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Psychotherapist—Bruce Ecker: What’s the problem as you experience it?

COMMENTARY 1: These opening words begin to suggest to the client the direction the work will take: the therapist will be more interested in learning how the client constructs the problem, than how the problem happens to the client. The client relates to the problem situation using a uniquely personal construction of reality. This construction has enormous influence on how the problem is experienced and how this experience can be changed.

Client: Well, I, ah, over the last four years or so have, um, really, um, become aware of a drop in my mood, um, getting into a, a pretty— what I’d call a kind of a depressed place, that happens every year, late summer, um, and carries over, um, until I quit thinking about it basically. I mean it, ah—And in and of itself it, it—I’ve known it in some way, shape or form most of my life but wasn’t as aware of it.
Ecker: Hm. How far back? Most of your life means how far back?
Client: Well, I don’t know that I ever—Four years ago I went to a therapist, um, to talk about it and what was going on for me. That’s the first time I really said, hey, wait a minute, this is not okay, I’m not comfortable right now. And I didn’t know at that time that there was a, a, that there was some kind of a pattern to it, or at least I didn’t
think that way.
Ecker: So, at least four years ago.
Client: Correct.
Ecker: And—
Client: My wife has told me—and we’ve been together for longer than that—and she, when I did that she—in somewhere in that time frame—um, admitted to me that she had noticed that before.
Ecker: Okay.
Client: Um, and then I starting putting together other things, of course, about it. Um, looking back and saying, you know, I always thought of Fall as my favorite time, and then trying to make sense out of that. And, ah, so I think there’s been some element of it going on for probably quite a long time.
Ecker: Mm-hm.
Client: Um, and in and of itself it, it—I don’t know that it was all that, um, problematic for me. What, what became problematic was some of the symptoms of it, some of what happened in conjunction with it, or whatever. I, ah, when I first went to the therapist it was because, um, I was in a job situation and I, and I found myself feeling so insecure in that, and questioning everything I was doing and becoming, um, very, um, engaging in a lot of power plays with my, with the people I supervised and, um, being very short and impatient and, um, snapping and, uh—I mean, it was uncomfortable for them, it
was uncomfortable for me. Um, I, I mean, I was angry, I was—I didn’t want to be there and I wanted to be there. I mean, it was just very uncomfortable and—
Ecker: And this is associated with this drop in your mood at the end of summer.
Client: Yeah, yeah…
Client: Well, and I end up very—I mean, at the same time, I mean, there are other elements of it. I mean, I’m very, I get the typical kind of imposter kinds of thoughts. I mean, I, I get worried that I’m going to get found out; um, that I don’t know diddly squat; that I’m a, what am I don’t?
Ecker: So, what, what, what is the end of summer, in your life? What, ah, in your current actual circumstances? Do you have a teaching job? Is summer the beginning, ah, the—
Client: No.
Ecker: No.
Client: No, it really doesn’t mean anything in my current—well, of course it means something, but, um, not associated with my job, per se. Um—
Ecker: Has there ever been any major event in your life at the end of summer? Ah, upheaval, or—

COMMENTARY 2: The client has described a cluster of longstanding symptoms—depression, anger, and imposter feelings—that occur together regularly at the end of summer. In relation to this he has also indicated a considerable degree of unconsciousness: until four years ago he was unaware of these symptoms, then noticed the anger component first because of the interpersonal trouble it caused him, then gradually realized the annual recurrence of the whole cluster; he describes the “drop” in his mood as something that happens to him involuntarily; and he has not been able to make sense of having such symptoms during what he thought was his favorite time of year, Fall. In the first stage of coherence therapy, the therapist works to discover the client’s unconscious but coherent context, or construction of emotional reality, within which the presenting symptoms are compelling to have and fully make sense to have. In what the client has revealed so far, the “end of summer” is very likely an element of just such a pro-symptom emotional reality and can serve as a point of departure for further accessing of that unconscious construction. To do this, the therapist is bringing the client’s attention to “end of summer” and is prompting him to access subjectively whatever personal meaning then stirs into awareness.
Note that the therapist probed first for how the emotional significance of “end of summer” might be apparent in current life circumstances, found no resonance, and only then directed the client’s attention to the past. As a constructivist, the therapist is not really asking about the factual past even though he necessarily uses conventional language that sounds as though he is; nor is he, in bringing attention to “the past,” searching for causes in the past. Present symptoms are produced entirely on the basis of presently held constructs of reality, but it is often the case that these symptom-producing constructs were formed in the past and depict an emotional reality first experienced in the past. The client still holds and applies these constructs unconsciously in the present, making the past reality truly exist in the present.

Client: Oh yeah, I think, I think there probably was, ah, every year, going back to school. Um, and, and there was at least one year when I was really, um, I was ten years old and my, um—I’m the oldest of six kids and my parents are both physicians and, and, eh, my Mom’s a Swedish citizen so my father thought it would be a wonderful idea, all of our lives, for us to, to take advantage of her being from another culture, another language. And, when I was ten, um, somewhere in the middle of summer I flew off with a friend of our family to Europe, and spent time with this adult and his adult family, and then was put
on a plane and, ah, shipped up to Sweden to connect briefly with my aunt and my cousins, and driven out into the middle of Sweden to a boarding school and dropped off and good-bye and now I’m supposed to be here for the year at this boarding school, and I was ten. And it was traumatic as hell. Um, I did not stay, ah, to make a long story relatively short, but it was very painful.
Ecker: And that was at the end of summer.
Client: Yeah, well, yeah.
Ecker: Yeah. And you knew that was coming.
Client: You know, it’s very interesting, I’ve never associated this with it, yeah. I—I didn’t know it was going to be that painful because it was supposed—I was supposed to have a stiff upper lip, it was supposed to be an opportunity. It was, ah, I mean, that, that was the language of the adults, the “wonderful experience.”
Ecker: Yes, yes.
Client: Ah, but, emotionally for me, it was, um, extremely traumatic. I mean, I, it was very painful.
Ecker: Sounds really intense.
Client: It was.

COMMENTARY 3: A childhood, end-of-summer “trauma” that he has never consciously associated with his symptoms has surfaced. It is now time to stop talking about this and begin a fully experiential process of finding how his construction of that trauma leads him to produce his presenting symptoms. For this purpose the therapist will next repeatedly use the technique of overt statement, in which the client verbally expresses disowned emotional truth directly to the relevant figures (visualized or in person). If the therapist persists in having the client express phrases vividly capturing his emotionally true, symptom-requiring position, that position cannot remain split off and unconscious. The client will feel the emerging emotional themes in the present moment and experience them as present emotional realities. It is only in such direct, subjective experiencing of unconscious constructs that they are truly accessed and made available for swift, lasting change.

Ecker: I’d like you to try something, if you’re willing. I’d like you to, I’d like you to picture your parents.
Client: Yeah.
Ecker: Get, get a, got an image, an image of them in front of you?
Client: Essentially, yeah.
Ecker: Yeah, okay. That’s good enough to start off. And I’d like you to try out beginning to tell them, in straight terms, what that experience was for you—how that really felt for you.
Client: (Sighs.)
Ecker: And you can do that either out loud or quietly inside. It can be silent. Whatever feels right for you.
Client: (Sighs.) I have told them—
Ecker: You have.
Client: —but not very fully, I don’t think.
Ecker: All right. What’s the part that you haven’t told them yet? What’s the “fully”?
Client: I don’t think I’ve, um, really blamed them. I don’t think I’ve really been angry at them. Ah, I’ve kind of laughed it off.
Ecker: Ah. So, how would you tell them about this without any laughing it off, and showing them what you really feel and how it really affected you?
Client: (Big sigh. Voice slightly quavering.) I was ten years old. I mean I look at a ten-year-old kid now, and I can’t even imagine— (pause))—what happened.
Ecker: Yeah. Would you try out saying to them, to see if it, to see if it feels true for you, would you try out saying to them: “It was so awful for me that, to this day, I get very unhappy at the end of summer.”
Client: (Big sigh.) It was so awful for me—ah hell, it sucked! I mean it sucked and it sucks every year. (Pause.) And I’ve never put those things together.

COMMENTARY 4: The therapist has prompted an overt statement that links the client’s emerging emotional truth, “It was so awful for me (in Sweden),” to the concrete symptom, “that, to this day, I get very unhappy at the end of summer.” When the client then says, “And I’ve never put those things together,” the sentence has succeeded in fostering an experiential connection between his presenting symptoms and his childhood ordeal in Sweden. This is an example of how “unconscious” does not mean “inaccessible.” Unconscious, symptom-producing constructs carried for decades can be accessed in minutes if the therapist (a) assumes symptom coherence and, on that basis, initially does nothing but look for how the presenting symptom is necessary to have (rather than trying to get rid of it in any way), and (b) carries out this discovery experientially. It may seem surprising that such a psychologically aware, high-functioning person could live out decades of adulthood completely unconscious of the direct connection between his symptoms and his experience at ten. Actually, such unconsciousness of salient, pivotal emotional truth is the norm in therapy clients at all levels of psychological sophistication. At this point the therapist anticipates that the rest of the session will be used to fully unpack the emotional truth now emerging and to achieve as much experiential integration of this specific pro-symptom construction as possible.

Ecker: I see. (Pause.) Yeah. Would you try out saying to them—and change the words to make it fit for you just right—ah, “How could you do that to me? Didn’t you know?” What are your words for that?
Client: Um, I, I need to—aah. Who knows what this is, but—
Ecker: Yeah.
Client: —when you said that, the problem for me has always been is that that’s failure on my part.
Ecker: What is failure on your part?
Client: Not, not being able to accommodate their expectation.
Ecker: I see. Their expectation that you should—?
Client: That was my stuff, is that I’m a big boy. (Laughs.) I can handle this. This is, I mean, there’s not a problem here, this is an opportunity.
Ecker: Mm-hm.
Client: But that’s not how it felt.
Ecker: Okay. So, how about telling them, “I know you really wanted me to just handle it, like a big boy, but I was ten, just ten.”
Client: (Sighs.) Yeah.
Ecker: What do you want to say to them? “I wasn’t a big boy”?
Client: I, yeah (laughs)—No, I was telling ’em forwards and backwards, “I am a big boy, I am a big boy” and that fell, that flew in the face of my internal stuff—I hurt like hell. Um, I mean, ahh—I wanted, I guess now I want to tell ’em, despite what I was trying to show you that I could handle things and that I knew stuff and that I was on top of stuff, I didn’t. I couldn’t. And you needed to see that. You were the adults, for God’s sakes, I was a ten-year-old boy! (Tears.) You were supposed to know. Not just send me off there and look at my smile and say, “Oh, he’ll be fine.” (Cries.) It wasn’t fine.
Ecker: Yeah. (Pause.) Good, keep, keep going. Tell them, tell them more of what, what the experience really was for you, some of the details. What was the worst of it for you? Tell them.
Client: I don’t know what the worst was, I just remember it was really painful, it was scary, I was very homesick. I, ah—I mean there were really, there were a lot of good things, too, but, ah, and I remember them. You know, funny, you ask me, “Tell ’em how bad it was” and what comes to my mind is the fun stuff. I mean, um, but I didn’t know the language, I didn’t know anything.
Ecker: Are you willing to tell them, “I was so homesick, it was so painful.”
Client: Yeah, that’s the stuff they did hear.
Ecker: They did hear that.
Client: Well, (laughs) um, oh hell, it was 1960—I don’t know, four or something like that, ’63—and I can remember that, it was, there was a transatlantic cable then, there were no satellites, so the telephone calls took forever to connect and, and you’d get called back by the operator. And I was a ten-year-old kid so I’d get this call and I’d go running for it, and I would try and diplomatically tell, talk them into taking, letting me come home. And let it be reasonable, intellectually. (Laughs.)
Ecker: In other words, by not, not showing what was really going on.
Client: Yeah, except for I couldn’t do that. I mean, I would break into tears, and plead and beg and, and they’d keep trying to shore that up, so it would be okay.
Ecker: So, what do you need to say to them now about that? “Couldn’t you see what was happening to me?” What, what do you, what do you want to say to them about that?
Client: I don’t know, I don’t know. I, um—

Client: I mean, I buy into a lot of what, of the other side of it, which is, ah, you know, I—Yeah, well, but I think that, I think that they thought that, you know, if I could just get by the initial insecurity then it would be a wonderful experience.
Ecker: All right. Try this, if you would. Try saying to them, “I agree with you that I should have been able to handle it well.” How ’bout giving voice to that side of your own feelings?
Client: Yeah, well, part of me at least does agree with that. That I, I, I, I should have been able to get through with it, um, to get to a place that was more comfortable. Um—
Ecker: Mm-hm. Okay. And now, would you let yourself, to whatever degree is there for you right now, let yourself feel or connect with that particular kind of feeling that develops at the end of summer, now in your life? I think you said a drop, a drop in your feelings happens. Let yourself feel that. Let yourself speak to them, your parents, from that drop. What needs to be said, to them, from that drop in your feelings?

COMMENTARY 5: When first asked to tell his parents “in straight terms, what that experience was for you—how that really felt for you,” the client equivocated and then said, “I don’t think I’ve, um, really blamed them. I don’t think I’ve really been angry at them. Ah, I’ve kind of laughed it off.” This indicates extensive suppression of the emotional truth of his experience in Sweden and of the associated unresolved themes and meanings in relation to his parents. Heading directly for this material, the therapist has twice invited him to tell his parents imaginally of the emotional suffering their choices caused him, and to ask for some accounting for this from them. He managed to do some of this but each time soon cut off the process by shifting into self-blame, the view that his ordeal in Sweden was due to his own inadequacy. The therapist sees this self-blame or low self-worth as a distinct symptom in itself, and has responded to it in the manner characteristic of coherence therapy: he accepts the symptom of self-blame as being what’s so for the client and, in order to discover how it is more important to have than not to have, invited fuller expression of the client’s powerful position of producing it. The client engaged this to a degree but remained at too cognitive a level for the work to advance usefully. The therapist therefore decided to focus where deeper experiential accessing would be more likely to occur—the subjective state of the drop in feelings. In going into his state of producing the symptom, the client is activating and occupying his pro-symptom position.

Client: (Long pause. Sighs.) The only thing that comes to my mind is that no, I’m really not what you think I am.
Ecker: Good. Keep going with that.
Client: I, I’m, yeah, boy, I’m really not, ah, as secure or as comfortable in things. (Pause.) I’m really quite frightened. (Sighs.) Huh.
Ecker: Tell them, of what.
Client: (Sighs.) I’m frightened of being found out, I’m frightened of being, ah, of being inadequate, of being, um, not able to meet up to the expectations.
Ecker: Your expectations? Their expectations, I mean?
Client: (Laughs.) Is there a difference? (Laughs.)
Ecker: Yeah, exactly. So, then, is what you’re getting at something like, “I’m really frightened”—Well, it’s the first thing you said, “I’m really not what you think I am, and I’m really frightened that you’ll find that out, and you’ll see I’m, I, I don’t live up to your expectations. And every Fall I get troubled and depressed about that.” Is that what this is
leading to?
Client: Yeah, it’s, it’s become the parents in general—the world around me, my own parent, everything.
Ecker: Mm-hm.
Client: I get really frightened that I’m going to get found out, that I’m, that I’m not okay, that I’m not capable, that—and I, and I get really pissed ’cause I don’t like the pressure of having to keep proving that I am.
Ecker: Ah—so there’s the anger part of it there.
Client: Yeah.
Ecker: Mm-hm.
Client: I mean it takes a, for me it takes an awful lot of effort, it feels like, to keep proving that I’m worthy…
Ecker: So, picture your parents again, and just try out saying directly to them, just what you were getting in touch with and putting words on—ah, “I’m not what you think I am, and I’m really frightened you’ll find out that I, I don’t live up to your expectations.” Would you try out just direct to them, saying that.
Client: I’m not what you think I am. Heck, I’m afraid that you do think right of what I am and that I’m not okay, and you don’t think I’m okay. That’s what I really think. I’m not afraid that they—I’m afraid that they already know that I’m not okay.
Ecker: I see. I see.
Client: That’s what I, that, that’s the real stuff, is that we can all keep up the act, but, underneath all that, they, supervisors, authority figures, whatever, already know that somehow I’m not okay.
Ecker: Mm-hm.
Client: No wonder I get angry. (Laughs.)
Ecker: No wonder you get angry?
Client: Yeah. (Laughs.)
Ecker: What do you mean?
Client: Well, (laughs) I’m thinking that, you know, I work really hard to prove I’m okay all that time, and, at a certain point I get really tired of it. And I just want to tell them to fuck off, you know, just, give it up, already, you know?

COMMENTARY 6: The coherent basis of the client’s anger, one of his presenting symptoms, is beginning to emerge: He carries the construction that all authority figures already see him as he sees himself, fundamentally inadequate, and only act as though he might be adequate. He is angry over this falseness that endlessly leads him on to make futile efforts in hope of getting them to think he is adequate, and he is angry over the impossibility of ever changing their unspoken view of him. These themes are a direct generalization of the construals he formed in relation to his parents after his stay in Sweden.

Ecker: Go ahead. Who’d you like to picture—
Client: (Laughs.)
Ecker: —to say that to?
Client: (Laughs.)
Ecker: Who’s top on the list?
Client: (Laughs.) Boy, I don’t know.
Ecker: Who would you most like to say, “I’m really tired of trying to convince you I’m okay, when I think you already think I’m not, and it’s an impossible task.”
Client: Hm. Probably myself. (Pause.) Probably myself.
Ecker: You’re tired of trying to convince yourself you’re okay.
Client: That sounds horrible. (Laughs.)
Ecker: What’s horrible about that?
Client: I shouldn’t have to convince myself that I’m okay. I mean I shouldn’t have to. But I do, all the time…

COMMENTARY 7: In acknowledging his endless efforts to convince himself he is “okay,” adequate, he plainly sees his “horrible” emotional truth of feeling inadequate. The therapist now wants to discover the coherence of this low self-worth, that is, the unconscious themes and purposes within which low self-worth is necessary to maintain. For this purpose the therapist is next going to apply the technique of symptom deprivation, or viewing from a symptom-free position. Having a client experientially sample being without the symptom in the very situation where the symptom happens strongly is likely to surface the unconscious theme or purpose making the symptom necessary to have—the emotional truth of the symptom. The aim of the technique is the discovery of that specific theme or purpose, not a permanent change to a symptom-free state.


Ecker: Yeah. All right then, then I have an idea of something I’d like you to, to do next.
Client: Okay.
Ecker: Again, picturing your parents. And now, I’d like you to try out seeing what happens for you if, if you look at them, knowing you’re okay. Not, not trying to convince yourself you’re okay. And it’s not, I’m not aiming for, that by the end of session you’ll stay there
and always feel okay. Just for a minute or two, here, I’d like you to see what it’s like for you, what starts to happen, if you look at them, seeing them as putting these, these expectations on you that don’t match who you are. And seeing that as a kind of, probably a very well intentioned, misattunement with you. They’re failing to see you and accept you—again, with the best of intentions. But I would just like you to look at them from a place of knowing you’re sufficient, you’re fine, but you’re suffering this, this misattunement that they carry out. Just see what, what that feels like, and what, what they seem like, what changes you notice.
Client: (Laughs.)
Ecker: What’s that?
Client: Ah, it’s a really different picture. (Laughs.)
Ecker: What is it?
Client: Well, for one, they’re really small. Um, and there’s a distance. And I feel pretty stable and constant, but, they’re, that, and—it’s kind of fuzzy.

COMMENTARY 8: Symptom deprivation is working. In holding a position of regarding himself as adequate, the client reports a loss of attachment, a considerable new degree of separateness and emotional distance from his parents. This is not an interpretation coming from the therapist but an experience he is having for himself, directly. (This “incredible shrinking parent” experience is a quite common result of guiding a client to sample being free of low self-worth while imaginally in the company of parents.) The therapist has learned now that in this man’s unconscious emotional world, maintaining his original attachment with parents is a top priority that necessitates construing the suffering he experienced in Sweden as due to his own inadequacy, rather than due to his parents’ making inappropriate choices that hurt him. When invited by the therapist to inhabit the latter view, he has managed briefly to experience it but has quickly reverted to self-blame.