Coherence therapy is a model of constructivist therapy , based on the principle of symptom coherence (which we will explain later). It was born 25 years ago by 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 its most relevant assumptions and characteristics are.

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 more than 25 years ago (around the 90s). Over the years, therapy has been improved and changes have been made to it.


What is constructivism? First of all, let’s go back to its origin. Constructivist thinking” appeared in the paradigm of psychology in 1976, by the hand 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, fundamentally based on how people understand reality , that is, on all those meanings that we attribute to everything that we experience. Through this contact and knowledge of reality, we construct 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 it. Well, from constructivism we work with all those constructions of the patient, whether personal, social, work, relational constructions…

Constructivist psychotherapy works to identify these constructs of the patient, 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.

Origin of this type of psychological intervention

The origin of coherence therapy, as we have mentioned, can be found in the authors Bruce Ecker and Laurel Hulley, who analysed a large number of therapeutic sessions with patients; through them, they observed how certain changes in the patient gave rise to the cessation of the symptoms of suffering and discomfort .

They also noted that there were a number of “rules” within psychotherapy that facilitated such therapeutic changes. These changes, however, were lasting and profound. Based on these observations, Ecker and Hulley developed coherence therapy, starting from a non-pathologizing approach to life experiences and situations.

Purpose and operation

Through coherence therapy, and from its constructivist approach, the aim is to identify those emotional, unconscious and adaptive constructions that the patient has developed throughout his life, and that maintain and intensify his current problem (“the symptom”).

All this is achieved through a series of steps, which have the purpose of changing certain emotional learnings that the individual has internalized; it is a process of memory reconsolidation . Furthermore, neuroscience supports this process, as we will see later on (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 through these steps, in order to achieve a lasting and therapeutic change in him/her that eliminates his/her suffering or concerns (which are usually born from unconscious constructions of reality).

Neuroscience support

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

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

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

Assumptions and characteristics

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

1. Importance of unconscious constructions

We have already seen what each person’s constructions are, and how they relate to the way in which each person constructs his or her reality. Thus, coherence therapy gives importance to these constructions, especially to the unconscious ones (of which the individual is not explicitly aware, but which interfere with his well-being).

One of the objectives of therapy is to identify these constructions so that they can be worked on. Thus, we can say that the coherence therapy approach, although it is constructivist, also has notions of the psychodynamic approach .

2. Non-pathological vision

Coherence therapy moves away from the psychodynamic approach in terms of its view of the 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 the patient experiences and constructs his reality subjectively , explicitly (explicit constructions) and implicitly (implicit constructions).

3. Symptoms as personal choices

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

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

4. Principle of the coherence of the symptom

Coherence therapy is based on a principle, called the “principle of the coherence of the symptom”. In fact, all therapy revolves around it. This principle has to do with the fact that people need convincing narratives at 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 the patients, they are compatible, minimally, with an adaptive scheme of reality, the way we have to understand it. But how does this scheme come about? Through its codification in our implicit memory , at some point in our lives.

In other words, and in order for it to be understood; according to the principle of the coherence of the symptom, the symptom must be coherent with certain adaptive constructions of the individual, necessary for it to be maintained.

5. Cessation of symptom

The goal of coherence therapy, like all psychotherapies, is that the symptom that causes suffering should no longer condition the patient’s life. For this to happen, the symptom must not be required by the person’s current constructs of reality ; that is, when his construction (or construct(s)) of reality does not “need” the symptom, it will disappear.

Bibliographic references:

  • Ecker, B. and Hulley, L. (1996). Depth-Oriented brief therapy. San Francisco: Jossey-Bass.
  • Ecker, B. and Hulley, L. (2011). Coherence therapy manual and training guide. Oakland: Coherence Psychology Institute.
  • Jasiński, M. and Feixas, G. (2015). Coherence therapy and its place on the constructivist landscape. Paper presented at the XXI International Congress of Personal Construction Psychology. Hatfield: University of Hertfordshire.
  • Jasiński, M., Paz, C. and Feixas, G. (2016). Coherence therapy: a constructivist approach supported by contemporary neuroscience. Psychological Action, 13(1): 131-144.