“Therapy is a process, not an event” – is IT true?

When I was training to be a therapist, my first trainer had a mantra about therapy. It stuck with me. He would say: “Therapy is a process, not an event.” It would come to mind during my work and I found it helpful. At times, I would share it with clients who were experiencing stuckness or frustration with themselves.

In this article, I want to look at that statement more closely, given the discovery of memory reconsolidation. Is this mantra still true?

I will break down each part of it, to reach a conclusion in light of what we now know.

  • Therapy is not an event?
  • Therapy is a process?
  • Both/And vs Either/Or?

By the end of the article, you’ll understand the component parts of therapy from a memory reconsolidation lens. You’ll also appreciate the pace of each, and how to apply them in the therapy room.

Therapy is not an event?

There are two key ways that change occurs. One is that we make incremental changes. Life improves and we need to keep working at it to keep the old issues at bay.

I think of this as bathing-level change. If I don’t keep on bathing then the problem reoccurs. It requires the client to keep working to maintain their progress

Yet, the other kind of change can be thought of as transformational change. The change is sudden and it is permanent. Once the change is made, the client expends no energy to maintain it. This is the kind of change delivered by memory reconsolidation.

Memory reconsolidation is the only known brain mechanism that overwrites old trauma pathways. When triggered, this overwrite means that the old trauma responses are simply no longer there. As a result, there is nothing to keep at bay anymore. It is gone.

The word “triggered” signifies an event. Think of any other bodily mechanism that occurs. An eye blink. A cough. A laugh. A fart. Each is an event. They happen in a moment. There is a clear before and after.

Likewise, when this brain mechanism happens it is also an event. Without successfully triggering it, transformational change does not occur.

When it comes to permanent, effortless change, it is no longer true to say that “therapy is not an event.” Indeed, it depends upon the event of memory reconsolidation taking place.

Therapy is a process?

Now to assess the first part of the statement. “Therapy is a process.”

Therapists who engage in memory reconsolidation will think of our work in two stages. Much like an archer, the first stage is to find the target. Only then can we fire the arrow and hit the bullseye.

Hitting the bullseye is clearly an event. But the search for the target is a process.

Imagine being randomly dropped into a dense forest and told to hit the bullseye. You couldn’t. You would first have to go through the process of finding the target.

In terms of time taken, most of it is spent in this stage. Similarly, with our clients, we are spending most of our time walking through the dense forest with them.

During this part of our work we are engaged in radical inquiry. We seek to find the beliefs, unmet needs, feelings and memories that reproduce their problem.

It is a process of learning and discovery. We notice their autonomic nervous system responses. We gain insight into how these responses and their beliefs were learned. We discover the unmet needs that are still craved for. We identify how the current problem makes sense and what it may defend against.

When we know there is an event to get to, the temptation can be to rush this stage. Ironically, the temptation to rush can slow us down. After all, we can’t hit the bullseye when firing at the wrong target. Time, and the faith of the client, can be expended firing aimlessly.

There are two things the brain needs to trigger the mechanism of memory reconsolidation: a mismatch experience and repetition of that mismatch experience.

The surprise of the mismatch opens the brain pathway for rewrite. The repetition updates the learning. It follows that we can’t create mismatch experiences unless we know what needs to be mismatched.

A person may fear rejection if they allow themself to be more visible. They may also think Coca Cola is better than Pepsi. Needless to say, creating a mismatch experience where they see the merits of Pepsi will do nothing for their fear of rejection.

Finding the right target matters. This is indeed a process.

Both/and vs either/or

With clients, a possible mismatch experience can be the reframe from either/or to both/and.

Think of a person with low self worth. Even in moments of feeling proud of themself, they batter it down with a need to be humble.

I might ask: “Is it possible perhaps to be both proud AND humble?”

This question can deliver a mismatch experience. They once thought of these ideas as mutually exclusive. Now they reflect on the possibility that they can co-exist.

So it is with the statement: “Therapy is a process, not an event.”

We see instead that therapy is both a process AND an event. Indeed, we can rephrase it as: “Therapy is a process that leads to an event.”

We now know that permanent change takes place through the event of memory reconsolidation. The initial statement is only half true.

Remember Bruce Ecker’s steps of memory reconsolidation.

First, the preparation:

  • Identify the problem
  • Identify the target learning
  • Gather mismatch information

This is the process.

Next, the implementation:

  • Create a mismatch experience (a mismatch experience is one that disconfirms the target learning)
  • Repeat

This is the event.

summary

“Therapy is a process, not an event” is only half true.

Instead, for transformational work to occur, it is more accurate to say that: “Therapy is a process that leads to an event.”

Both sides of the equation are important. Without the event, we are stuck with bathing-level change or, worse, therapy that ultimately goes nowhere.

Yet without the process of discovery, it becomes much harder to hit a bullseye you haven’t yet found. It’s not impossible, as inadvertent mismatches can happen too. But one needs a lot of luck to be inadvertently successful on a consistent basis.

Both process and event are important parts of the same transformation. Like a Broadway show, the event is the dazzling part of the work. Yet there is a lot that goes before that to make the dazzle happen.

There is no dazzling event without the preparation process, and little point to the preparation if there’ll be no event.

As therapists, it is likely that most of our time is spent in the process part. After all, an event is quick by its very nature. Throw a ball into the air. The process of rising and falling takes a lot longer than the event of the bounce.

If we want to create change sooner rather than later, becoming skilled at the process of discovery might even be the more critical skill to develop.

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