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A new zone of effectiveness for psychotherapy contd ...

 

However, the majority of therapists work from the disorder paradigm, and for most of these clinicians cognitive interpretations and understandings are a mainstay. Within the psychodynamic school, which relies centrally on interpretation, there has only recently been a dawning recognition of this technique's ineffectiveness (Henry, Strupp, Schacht, & Gaston, 1994). In the 1990s, research in neuropsychology revealed why cognitive insight does not have therapeutic potency (Panskepp, 1998). Formations of personal reality that involve urgent emotion are stored and implemented by the brain's limbic system, operating quite independently of the brain system that uses verbal-conceptual understanding, the neocortex. In other words, a therapy client's cognitive insights occur in a brain system that does not contain and cannot revise the emotionally intense construction generating the symptom. Furthermore, the representational form of the material in the limbic brain is nonverbal, consisting of emotional, perceptual and somatic constructs or knowings. The therapy field, in relying so widely on cognitive insight, is "unwittingly investing enormous energy in approaches that are, to a large extent, at odds with our brain's most fundamental functions" (Atkinson, 1999, p. 25).

Operationally this means that in order for a therapy client to access and change the compelling emotional themes driving his or her presenting symptoms, the therapist must use experiential methods that directly engage the client's limbic system where this material actually lives.

The psychobiological findings also explain why the imaginal techniques so often used in experiential work are therapeutically effective for accessing key material: The limbic system does not know the difference between imagined and actual perceptions. If you visualize your father characteristically saying, "Just an A-minus? How come not an A-plus?", your limbic brain responds as if Dad is actually present and behaving in those ways and it activates the relevant modules of emotional reality.

An assumption dominating the psychotherapy world is the view that unconscious emotional realities formed in childhood and generating symptoms for decades necessarily require many months or years of therapy to change. In order to make therapy time-effective, the postmodern brief and systemic therapies developed in the 1960s, 70s and 80s strictly avoided in-depth work on unconscious and emotional material. These approaches, which include strategic and solution-oriented therapy, arose in fervent reaction against psychoanalysis and viewed in-depth work as necessarily entailing the most objectionable features of that school (unverifiable interpretation, an authoritarian and pathologizing therapeutic stance, preoccupation with understanding causes in the past, a snail's pace of change, and dubious ultimate effectiveness).

Ironically, in excising the intrapsychic world from therapy these progressive modalities were still subscribing to the psychoanalytic assumption that therapy must be either deep or brief, never both. The depth-avoidant, maverick modalities merely made the opposite choice within the same assumed dichotomy, sacrificing depth for brevity.

The unification of the century-old deep-versus-brief split has begun with the coherence-oriented therapies that emerged in the 1990s. These demonstrate empirically that genuine in-depth therapy can be brief because the mind has native processes for (a) swiftly and accurately bringing to awareness the specific emotional schemas unconsciously giving rise to a particular clinical symptom, and then (b) transforming this material. The result is both symptom cessation and relief from longstanding emotional disturbances and wounds, often in only 3, 8 or 20 well-focused experiential sessions. The psychological processes involved in such therapies have been described in detail in the technical terms of cognitive science (Greenberg and Pascual-Leone, 1995) and in the more therapist-friendly language of DOBT (Ecker & Hulley, 1996, 2000a-b).

Will psychotherapists, who expect their clients to accept the discomfitting process of change, themselves be open to a new assumptive base that could bring our field into a quantum leap of therapeutic effectiveness?

The authors

Psychotherapists Bruce Ecker, M.A., L.M.F.T. and Laurel Hulley, M.A. are the co-originators of depth-oriented brief therapy and co-authors of Depth Oriented Brief Therapy and of various chapters and articles on DOBT. Both are in private practice in the San Francisco Bay Area. Ecker teaches DOBT widely, including graduate courses at John F. Kennedy University. He is co-author of a volume on the psychology of involvement in spiritual groups and practices, Spiritual Choices: The Problem of Recognizing Authentic Paths to Inner Transformation. Hulley develops clinical trainings for Pacific Seminars and is co-producer of the DOBT training video series. She is a co-founder and board member of the Julia Morgan Middle School for Girls.

They can be contacted at B.Ecker@dobt.com and L.Hulley@dobt.com.

 

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