Coherence therapy and memory reconsolidation

1. Introduction

Version followed: Coherence Therapy as published by Bruce Ecker and Laurel Hulley through the Coherence Psychology Institute (three phases: discovery, integration, transformation, plus verification), using the technique names of the Therapist's Cue Card v3.1 (2010) and the clinician proficiencies list, mapped onto the "Therapeutic Reconsolidation Process" (TRP: steps A-B-C, 1-2-3, V) as summarised in Clinical Note #6 v1.1 (Ecker & Hulley) from Ecker, Ticic & Hulley (2012). The paid 93-page Practice Manual and the 2012 book are not drawn on beyond their contents listings; detail they hold (e.g. resistance techniques, contraindications) is marked [uncertain] where it matters. [source: CT Practice Manual page; CNOTE2; CNOTE6]

What it is: an experiential, constructivist psychotherapy, first published in 1996 as Depth Oriented Brief Therapy (DOBT) and renamed Coherence Therapy in 2005. Ecker and colleagues later argued that its change process matches the steps neuroscience identifies for memory reconsolidation, and proposed the TRP as a theory-independent template that other therapies (AEDP, EFT, EMDR, IPNB, IFS, Gestalt chair work, Focusing) can also meet. So the entry covers two things: a specific therapy (Coherence Therapy) and a transtheoretical framework (the TRP) for organising any experiential method around a defined change sequence. [source: Wikipedia, Coherence therapy; Sibson & Ticic 2014; CNOTE6]

Core idea of change: a symptom is produced because, inside at least one implicit, emotionally learned schema (a "pro-symptom position"), it is necessary, for example to avoid a specific suffering. The symptom stops when no such schema remains. Change happens by (1) bringing the symptom-requiring schema into felt, explicit awareness, then (2) having it felt at the same time as a vivid, lived knowing that flatly contradicts it (juxtaposition, the clinical counterpart of the "mismatch" or prediction error that unlocks a memory for revision), repeated until the old schema no longer feels true. Counteracting the symptom (overriding, suppressing, replacing it) is held to leave the schema intact and relapse-prone. [source: Ecker & Hulley 2008; CT Tool Kit 2015; CNOTE6; Ecker 2018]

2. Framework

TRP and Coherence Therapy phases (Coherence Therapy names in brackets) [source: CNOTE6; CNOTE2; Sibson & Ticic 2014]:

Step	Goal	Coherence Therapy activity
A. Identify symptom	Concrete, agreed target: the behaviours, moods, thoughts or body states the client wants gone	Symptom focus on a specific recent occurrence
B. Retrieve target learning	Symptom-requiring schema felt and explicit	Discovery, then integration
C. Identify disconfirming knowledge	Find a lived knowing that sharply contradicts the schema	Finding contrary knowledge
1. Reactivate target learning	Schema felt as true now	Overt statement, card, scene re-entry
2. Activate disconfirming knowledge	Contradiction felt in the same moment	Juxtaposition
3. Repeat the mismatched pairing	Schema loses its realness	Repeated juxtaposition
V. Verify	Confirm change	Re-evocation test; symptom gone without effort

Phase goals and moving criteria:

Discovery: surface the pro-symptom position (psp) experientially, reaching at least "third-order" depth, i.e. the purpose the symptom serves. Move on when the client feels the psp as their own truth and recognises their own agency in producing the symptom. [source: Ecker & Hulley 2008; Proficiencies page]
Integration: repeated in-session and between-session experiences of the psp until the client "owns" it with steady awareness. Can take one session or several, often days to weeks. A well-integrated schema is a ripe target. Cue Card rule: "Not too soon!" (do not start transformation before integration is solid). [source: CNOTE2; CNOTE6; Ecker & Hulley 2008]
Transformation: guide juxtaposition and repeat it. About half the time juxtaposition occurs spontaneously during integration; the therapist must recognise and use it. [source: Sibson & Ticic 2014; Ecker & Hulley 2008]
Verification: move to close a target when the schema cannot be re-evoked (feels implausible, silly, lifeless), the symptom no longer occurs to former triggers, and this holds without effort. Then check for further psps or close with follow-up. [source: CNOTE6; Handout PNS 2007; Ecker 2018]

Session count and format: usually 5-10 sessions; some clients shift in one; a small minority need more than 20 (2008). With advanced practitioners, 4-8 sessions for one or two schemas; complex attachment trauma may need 25-80 or more (CNOTE6). Published cases: panic, 5 sessions; depression, 6 sessions over months; leaving home, 8 sessions over 11 weeks. Individual format is the default; the Practice Manual has a section on couples and families [uncertain]; phone sessions appear in a published case. Between-session tasks (index card, real-time recognition) are standard. [source: Ecker & Hulley 2008; CNOTE6; CT Tool Kit; CaseEx Depression; Sibson & Ticic 2014]

Scope limits: the method targets symptoms driven by emotional learning. It does not apply to natural distress or to symptoms not rooted in learning (examples given: hypothyroid depression, neurodevelopmental conditions, biochemical aspects of addiction). Contraindications are listed in Ecker, Ticic & Hulley (2012, p. 34), which is not drawn on [uncertain]. [source: CNOTE6; Ecker 2018; Wikipedia]

3. Guiding principles

Symptom coherence: assume the symptom makes emotional sense; your job is to find the schema in which it is necessary, not to fix it. [source: Ecker & Hulley 2008]
Emotional truth of the symptom: the client, not you, supplies what the symptom is for. [source: CT Tool Kit]
Pro-symptom and anti-symptom positions: the conscious anti-symptom view ("this is senseless, I want it gone") is real but not the driver; there may be several psps. [source: Ecker & Hulley 2008]
No anti-symptom interventions (non-counteractive): no coping skills, reframes, disputation or reassurance aimed at the symptom during the work; they push the schema out of view. [source: CNOTE2; Handout PNS 2007]
Keep the symptom in mind; focus on a specific occurrence: every move should link back to one concrete episode, so the session does not drift into general life review. [source: CNOTE2]
Experience before insight: create experiences; insights follow. Have the client speak from the truth in first person, present tense, not about it. [source: Ecker & Hulley 2008; CNOTE2]
Avoid interpreting: ask questions that let the client find the construct; if you have a hypothesis, treat it as a map, not the territory. [source: CT Tool Kit; Ecker & Hulley 2008]
Therapist leads the process, client leads the content ("process directive / active intentionality"): be directive about which experience to create next while deferring to the client's words and meanings. [source: Ecker & Hulley 2008; Proficiencies page]
Coherence empathy: empathise with why the symptom is necessary, without endorsing factual claims about others. [source: Proficiencies page; CaseEx Depression]
Phenomenological, anthropologist's view: study the client's world of meaning as it is lived, with curiosity rather than diagnosis. [source: Proficiencies page]
"Powerlessness" and "freedom to clarify" are named stance elements; their exact meaning is in the Manual [uncertain]. Plausible practical reading: you cannot and need not make change happen, and you are free to ask the client to clarify anything [synthesis].
Limbic language: phrase statements in vivid, concrete, emotionally specific words (e.g. "lethal" rather than "not ideal"); abstract wording does not reach the schema. [source: CT Tool Kit; Proficiencies page; CNOTE3 title on Clinical Notes page]
Go only as deep as needed to dispel the symptom. [source: CT Tool Kit]
Not too soon: do not push for disconfirmation before the psp is integrated. [source: CNOTE2]
Neutral in juxtaposition: favour neither knowing; let the client's own mind resolve the contradiction. [source: Ecker & Hulley 2008; Handout PNS 2007]
Disconfirmation must be lived and specific: affirmations, general reassurance or a vaguely "corrective" relationship do not count; the contrary knowing must contradict this schema's specific content. [source: CNOTE6; Ecker 2018]
Resistance is coherent too: treat it as information about another psp, an ally, not an obstacle. [source: CT Tool Kit; Wikipedia]
Verify, don't assume: partial relief is not evidence of transformation; test by trying to re-evoke the schema. [source: Ecker 2018; CNOTE6]
Theory-independent mechanism: techniques from other therapies can be used inside the TRP steps, so long as the steps are met. [source: CNOTE6; Sibson & Ticic 2014]
Memory is not the target: recovering episodic memories is not required for unlearning, and autobiographical memory stays intact after change. [source: Ecker 2018; Sibson & Ticic 2014]

4. Intervention inventory

Organisation follows the Cue Card (preliminary guidelines, discovery, integration, transformation) plus the TRP's verification step. Several techniques serve more than one phase (overt statement appears under both discovery and integration). Where the sources only name a technique, the entry says so and any steps given are [synthesis]. Example language is illustrative unless a short quote is marked and cited. [source: CNOTE2; Proficiencies page]

A1. Symptom identification and focus on a specific occurrence (TRP step A)

Purpose: get an explicit, concrete agreement on what is to change, and anchor all later work to one real episode. Use at the start and whenever the session drifts. [source: CNOTE2; Proficiencies page; CNOTE6]
Steps: (1) Ask what the client wants to be free of; translate global complaints into specific behaviours, moods, thoughts or body states. (2) Agree explicitly that this is the target. (3) Ask for a recent occurrence and have the client describe it in concrete sensory detail (where, who, what happened just before, what was felt in the body). (4) Note the client's own theories without accepting or arguing them. (5) Keep returning to this occurrence. [source: CaseEx Depression; Ecker & Hulley 2008]
Example language (illustrative): "Take me to the last time it happened. Where were you, and what was the first thing you noticed in your body?"
Watch for: abstract, detached or intellectualised talk ("I've processed it to death"); answer with sensory questions rather than more discussion. Working when the client's affect and body start to show up in the room.

A2. Scene engagement, emotional snapshot and clearing breath

Purpose: experiential access to the moment the symptom starts. [source: CT Tool Kit]
Steps: (1) Have the client imagine being back in the recent moment the problem began and describe perceptions, thoughts, feelings as they happen. (2) Ask them to take an "emotional snapshot" of that state. (3) Have them take a breath that clears the scene before moving to a contrast scene (A9) or back out. [source: CT Tool Kit]
Example language (illustrative): "Let yourself be there again, just as it was... Now take a mental snapshot of how that feels. Good. And take a breath and let the scene go."
Watch for: the clearing breath doubles as a simple containment step; if the scene is a trauma scene, see the trauma precautions in C3 and section 5 [synthesis].

A3. Direct empathic eliciting and "What's the connection?"

Purpose: invite the client to find, at a feeling level, how the symptom links to what it protects, as a less leading alternative to naming it. Used in discovery (2008 chapter) and listed under integration on the Cue Card. [source: Ecker & Hulley 2008; CNOTE2; Proficiencies page]
Steps: (1) Reflect the symptom and the feeling that has just emerged side by side. (2) Ask softly how they connect, "on a feeling level". (3) Wait; let the client find the link. (4) Reflect their words back without adding interpretation.
Example language (illustrative): "You go blank at dinner, and you just said you feel invisible there. What's the connection, on a feeling level?"
Watch for: a reasoned answer ("probably because...") means the client is in their head; slow down and return to the scene.

A4. Symptom deprivation

Purpose: reveal what the symptom protects against by having the client sample life without it and notice what feels bad, dangerous or unbearable. A key discovery technique. [source: Ecker & Hulley 2008; CaseEx Underachieving; Networker panic article]
Steps: (1) Pick the specific situation where the symptom normally occurs. (2) Start with a light conceptual preview ("suppose it just didn't happen"), moving to more immersive imagery if needed. (3) Guide a soft, paced visualisation of that situation without the symptom, in the presence of the key people, with a concrete detail of what is different. (4) Pause and track body and affect. (5) Ask what they notice, especially any unease. (6) Follow the unease: what is bad about being without the symptom? (7) Optionally assign it as homework: when the symptom starts, notice what would happen if it did not. [source: Ecker & Hulley 2008; CaseEx Depression; Networker panic article]
Example language (illustrative): "Let's try an experiment. Picture next Sunday at your parents' place, and this time you're not shutting down at all. You're fully there... What happens in you as you imagine that?"
Short case quote: "Can you sort of try on that reality for a minute...?" [source: CaseEx Underachieving]
Watch for: rising tension, fidgeting or fear of not having the symptom is the technique working, not failing (published cases treat it so). If the client feels only relief, the symptom may be functionless or the scene too general; make it more specific. With panic or trauma-linked symptoms, keep the dose short and offer the clearing breath [synthesis].

A5. Sentence completion

Purpose: bypass deliberate reasoning so implicit meanings surface; useful when direct questions or imaginal interaction meet a block. [source: CaseEx Underachieving; CaseEx Depression; CNOTE2]
Steps: (1) Craft a stem in first person, present tense, ending at the point of meaning (e.g. "If I let myself succeed..."). (2) Ask the client to say the stem aloud and finish it with whatever comes, without planning or censoring. (3) Repeat the same stem several times; each round usually goes a layer deeper. (4) If "nothing's coming", have them repeat the stem and wait. (5) Reflect the deepest completion back and test it with an overt statement (A7). [source: CaseEx Underachieving; CaseEx Depression]
Example language: published stem "If you think I'm doing well—" [source: CaseEx Underachieving]; illustrative stems: "If I stopped worrying about her...", "The bad thing about feeling calm is..."
Watch for: the same answer every round (stem too abstract; reword it more personally); completions that surprise the client (good sign).

A6. Imaginal interaction

Purpose: evoke the relational schema by having the client picture a key person and speak or listen to them directly. [source: CaseEx Underachieving; Proficiencies page]
Steps: (1) Have the client picture the person, at whatever distance feels manageable. (2) Ask them to say a specific sentence to that person, or simply notice what happens in them in that person's presence. (3) Track what arises. (4) If the client becomes edgy or cannot focus, name it without pushing and switch to a less direct method such as sentence completion. [source: CaseEx Underachieving; CaseEx Depression]
Example language (illustrative): "Picture your father there, across the room. Just see him... and tell him what you just told me."
Watch for: avoidance of looking at the image, sudden numbness; slow down or use distance. Do not use with a perpetrator image in a client not yet stable [synthesis].

A7. Overt statement (discovery and integration)

Purpose: have the client voice the psp explicitly, first person, present tense, to the relevant person, so it is felt as their own truth. The central integration technique. [source: Ecker & Hulley 2008; CT Tool Kit; CNOTE2]
Steps: (1) From what has surfaced, draft the psp in the client's own words, vivid and specific. (2) Have the client visualise the relevant person at a safe distance. (3) Ask them to say the statement aloud to that person, making clear it is an in-session exercise, not a rehearsal for real life. (4) If the client balks, offer a lead-in phrase (published example: "I hate to admit this, but—") or acknowledge that the position is a purpose, not a preference. (5) Offer your wording only as a draft; invite edits; defer to the client's phrasing. (6) Repeat two or three times until it feels real. (7) Ask what it is like to say it. [source: CT Tool Kit; CaseEx Underachieving; CaseEx Depression; Ecker & Hulley 2008]
Example language (illustrative): "Try saying this to them, and change any words that aren't quite right: 'I keep my life small so you'll never have a reason to be angry with me.'"
Watch for: depersonalised or abstract wording ("one tends to...") must be redirected to vivid I-statements; a statement that lands produces visible affect, recognition, or "that's it". Cosmetic agreement without affect means it is not yet the real psp.

A8. Trial sentence (trial statements)

Purpose: test a hypothesis about the psp without imposing it; the client says a sentence, even one they doubt, and notices whether it fits. [source: CaseEx Underachieving; CT Tool Kit]
Steps: (1) Offer a sentence as a test, explicitly not as a claim. (2) Ask the client to say it to you or to the imagined person. (3) Ask what they noticed. (4) If it misses, offer a second version or let the client correct it. (5) For integration, choose high-stakes wording that captures the full emotional truth. [source: CaseEx Underachieving; CT Tool Kit]
Example language (illustrative): "Would you try this sentence out, just to see if it fits or not: 'If I do well, he wins.'"
Watch for: a strong reaction (head shake, laughter, swearing, tears) is data either way; follow it.

A9. Exceptions and contrast scene

Purpose: find the symptom-requiring construct by comparing a symptomatic situation with one where the symptom is absent. [source: CT Tool Kit; CNOTE2]
Steps: (1) After the snapshot of the symptomatic scene, clear it with a breath. (2) Have the client recall a situation where the problem does not occur and enter it. (3) Ask what is different in how they experience themselves and others. (4) Return to the symptomatic scene and ask, softly and openly, what in it makes sense of the symptom. [source: CT Tool Kit]
Example language (illustrative): "In the scene with your friends, you're relaxed. Now go back to the meeting. What is it about the meeting that makes the tension make sense?"
Watch for: the difference is often a person, a role or a perceived danger; that is the lead.

A10. "First time" (first time you felt this way)

Purpose: locate an early formative experience where the psp was learned, to deepen discovery and later supply contrast. Named in the Cue Card and proficiencies; steps below are [synthesis] from the general method. [source: CNOTE2; Proficiencies page]
Steps [synthesis]: (1) With the client in the felt state, ask whether it is familiar. (2) Invite, without pressure, whatever earlier time comes to mind. (3) Accept "nothing comes"; do not search or suggest. (4) If a scene arises, explore what the child concluded about self and others.
Example language (illustrative): "Staying with that feeling: is it familiar? Does an earlier time come to mind, or not?"
Watch for: treat whatever emerges as the client's experience, not as historical fact; never suggest content. Episodic recall is not required for change. [source: Ecker 2018; brief Domain VI rule]

A11. "Who else?"

Purpose: widen the relational picture: who else the psp involves or protects, who else is affected. Named only; steps [synthesis]. [source: CNOTE2; Proficiencies page]
Steps [synthesis]: when a psp involving one person has surfaced, ask who else is in this picture, then test the psp with each (overt statement to each).
Example language (illustrative): "Who else is in this, besides your mother?"
Watch for: published case shows the same psp across several relationships (family, partner, friends), which broadens integration. [source: Ecker & Hulley 2008]

A12. "What's under this?" and "Get to purpose"

Purpose: go down layer by layer from the symptom to its purpose (the "third-order" depth), only as deep as needed. [source: CT Tool Kit; CNOTE2; Proficiencies page]
Steps: (1) When a theme surfaces, ask what lies beneath it. (2) Ask questions about what the client must be, or what would happen, for the symptom to be necessary ("What kind of person must you be...?" form). (3) Let the client arrive at the construct; do not name it. (4) Stop when you reach what the symptom is for. [source: CT Tool Kit]
Example language (illustrative): "And what's under that feeling of being too much?" / "So staying unwell does something important. What does it make sure of?"
Watch for: a purpose statement usually brings relief or recognition; if it doesn't explain the symptom, keep going.

A13. Two-step

Named in the Cue Card and proficiencies as a discovery technique; no source describes it. [uncertain] Not described here to avoid inventing it; see the Practice Manual (Review of Techniques). [source: CNOTE2; Proficiencies page]

A14. Construct questioning (wide-angle inquiry)

Purpose: an open question that brings an unexamined assumption into view, producing what the published case calls "presupposition shock", without an interpretation. [source: CaseEx Depression]
Steps: (1) Notice an assumption the client lives by but never states. (2) Ask a question that presupposes it, so the client sees it for themselves. (3) Pause for the reaction.
Example language (illustrative): "What ways have you found to keep people from ever really reaching you?"
Watch for: surprise or a sense of being seen; if the client defends or argues, you have interpreted too much.

B1. "Stay there!"

Purpose: keep the client inside the felt psp instead of moving quickly to coping, analysis or a new topic; integration needs sustained contact. [source: CNOTE2; CT Tool Kit]
Steps: (1) When the psp has just been felt, slow the pace. (2) Invite the client to remain with it, notice body and feeling, and say it again. (3) Block premature solutions gently (yours and the client's). (4) Keep the client inhabiting the schema until all its parts are accessed. [source: CT Tool Kit; CNOTE2]
Example language (illustrative): "Before we do anything with that, just stay with it a moment. Where do you feel it?"
Watch for: rushing to "so what should I do?" is often an anti-symptom move; name it kindly and return.

B2. Cycling

Named as an integration technique; no source describes it. [uncertain] Not described here; see the Practice Manual. [source: CNOTE2; Proficiencies page]

B3. Pro/anti synthesis

Purpose: help the client hold both the pro-symptom position and their conscious anti-symptom position as their own, so the conflict is felt rather than split. Named only; steps [synthesis]. [source: CNOTE2; Proficiencies page]
Steps [synthesis]: (1) State both sides in the client's words. (2) Have the client say both, as "I" statements, one after the other. (3) Ask what it is like to know both are theirs.
Example language (illustrative): "One part of you says 'I want to finish this degree.' And you've found another truth: 'If I finish it, Dad gets the credit.' Both are yours. What's that like to see?"
Watch for: the client disowning the psp ("that's just my stupid side"); return to its purpose.

B4. Connecting up (and prompting agency)

Purpose: link the psp to the client's wider life and history so it becomes a coherent narrative, and help the client recognise that they themselves produce the symptom for a reason (the "pivot into agency"). [source: CT Practice Manual page; CNOTE6; Proficiencies page]
Steps [synthesis, from named elements]: (1) Ask where else this truth operates. (2) Invite gaps in the life story to be filled by it. (3) Reframe the symptom from something that happens to them into something they do for a purpose (e.g. "it's not that you like it"). [source for 3: CaseEx Underachieving]
Example language (illustrative): "So the numbness isn't happening to you. It's something you do, to keep from being cut down again. Does that fit?"
Watch for: agency should feel like recognition, not blame; if the client hears accusation, return to coherence empathy (B9).

B5. Index card (between-session integration)

Purpose: keep the psp in everyday awareness between sessions without trying to change it. [source: Ecker & Hulley 2008; CT Tool Kit; CNOTE6; Sibson & Ticic 2014]
Steps: (1) Write the overt statement on a small card in first person, present tense, in the client's own words. (2) Client reads it at set times (published examples: morning and evening, or daily) and at moments of symptom urge. (3) Optional additions: rate the felt need at set times and note where it is felt in the body. (4) Instruct explicitly not to change the behaviour yet. (5) Review reactions next session. (6) Later, a "deck" of cards can be used to test for remaining resistance before ending. [source: CT Tool Kit; CNOTE6; CaseEx Underachieving]
Example language: published instruction "Just stay in touch with it; don't try to change anything, for now." [source: CaseEx Underachieving]
Watch for: reactions to the card (low mood, then anger, then motivation) are integration in progress. If the card produces no reaction at all, the wording is off or transformation may already have happened (test it, C6).

B6. Hindsight recognition

Purpose: have the client see, looking back over recent episodes, how the psp was operating. Named only; steps [synthesis]. [source: CNOTE2]
Steps [synthesis]: at the start of the next session, ask the client to recall a symptom episode since last time and identify, with the card in mind, what the symptom was doing for them then.
Example language (illustrative): "Looking back at Tuesday's argument, can you see the card's truth at work there?"
Watch for: moves toward self-criticism; keep the tone curious.

B7. Real-time recognition

Purpose: the client notices the psp as it operates in a live situation, without confronting anyone or changing anything. [source: CT Tool Kit; CNOTE2; CaseEx Depression]
Steps: (1) Pick a predictable trigger situation (e.g. a weekly phone call). (2) Client keeps the card in view or in mind. (3) Client treats the onset of the symptom as a cue to notice what it is protecting. (4) No confronting, blaming or behaviour change. (5) Debrief next session. [source: CT Tool Kit; CaseEx Depression]
Example language (illustrative): "During Sunday's call, keep the card next to the phone. Just notice the moment the truth on it shows up. Nothing to say to her, nothing to change."
Watch for: clients often spontaneously notice contradicting evidence during this task (e.g. their own gentleness), which is spontaneous juxtaposition; use it.

B8. Playing possum (deliberate enactment)

Purpose: the client knowingly and deliberately does the symptom in the feared situation, so the protective pattern becomes a visible, chosen act. The source stresses this is not a paradoxical injunction. [source: CaseEx Depression]
Steps: (1) Once the psp is integrated, identify the next situation where the symptom will occur. (2) Ask the client to do the protective behaviour on purpose, knowing what it protects. (3) Debrief what it was like to choose it. [source: CaseEx Depression]
Example language (illustrative): "Next time you visit, go quiet on purpose, as protection you're choosing, and notice what that's like."
Watch for: if it is framed as a trick to make the symptom go away, it becomes counteractive; frame it as honouring the protection.

B9. Coherence empathy (empathic validation)

Purpose: convey that the symptom makes sense given the client's emotional truth, which reduces shame and resistance and deepens access. [source: Proficiencies page; CaseEx Depression; CNOTE6]
Steps: (1) Reflect the logic of the psp in its own terms. (2) Do not endorse factual claims about other people. (3) Make no attempt to change the view. (4) Empathise equally with the anti-symptom side.
Example language (illustrative): "Of course you'd go numb, if being seen meant being cut down."
Watch for: intense affect (e.g. rage) peaking and then settling is expected; stay steady.

B10. Resistance as an opening

Purpose: treat any reluctance, block or drift as an expression of another psp, and bring it into the work. The Manual has conscious and unconscious resistance techniques [uncertain]; the steps below are from the sources. [source: CT Tool Kit; CT Practice Manual page; Wikipedia]
Steps: (1) Notice the recurring pattern (e.g. the client keeps leaving themselves out of the picture). (2) Name it gently and descriptively. (3) Ask the client to explore how it connects to the core theme. (4) If the client argues with a psp, ask how they know rather than debating. (5) Treat the answer as further discovery. [source: CT Tool Kit; CaseEx Depression]
Example language (illustrative): "I keep noticing that when we get close to your own wants, you move to talking about your sister. Can we look at that together?"
Watch for: resistance to discovery, to integration and to transformation are distinguished in the proficiencies; each points to a different hidden stake [source: Proficiencies page].

C1. Finding contrary (disconfirming) knowledge (TRP step C)

Purpose: locate a lived knowing that sharply contradicts the specific content of the psp. Without it, accessing alone does not transform. [source: CNOTE6; Sibson & Ticic 2014; Handout PNS 2007]
Steps: (1) State the psp precisely; disconfirmation must hit its specific model. (2) Search sources in roughly this order: (a) knowledge the client already holds but has not set against the schema (most common), found by focused inquiry or by having the client state the psp aloud and noticing what objects; (b) current here-and-now facts (e.g. the parent is now healthy and safe); (c) things noticed in daily life once the psp is integrated; (d) knowledge received from others; (e) new experiences created in session (empowered re-enactment, role play, sculpting, psychodrama); (f) the client-therapist relationship, only when it contradicts the specific content; (g) other relationships or revisiting childhood from adult perspectives. (3) Check that it feels real from lived experience. [source: CNOTE6; Handout PNS 2007; Sibson & Ticic 2014]
Example language (illustrative): "When you say that card out loud, is there anything in you, anything you've seen, that doesn't go along with it?"
Watch for: affirmations, general reassurance and your own opinion do not count. A contrary knowing too remote from the client's expectation may fail to unlock the schema; older and stronger learnings need a stronger, clearer mismatch. [source: CNOTE6; Ecker 2018]

C2. Juxtaposition: deliberate and spontaneous (TRP steps 1-3)

Purpose: the transformation step: have the psp and the contrary knowing felt as true at the same moment, though both cannot be true, and repeat until the psp loses its realness. [source: CNOTE6; Ecker & Hulley 2008; CT Tool Kit; Handout PNS 2007]
Steps: (1) Reactivate the psp as felt truth (read the card aloud, overt statement, scene). (2) Bring in the contrary knowing vividly. Order does not matter; either can come first. [source: Ecker 2018] (3) Hold both together; have attention move back and forth. (4) Use an empathic review of both knowings, with pauses. (5) Ask neutrally what it is like to know both, or how the client makes sense of the contradiction. (6) Do not say which is right; let the client's mind resolve it. (7) Repeat the pairing several times within the session and across sessions. (8) Recognise spontaneous juxtaposition (about half of cases), when the client brings up contrary knowledge unprompted during integration, and slow down to let it register. [source: CNOTE6; Sibson & Ticic 2014; Ecker & Hulley 2008; CT Tool Kit]
Example language (illustrative): "Part of you knows, 'If I leave, she'll die.' And you also know she's well, independent, with someone who looks after her. Feel both for a moment... What's it like to know both of those?"
Watch for: markers of transformation include shifts in posture, movement, energy; affect may shift (e.g. anger to grief); the old statement starts to sound odd. If the client argues for one side, you have taken a side; return to neutral. [source: CT Tool Kit; CaseEx Underachieving]

C3. Imaginal empowered re-enactment (trauma-linked schemas)

Purpose: create new contrary knowledge for a schema learned in a frightening event (e.g. "I'm helplessly trapped"): in imagination the client makes an effective self-protective response that disconfirms the helplessness. [source: CNOTE6; Ecker 2018; Handout PNS 2007]
Published limit: only for events in which the client was aware of the danger and had time to respond (so a protective response is a meaningful contrary experience). [source: CNOTE6]
Readiness criteria [synthesis; not given in the sources]: client is stable day to day (no current crisis, active self-harm, or unmanaged dissociation); can notice and name body states and return to the present on request; has a working alliance and a known stop signal; the psp has been discovered and integrated; consent obtained after explaining that this is imagination, not a search for what "really" happened.
Steps: (1) Agree on the scene the client already remembers; do not search for or suggest new content. (2) Grounding first: feet, breath, room, with a stop signal agreed [synthesis]. (3) Have the client briefly re-enter the scene up to the moment of danger, keeping a dual awareness of the present room [synthesis]. (4) Ask what they would want to do, if they could, to protect themselves. (5) Let them carry it out in imagination, with voice and body if possible (published example: commanding the father to stop the car). (6) Have them notice what it feels like to be able to act. (7) Juxtapose: reactivate the old helplessness knowing alongside the new knowing (C2). (8) Clear the scene with a breath, re-orient to the room, debrief. [source for 4-7: CNOTE6; Ecker 2018; Handout PNS 2007; other steps synthesis]
Dosing [synthesis]: the sources give no time limits. Keep each pass short (re-entry only as far as needed to evoke the schema), stop and ground at signs of overwhelm, and leave at least 10-15 minutes for closure.
Example language (illustrative): "You're here with me, and you're also seeing the car. As you see it now, what do you want to do? ... Go ahead and do it, here, in your imagination."
Watch for: published outcome markers are cessation of the frozen or helpless response in later situations. Dissociation, flat voice, loss of contact or flooding means stop the scene and ground (section 5). Never use imagery or suggestion to uncover memories; work only with what the client already reports, as their experience. [source: Ecker 2018; brief Domain VI rule; synthesis]

C4. New experience created in session: role play, sculpting, psychodrama, reenactment

Purpose: when no contrary knowledge exists, create it through an in-session experience. Named as sources of contrary knowing; procedures not detailed in the sources. [source: Handout PNS 2007]
Steps [synthesis]: (1) Design an enactment that would directly contradict the psp's specific prediction (e.g. the client says the forbidden thing and the role-played person responds differently). (2) Run it while the psp is active. (3) Juxtapose the old expectation with what just happened. (4) Debrief.
Example language (illustrative): "Your card says that if you say no, people leave. Let's try it: say no to me, and notice what actually happens here."
Watch for: an enactment that feels staged or reassuring will not disconfirm; it must be felt as real.

C5. The client-therapist relationship as a source of contrary knowledge

Purpose: use the therapist's actual responses as lived disconfirmation, when the psp's content concerns how others will respond. [source: CNOTE6]
Steps: (1) Check whether the psp's specific content is something the relationship can contradict. (2) Draw attention, in the moment, to how you are actually responding. (3) Juxtapose with the psp. [source: CNOTE6; steps 2-3 synthesis]
Example language (illustrative): "You expected me to lose patience when you said that. What do you notice about how I'm actually responding?"
Watch for: the source cautions that the relationship often fails to disconfirm the specific content, and a generally corrective relationship without juxtaposition does not reliably transform. The Manual has "techniques for utilizing transference" [uncertain]. [source: CNOTE6; CT Practice Manual page]

C6. Verification (TRP step V; "testing for depotentiation")

Purpose: confirm that the schema is gone, not just quieter. [source: CNOTE6; Handout PNS 2007; Ecker 2018; Ecker & Hulley 2008]
Steps: (1) Try to re-evoke the psp: have the client read the card aloud, make the overt statement again, or re-enter a former trigger scene. (2) Check three markers: the symptom no longer occurs to former cues; the psp no longer feels true or charged (implausible, lifeless, silly, even laughable); the change holds without effort or coping. (3) Check the client's new way of making sense of the former symptom. (4) If charge remains, return to integration or find further contrary knowledge. (5) Check for other psps (a card "deck" can test for remaining resistance). [source: CNOTE6; Handout PNS 2007; CT Tool Kit; Sibson & Ticic 2014; CaseEx Underachieving]
Example language (illustrative): "Read the card to me again, as if it's true... What happens now when you say it?"
Watch for: partial relief is not verification. Behavioural change outside sessions (e.g. moving out, joining social events) and stability under stress at follow-up are corroborating signs. [source: Ecker 2018; Sibson & Ticic 2014]

C7. Follow-up

Purpose: confirm effortless permanence. [source: CT Tool Kit; Sibson & Ticic 2014]
Steps: offer further sessions as needed; schedule check-ins (published cases report 2-month, 5-month, 6-month and 2-year follow-ups); ask about symptom recurrence under stress and the client's current sense of the old psp. [source: CT Tool Kit; Sibson & Ticic 2014; CaseEx Depression; Ecker & Hulley 2008]
Example language (illustrative): "It's been six months. Has the old pattern shown up, even under pressure? When you think of that card now, what happens?"
Watch for: a returned symptom usually signals a second, untouched psp rather than failure; restart discovery on it [synthesis].

C8. Importing techniques from other therapies within the TRP

Purpose: the TRP is defined independently of any therapy, so methods from EMDR, AEDP, Internal Family Systems, Emotion-Focused Therapy, Gestalt chair work, Focusing, person-centred work, inner child work or psychodrama can be used to carry out steps B, C or 1-3. [source: CNOTE6; Sibson & Ticic 2014]
Steps: (1) Name which TRP step you are trying to achieve. (2) Choose a method you are trained in that can achieve it (e.g. two-chair work to retrieve a schema). (3) Check that the step is actually met (schema felt; contrary knowledge felt; both together; repetition). (4) Verify (C6). [source: CNOTE6; steps 1 and 3 synthesis]
Example language: as per the borrowed method.
Watch for: use only methods within your training and competence [synthesis]; a borrowed method used counteractively (e.g. to soothe away the symptom) does not meet the TRP.

5. Handling problems

Coherence Therapy reads most problems as further coherence: a stuck point or resistance usually means another psp is operating. The Practice Manual sections on dispelling resistance and on what limits the rate of change are [uncertain]; guidance below is cited where sourced and marked [synthesis] otherwise.

Client stays in the head, abstract, intellectualising: return to a specific occurrence and ask sensory questions; avoid interpretations, which push clients further into analysis. [source: CaseEx Depression; CT Tool Kit]
Nothing comes (blank sentence completion, no response to symptom deprivation): repeat the stem and wait; make the scene more concrete; switch technique (imaginal interaction to sentence completion or vice versa). [source: CaseEx Underachieving; CaseEx Depression] If still blank, ask what it is like not to know, and whether not knowing might be protective [synthesis].
Client rejects the psp ("that's screwed up", "I'm not that stupid"): don't argue; ask how they know; reframe it as a purpose, not a preference; offer a lead-in phrase; offer your wording as a draft for editing. [source: CaseEx Underachieving; CaseEx Depression]
Recurring avoidance pattern in session: name it descriptively and ask how it connects to the theme (B10). [source: CT Tool Kit]
Client wants solutions or coping now (anti-symptom pull): acknowledge the wish, explain briefly that you will get to change faster by understanding what the symptom is protecting, and return to the scene. [synthesis] If acute risk or functional collapse makes coping skills necessary, provide them as a separate safety layer and note that discovery is paused [synthesis].
Non-adherence with the index card or real-time task: explore the non-reading itself as data (what was it like to imagine reading it?); shorten or re-word the card into the client's own vivid language; make reading tie to an existing routine. [synthesis, building on B5 and B10] The proficiencies ask the therapist to follow up on every task next session. [source: Proficiencies page]
Card makes the client feel worse: low mood or anger in response to the card is expected during integration; review it next session. [source: CaseEx Underachieving] If distress is severe or persistent, reduce reading frequency, add a grounding step after reading, and check risk [synthesis].
Juxtaposition doesn't "take": check integration ("Not too soon!"); check that the contrary knowledge contradicts the specific psp and is felt as lived, not argued; check you are not taking sides; strengthen or repeat the mismatch; look for a second psp. [source: CNOTE2; CNOTE6; Ecker 2018; Ecker & Hulley 2008]
Partial relief only: do not declare success; run the re-evocation test; look for residual charge or other psps. [source: Ecker 2018; CNOTE6]
Symptom returns later: treat as a separate or newly activated psp and restart discovery on the new occurrence. [synthesis]
Overwhelm in session (flooding, panic, shaking, crying that escalates): stop the technique; shift to present-moment orientation (eyes open, name objects in the room, feet on floor, slow breathing); reduce intensity (distance the imagined person, use a contrast or safe scene, the clearing breath from A2); resume later at lower intensity or move to integration of what has already surfaced. [source for clearing breath: CT Tool Kit; rest synthesis]
Dissociation (glazed look, delayed responses, numbness, "far away"): stop imaginal work; ground with sensory orientation and simple present-tense questions; check orientation before ending; for clients with frequent dissociation, prioritise stabilisation and consider referral to or consultation with a trauma specialist before memory-linked work. [synthesis]
Complex trauma: expect longer courses (25-80+ sessions) with several schemas. [source: CNOTE6] Sequence stabilisation first, then single-schema work, and keep sessions closed with grounding and a check of state before leaving [synthesis].
Memory concerns: if the client asks whether an image "really happened", stay with its meaning as their experience; do not confirm, deny or probe for further details. Change does not require episodic memory recovery. [source: Ecker 2018; synthesis]
Ruptures: repair is a named common-factor competence. [source: Proficiencies page] Typical triggers here are the therapist imposing a psp, taking sides in juxtaposition, or the client hearing "agency" as blame; name your part, return to the client's own words and coherence empathy. [synthesis]
Symptom is not learning-based or is natural distress (e.g. grief, medical causes of depression, neurodevelopmental traits): the method does not apply; refer for medical assessment or use suitable alternatives. [source: CNOTE6; Ecker 2018; Wikipedia]
Suicidal risk or self-harm: assess risk with standard procedures before and during the work; a symptom with protective meaning (e.g. self-harm as relief) can still be explored for its psp only after safety planning and lethal-means counselling are in place; symptom deprivation must not be set as homework for self-harm or suicidal urges. [synthesis]
Contraindications: listed in Ecker, Ticic & Hulley (2012, p. 34) [uncertain]. Prudent additions [synthesis]: acute psychosis, severe untreated dissociative disorder, active substance intoxication, and current danger (e.g. ongoing domestic violence, where a "psp" may be an accurate safety strategy that must not be dissolved).

Sources

Sources: