her own emotional learning, and were, in themselves, significant therapeutic changes in her identity and model of herself. The component experiences of the ECPE are apparent in how that change occurred: While she was viewing her depressed state of mind and behavior as pathology, she also experienced a very different, contradictory meaning that felt unmistakably true, and that juxtaposition of the two incompatible meaning-schemas was naturally repeated a few times in the rest of the session. Thus the ECPE was fulfilled and her pathologizing meaning for her depression was disconfirmed and erased. The retrieval of coherent emotional learnings in the initial, discovery phase of Coherence Therapy usually fulfills the ECPE in this way and has this dual effect of de-pathologizing the symptom and revealing the client’s personal agency in producing it self-protectively. However, this would not be the only implementation of the ECPE in Tina’s therapy.
At the start of her next session, Tina said she knew all along that in her family there was almost never any expression of love or affection, but it was new for her to recognize that in life with them she was “swimming with sharks.” After five sessions of such work, the ECPE had also been applied to Tina’s core belief that her family members’ harsh negativity toward her was deserved and was caused by her own worthlessness. That mental model had been disconfirmed and replaced by the differently painful understanding that their behavior was caused by their own “emotional baggage” and their inability to be kind and loving. That work entailed feelings of hurt, anger, betrayal, and grief, yet her overall mood and appearance had lifted significantly, so she and the therapist agreed that she would schedule another session only if and when needed.
A few months later, she scheduled session six because, she explained, despite no longer being in a black cloud, a general apathy and lack of motivation had persisted. That report meant to the therapist that some part of her original emotional learning was still intact and perhaps was not yet fully retrieved into awareness.
To continue the discovery work, the therapist now guided Tina to imagine, just a little bit, how it will feel when she is no longer apathetic, actually has some interest and motivation in her own pursuits, and also mentions something about her pursuits to her parents. That is the discovery technique of symptom deprivation, often used in Coherence Therapy (Ecker and Hulley 2019). It is not a rehearsal for the client to then remain symptom-free after the session, which is explained to the client. Rather, any distress that develops due to being without the symptom during the exercise begins to reveal the emotional learning that the symptom is urgently necessary for avoiding that particular distress.
As Tina sampled the imaginal experience of mentioning her pursuits to her parents, she became quite uncomfortable in her chair and felt “pretty tense.” The symptom deprivation exercise was working. A further implicit learning was emerging, and to bring it more fully into explicit expression, the therapist now invited Tina to let this sentence complete itself without pre-thinking: “If they know I’m doing things that matter to me—”. Tina said it once, and then again, and then very quietly she said: “She’ll take it.” She then became motionless, and after several seconds said loudly, in obvious amazement, “I erased myself!” As she then continued to find words for what had come into awareness, her voice and face became rageful: “She takes everything! She f***ing takes it all! So I’ve got to erase myself! She always, always makes it her accomplishment, not mine—so why should I be anything!”
Tina had retrieved into explicit awareness her emotional learning of both the ever-present danger of being pillaged and zeroed by her mother and the urgent need to thoroughly zero herself into apathy and blankness so that her mother will have no opportunity to do that to her ever again. What had seemed to be “depression” was now even more fully revealed to be Tina’s own self-protective, adaptive tactic of making herself blank and “playing possum” to avoid that repeating ordeal.
This was major progress and another potent shift in Tina’s experience. Even so, direct awareness of a symptom-generating emotional learning does not, in itself, necessarily produce a liberating nullification of it, as many experienced clinicians have observed. The ECPE maps out exactly what is needed for the brain to unlearn and nullify this deeply held material, producing transformational change: the experience of a contradictory knowing, in juxtaposition with the target learning. That had not yet occurred, and until it did, this material would remain in force.
Indeed, after several minutes of feeling both jubilant in her self-validation and empowered by her anger at her mother, Tina’s state of mind slumped again as she grimly realized, and explained to the therapist, that her mother is still the same, so it feels as dangerous and scary as ever to care about anything and have any of her own interests and pursuits, or to even imagine revealing any such to her mother.
Hearing that, the therapist understood that there was still more to discover. Tina’s continuing experience of raw vulnerability in relation to her narcissistic mother begged the question: What mental model of their relationship did Tina learn as a little girl that now, as an adult woman, keeps her feeling fully vulnerable to her mother? In Coherence Therapy parlance, what terms of attachment had her mother imposed that maintained such endangerment? The answer to that crucial question was in Tina’s implicit learnings, and the therapist now had to find a way to elicit that material. Sentence completion, which had been effective earlier in the session, again fit the moment and the material. The therapist said, “Let this sentence complete itself, again without pre-thinking the ending, as we did earlier, ok? ‘Mom can still take away whatever I might do or care about because—’. Say it yourself and just see what comes up to finish it.”
Tina said, “Mom can still take away whatever I might do or care about because—anything I do or care about is right there in front of her, and she can take it away in one scoop.” Tina then made a facial expression and gesture that meant, “Wasn’t that really obvious all along?”
The implicit learnings of clients become obvious after they are discovered, but before that happens, they are deep, dark mysteries. For the therapist, what Tina had just described was a major revelation because it was now clear that her deadened state, and the whole schema maintaining it, were based entirely on this one core expectation, learned as a little girl, of being totally visible to her devouring mother. Reflecting back what Tina had revealed, the therapist said, “I see. Mom sees everything that you ever care about or do, and she takes over and takes away everything that she sees you ever caring about or doing, so your only way to be safe from that is for you to care about nothing and do nothing, so there’s nothing that she sees.”
Tina replied, “I never thought about it like that before—just putting it in plain words like that—but that sums it up really well.”
Having revealed that schema, the therapist, as a practitioner of the ECPE through Coherence Therapy, was now aiming to find contradictory knowledge that could disconfirm it. Tina’s core expectation that anything she cares about or does is going to be visible to her mother was clearly a child’s model of reality, and it might be readily disconfirmed by contrary adult knowledge already in Tina’s possession if the two were brought into juxtaposition. In order to prompt Tina to find the needed contradictory knowledge, the therapist now gently said, “You feel just as vulnerable as ever to your mother taking things away. So tell me: In what ways do people keep other people from just reaching in and taking away things?”.
That Socratic question was intended to guide Tina’s attention into examining a crucial piece of her emotional learning that had always been outside of awareness and unthinkable. As Tina registered that question, her eyes blinked several times, she uttered a few fragmentary thoughts, then paused, furrowed her brow, and finally said, “It’s as if there has been a ‘no walls’ rule all along. I think I’ve been obeying a ‘no walls’ rule.” She then expressed amazement over seeing the possibility of “having walls” and keeping her personal affairs “behind walls” and totally unknown to her mother or others. Her seeing that such a possibility existed and was available to her was contradictory knowledge, and it came directly into juxtaposition with her mental model of her mother as all-seeing.
She again felt jubilant. This time, her elation was a marker of schema nullification and liberating change that persisted. The therapeutic process had gone beyond the retrieval and recognition of her emotional learnings to carrying out the ECPE once again, producing disconfirmation and a transformational change, as explained below. No further sessions were scheduled. In a follow-up phone talk two months later, Tina said her sixth session was a “major breakthrough” and laughed gleefully about having significant personal developments that she had kept fully private from her parents and siblings. She explained that the first month after her last session had been a rocky period of intense rage at her parents, but she now experienced only an occasional negative feeling toward them. Two years later, in another follow-up by telephone, Tina was nine months into a new career in computer programming and spoke about her future with enthusiasm. She said she was completely free of the black cloud and antidepressants. She added, “The work I did about my mom and her self-centeredness helped me a lot. I could step back—that's been really nice. Things are good, in many ways,” she said with vitality in her voice, and then repeated, "Things are very good."
In Tina’s final session, fulfillment of the ECPE is apparent from close examination of the moment-to-moment process. The target learning, now in awareness, was her mental model of her connection to her mother, a “no walls” model in which her inner and outer life were completely visible to mother and therefore always completely vulnerable to being plundered and pillaged by her. That mental model, formed in early childhood on the basis of myriad interactions between them, and then reinforced by myriad interactions all through growing up, was the very basis of the feeling of endangerment that made Tina’s self-zeroing urgently necessary. She was solving the problem of selfhood robbery by having nothing to rob, a very costly solution that impoverished her mind and her life. The possibility of solving the problem by having walls, boundaries, and privacy from her mother had never existed for Tina. The therapist used a Socratic question to direct Tina’s attention to discover that possibility for herself: “In what ways do people keep other people from just reaching in and taking away things?” Her adult knowings already held the answer to that question. With Tina’s jolt of recognition that having walls is an option for her, the disconfirmation and erasure of the target learning were immediate and, therefore, so too was the ending of Tina’s depression, lack of motivation, and social isolation, which had been necessitated and produced by nothing more than that emotional learning of helpless visibility. Two years of follow-up found that these transformational changes had persisted effortlessly, confirming erasure through the ECPE.