Case example of Coherence Therapy for Underachieving [pdf]

From the case example introduction

Coherence Therapy is based on its core principle of symptom production and symptom coherence. A symptom or problem is produced by a person because he or she harbors at least one unconscious construction of reality—one set of reality-defining themes, purposes, meanings, and frames—in which the symptom is compellingly necessary to have, despite the suffering or trouble incurred by having it. Conversely, when there is no longer any construction within which the presenting symptom is necessary to have, the person ceases producing it.

At the start of therapy, of course, the symptom is viewed by the client as having no coherence at all. The client regards the symptom as senseless, valueless, something involuntary and victimizing, laden with negative meanings about the self or others (e.g., bad, sick, stupid, crazy, deficient). This set of initial, predictable views of the symptom is referred to in Coherence Therapy as the client’s anti-symptom position—“anti” meaning simply against having the symptom. However, clinical experience shows that this is an incomplete account of the client’s emotional relationship to the symptom.

Coherence Therapy is based on the empirical finding that the coherence of the symptom—how it is necessary to have—is inevitably present in a very separately held, unconscious position of the client. We refer to this as the client’s pro-symptom position—“pro” in the sense of being for having the symptom. The themes and purposes in this pro-symptom construction of reality comprise the deep sense and strongest emotional significance of the symptom in the client’s world of meaning. To find the client’s pro-symptom position is to find the emotional truth of the symptom.

The principle of symptom coherence should not be narrowly construed as merely a function-of-the-symptom model. It is far more comprehensive than that and applies to the production of functionless as well as functional symptoms. Which type the symptom is becomes apparent in Coherence Therapy empirically and non-speculatively as the symptom-necessitating construction is revealed.