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Misconception 10: Carrying Out the Steps Required for Reconsolidation and Erasure Sometimes Fails to Bring About a Transformational Change, Which Means That the Reconsolidation Process Is Not Effective for Some Emotional Learnings

In psychotherapy there are four distinct situations in which the reconsolidation process can appear to fail to produce decisive change when actually the process is not failing, but rather is not in fact taking place for some specific, identifiable reason:
1. Resistance to dissolution. In some cases, the therapist has indeed guided the sequence of experiences necessary for reconsolidation and erasure, but the target learning does not dissolve and remains in force (continues to retrigger, feel real, and produce symptoms). We will see below that in such cases, the shift is prevented by a blockage or resistance that can be cleared away, allowing dissolution to occur when the sequence is guided once again. The blockage is a separate, distinct phenomenon that does not imply a fundamental failure of the reconsolidation process.

2. Multiple symptom-generating schemas. In other cases, in response to the necessary sequence of experiences, the target learning does dissolve and no longer activates or feels real, but the symptom produced by that target learning continues to occur. This means that there is at least one other emotional learning or schema, distinct from the one that has been dissolved, that also produces the same symptom. It is common for therapy clients to present a symptom or problem that is driven by more than one emotional schema. A symptom ceases to occur only when all of its underlying emotional learnings have been nullified.

3. Nonimplementation. In other cases, the therapist believes he or she has guided the required sequence of experiences, but has not actually done so. As explained below, the necessary experiences have aspects that can be misperceived, particularly by clinicians who are relatively new to guiding this process.

4. Not based in learning. One other situation in which the reconsolidation process can erroneously appear to be failing is where the client’s problem or symptom is not rooted in acquired, underlying emotional learning. This category includes autism spectrum and other conditions that have genetic causes, or purely physiological conditions such as depression caused by hypothyroidism. For dispelling or moderating such conditions, the memory reconsolidation process does not apply and should not be used, so it cannot correctly be said to fail in such cases. A very wide range of symptoms has been dispelled decisively in therapy by the reconsolidation process (Ecker et al., 2012, p. 42), which shows how pervasively emotional learnings are the underlying cause of presenting problems.

In the case of resistance to dissolution, the erasure sequence is well fulfilled by juxtaposition experiences, as required by the brain for dissolution of the target learning, and yet dissolution does not occur because it is blocked by another, distinct dynamic. The erasure of an emotional learning is the profound unlearning and dissolution of what has seemed to be a reality. For example, after dissolution of an implicit emotional learning verbalized as “Dad never talking to me or playing with me means I’m unlovable and don’t matter,” the individual now either has no way of making sense of being neglected by Dad, or realizes emotionally that “I was lovable and did matter, and yet Dad never talked to me or played with me.” Such alterations of personal reality entail difficult emotional adjustments, particularly when the target learning is a core element of a deeply vulnerable area, such as primary attachment relationships, identity, or sense of justice, for example. Even if the series of experiences required for dissolution has occurred as required, dissolution is blocked by the emotional brain if the emotional consequences of dissolution do not feel tolerable, whether or not those consequences are recognized consciously. Thus the unlearning and dissolution process is not governed by mechanistic neurological processes. Higher-order, abstract meanings that are distressing can block it.

For example, many times I have seen a therapy client hold back from a liberating shift because of an accompanying realization that if the shift were to occur, it would mean that decades of life were wasted by living according to unconscious, life-choking beliefs that have turned out to be completely false. That abstract meaning of “life wasted” tends to produce initially intolerable emotional pain of grief and injustice. If any consequences of dissolution feel unworkably distressing, the dissolution is blocked. This unconscious blockage can be understood as a self-protective response to the expected consequences of the change. The therapist considers that such resistance may be occurring when he or she is reasonably confident that genuine juxtaposition experiences have occurred (with both the target learning and contradictory knowledge experienced concurrently and vividly), yet the target learning remains in effect (continues to feel real and to generate the client’s symptoms). Then the therapist’s task is to guide the client gently to bring awareness to the specific distress that is expected to result from dissolution (such as disorientation, loss, grief, pain, or fear), making dissolution too daunting to allow. The expected distress itself consists of meanings, models and ego states that now become the focus of transformational change. When, as a result of this work, there is no longer any intolerable emotional consequence to dissolution, the juxtaposition experience is repeated and dissolution readily occurs. In other words, the dissolution of any one emotional schema necessarily takes places within the whole ecology or network of interconnected meanings and models that constitute the person’s experiential world, and that world may first have to be prepared so as to make the emotional consequences of dissolution tolerable and acceptable.  At that point, the required sequence of experiences (which is the creation of a juxtaposition experience repeated a few times) successfully dissolves the target learning maintaining the symptom.  (For a case example illustrating this process, see Ecker et al., 2012, pp. 77–86.) Nonimplementation of the required sequence of experiences is the other situation that needs to be examined here. Nonimplementation may be the actual situation though the therapist believes mistakenly that the sequence has been fulfilled. Such cases can involve misperceptions of various kinds.

One mistake of this kind consists of assuming that a particular procedure or technique necessarily creates a particular subjective experience had by the client. The brain’s requirement for deconsolidating and erasing a target learning is a certain sequence of internal experiences, not external procedures or techniques. In other words, there is an important distinction between the procedure that is carried out visibly in the room, and the internal phenomenology occurring in the therapy client’s subjective experience. A particular procedure intended to create the necessary experience may or may not be successful at inducing that internal experience (be it reactivation of the target learning in explicit awareness, or a disconfirming mismatch of the target learning, or the juxtaposition of the two). If the therapist does not verify the quality of the client’s inner experience, he or she might assume the experience was properly created when actually it was not created by the procedure used. In that case it will appear that memory reconsolidation has failed to be effective, when in fact it was not properly induced in the first place. The first step of the erasure sequence is the reactivation in conscious awareness of the target schema that underlies and generates the client’s problem or symptom. This requires the target schema to be not only retriggered by a suitable cue, but also present in the foreground of conscious awareness, so that the specific set of meanings and expectations that make up the schema are lucidly and explicitly in awareness. This explicit awareness is facilitated through specifically verbalizing this material while feeling it emotionally and somatically.  Such conscious reactivation requires the implicit, nonverbal target schema to be integrated into conscious awareness.

Typically, however, symptom-generating schemas are fully and deeply implicit and nonconscious, and in the course of decades they are retriggered hundreds or thousands of times without becoming conscious in the least. A therapist might guide a retriggering by guiding the client to revisit imaginally a recent situation that did retrigger the schema and the symptom. The therapist might believe that this retriggering procedure has fulfilled the reactivation step, though it has not done so because the emotional reactivation of the schema is not accompanied by integrated, cognitive awareness of the specific contents of the schema. The inner experience of reactivation required for reconsolidation has not occurred, so transformational change will not result when the remaining steps are carried out. The therapist, believing all the steps to have been fulfilled, comes to the false conclusion that sometimes the reconsolidation process fails to work.

Similarly, a procedure that the therapist believes has created a disconfirming experience or vivid contradictory knowledge—the next step in the key sequence of experiences—might not have actually created the inner experience of juxtaposition (mismatch or prediction error) that the brain requires for unlocking synapses, deconsolidating the target learning. There are various ways in which a mistaken belief that a juxtaposition experience has occurred may arise. To begin with, both sides of the juxtaposition need to be richly experiential. That is, the client must be having her or his own lucid experience of the felt realness of both (a) the target schema and (b) some other personal knowledge that absolutely contradicts what the target schema “knows” or expects.

Therapists may believe they are guiding a sufficiently experientially vivid state of mismatch, engaging the client’s limbic system in the disconfirmation experience as is necessary, when actually the work is too cognitive and not sufficiently experiential to create a true juxtaposition experience. This too can give the impression that the process has been ineffective, when actually it has not been properly guided and the brain’s requirements have not been fulfilled. The therapist, believing that the necessary conditions have been fulfilled, may conclude that the reconsolidation process has failed to work. This was the case of a therapist who wrote to me that in his experience, he “can offer reframes, tell Ericksonian stories, etc.; [but] simply offering and juxtaposing a mismatch does not guarantee transformation.” He was assuming that those techniques were creating juxtaposition experiences as required. He was defining juxtaposition by the procedure rather than by the quality of the client’s inner experience. In reply I pointed out that the contradictory knowledge that creates the mismatch must be the client’s own living experience of contradictory knowledge, not just something the client is hearing about informationally from the therapist. I mentioned also that a procedure that has successfully created an effective juxtaposition experience for one client may fail to do so for another.

Another aspect that can be misjudged by the therapist is the matter of what is being mismatched and disconfirmed. The target of disconfirmation needs to be a core symptom-necessitating construct, or symptom production will be unaffected by the disconfirmation. Identifying suitable target constructs requires doing a thorough job in the preparation steps of finding, making explicit, and guiding integrated awareness of the implicit learning or schema driving symptom production (the methodology for which is described in detail by Ecker et al., 2012, and Ecker & Hulley, 2011). Symptom-generating schemas often have several layers. Therapists sometimes do an incomplete job of retrieving this material into integrated awareness, and then target a relatively superficial or even tangential construct. A transformational shift will not result from a mis-targeted juxtaposition experience, but that is not a failure of the reconsolidation process to effect change. When all four of the situations described in this section are navigated skillfully, the therapeutic reconsolidation process is consistently effective in producing the distinct and verifiable markers of transformational change.

Conclusion
The profound unlearning and cessation of acquired behaviors and states of mind occurs through the process of memory reconsolidation, according to the best available scientific knowledge and as extensive clinical experience bears out. A sound understanding of memory reconsolidation is therefore a vital guide for facilitating lasting, liberating change in psychotherapy and counselling with maximum regularity. The study, practice, and effort required to arrive at a sound understanding and use of memory reconsolidation and avoid the various possible misconceptions are a price well worth paying for the clinical effectiveness gained. It is my hope that the accounts and clarifications provided in this article will help to communicate this invaluable body of knowledge to mental health practitioners everywhere.

References
http://reprogrammingmind.com/references-for-the-ten-misconceptions-of-memory-reconsolidation/

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