Consistency therapy: what it is and how it is used in psychology

Consistency therapy is a constructivist cut therapy model , based on the principle of symptom coherence (which we will explain later). He was born 25 years ago by the hand of Bruce Ecker and Laurel Hulley, two renowned psychotherapists.

In this article we will see what this therapy is based on, how it works and what are its most relevant assumptions and characteristics.

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Coherence therapy: what is it?

Coherence therapy is a type of psychological intervention based on an experiential and constructivist approach. It was created by psychotherapists Bruce Ecker and Laurel Hulley over 25 years ago (around the 1990s). Throughout these years, the therapy has been improved and changes have been made in it.


What is constructivism? First of all, let’s go to its origin. “Constructivist thinking” appeared in the paradigm of psychology in 1976, at the hands of Watzlawick. However, it was George Kelly who first spoke of personal constructs, twenty-one years earlier (in 1955), when he published his work The Psychology of Personal Constructs .

Constructivism is one of the orientations of psychology, based fundamentally on how people understand reality , that is, on all those meanings that we attribute to everything we experience. Through this contact and knowledge of reality, we build our vision of it, in a totally subjective way and influenced by numerous factors.

Thus, each reality is lived in a unique way, and we build this reality as we live and experience. Well, from the constructivism one works with all those constructions of the patient, be they personal, social, labor, relational constructions …

From constructivist psychotherapy, we work to identify these patient constructs, to understand them, to modify them when they are too permanent and rigid , to locate which constructs are perpetuating the symptom, etc. In this way, coherence therapy is based on this type of psychological orientation.

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Origin of this type of psychological intervention

The origin of coherence therapy, as we have mentioned, is found in the authors Bruce Ecker and Laurel Hulley, who analyzed a large number of therapeutic sessions with patients; Through them, they observed how certain changes in the patient resulted in the cessation of symptoms of suffering and discomfort .

They also observed that there were a series of “rules” within psychotherapy, which facilitated these therapeutic changes. These changes, of course, were lasting and profound. From these observations, Ecker and Hulley were developing coherence therapy, based on a non-pathologizing approach to life experiences and situations.

Objective and operation

Through coherence therapy, and based on its constructivist approach, it is intended to identify those emotional, unconscious and adaptive constructions that the patient has been developing throughout his life, and that maintain and intensify his current problem (“the symptom “).

All this is achieved through a series of steps, which are intended to change certain emotional learning that the individual has internalized; It is a process of reconsolidation of memory . In addition, neuroscience supports this process, as we will see later (where we will also explain in more detail what this “memory reconsolidation” consists of).

Thus, coherence therapy works through a series of steps; The therapist is the one who guides the patient in these steps, in order to achieve in him a lasting and therapeutic change that eliminates his suffering or his worries (which are usually born as a result of unconscious constructions of reality).

Neuroscience support

The field of neurosciences, interested in finding out everything possible about the brain and its functioning, yielded a series of conclusions that supported the model on which Ecker and Hulley’s coherence therapy is based. We are talking about the process of “reconsolidation of memory”, already mentioned.

Specifically, in the year 2000, from the neurosciences this process was described. It is the only mechanism of neuroplasticity that allows the brain to permanently modify certain emotional learning that it has very internalized.

Thus, it was seen how this process of reconsolidation of memory, corresponded in its entirety to the process described from the coherence therapy to achieve therapeutic changes and cessation of the symptom.

Assumptions and characteristics

To get an idea of ​​coherence therapy, let’s see what are its assumptions and its most relevant characteristics. These are just some (the most important), although there are more:

1. Importance to unconscious constructions

We have already seen what each person’s constructions are, and how they relate to the way in which each one constructs their reality. Thus, coherence therapy gives importance to these constructions, especially those unconscious (of which the individual has no explicit conscience, but which interferes with their well-being).

One of the goals of therapy is to identify these constructions in order to work them. Thus, we can say that the coherence therapy approach, although constructivist, also has notions of the psychodynamic approach .

2. Non-pathologizing vision

Consistency therapy moves away from the psychodynamic approach in terms of its vision of symptoms (or its pathologizing approach). Thus, the patient’s symptoms, that is, those that create discomfort and / or suffering, are not conceived from a pathologizing point of view.

In this way, coherence therapy avoids classifying or pathologizing the patient’s behaviors, and focuses on how he experiences and subjectively constructs his reality , explicitly (explicit constructions) and implicitly (implicit constructions).

3. Symptoms as personal choices

Consistency therapy understands the patient’s symptoms as a result of personal choices , not as a result of cognitive errors (as cognitive therapy would do).

As for its characteristics, these choices are personal, generally unconscious, and adaptive. Thus, the individual chooses what he wants at each moment, but as a result sometimes symptoms arise.

4. Principle of symptom coherence

Coherence therapy is based on a principle, called “symptom coherence principle”. In fact, all therapy revolves around him. This principle has to do with the fact that people need compelling narratives on a conscious and unconscious level (when we talk about narratives, we mean personal constructions).

This means that, although the symptoms are perceived as something negative for patients, they are compatible, minimally, with an adaptive scheme of reality, the way we understand it. But how was this scheme born? Through its codification in our implicit memory , at some point in our life.

In other words, and so that it is understood; According to the principle of the coherence of the symptom, the symptom must be consistent with certain adaptive constructions of the individual, necessary for this to be maintained.

5. Cessation of the symptom

The goal of coherence therapy, like that of all psychotherapies, is that the symptom that causes suffering ceases to condition the patient’s life. For this to happen, this symptom must not be required by the current constructions that the person has of reality ; that is, when its construction (or construct / s) of reality does not “need” said symptom, it will disappear.

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