How to B e B rief

W he n Y ou W e r e T r a i n e d
to B e D eep — and V i c e V e rs a

DEPTH
ORIENTED

HREF
THERAPY
1L

B ruce Laurel
E cker H ulley
Depth-Oriented
Brief Therapy
Depth-Oriented
Brief Therapy
How to Be Brief W hen
You W ere Trained to Be
Deep— and Vice Versa

Bruce Ecker and Laurel Hulley

Jossey-Bass Publishers • San Francisco

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Library of Congress Cataloging-in-Publication Data
Ecker, Bruce, date.
Depth-oriented brief therapy : how to be brief when you were trained to be deep
and vice versa / Bruce Ecker and Laurel Hulley.
p. cm.—(Jossey-Bass social and behavioral science series)
Includes index.
ISBN 0-7879-0152-0 (alk. paper)
1. Brief psychotherapy. 2. Unconsciousness. I. Hulley, Laurel, date. II. Title.
III. Series.
RC480.55.E33 1996
616.89' 14—dc20 95-18735

HB Printing 10 9 8 7 6 5 4 3 FIRST EDITION

Contents
Preface ix
Introduction: Joining “Deep” and “Brief’ in
Psychotherapy 1
What Is an Effective Therapy Session? 13
Resolving Emotional Wounds 41
The Emotional Truth of the Symptom 93
Radical Inquiry: The Stance 127
Radical Inquiry: Techniques 157
Experiential Shift: Changing Reality 203
Conclusion 259
References 263
The Authors 269
Index 271
To our parents,
Miriam and Sam Ecker
and
Ruth and Robert Shaffer
with gratitude
 Preface

At a 1978 workshop, Italian family therapist and trainer Mario

Andolphi was heard to say, “To make shorter the therapy, make
longer the training.” His words contain two important implications:
making therapy shorter is desirable and making therapy shorter is
a special skill.
Many therapists, however, regard brevity as highly undesir­
able because brief therapy is seen as sacrificing vital qualities of
the work—the depth and durability of resolution reached; the
thoroughness of change in the em otional an d unconscious
aspects m aintaining the problem ; the a u th en tic, trust-based
client-therapist relationship. Actually, with regard to many types
of brief therapy, these skeptics are right. With regard to the ther­
apy described in this book, the picture changes.
We have developed a brief therapy that preserves what we value
most in the work: the complex depths of meaning and feeling in
which hum an beings participate. Not only is it possible to retain
this depth-dim ension in brief practice, but it is also by working
directly with the core elem ents of em otional and unconscious
meaning that the therapy becomes so effective as to be brief.
When therapy no longer sacrifices its best qualities to be brief,
then brevity becomes desirable.
Then there is the second point: that a particular kind of learn­
ing and skill are required for doing effective therapy briefly. Learn­
ing depth-oriented brief therapy involves a distilling and honing
of the best skills and sensitivities of our profession. Anyone who
loves the work of therapy will also love the challenge we offer in
this book—the challenge of moving rapidly to the center of the
client’s world of meaning. Doing this will open up a new level of
richness and satisfaction in time-effective work.
O ur approach has a well-defined methodology, guided by a
comprehensive conceptualization of problems and change. The

ix
X P reface

presentation of our approach in this book is designed to be acces­

sible and engaging to clinicians at all levels, from experienced pro­
fessionals to graduate students.
Depth-oriented brief therapy is to our knowledge the first non-
pathologizing brief therapy to fully address the em otional and
unconscious aspects of the presenting problem on an equal foot­
ing with cognitive, behavioral, and systemic-interactional aspects.
In our training activities we find that the integrative, constructivist
character of depth-oriented brief therapy makes it appealing
and highly useful to clinicians of all orientations. Its inclusion of
emotions and the unconscious makes it relevant to psychodynamic
therapists, and its use of em pathic inquiry to find hidden em o­
tional sense in the client’s internal experience is familiar to self
psychologists. Its strong emphasis on experiential and phe­
nomenological methods is natural to humanistic and existential
therapists. Its focus on current constructions and internal repre­
sentations created in the course of development gives it much com­
mon ground with the object relations school and with cognitive
therapies. Its systemic application with couples and families makes
it pertinent to family systems therapists as well.
Both the methodology and the conceptualization of depth-
oriented brief therapy contain significant innovation, such as an
extension of the concept and technique of “second-order change”
to third-order and fourth-order change, which we describe with
detailed examples. The approach also expands the scope of post­
modern constructivist thought and practice into including the full
range of conscious and unconscious psychological activity. We have
for many years felt that the therapeutic potential of constructivism
is far greater than has yet been dem onstrated, and our work for
over a decade has focused on learning how to bring construc­
tivism’s nimbleness into the same depths of emotional and uncon­
scious, autonomous process as is addressed by our psychoanalytic
and psychodynamic colleagues—though we see those depths
through a different conceptual lens. This is a dom ain of con­
structed reality that is largely disregarded by narrative constructivists
and social constructionists, the influential domain of unconscious
emotional meaning that is not always based in language.
What is new in depth-oriented brief therapy stands on a base
synthesized from many influences across the spectrum of thera-
 P reface XI

peutic schools. O ur approach draws importantly from the work of

Virginia Satir, R. D. Laing, and Carl Jung (for the coherence and
positive function of the psyche in producing the symptom, the
ontological unfoldm ent of self, and the conscious/unconscious
dialectic); Gregory Bateson (for the hidden, epistemological aspect
of human functioning and the logical types of constructs); Milton
Erickson (for the nonpathologizing view of the client’s uncon­
scious process as readily accessible, responsive, and capable of
cooperation with the therapist); Fritz Peris,James Simkin, and Carl
Whitaker (for the therapist’s use of self, the necessity of experien­
tial engagement of the client, and the view of the client as the pre­
eminent expert on her or his own experience); and Robert Shaw
(for the accessibility of the hidden construction of the presenting
problem and for the immediate availability of that epistemological
and ontological structure for transformation).
In the many clinical examples that follow, the therapist is always
one of the two authors. Session transcripts are in most cases tran­
scriptions of tape recordings or videos, and in a minority of cases
are a reconstruction of the session based on notes taken during or
immediately after it. Identifying details have been altered to assure
the confidentiality and anonymity of clients.
There are a num ber of acknowledgments we are pleased to
make:
B.E.: My thanks and lasting gratitude go to psychotherapist
Elizabeth Heaney for the steady enthusiasm, encouragement, and
substantial efforts that brought about the presentation of depth-
oriented brief therapy to the professional community. Also greatly
appreciated is the energetic support and generous efforts of ther­
apist trainer Vicky Stromee and family therapist Grace Manning-
Orenstein in helping present our approach. My appreciation goes
as well to psychologist Philip Manfield for viewing videos of the
work and offering comments from an object relations viewpoint.
L.H.: I would like to express my appreciation to Professor John
Watson of the infant developmental psychology departm ent at the
University of California at Berkeley, whose research and clarity of
teaching regarding how human beings structure experience from
the first hour of life became a lasting basis for my clinical perspec­
tive; to Professor James Coyne, under whom I worked at the Stress
and Coping Project at UCB, for requiring me to become aware of
XII P reface

the sociopolitical dimensions operating at all levels of psychother­

apy and to seek an ever greater refinement of skills in each therapy
hour; to Professor Kathleen Hulley of New York University for her
always fresh views and knowledge of French deconstruction theory,
a perspective I was later able to convert into a therapeutic tool; and
to psychologist Felix Polk, for persistently prom pting me further
into my own difficult journey into unconscious emotional truth.
We jointly want to acknowledge and thank Dr. Robert Shaw,
D irector of the Family Institute of Berkeley, California, for his
brilliant teaching and his contagious conviction that the thera­
pist can and should find a way, moment-to-moment, to be effec­
tive in every session. O ur gratitude also goes to Jossey-Bass editor
and psychotherapist H ugh Grubb, who invited us to write this
book and whose steady and sound advice we always followed; to
our friend Gail H ann for her unstinting support in the care of
our family while we wrote; and especially to our courageous and
hard-working clients and therapist-trainees, every one of whom
has been a world of learning for us.

Oakland, California B ruce E cker

August 1995 Laurel H ulley
Depth-Oriented
Brief Therapy
 Introduction:
Joining "Deep" and "Brief"
in Psychotherapy
Could it be possiblefor a therapy to move within
the domains of the emotions and the unconscious,
preserving the depth, authenticity and poignancy
we value so highly in the work, and yet make an
unmistakable difference in every session and
therefore be brief?

Depth-oriented brief therapy developed out of our intention to

find an affirmative answer to this question.
We were dissatisfied with the prevailing assumption in the tra­
ditional branches of the profession that it was inevitable for a sig­
nificant number of sessions to be of unclear impact, leaving either
the client or therapist privately not sure if the session had actually
made a valuable and significant difference or if time and money
had been well spent. Strategic and solution-oriented brief thera­
pies em phasized making every session effective, but sacrificed
depth and the quality of the therapist-client relationship in the
process. Psychodynamic brief therapies, on the other hand, sought
depth but insisted upon viewing clients through an exceedingly
thick lens of pathologizing theoretical constructs, which too
severely lim ited the therapist’s view of the client’s capacity for
change, the allowed repertoire of therapeutic techniques, and the
range of acceptable clients.
We examined thousands of our own therapy sessions with indi­
viduals, couples, and families for key m om ents in which deep,
symptom-dispelling change took place. What distinguished these
hours from others? What was it that we as therapists had to know

1
2 I n tr o d u c tio n

and had to do or not do in order to generate that kind of effec­

tiveness all the time?
We found consistendy that the interactions that produced ther­
apeutic breakthrough did not inherently require preparatory
months or years of sessions. The crucial exchanges would in most
cases have been equally effective if carried out in the very first ses­
sions, if only the therapist had somehow known what they were.
Depth-oriented brief therapy (DOBT) developed as we identified
how to bring the client and therapist to those pivotal moments very
rapidly, without reducing the therapist’s role to one of technician
or manipulator, as some other brief approaches seemed to do.
It emerged that the key condition for deep, brief work was the therapist fs
conviction that the unconscious constructs generating the client s problem
are immediately accessible and changeable from the start of therapy. This
book presents the comprehensive approach that developed as a
result of reorganizing therapy around this central conviction. The
fact of immediate accessibility means that profound therapeutic
change can consistently be brought about far more rapidly than is
allowed for in traditional in-depth approaches.
O ur interest in effectiveness had led us to train in and affiliate
initially with the systemic-strategic-cybernetic paradigm of psy­
chotherapy, which in the 1960s and 1970s had opened up exciting
new ways of conceptualizing problem s and producing change,
making new levels of clinical effectiveness possible. Increasingly we
inhabited the constructivist ways of thinking and interacting that
have characterized systemic family therapy from its inception.
In reaction to the psychodynamic orthodoxy that had pre­
ceded it, systemic and strategic therapy shunned the individual’s
intrapsychic process and eliminated emotions and the unconscious
as legitimate areas of therapeutic focus. Family therapist and
anthropologist Inga-Britt Krause, in summing up her review of the
positions of the major forms of systemic family therapy with respect
to emotion, writes, “For all of them motivation, articulated as feel­
ings and emotions, was attributed to individuals and to address
these was considered to be unim portant and perhaps even sub­
versive to systemic theory and therapeutic practice. Representing
what we may gloss as ‘orthodox’ family therapy, . . . the processes
which take place inside individuals were considered to be outside
the remit of observation and study.”
 In tr o d u c tio n 3
Yet as we studied our own sessions we found that the ones in
which key, in-depth breakthroughs occurred were precisely those
in which we diverged from the systemic avoidance of emotional
and unconscious material and worked directly with these dim en­
sions of the client’s problem no less than the cognitive, interac­
tional, and systemic aspects. But we did so as constructivists, not as
psychodynamic therapists, and found that we could evolve the
assumptive base of constructivism in a way that enabled us to work
with emotional and unconscious process with surprising effective­
ness. (As theorist Michael J. Mahoney observes, “only recently has
the term unconscious begun to be liberated from exclusively psy­
choanalytic connotations.” This book participates in that impor­
tant trend. We use the term unconscious broadly to encompass all
cognitive, emotional, and somatic contents, states and processes
that are outside of awareness. Specific degrees or types of uncon­
sciousness will be indicated when necessary.)
We learned from our clients that what m attered most in trig­
gering lasting change was for the client to find and experience the
already-existing but hidden emotional meaning that the problem
had for him or her. This was always the most strongly m eaning­
laden view of the problem and invariably opened avenues to rapid
change. To arrive at this point required reaching into the client’s
constructions operating outside of awareness. W hen we began
intentionally to seek the problem’s emotional truth—an unconscious
construction of passionately felt meaning—from the very start of
therapy, our work began to reliably achieve the level of effective­
ness we were seeking.
What distinguishes depth-oriented brief therapy from other brief
therapies is this active engagement with the full phenomenology—
emotional, cognitive, somatic (kinesthetic and somesthetic), and
behavioral, conscious and unconscious—in the focused, efficient
manner required for brief work and, at the same time, in the respect­
ful and authentic manner required for a subjectively rich, meaningful,
collaborative client-therapist relationship. Applied to this complete
phenomenology, depth-oriented brief therapy’s nonpathologizing,
constructivist approach produces results that under orthodox
assumptions are impossible—supporting the argument that the effec­
tiveness of psychotherapy is limited more by the constructions put
upon it by therapists than by the psychological makeup of our clients.
4 In tr o d u c tio n

D epth-oriented brief therapy is able to integrate “deep” and

“brief” by applying two convictions in tandem: (1) nothing under­
lies present problem s but present cognitions, em otions, and
kine/somesthetics, both conscious and unconscious; (2) uncon­
scious, symptom-generating elements of the client’s world of mean­
ing are “in the room,” always close at hand, immediately accessible,
and therefore transformable.
In short, this approach holds that the elements necessary for
in-depth resolution always are present and available for change.
DOBT provides a practical methodology for rapidly and accurately
locating and changing this key material. It is this principle of imme­
diate accessibility—accessibility of unconscious, symptom-generating
constructions—that dissolves the traditional opposition of “deep”
and “brief.”
As our many case examples will also show, the inherent effects
of the methodology go beyond symptom relief and generate a new
awareness of wellness and worth at the core of self.
It is no surprise that within the traditional frameworks of the
psychoanalytic and psychodynamic schools, depth and brevity are
seen as mutually exclusive qualities o f clinical work. It is quite
ironic, however, that even some of the postmodern, constructivist
brief psychotherapies—strategic, solution-oriented, and narrative
approaches—conform to the same root assumptions as mainstream
orthodoxy in that they generally dispense with unconscious depth
in order to achieve brevity, as noted earlier.
O ur aim in this book is to point to the brief, fully in-depth psy­
chotherapy that is made possible by a new assumptive base, con­
structivist in nature. T hroughout the chapters of this book our
clinical examples will show how depth-oriented brief therapy is car­
ried out and how it differs from other approaches. DOBT has been
successful with a wide range of clinical problems, including ago­
raphobia; anxiety and panic attacks; depression; addictive/com-
pulsive behaviors such as compulsive eating, workaholism, and
manic activity; sexual problems; symbiotic attachment and depen­
dency; effects of traum a and abuse, such as dissociative states,
shame, self-blame, and chronic low self-esteem; and couple, fam­
ily, and interpersonal problems. We will also discuss the limits of
the approach. Even highly effective therapy is not always brief, and
we will explain why.
 In tro d u c tio n 5

O v e rv ie w o f th e C ontents
Chapter One provides an introductory guided tour of the method­
ology and conceptual framework of DOBT, with several case exam­
ples. C hapter Two then dem onstrates the approach in detail,
applying it to clients whose presenting symptoms are driven by
unresolved, lifelong emotional wounds. By the end of Chapter Two
we will have seen DOBT deal with agoraphobia, low self-esteem,
psychogenic pain, chronic depression, workaholism, and repeti­
tion compulsion. Chapter Three completes the conceptual picture
sketched in C hapter O ne and points out im portant, supporting
developments in cognitive neuroscience. Chapter Four describes
the therapeutic stance for carrying out DOBT’s methodology of
discovery, radical inquiry, in preparation for Chapter Five’s detailed
survey of specific techniques of this methodology, including tech­
niques for working with client resistance. C hapter Six likewise
details techniques for DOBT’s methodology of change, experiential
shift Chapters Five and Six continue the presentation of illustra­
tive case material, including couple and family therapy.

The Constructivist A pproach_______________________

A short statement of the constructivist basis of DOBT will be our
point of departure. (For more extensive expositions of the range
of constructivist perspectives in psychotherapy, we recommend the
writings of Michael J. Mahoney, Robert A. Neimeyer, and William J.
Lyddon, cited at the end of the chapter.)
In line with our insistence on experiential rather than analyti­
cal avenues to change, we begin by involving the reader in a koanr
like problem: Consider a live goose inside a large, narrow-necked
glass bottle. How to get the goose out of the bottle without hurt­
ing the goose or breaking the bottle? Ponder the problem as you
read on, and we will return to it not far along.
Constructivism has two essential ideas at its base. The first is
this: Each person actively forms or assembles the experiential reality, the
experiential world of meaning, that he or she inhabits and takes as inde­
pendent, real, and self-evident
The constructivist view is that nearly all of this construing and
assembling of reality is done unconsciously, both at the neurobiological
6 I n tro d u c tio n

level of synapses and neural networks and also at the social-psycho­

logical level of construing and assigning meanings to perceptions. We
become completely absorbed in our own construction of reality pre­
cisely because we are unaware of our role as its construer-author. Even
the stock versions of reality received from family and culture are not
just passively experienced, but are actively if unconsciously invoked
and applied by the individual (authorized if not authored).
In this view, whatever a psychotherapy client defines as the
symptom or problem —compulsive eating, depression, a child’s
bed-wetting—is seen not as a sign of pathology but in less dire and
rath er m ore hopeful terms: The occurrence of the presenting
symptom is dictated coherently by the individual’s currently oper­
ating constructions of meaning. Therefore, the target of change,
as described by therapist Laura Rice, is the client’s specific “endur­
ing constructions or schemes that are brought to bear on each new
experience . . . [and] that are relevant to the recurrent situations
in which the client reacts in unsatisfactory ways.”
A construct is defined simply as any internal representation of
any aspect of self or world. Every construct functions as an item of
personal knowledge. However, use of the terms construct, construc­
tion, or construing in describing psychological processes does not
in itself comprise the constructivist position. For example, object
relations-oriented clinicians keenly appreciate that people con­
struct their own representations and experiences of reality, yet
these therapists are not necessarily constructivists. Constructivism
involves this additional core idea: There is no one objectively “correct”
version of reality, no single “true”meaning of events, that distinguishes
mental health or toward which a therapist should necessarily orient the ther­
apy client.
A constructivist th erap ist assumes th ere are any nu m b er
of viable ways the client’s view of reality could change that would
dispel the presenting problem, and in a spirit of collaboration,
the therapist and client consider and try out such possibilities.
The differences among constructivist therapies are differences
in how they select an altern ate, symptom-free view o f reality
for the client to experimentally inhabit, and in how they invite
and assist the client to do so. Their common ground is this: The
therapist does not take the objectivist position of being a diag­
nostic authority on the “correct” view of reality, but rather offers
 In tr o d u c tio n 7

expert skill in m odifying realities so as to elim inate th eir

unwanted consequences.
A constructivist therapist is rather like an anthropologist who
accepts the validity of many different experiential realities and
within broad limits does not presum e to define how a person
should think, feel, and live. This is a postmodern position in that
it decenters any absolute, timeless truth about people’s lives and
instead recognizes a varying, local formulation of truth.
This epistemological position has sweeping implications for
conducting psychotherapy. In contrast to (1) the traditional objec-
tivist view of treatm ent as requiring discovery of factual, causal
conditions in childhood and (2) the behaviorist-interactional view
of the individual as controlled by the social environment, the con­
structivist view is that problems are generated entirely by the indi­
vidual’s cognitions and emotions comprising his or her present
construction of reality. These present-time elements can, of course,
include representations of past experiences, but these representa­
tions exist in the subjective present and should not be confused
with an objective past. As theorist Gregory Bateson pointed out, if
it really were past events in themselves that cause us to experience
and act as we do, then “there could be no psychotherapy. The
patient would be entitled and even com pelled to argue, ‘My
mother slapped me down in such and such ways, and therefore I
am now sick; and because these traumata occurred in the past they
cannot be altered and I, therefore, cannot get well.’”
The therapeutic task is, therefore, to assist the client to further
evolve his or her construction of reality, or matrix of meanings, in
such a way that the presenting problem is alleviated. This is
approached as an intrinsically progressive and creative process
rather than a corrective or curative one. The therapist’s view of the
mind as an inherently active and potent meaning maker gives him
or her a genuine conviction in the client’s native capacities for
meaningful change, a stance that is contagiously hopeful without
necessarily being one-sidedly or glibly “positive.” “There is nothing
so obvious that its appearance is not altered when seen in a differ­
ent light,” wrote therapist George Kelly, a pioneer of clinical con­
structivism. “Whatever exists can be reconstrued.”
However, the view of the client’s problem as being entirely a
consequence of how he or she currently construes reality has led
8 In tr o d u c tio n

many a constructivist into a naive analysis o f the experience of

trauma and hardship. Some have gone so far as to write, “as con­
structivists, we must insist that the ‘traum a’ of rape takes place in
language, as part of a socially sanctioned narrative.” The double
error here is, firstly, a gross overestimation of the role of language
and cognitive processes in generating experience and, secondly,
the assumption that all suffering can be avoided by making the
purely internal movement of adopting the right point of view. The
latter position may be appropriate in the context of serious spiri­
tual practice, but not in the context of psychotherapy. To suffer is
an appropriate, meaningful response to experiencing such ordeals
as grinding poverty, political oppression, or rape; the suffering,
grief, and rage felt by people whose lives meet with such ordeals
are not necessarily symptoms requiring a therapist’s assistance.
Rage over injustice and violation, for example, could be consid­
ered symptomatic only if it were expressed destructively, aimed at
innocent targets, or not given any suitable expression over time.
In constructivist approaches, the therapeutic strategy is not to
work directly on the symptoms in order to diminish them and pro­
duce more agreeable, less symptomatic conditions within the same
view of reality—which would be first-order change. Rather, the
approach is to usher the client into an alternate view of reality that
does not include producing the symptom. This has been termed
second-order change, a concept fundamental to construcdvist brief
therapies, and one which we further develop in this book.
For example, a very alienated and unhappy couple described
their “communication problem ”: The wife com plained that her
husband viewed everything she said to him as criticism, and that
he would therefore counterattack and behave in general as though
they were adversaries. He agreed it always felt like they were adver­
saries but saw this as her fault; he felt she continually attacked him
emotionally and verbally. The therapist witnessed a typical prob­
lematic interaction and saw that the husband did indeed respond
to his wife’s moderate comments as though he were under attack.
The therapist then explained that he needed to do an experiment
in order to find out how comfortable or uncomfortable the wife
would feel if the husband didn 9t see her as attacking. He coached
them through a replay of the earlier, combative interaction, a
replay in which the husband, with the therapist’s help, managed
 I n tr o d u c tio n 9

to respond to his wife’s comments as “views shared between part­

ners rather than as enemy fire.”
After a few minutes of this atypical, amicable interacting, free
of the construal of “attack,” the therapist asked the spouses how
they were feeling. The wife said, “Relieved.” The husband said,
“Defenseless.” He was quiet for a few seconds and then added, “All
I can tell you is, now I feel unjustified in sticking up for myself.” A
few more steps of inquiry drew out the unconscious emotional real­
ity in which this man usually lived, a reality in which he is “bad and
selfish” if he expresses his own views, wants, and needs, and in
which it is legitim ate for him to do so only if he is under attack
(hence his great need to see his wife as attacking him, illustrating
the constructivist view of perception as inseparable from presup­
position).
His disentidement to self-affirmation now became the focus. A
change in that previously unconscious, disentided position by the
end of the next session allowed him to begin to feel justified in
expressing himself autonomously even if not under attack. His now
unneeded construal of his wife as attacking then fell away naturally
over the next few sessions.
Here the “com m unication problem ”—his great reactivity to
her comments about him—was eliminated by second- and higher-
order changes in how he construed interpersonal reality, with no
change at all in her behavior. For the therapist to have focused on,
say, improving “communication skills” within the original, unrec­
ognized reality would have been a first-order change and would
have encountered resistance or at best resulted in a fragile
im provem ent lasting only until the next time his unchanged,
unconscious presupposition of disentidement came into play.
In the constructivist view, then, a client’s presenting symptoms
are the unacceptable costs or consequences of the client’s current
way of construing reality. Because it is the client who set up that
construction of reality in the first place, it is the client who can
change it, if skillfully guided to do so, in order to eliminate those
unwanted consequences. Competently executed, this approach
tends to result in particularly durable therapeutic change and can
occur rapidly.
The hallmark of constructivism is the creation of new meaning
and the plasticity of experiential reality. However, the position of
10 I n tr o d u c tio n

constructivists is not that “anything goes” or that people are free to

make up any reality they wish. People have neither the current abil­
ity nor the ethical license to arbitrarily or immediately create any
wished-for reality, such as “I am a cardiologist.” Rather, the con­
structivist point is that people have much more ability than they real­
ize to modify the reality they currently inhabit. Constructivism does
not maintain that all alternative realities are equally acceptable;
that is, it does not reject values, but neither does it prescribe them.
Within its metastrategy for problem resolution in psychother­
apy, constructivism coordinates and integrates the use of “a variety
of therapeutic techniques originating from many different thera­
peutic traditions w ithout. . . encountering the dangers of an arbi­
trary eclecticism.” Clinical examples th roughout this book will
indeed demonstrate a wide range of techniques used to carry out
our particular constructivist approach to problem resolution. The
reader will undoubtedly recognize some of these techniques (cog­
nitive, Gestalt, Ericksonian, and so forth) and should rem em ber
that it is the therapeutic design being served by the technique, not the tech­
nique itself, that constitutes the DOBT/constructivist dimension of the work.
At this point we pause to ask the reader how he or she is doing
with getting that goose out of the bottle without hurting the goose
or breaking the bottle. There is a way, very simple, already at hand.
Ready? There! Poof! It’s out!
The problem existed only as a construction in the re a d er’s
imagination. It never consisted of a physical goose in a physical
bottle and was not governed by the same properties as physical
objects. If the reader construed the imaginary goose and bottle as
having to have the properties that a physical goose and bottle
would have, the reader unconsciously invented a world and then
took it to be real—and gets, in retrospect, a glimpse of our con­
stant but unconscious use of the m ind’s ability to construct and
inhabit realities. An imaginary goose is easily removed from an
imaginary bottle in which it suffers unnatural confinement, with­
out hurting the goose or breaking the bottle. Likewise, the very
real suffering of therapy clients is due to conditions and con­
straints that clients themselves have unwittingly put into effect in
response to external events, and which clients therefore have the
capacity to dissolve. Even in the midst of objective hardship, the
difference between a trium ph and a collapse of the spirit is the
 Introduction 11

difference in how the ordeal is construed—the construction of

meaning by which the individual relates to circumstances.

Notes
P. 2, characterized systemic fam ily therapy from its inception: See, for example,
J. Bogdan (1988), “What’s All the Fuss?” Family Therapy Networker,
72(5), 51;J. S. Efran, R.J. Lukens, and M. D. Lukens (1988), “Con­
structivism: What’s in It for You?” Family Therapy Netxuorker, 72(5),
26-35.
P. 2, eliminated emotions an d the unconscious as legitimate areas o f therapeutic
focus: See, for exam ple, P. Watzlawick, J. Beavin, and D. Jackson
(1967), Pragmatics of H um an Communication, New York: W. W. Nor­
ton; J. Haley (1978), “Ideas Which Handicap Therapists,” in M. M.
Berger (Ed.), Beyond the Double Bind , New York: Brunner/Mazel; E.
Lipchik (1992), “A ‘Reflecting Interview’ with Eve L ip c h ik ,”Journal
o f Strategic a n d Systemic Therapies , 7 7, 59-74; I.-B. Krause (1993),
“Family Therapy and Anthropology: A Case for Emotions,” Journal
of Family Therapy, 15, 35-56.
P. 2, uFor all of them . . . the processes which take place inside in dividu als were
considered to be outside the remit o f observation an d study: ” I.-B. Krause,
op. cit. (p. 43).
P. 3, uonly recently has the term unconscious begun to be liberated from exclu­
sively psychoanalytic con n otation s”: M . ] . Mahoney (1991), H u m an
Change Processes: The Scientific Foundations o f Psychotherapy (p. 107),
New York: Basic Books.
P. 5, M ichael J. Mahoney: M. J. Mahoney (1991), H um an Change Processes:
The Scientific F oundations o f Psychotherapy, New York: Basic Books;
M. J. Mahoney (1988), “Constructivist Metatheory: I. Basic Features
and Historical Foundations,” International Jou rnal o f Personal Con­
struct Psychology, 1, 1-35; M.J. Mahoney (1988), “Constructivist
Metatheory: II. Implications for Psychotherapy,” International Jour­
nal of Personal Construct Psychology, 1, 299-315.
P. 5, Robert A. Neimeyer: R. A. Neim eyer (1993), “An Appraisal o f Con­
structivist Psychotherapies,”Jou rn al o f C onsulting an d C linical Psy­
chology, 61( 2) , 221-234.
P. 5, William J. L yddon .W . Lyddon andj. McLaughlin (1992), “Construc­
tivist Psychology: A Heuristic Framework,”Journal o f M ind and Behav­
ior, 13, 89-107.
PP. 5-6, level of synapses and neural networks: H. von Foerster (1981), Observ­
ing Systems, Salinas, CA: Intersystems; H. von Foerster (1984), “On
Constructing a Reality,” in P. Watzlawick (Ed.), The Invented Reality
(pp. 41-62), New York: W. W. Norton.
12 I n tr o d u c tio n

P. 6, level of construing and assigning meanings to perceptions: P. Berger and

T. Luckman (1966), The Social Construction of Reality, New York: Dou­
bleday; C. Geertz (1973), The Interpretation of Cultures, New York:
Basic Books; W. B. Pearce and V. E. Cronin (1980), Communication,
Action, and Meaning: The Creation of Social Realities, New York: Praeger.
P. 6, “enduringconstructions . . . in unsatisfactory ways”: L. N. Rice (1974),
“The Evocative Function of the Therapist,” in L. N. Rice and D. A.
Wexler (Eds.), Innovations in Client-Centered Therapy (p. 293), New
York: Wiley.
P. 6, additional core idea: See, for example, B. Held (1990), “What’s in a
Name? Some Confusions and Concerns About Constructivism,nJour­
nal of Marital and Family Therapy, 16, 179-186.
P. 7, As theorist Gregory Bateson pointed out: G. Bateson (1972), Steps to an
Ecology of Mind (p. 272), New York: Ballantine.
P. 7, wrote therapist George Kelly: G. Kelly (1969), Clinical Psychology and Per­
sonality: The Selected Papers of George Kelly, B. Maher (Ed.), New York:
Wiley.
P. 8, “the 'trauma' of rape takes place in language”:]. S. Efran, R. J. Lukens,
and M. D. Lukens (1988), “Constructivism: What’s in It for You?”,
Family Therapy Networker, 12(5), 29.
P. 8, second-order change: See, for example, P. Watzlawick,J. Weakland, and
R. Fisch (1974), Change: Principles of Problem Formation and
Problem Resolution, New York: W. W. Norton; W. Lyddon (1990),
“First- and Second-Order Change: Implications for Rationalist and
Constructivist Cognitive Therapies,”foumal of Counseling and Devel­
opment, 69(6), 122-127; R. A. Neimeyer (1993), “An Appraisal of
Constructivist Psychotherapies,”foumal of Consulting and Clinical
Psychology, 61(2), 221-234.
P. 9, constructivist view ofperception as inseparablefrom presupposition: See, for
example, C. Sluzki (1990), “Negative Explanation, Drawing Dis­
tinctions, Raising Dilemmas, Collapsing Time, Externalization of
Problems: A Note on Some Powerful Conceptual Tools,” Residential
Treatment for Children and Youth, 7(3), 33-37.
P. 10, “a variety . . . dangers of an arbitrary eclecticism”: G. Feixas (1990),
“Approaching the Individual, Approaching the System: A Con­
structivist Model for Integrative Psychotherapy,”fournal of Family
Psychology, 4(1), 27.
 CHAPTER 1

What Is an Effective
Therapy Session?
Sometimes we have to be reminded that we have capacities
weforgot we have.
V irginia S atir

Wanting to describe the nature of her therapy experience, one of

our clients shared the fable of the musk deer—the deer who end­
lessly searches the forest for the wonderful source of an exquisite
perfume she always smells, and in the end finally discovers that the
wonderful source is herself. It is characteristic of depth-oriented
brief therapy for the client to experience just such a complete rever­
sal of meaning and to discover, “It is I who create the very experi­
ence I thought was happening to me, and I who can transform it.”
This remarkable discovery happens in a most natural way. The
therapist’s intentionality is focused fully on finding, and drawing
the client into experiencing, what we term the emotional truth of the
symptom—a kind of lost continent of meaning in the client’s evolv­
ing world. It is this discovery that has the liberating effect.
The emotional truth of the symptom can be understood as one
of the more influential formations within the person’s world of
meaning. In depth-oriented brief therapy, such formations of mean­
ing are conceptualized principally in terms of what we call positions.

Positions__________________________________________
A position is essentially a constructed version of reality plus a strat­
egy for responding to that reality. A position consists of a linked

13
14 D epth-O rien ted B rief Therapy

set of conscious or unconscious feelings, beliefs, images, memo­

ries, values, presuppositions of meaning, and bodily tensions or
sensations, which activate together in response to situations that
appear pertinent to them, triggering a strong predisposition to
respond in a particular, preset way.
Recall the man, described in the Introduction, who felt
“attacked” by virtually any substantive com m ent his wife would
make to him. As already described, the therapist brought to light
this man’s unconscious presupposition that within close family rela­
tionships, he was not entitled to be assertive and autonom ous
unless under attack. This in turn made it very im portant to con­
strue his wife as attacking him, so that he could legitimately be self-
assertive. This whole, unconscious, cognitive-affective construal of
reality, including the self-protective behavior o f finding every
opportunity to see his wife as attacking him, constituted a position
he held in relation to her. Cast into words, this position could be
phrased, “I have no right to differ with you or assert my own wants
and needs unless you are attacking me, and since I have no inten­
tion of being powerless with you, I will see you as attacking when­
ever I possibly can.” That was the emotional truth of the symptom.
However, he had been aware of neither holding this position nor
of powerfully asserting it, because he was unconsciously presup­
posing its truth. Consciously he felt quite the opposite, felt himself
to be a victim of her “attacks” and unable to get her to stop attack­
ing him. He had no inkling that it was his own position creating
this bubble of experiential “reality” (“illusion” would be more accu­
rate) that seemed so real.
More exactly, we define a position as a linked set of conscious
a n d /o r unconscious emotions, cognitions, and somatics that (1)
constitute the person’s construal of meaning for a certain kind of
situation, creating an experiential reality; (2) are activated when
current perceptions seem in some way to match the stored repre­
sentation (“memory”) of that kind of situation; and (3) distinctly
predispose the person to respond to the situation with specific pro­
tective actions designed to secure safety or well-being or avoid harm
or suffering. This ready, pre-set response, which is behavioral
a n d /o r internal (as in dissociating, obsessing, psychogenic pain,
and so on), is itself an integral elem ent of the position.
As useful as the concept of position proves to be in under-
 W hat Is an E ffective T herapy S ession? 15

standing symptoms and change, the notion of position by and

large does not arise in the spectrum of psychotherapies. In the few
places where it has been systematically used—in the brief strategic
therapy model of the Mental Research Institute and in some con­
ceptual analyses of narrative therapy—the concept o f position
denotes already or incipiently conscious views and attitudes of the
client. In depth-oriented brief therapy, the full inclusion of truly
unconscious positions in the methodology and conceptual picture
results in fundamental and sweeping differences from other brief
approaches and forms a comprehensive psychotherapy with alto­
gether new capabilities.
Positions organize reality. Oddly, a hum an being can harbor
simultaneous, divergent positions that establish quite different real­
ities in relation to the same item of experience, and therein lies
the genesis of nearly all problems that bring people to therapy.
This heterogeneous construction of reality is a central feature in
DOBT’s view of people, problems, and change. Specifically, a ther­
apy client has two divergent positions that are of utmost relevance
to the therapist’s task.

The Anti-Symptom Position

Nearly always, therapy begins as follows: The client comes in and
describes a problem or symptom (by symptom, we mean the specific,
identifiable features of the presenting problem [s], such as spousal
arguments, anxiety attacks, compulsive eating, child cutting school,
and so on). In the client’s description she directly or indirectly
expresses the following views and attitudes:

• She sees the problem or symptom as senseless or irrational.

• She sees the problem or symptom as completely valueless and
undesirable and therefore wants it to stop.
• She sees herself as its victim—that is, she views the problem as
an involuntary experience and views herself as powerless or
having no control over the external situation a n d /o r herself.
• She takes the problem to mean certain negative things about
herself or others (for example, she is [or they are] bad,
shameful, defective, crazy, stupid, inadequate, uncaring, and
so on).
16 D epth-O rien ted B rief Therapy

The client has, as all people do, a fundam ental need to make
sense of all experience and so resorts to these consciously avail­
able ways of construing the problem. In DOBT this set of views
and attitudes—the clients initial, conscious constructions in rela­
tion to the presenting problem —is term ed the client’s conscious
anti-symptom position.

The Pro-Symptom Position

Experience shows that the conscious, anti-symptom position gives
an incomplete account of the client’s emotional relationship to the
problem.
As we will demonstrate many times over in this book, the client
inevitably also has an unconscious, /mwymptom position toward the
problem, an unconscious construction of meaning that proves to
be the key to rapid, in-depth resolution and is the central focus of
DOBT both methodologically and conceptually. This pro-symptom
position contains the truest emotional significance of the symptom
and the full phenomenology of how the client generates it. In con­
trast to the m akeup of the conscious, anti-symptom position
described above, reality in the unconscious, pro-symptom position
consists of the following knowings and attitudes:

• The symptom or problem has deep sense and compelling per­

sonal meaning.
• The symptom or problem is at certain times vitally necessary
and is of crucial, positive value, so it must not simply stop or be
disallowed.
• The symptom is created and authored by me myself and is
implemented by me as needed.

A pro-symptom position is an unconscious m odel o f reality

in which the symptom seems necessary to have, and it is from
this position that the client produces or implements the symptom.
The man who felt attacked by his wife had an unconscious, pro­
symptom position in which the view of reality—“I am unentitled
to autonomy unless attacked”—made it emotionally very im por­
tant to construe “attack,” despite the fact that in his conscious posi­
tion he strongly disliked this experience. This pro-symptom
 W hat Is an E ffe c tiv e Therapy Session? 17

position involved an emotional wound related to autonomy, a pre­

supposition of when autonomy is legitimate for him, and a conse­
quent protective action of construing attack in order to avoid being
deprived of autonomy.
As a rule, these three elements—emotional wounds, presupposi­
tions, and consequent protective actions—are the primary components
of pro-symptom positions.
Very often the client’s presenting symptom is a protective
action, though it may be unrecognized as such. Protective actions
avoid the occurrence of any unwanted experience or event. Pro­
tective actions take an extremely wide range of forms, including
dissociation, obsessing, depression, anger, blaming, shame, low self­
esteem, and such addictive-compulsive (mood-altering) behaviors
as binge eating, workaholism, manic activity, and many others.
A protective action associated with an emotional wound serves to
protect against directly experiencing the em otional pain of an
unhealed emotional wound a n d /o r against ever again receiving
any similar violations, blows, or losses.
In the course of the next two chapters we will more closely
define presuppositions, emotional wounds, and protective actions
and see how they are organized within a position. Here our focus is
on the fundamental fact that within the view of reality created by
emotional wounds and presuppositions in the pro-symptom posi­
tion, the presenting symptom is compellingly im portant to have.
As the example in the next paragraph shows, the client is at first
thoroughly unaware of how needed and meaningful the symptom
is to her or him, since the pro-symptom position is unconscious. A
central feature of DOBT is the therapist’s direct work, from the
first session, with these unconscious constructs that are creating
and maintaining the problem.
Consider the client whose symptom of “procrastination” was
destroying his graduate school career, which had only recently
begun. He felt himself to be “a failure,” wanted therapy to get him
to carry out his schoolwork, and saw the problem self-blamingly in
terms of “weakness of character,” “laziness,” and “self-sabotage”—
all elem ents of his conscious, anti-symptom position. He was
amazed to discover his pro-symptom position, fully unconscious at
the start of therapy, which consisted largely of the conviction that
it was urgently im portant not to submit to a life program that he
18 D ep th -O rien ted B rief Therapy

himself didn’t actually want, this graduate program having been

decided upon by his parents. When therapy ended four sessions
later, he had direct, feeling-centered awareness of this as his own
emotional truth; knew his non-pursuit of this graduate program to
be not a weakness or failure but an actual success at keeping his
life his own; and had decided to drop out of the program because
it was not what he wanted for himself.
In this case, the symptom of procrastination was a protective
action that the client affirmed and retained once he experienced
his actual purpose for im plem enting it. This is an extremely
simple, almost transparent example, yet the therapeutic process it
illustrates—arranging for resolution on the basis of discovering
an unconscious em otional truth or pro-symptom position—is
extremely broad in application.
This example also shows that the client’s best interests are not
necessarily served by defining success in brief therapy as achiev­
ing an outcom e agreed to by client and therapist at the start of
therapy, as it is in other brief approaches. In depth-oriented brief
therapy, the in-depth work involves discovery of the unconscious
construction of the presenting symptom, which as a rule results
in the client experiencing a thorough transformation of the con­
scious m eaning of the problem . Consequently, the outcom e
desired by the client often changes greatly or even reverses, as it
did in this example. Here the client’s initial desired outcome def­
inition was “I would be doing everything necessary to complete
my course work and program requirem ents without significant
delays.” This sounds like a positive and verifiable behavioral goal—
very much the kind of goal established in solution-oriented,
strategic, and behavioral therapies. Suppose the therapist had
designed the therapy to bring about this conscious agenda of
completing his graduate program and had creatively generated
enough motivation for him to do that—and to continue to unwit­
tingly override his still-unconscious reasons for wanting not to.
The therapy would count as a “success” in a study of short-term
outcomes. However, this m an’s fundam ental alienation from his
field and his about-to-erupt autonom y issues would have
rem ained hidden, and his em otional involvement in his line of
work would have been built on quicksand. We would predict that
the same collapse of motivation that first brought him into ther-
 W h at Is an E ffk ctiv e T hkrafy Skssion? 19
apy would recur farth er along his path, perhaps with an even
greater sense of personal failure.
In our view, the client is served much better, and more ethically
as well, by gaining full, felt awareness of his emotional truth, his
pro-symptom position, and then reassessing what the outcome of
therapy should be. We take the client’s initial definition of the out­
come seriously, but what we are committing and agreeing to whole­
heartedly at the start of therapy is not the client’s initial concept
of resolution, but the client’s arriving at a genuine, lasting resolu­
tion, knowing that this will not necessarily be what the client orig­
inally pictured.
If we as therapists are aware that the client’s initial concept of
a desirable outcome is a product of the same limiting view of self
and world that is generating the problem itself, then we are ethi­
cally obligated to invite a reassessment by the client of the desired
outcome in light of some fuller view of the client’s own purposes.
Therapies that neglect the unconscious are, of course, free of this
inconvenience.
The client’s anti-symptom position insists upon change (“stop
the symptom”), while his or her pro-symptom position insists upon
stability (“keep the symptom”). Thus DOBT’s handling of the
dialectical tension between these two positions is a way of working
simultaneously with the client’s two-sided com m itm ent to both
change and stability.
At the start of therapy, the clien t’s pro-symptom position,
despite being unconscious, is the emotionally governing one, in
this sense: The client keeps manifesting the symptom despite con­
sciously and even desperately wanting not to do so. While the pain
or trouble of the presenting symptom motivates the client to get
rid of it, the very fact that the client keeps producing (or, in a cou­
ple or family, co-producing) the symptom means that, given every­
thing—in particular, given the imperative emotional themes in the
client’s pro-symptom position— having the symptom is actually a
higher priority than not having the pain and trouble it brings. The
therapist’s work in DOBT is at all times guided by the active con­
viction that the symptom is the way it is because some position of the client
xvants or needs it to be exactly that way. Every aspect of every symptom
is a coherent m anifestation purposefully and precisely imple­
m ented or expressed by a co h eren t position of the client. The
20 D epth-O riented B rief T herapy

symptom is never the client being out of control or defective,

though that is how the client’s conscious, anti-symptom position
construes it.

The Therapist's Tw o Top Priorities_________________

In DOBT the therapist empathizes with the client’s suffering and
accepts the client’s wish to be rid of the symptom.
Then the therapist’s first main task is to achieve clarity into
those imperative but hidden emotional themes that constitute the
client’s pro-symptom position and that make the symptom actually
more important to have than not to have. The specific methodol­
ogy of DOBT for rapidly achieving this decisive clarity is called rad­
ical inquiry. It is “radical” because of its swiftness and accuracy in
discovering the problem ’s hidden root (radicalderiving from the
Latin radix, meaning root) and because of its assumptive framework,
an application of constructivist epistemology that departs radically
(root level) from traditional conceptions of the unconscious.
Having discovered the client’s pro-symptom position (or a sig­
nificant part of it) through radical inquiry, the therapist’s second
task is to carry out DOBT’s methodology of change, which overall
we call experiential shift, to emphasize the necessity of experiential
rather than analytical or interpretive approaches to change. The
therapist is now seeking for the client to have an actual experience
of change in the constructs comprising his or her pro-symptom
position.
The phrase experiential shift refers to either the process of change
or to the change itself, in the same way that the word change may
refer to the process or to the final result of change; the appropriate
meaning is always clear from the context. In depth-oriented brief
therapy, both the process and the final result of change are always
experiential.
As both radical inquiry and experiential shift require the client
to face and feel emotionally unresolved or dystonic material, they
require of the therapist empathy, sensitivity, skill with emotional
and cognitive process, and a strong ability to establish warmth and
safety in the client-therapist relationship.
Radical inquiry is the therapist’s highly focused process of
bringing to light the client’s pro-symptom position(s) involved in
 W iiat Is an E ffective T herapy S ession? 21

the problem. Experiential shift is the equally focused process of

involving the client in directly altering pivotal pro-symptom con­
structs. Since an effective session in DOBT is one in which radical
inquiry or experiential shift is carried out, these two activities are
the therapist’s two top priorities in every session.
With sufficient commitment to the notion that the important
symptom-generating positions and processes can be immediately
contacted, the therapist will shape interventions that experiendaily
bring this about. The therapist’s genuine readiness to m eet the
client’s emotional truth, right now, communicates itself and lets
the client know on conscious and unconscious levels that here,
now, it is safe and appropriate to let this happen. Engaging clients
experientially in their own pro-symptom material makes everyone
present know that something of moment is occurring in each ther­
apy hour. In contrast, talking about the problem or its resolution,
accurate or insightful as such talk might be, rarely produces in-
depth, lasting resolution.
In depth-oriented brief therapy the rule is: radical inquiry and/or
experiential shift in every session, from thefirst session. The therapist stays
on purpose and does not let the session drift away from these two
pursuits, both of which focus on the client’s pro-symptom position.
This is the basis for consistently doing deep, brief, unmistakably
effective work with lasting results with individuals, couples, and
families.
We find in training clinicians in DOBT that many therapists
habitually focus on the client’s an/i-symptom position in an effort
to build up that position to the point of defeating the symptom. In
this they conform to the expectations of clients, who naturally
believe that the path to being free of the symptom is through
attending to their anti-symptom position—working against the
symptom and trying to get away from it. Many therapists conceive
of therapy in the same way and devote sessions to empathizing with
the client’s an^-symptom views and feelings and supportively
encouraging the client’s attempts to not have the symptom happen.
This is, however, a prescription for ineffective work, because it
puts the therapist in the same ineffective position the client has
been in, unknowingly trying to override a hidden, emotionally
powerful pro-symptom position, a situation almost guaranteed
to produce resistance, relapse, symptom substitution, prolonged
22 D epth-O riented B rief Therapy

therapy, or a sense that the therapy is superficial and cannot deal

with “the real problem.”
In DOBT the therapist focuses the work on the client’s pro­
symptom position as soon as possible in the first session and then
keeps it there, making momentary exceptions for the purpose of
m aintaining em otional rap p o rt and em pathy when the client
relates from his anti-symptom position, and then drawing the focus
back to working with the client’s pro-symptom position through
radical inquiry or experiential shift.

Radical Inquiry
Radical inquiry has several aspects that operate together. We will
briefly introduce some of these aspects here and illustrate them
with case material; Chapters Four and Five provide a more thor­
ough discussion.
Radical inquiry is the therapist’s methodology for finding the
symptom’s emotional truth, which makes it lucidly clear how, and
why, the presenting symptom is actually more im portant to have
than not to have. This is a phenomenological-experiential process
of discovery, carried out entirely within the terms o f the client’s
subjective world of meaning. As such it involves no attem pt to get
the client to accept theoretical analyses or interpretations, does
not use psychiatric diagnostic categories, and is completely non-
pathologizing. Finding the emotional truth of the symptom also
involves no inventing or grafting of a “better narrative,” however
collaboratively constructed. The symptom’s emotional truth is com­
pletely the client’s own already-existing but unrecognized con­
struction of meaning, and it is through the recognition and further
evolution of that construction that change occurs in depth-oriented
brief therapy.
Radical inquiry, like the constructivist perspective it serves, is
not defined by any specific psychotherapeutic techniques or inter­
ventions; a great many techniques may be applied, adapted, or
devised. The defining feature is this: Whatever techniques are uti­
lized, any step of radical inquiry is crafted by the therapist in such
a way that responding to it inescapably brings the client into an
experience of the hidden, pro-symptom position, the hidden em o­
tional truth of the problem.
 W h at Is an E ffe c tiv e Therapy Session? 23

Let’s take an example from couples therapy. A couple in their

late twenties described their problem as “emotionally ugly verbal
battles that keep happening and keep us from feeling close. We
both jum p right in.” They said they were able to stay harmonious
for at most three or four days, at which point one of these bitter
fights would inevitably erupt. Hearing this information, the thera­
pist in DOBT feels interest in finding out what makes it overrid-
ingly im portant for these two individuals to have fights that end
the closeness. The therapist does not impose ready-made views of
why couples fight, why intimacy is frightening, why a couple system
would homeostatically reestablish distance after closeness, and so
on. In this case the therapist began radical inquiry by asking, “If
you were to stay close for long periods, weeks and weeks, as you
want, there are ways in which that would be so good, so enjoyable.
But I want to know in what way would it be in some way a difficult
problem in itself to remain close and happy, on and on?”
The therapist then held the focus upon this question and had
each of them construct and actually sample in imagination the
experience of day after day, week after week of harmony. This is an
example of how, in order to respond to a radical inquiry interven­
tion, the client must experientially access and report on some part
of the emotional truth of the problem. Within a few minutes each
experienced something completely new, but in fact very old: for
each of them , the very fact of being in happy harm ony uncon­
sciously had the distinct if indiscriminate meaning, “I’ve lost myself
in this relationship; I’m being passive and controlled.” Each held
a strong, unconscious conviction that harmony equals submission
equals loss of self, and each kept a stance of sharp vigilance against
being dominated in a relationship. Three or four days of closeness
were enough harmony to trigger an unconscious alarm, and they
would “both jum p right in” and have a fight that restored to each
a most reassuring sense of assertive independence. This explana­
tion was not what systems theorist Barbara Held terms a “prede­
term ined explanatory con ten t” imposed by the therapist, but a
direct, vivid, experiential realization and acknowledgment by each of
the partners. The unusual degree of sameness in their unconscious
positions made it especially easy in this case for a new kind of
mutual empathy to develop regarding these feelings and concerns.
In their next session two weeks later they reported that incipient
24 D epth-O rien ted B rief Therapy

fights were now quickly fizzling out because “we’re now so aware
of what we’re really up to, and we just kind of look at each other.”
Now that they were out of their unconscious reactive pattern of dis­
tancing, they were able to face and work fruitfully with their fears
of being controlled by allowing closeness.
From the initial, conscious position of both of them, the pre­
senting symptom of fighting appeared to be a completely unde­
sirable problem. From the unconscious, pro-symptom position, the
symptom was actually the very needed solution to a problem, an ini­
tially unacknowledged problem, but a problem so important that
its solution—the symptom—was actually more important to have
than not to have, despite all the suffering it brought. As occurs in
many cases, the therapist here found the problem to which the
symptom was the clients’ solution.

Experiential Shift
Experiential shift, the methodology of change in depth-oriented
brief therapy, has two stages. The first stage is to usher the client
into consciously inhabiting and integrating the discovered pro­
symptom position. This phase of the work we refer to simply as posi­
tion work. Here there is no attem pt whatsoever to change the
pro-symptom position; position work is purely a matter of having
the client incorporate this previously unconscious position into
how he or she consciously experiences the problem.
In many cases position work resolves the problem . W hen it
does not, an additional phase of experiential shift is required, the
transformation of constructs, which involves revising or dissolving the
emotional reality in the pro-symptom position so that there is no
longer any version of reality in which the symptom seems needed.
The client’s pro-symptom position, being unconscious, may be
“comprised of a set of meanings that are felt to be incompatible
with, unacceptable to, and threatening to the system of meanings
constituted in consciousness,” as psychoanalyst Thomas O gden
describes. The client’s conscious, anti-symptom position acts as an
obstacle or barrier to discovering and owning the unconscious,
symptom-generating position. This process may require sensitive
therapeutic facilitation (as shown by two cases detailed in Chap­
ter Two).
 W h at Is an E ffe c tiv e Therapy Session? 25

W hen the pro-symptom em otional reality has been deeply

unconscious, the client’s initial experiencing of it is a very state-
specific knowing, a quite altered state that may be lucid at the time
but is likely not to be retained in awareness when the client returns
to the very different reality in his or her habitual, conscious posi­
tion. This is to be expected, and so a focused process of integra­
tion is needed in order for the client to m aintain access to the
pro-symptom view of reality and consistently relate to the problem
from it, rather than from the anti-symptom position. Position work
carries out this vital step of integration. It will be illustrated in many
examples throughout these chapters and systematically reviewed
in Chapter Six.
With the couple described just above, position work brought
the partners to a stable awareness of actually im plem enting the
symptom of fighting as a solution to the problem of having a fal­
tering sense of autonomy, even though each hated the fighting.
This was a conscious integration of the /wo-symptom emphasis on
the value of having the symptom with the an^symptom emphasis
on the pain of having it: the partners directly apprehended that
having the symptom of fighting was, for them, worth the consider­
able pain and trouble that accompanied it. The client in position
work both experientially discovers and explicidy acknowledges how
the emotional worth or meaningfulness of having the symptom in
fact outweighs its costs. This is a crucial point in the work, a point
we term the pro/anti synthesis. Achieving this synthesis is a profound
change in the construction of the problem, and in many cases res­
olution is an immediate result.
The acknowledgment that having the symptom has been worth
the costs of having it does not mean the client’s suffering is any less
real or deserving of empathy. It means only that the therapist must
not confuse suffering with real readiness to live without the symp­
tom: the client wishes genuinely to be free of the symptom or prob­
lem but simultaneously has even higher priorities that require
keeping it. The existence and potent influence of these initially
unconscious higher priorities is not theoretical but empirical, a
matter of unmistakable experiential fact for the client. In depth-
oriented brief therapy the therapist em pathizes with both the
client’s suffering and the subjective priorities found to be necessi­
tating and maintaining the symptom. The therapist never naively
26 D ep th -O rien ted B rief Therapy

takes the client’s anti-symptom position as the full story and there­
fore never attempts merely to eliminate the symptom or to have
the client eliminate it without full clarification of the importance
of the symptom in the client’s world.

Problem Resolution: Congruence o f Positions______

Finding and then integrating the pro-symptom emotional truth of
the symptom is the prelude to two possible types of resolution:
either (1) the client’s pro-symptom position will be changed so that
the symptom no longer appears necessary to have and therefore
disappears, or (2) the client’s an/i-symptom position will be
changed by the revelation of the pro-symptom reality so that hav­
ing the symptom no longer appears to be a problem and the symp­
tom continues as a now valued or at least acceptable item in the
client’s experiential world.
In either case, the result will be that one of the positions has
come around to the o th e r’s view of the symptom as desirable or
undesirable to have. When this agreement or congruence of posi­
tions is reached, there is no longer any basis for the symptom to
exist or to be regarded by the client as a problem.
As the client’s initial, fragmentary view of his own relationship
to the symptom becomes m ore com plete in the course of the
work—as the client contacts the emotional truth of the symptom
and the meaning of the symptom undergoes a transformation—
he may reassess and come to regard the symptom as something he
wants to retain. We refer to this as reverse resolution, since it entails
a reversal in the status of the symptom from unacceptable to
acceptable.
If the symptom remains unacceptable even in light of its emo­
tional truth, and the client’s original desire for the symptom to
stop continues to define the outcom e of successful therapy, we
refer to this as direct resolution.
A simple example of reverse resolution is the work described
earlier with the graduate student “procrastinator.” Consciously, he
was attributing to his symptom negative m eanings of personal
defectiveness that are culturally prevalent but had nothing to do
with the unconscious emotional truth of his procrastination (his
pro-symptom position). Upon contacting and recognizing this
 W h at Is an E ffe c tiv e Therapy Session? 27

emotional truth—that what he had been calling procrastination

was actually an unconscious refusal to follow an unwanted path in
life—he took his stand on it and carried it out fully. W hat had
seemed an undesirable symptom underw ent a transformation of
meaning and became a desirable strength of self-determination
that he wanted to retain. His anfi-symptom position (“stop this pro­
crastination”) was transformed and brought into agreement with
his pro-symptom position (“keep this self-determ ination”) as a
result of coming into conscious contact with it.
In direct resolution, the symptom continues to be unaccept­
able even in full view of its emotional truth. A woman seeks ther­
apy because she wants to lose weight but has been unable to do so.
In her first session of therapy she experiences her pro-symptom
position, in which being overweight is very im portant as her fore­
most form of preserving autonomy against a mother she has expe­
rienced all her life as extremely controlling. Being overweight now
makes deep new sense and is no longer the “weakness of willpower”
she had thought it to be—yet she still wants to lose weight. Ther­
apy then focuses on arranging for this, either through disengag­
ing weight as the arena of the power struggle, or b etter still,
through transforming how she construes her relationship with her
mother so that the power struggle ends, making weight loss accept­
able. This change would constitute a new construction of reality in
which being overweight is now unnecessary, allowing direct reso­
lution to occur. The client’s pro-symptom position would be trans­
formed into a new position that does not require the symptom,
and that agrees with the anti-symptom position that the symptom is
unnecessary.
In general, then, since every client has the two divergent views
of the problem —anti and pro— problem resolution in DOBT
consists of transforming either the anti-symptom or pro-symptom
position, bringing the one construction of reality into alignment
or agreem ent with the other regarding the symptom’s unaccept­
ability (direct resolution) or acceptability (reverse resolution).
One of these two positions is going to prove to be a goose in a
bottle and lose its reality. Which one will dissolve always becomes
self-evident, either from the nature of the symptom at the start
of therapy or through the identification of the client’s pro-symp­
tom position.
28 D ep th -O rien ted B rief Therapy

The following case vignette provides a more complete exam­

ple of direct resolution and illustrates radical inquiry and experi­
ential shift more fully, showing how an effective therapy session is
one in which these two priorities are carried out. The in h eren t
capacity of DOBT’s m ethodology to produce in-depth benefits
beyond symptom relief will also be apparent.

Case Example: "A g o rap h o b ia" w ith "D elusion"

A middle-aged woman came in and explained that for many years
she had been experiencing difficult levels of anxiety over leaving
her house, even for such ordinary tasks as going to the grocery
store. The intensity of the anxiety had been increasing over time
and had become so strong that she now avoided going out on such
trips. She wanted relief, and she also expressed her very troubling
concern that this irrational fear meant she was going insane; she
urgently wanted to arrest what she saw as growing madness.
As many clients do, she was assuming a therapist would need a
great deal of personal history in order to get to the source of the
problem and help her, so she started telling her life story. But in
order to work deeply and briefly—and, in particular, in order to
carry out radical inquiry—the therapist has to maintain focus on
obtaining a certain kind of information, namely that which answers
the question, What construction exists that makes having the symp­
tom more im portant than not having it? So the therapist instead
asked her what she actually experiences while walking down the
street that triggers fear for her. This was a first step of radical
inquiry, a first step of looking for the client’s purposeful uncon­
scious activity, the value of which is worth the fear it brings.
She had not previously looked closely at exacdy what she expe­
riences that triggers fear, so to answer this question she had to go
to a new level of awareness of how her fears develop and, to some
extent, reexperience that process right there in the room —
an o th er example of how a radical inquiry intervention always
brings the client into an experience of the hidden positions and
processes driving the symptom.
She quickly identified specifically what triggers her fear: When­
ever she is out walking down a street, just going about her business,
she becomes concerned that a former therapist of hers, a woman
 W h at Is an E ffkctivk Thkrapy Skssion? 29
who moved out of state, is somewhere nearby on this street and is
watching her. She becomes involved in the idea and the feeling
that her former therapist is there, has noticed her, and is looking
at her.
She first feels self-conscious, burdened, and annoyed over
being watched by this woman and no longer having privacy, but
then, because she is aware she is imagining all this and yet regard­
ing it as real, she starts to think she’s truly going crazy. And then,
in turn, the idea that this is a psychotic experience triggers intense
anxiety.
When struggling there on the street against feeling her thera­
pist s presence, it was clear to her that this delusion meant insan­
ity, but this was too frightening to rem em ber in detail at other
times. All she knew as she prepared to leave her house was that
wout there” she would start to lose her mind. This is the “fear of
fear” commonly labeled agoraphobia. Within the first fifteen min­
utes of the first session on this problem, this much was now clear.
In standard diagnostic terms this woman would be labeled not
only agoraphobic but also obsessional and delusional, with symbiotic
separation anxiety and paranoia. However, a diagnostic label does
not denote a phenomenological entity; it reveals nothing of the hid­
den processes of thought, feeling, and behavior that generate the
symptoms, and that are within immediate reach. It is these very spe­
cific positions and processes that the therapist aims to discover
through radical inquiry. In the next twenty minutes or so, all that was
needed of the hidden process and the unconscious, pro-symptom
position generating this woman’s symptoms was discovered.
The therapeutic strategy at this point—the strategy of radical
inquiry—was to identify exactly how her symptom of imagining her
former therapist was valuable for her. To this end, the therapist
asked her to close her eyes and, very simply, to imagine walking
down the street and to see what would happen if she didn't start to
think or feel that this woman was present.
This is a technique we term vieiuingfrom a symptom-free position.
Having the client experience what happens if the symptom doesn’t
occur is a frequently useful technique for radical inquiry. The point
of experiencing what happens if the symptom doesn’t is not to get
the client to desist forevermore from producing the symptom, but
only temporarily—just long enough to find out what valuable effects
30 D epth -O rien ted B rief Therapy

of having the symptom are lost, and are revealed through their loss,
when the client is without the symptom in circumstances where usu­
ally it would be occurring. Often it is expedient to have the client
carry out viewing from a symptom-free position in imagination
rather than in vivo, making direct use of the client’s ability to con­
struct an experiential reality and sample it.
Coached by the therapist, this client went through the experi­
ence in imagination of finding out what would happen if she did
not start thinking her former therapist was nearby as she walked all
the way to the store, did her shopping, and then walked back home.
She readily experienced what would happen: she described
feeling a deep, old loneliness, a very painful feeling of being left
all alone. The therapist now understood her pro-symptom posi­
tion, and therefore began to do position work in order to bring
the client into awareness of that position. The therapist’s first step
of position work was simply to say in response, “So if you d o n ’t
imagine she’s there, then you feel this painful feeling of being left
all alone.” This adds no new inform ation; it simply focuses the
client’s attention on what she loses by being without the symptom,
and as a result, she said, “O h,—and I don't feel all alone if she’s
there, too—if I think she’s there with me.”
Therapist and client had identified the problem for which the
symptom was the solution. From this little exercise it became clear
to the client that she imagined her therapist was there, watching
her, to avoid this old emotional wound of feeling alone and aban­
doned. She experienced that that was her own emotional truth, and it
was deliberate on the part of the therapist for her to have just such
a direct encounter with what her symptom was doing for her.
It was now a small step to reach the client’s p ro /an ti synthesis.
T he therapist said, “Yes. And you kept im agining h er for this
im portant purpose, even though you think th at’s insanity and even
though that scares you so much. W hat do you make of that?” She
thought momentarily and answered, “I guess it’s more im portant
to me to not feel that feeling of being so alone.” This was an
explicit acknowledgment of her p ro /a n ti synthesis, the recogni­
tion by the client that the symptom has had a value that has in fact
been worth its costs. Position work was now well established.
Consider the experiential shift already produced for the client:
In realizing that she visualizes h e r therapist in o rd er not to feel
 W h at Is an E ffe c tiv e Therapy Session? 31
alone, her worry about insanity and pathology was already nearly
obsolete, as was her view of the symptom as involuntary. A power­
ful reframe consisting of second- and higher-order changes has
occurred, a change of categories defining the very meaning of the
symptoms, even with no explicit com m ent on these points from
the therapist. This reframe was not an externally applied invention
of new meaning, but an internal discovery of unconscious mean­
ing. We call this reframing to the emotional truth of the symptom, and it
is brought about through position work. The client apprehends
and feels the governing, personal significance of the symptom and
makes new sense of the symptom in relation to compelling em o­
tional themes that had been unconscious. Quite often this is an
extraordinary experience for the client, a profoundly meaningful
and memorable m om ent of self-understanding. (The concept of
the emotional truth of the symptom is more fully and technically
defined in Chapter Three.)
The experiential nature of this work is crucial. The client is not
taking the therapist’s word for it. The therapist is not theorizing,
diagnosing, or interpreting but is bringing the client into a direct
encounter with her own psychological material, her own emotional
truth.
Until now, though, the woman’s conscious mind wasn’t in on
this arrangem ent for avoiding feeling alone and abandoned. The
only way her conscious mind had been able to carry out its need
to make sense of the symptom was by construing that to imagine
her therapist was present meant she was going crazy. As described
earlier, a therapy client’s conscious view of the symptom is often
no more than a grab at whatever ideas place the symptom in some
familiar category of sense, such as “insanity,” even if this category
is itself very disturbing.
There then was one further step of radical inquiry: The thera­
pist, continuing to evoke the m om ents and the experience of
being on the street, said “As you continue to be there, let yourself
have this feeling, this deep, old feeling of being alone in this way.
And as you feel this alone feeling, there on the street, you can just
notice what, if anything, it means to you, or means about you, that
you feel alone. And what is it that you notice?” Here the therapist
is asking her to identify and reveal any presuppositions involved in
this state of feeling alone. She reflected with eyes closed for just a
32 D epth-O rien ted B rief Therapy

few seconds and said, “It means I’m unlovable.” This in itself
was a powerful part of the structure of the symptom—an ontolog­
ical presupposition, a construction of meaning that strongly influ­
ences the kind of being she “knows” herself to be. From her facial
expression and tone it was clearly new for her to be aware of mak­
ing the all-alone feeling mean “I’m unlovable.” (Presuppositions,
a key com ponent of pro-symptom positions and an essential area
of discovery in radical inquiry, are discussed in Chapter Three.)
The session still had another ten minutes, but even if it had
ended right here, it would have been an effective one, because
(1) through radical inquiry the therapist gained major clarity into
the client’s pro-symptom position, that is, why the symptom is more
important to have than not to have, and (2) the process of radical
inquiry has produced three significant experiential shifts for the
client, each a bringing-to-awareness of an aspect of the uncon­
scious, symptom-generating process: going into fear by imagining
her therapist, carrying out the protective action of imagining her ther­
apist in order not to feel painfully and frighteningly alone (her acti­
vated emotional wound), and assigning the meaning “I’m unlovable”
to the state of feeling all alone (her powerful presupposition), all
were brought experientially into the client’s awareness. All three
of the components that make up pro-symptom positions—protec­
tive action, emotional wound, and presupposition—are apparent.
In this case, it was clear that direct resolution would be required—
that is, alleviation of the symptom through a transformation of her
pro-symptom position. In general, with sufficient clarity and
em pathic reach into the hidden sense and construction of the
symptom, entirely new possibilities emerge for how the client might
be able to transform her experience of the problem. The therapist
sees that if a certain presupposition or emotional wound in the pro­
symptom construction were dissolved, the position as a whole
would dissolve or lose its power to create an experiential reality.
Each com ponent of the client’s pro-symptom position is a poten­
tial avenue of resolution that is invisible until the position becomes
clear. The therapist then carries out methods of experiential shift
(using well-known techniques or inventing new ones) that seem
most promising for altering these particular elem ents and re n ­
dering the presenting problem obsolete. For this purpose, learn-
able steps are spelled out later in this book. In practice and with
 W h at Is an E ffe c tiv e Therapy Session? 33

experience, however, radical inquiry brings the therapist to such a

degree of clarity that avenues to denouement spontaneously become
apparent. In fact, it is when this begins to occur that the therapist
knows radical inquiry may be complete.
That is what now occurred in the session. The therapist saw
that the client’s delusion-solution worked only if she was unaware
of her purpose for implementing it. If it was arranged for the client
to become aware of her purpose at the crucial moment, while walk­
ing along the street, the delusion could no longer be automatic
and autonomous.
The therapist therefore now said, “W hat’s wrong with thinking
about your therapist, to remind yourself that you have an important
connection with her. But whenever you really do want to befree of thefeel­
ing that she's present, all you have to do is ask yourself really ask your­
self ‘Am I willing to feel alone right now?”’
The question prescribed at the end of this communication has
the client consider the emotional truth of the symptom consciously
at exactly those moments when previously she would resort to the
symptom unconsciously. This question is simply a way to have the
client, right there on the street, self-administer the reframe to emo­
tional truth that position work had produced: conjuring up her
therapist no longer means she is insane. It now means she feels
painfully alone and wants relief from this feeling—and this regis­
ters very strongly as true for her. So the main trigger of her anxi­
ety, the idea that this is psychotic, is gone.
Note that the new construction of meaning was not an inven­
tion and was not co-constructed, as in oth er constructivist brief
therapies, but was a utilization of the clien t’s own unconscious
material, which makes it virtually irresistible, a perfect psycholog­
ical fit. The reorientation brought about by contacting her uncon­
scious position was relatively straightforward for this client.
There are many ways to carry out reframing to emotional truth,
and the type of question prescribed in the intervention detailed
above is only one of them. O ther techniques could no doubt also
have been used just as effectively. The assigned question, “Am I will­
ing to feel alone right now?” keeps the reframe in place between
sessions, that is, it keeps the client aware of the symptom’s emotional
truth, which can easily slip back into the dark unless anchored into
awareness in some way; and in addition, it is a double bind that puts
34 D ep th -O rien ted B rief Therapy

her in the position of being at choice on whether or not to resort

to imagining her therapist. DOBT provides a particularly effective
form of double bind because, as already indicated, the b in d ’s
reframe is constructed using the emotional truth of the symptom,
and so it is subjectively compelling.
Note especially that the prescribed question, like all interven­
tions made in DOBT, is not a message to the client to stop pro­
ducing the symptom. It is a way to position her consciously in the
em otional tru th of the symptom, which is a position of having
choice over whether or not to resort to the symptom. Implicit and
explicit messages to the client to stop producing the symptom are
therapeutically ineffectual in general, a point already well known
to brief therapists since the 1960s.
As mentioned earlier, radical inquiry and experiential shift are
not defined by the specific techniques used to carry them out.
Chapters Five and Six survey a wide range of specific techniques we
find useful. In the therapist’s key communication, for instance, he
used evocative modulations of voice tone both to focus attention
and to invite the client to feel and experience rath er than only
think. He said, “W hat’s wrong with thinking about your therapist,
to [pause; tone drops, softens, and slows] remind yourself that you have
an important connection with her?” This message acknowledges the
deep sense of the symptom—the deep validity of the need that the
symptom was meeting, the need for a sense of connection to caring
figures—and gives her permission to continue to meet that need,
but to meet it overtly, rather than covertly through a symptom.
One might think that for this woman to face rather than sup­
press her feeling of aloneness would only exacerbate her anxiety,
but it did not. (Most therapy clients, we find, are not nearly as frag­
ile as is assumed in psychodynamic approaches.) One week later,
in the next session, she said that from using the prescribed ques­
tion she immediately did get control over imagining the presence
of her therapist, and the anxiety about going out had diminished
greatly. In order for in-depth therapy to be highly effective and
therefore brief, it is essential that it not be the therapist’s limiting
assumptions that are cutting off the therapeutic possibilities
in each session. The client’s limiting assumptions are more than
enough to deal with.
In this second session she also said that using the question
 W h at Is an E ffe c tiv e Therapy Session? 35
made her experience a new awareness of going through life in the
role of being an abandoned child. She said that even though she
was forty-six, she d id n ’t feel herself to be a grown-up, and that,
although it took some courage, choosing to feel alone on the street
began to open up a sense of being an adult who is no longer hop­
ing for some parent to enfold her. So this work also forwarded the
separation-individuation issues in this woman’s life.
During this second session, in order to continue to solidify the
client’s awareness of the emotional truth of the symptom, the ther­
apist, in a natural way, referred several times to how much sense it
had turned out to make that she would think of her former thera­
pist when feeling too alone. The therapist also warmly chided her
about thinking she was crazy, and told her that if ever again she
thinks she’s crazy, it is a definite sign that she is actually on the
verge of discovering another im portant, hidden meaning in her
life.
In the third session she reported that the anxiety, a problem
that had troubled her for years, was completely gone; she said she
was no longer imagining her old therapist at all. Ten months later
she came in to deal with some o ther issue (involving h er adult
daughter, who was moving back into the state and wished to live
with h er), and when asked if the previous work had held, she said
it had held very well.
Although this was a problem with rather complex roots, the
actual breakthrough took about thirty minutes. The breakthrough
had great simplicity, yet the rapidity and depth of the change did
not involve any “tricks,” strategic or otherwise. The work with this
client did not extend explicitly into her emotional wound of aban­
donm ent in her family of origin for two reasons: first, it proved
unnecessary to do so for resolving the presenting problem; second,
the client was not requesting such a focus and in fact wanted not
to address it. Nonetheless, the work was perceived by both client
and therapist as experientially deep. The m om ent in which posi­
tion work brought the emotional truth of the symptom into aware­
ness was a m om ent in which the client experienced a sudden
depth of self-connection and cogency of self: an expansion of self­
understanding and a surprising sense of functioning with more
coherent m eaning than she had realized (more on this point at
the end of this section). Also, the client’s choice to inhabit an adult
36 D ep th -O rien ted B rief Therapy

identity at times of aloneness was a fundamental change in her way

of being in the world.
With some clients the work does go directly into major, unre­
solved emotional wounds carried since childhood, as Chapter Two
will show in detail. For depth-oriented brief therapy we go as deeply
into unconscious constructs as is necessary for resolving the pre­
senting problem, and no further, unless the client has motivation
to do so and defines the further depth as a new focus for therapy.
Let’s review the process of change that occurred in terms of
the client’s positions, bearing in mind what is axiomatic in DOBT:
Change is blocked when a person tries to move from a position that he or
she does not actually have as a governing emotional truth. Therefore, for a
client to achieve rapid change, first have the client take the pro-symptom
position he or she actually has.
The client’s conscious, anti-symptom position was, in effect,
“Feeling that my therapist is there when I’m walking down a street
is unwelcome and very frightening, because it’s psychotic. I want
it to stop.” This conscious position turned out to be an emotion­
ally incomplete account of the situation, as we have seen.
Her unconscious, pro-symptom position was, in effect, “Walk­
ing down a street all alone means I am abandoned, all alone in the
world, and unlovable. All this is too painful to let myself feel, so it’s
necessary to avoid this hurt by dream ing that my old therapist is
nearby and aware of m e.” This was found to be the emotionally
governing position, where “governing” means simply that this posi­
tion was prevailing in her experience and behavior, regardless of
opposition from her conscious position. The unconscious, pro­
symptom position is by definition emotionally governing, since the
symptom would not occur if it weren’t.
In other words, before this woman came in for therapy, when
her pro-symptom position was still fully unconscious and unknown
to her, she nevertheless asserted it through the symptom of imag­
ining realistically that her therapist was present there on the street,
even though consciously she knew better and consciously wanted
not to do so. This shows the autonomy of unconscious positions,
and of course it is because of that autonomy that symptoms are so
mysterious and upsetting to the conscious attitudes.
Constructs comprising unconscious positions are kept sepa­
rate from incompatible conscious constructs. Bringing her pro-
 W h at Is an E ffe c tiv e Therapy Session? 37
symptom position into full, felt awareness had the effect of bring­
ing its constructs into contact with conscious constructs she har­
bors. Contact of incompatible constructs and the resulting dissolution of
one by the other occurs only when both are in awareness and experientially
vivified simultaneously. For, example, when the unconscious, non­
verbal, pro-symptom construct “the hallucination of the therapist
is necessary in ord er to avoid feeling ab an d o n ed ” was brought
into contact with the conscious construct “this hallucination is psy­
chotic,” the latter was dissolved. Likewise, when that same pro­
symptom construct also came into contact with the oth er
conscious construct of knowing that she could tolerate feeling
alone on the street, the latter in turn dissolved the pro-symptom
need to dream up her therapist.
Intervening at the level of the emotional truth of the symptom
produces resolution and healing of a deeper kind than is the cur­
rent norm or aim in the brief therapy field. In discovering the pre­
senting symptom’s emotional truth, the client discovers the great
sense hidden in what she thought was h er worst nonsense. The
woman in the vignette didn’t just get rid of her presenting symp­
tom of fear of going out onto the street. W hat she thought was
insanity—a profound defectiveness in her being—turned out to be
full of emotional sense and personal meaning. Turning “craziness”
into deep emotional sense illuminating im portant life themes did
more healing of her core self-worth than did merely getting rid of
a painful symptom.
Once symptoms fall away, people generally do not think of
them any longer and even forget they ever had them. But what
clients gain through the realization o f their pro-symptom posi­
tion, their em otional truth, is an awareness of having an inner
self that operates throughout its depths with remarkable coher­
ence, active intelligence, and com plete em otional sense. T hat
makes a deep and lasting impression. That is an ontological heal­
ing, a transformation in the kind of being the client knows him-
or herself to be. The phenom enological-constructivist spirit of
depth-oriented b rief therapy, which clients experience as pro­
foundly respectful of their subjective world, is well suited to reveal
this innate coherence and gives the approach a natural capacity
to time-effectively produce changes well beyond symptom relief.
We will m ore fully describe the p art played by an individual’s
38 D ep th -O rien ted B rief Therapy

ontology in the structure of his or her positions in the course of

the next two chapters.

Sum m ary_________________________________________
Depth-oriented brief therapy is based on the clinical experience
that a therapy client’s conscious, an/i-symptom position in relation
to the presenting problem is always accom panied by an uncon­
scious but emotionally governing pro-symptom position. For the
client to inhabit and experience that pro-symptom position is to
experience the emotional truth of the symptom—the construction
of reality in which the symptom is necessary to have. In working
with the pro-symptom position, client and therapist are working
directly with the emotional and unconscious meanings that struc­
ture the very existence of the problem.
The essential methodology of depth-oriented brief therapy is
simple: empathize accurately and sensitively with the client’s anti­
symptom position, knowing that a pro-symptom position awaits dis­
covery; one-pointedly find that pro-symptom position; usher the
client into experiencing the emotional truth of that position; and
then, as necessary, assist the client experientially to transform that
position. The effectiveness of depth-oriented brief therapy results
from adhering closely and fully to this methodology.
Several case examples have dem onstrated how an effective
depth-oriented brief therapy session is one in which the therapist
(1) carries out radical inquiry for achieving clarity into the unknown,
pro-symptom constructs an d /o r (2) facilitates an experiential shift,
producing actual change in how those constructs are held by the
client. These are the categorical objectives in every session.
Radical inquiry by definition is experiential and not analytical
or interpretive. When radical inquiry is complete—when the emo­
tional sense and necessity of the symptom in the client’s world are
lucidly clear—the therapist engages the client in experiential
shifts that integrate the pro-symptom em otional reality—the
process of position work—and that transform or dissolve con­
structs in the positions involved in the problem. These changes
occur either in the pro-symptom position, so that the symptom is
no longer necessary and therefore ceases to occur (direct resolu­
tion), or in the anti-symptom position, so that the client’s objec-
 W h at Is an E ffe c tiv e Therapy Session? 39
tions to having the symptom dissolve and the symptom is retained
(reverse resolution).
From this overview of depth-oriented brief therapy, we turn
next to a closer look at the m oment-by-moment process of the
client-therapist interaction in the course of rapidly resolving long­
standing emotional wounds.

Notes
P. 13, “Sometimes . . . forgot we h a ve”:V . Satir (1983, November), spoken
comment at clinical workshop, San Francisco.
P. 15, in the brief strategic therapy model o f the M ental Research Institute: R. Fisch,
J. Weakland, and L. Segal (1983), The Tactics o f Change: Doing Therapy
Briefly, San Francisco: Jossey-Bass.
P. 15, in some conceptual analyses o f n arra tive therapy: See, for example,
H.J.M. Hermans, H.J.G. Kempen, and R.J.P. van Loon (1992), “The
Dialogical Self,” American Psychologist, 47(1), 23-33.
P. 18, as it is in other brief approaches: See, for example, P. Watzlawick, J.
Weakland, and R. Fisch (1974), Change: Principles o f Problem Forma­
tion an d Problem Resolution, New York: Norton; S. de Shazer (1985),
Keys to Solutions in Brief Therapy, New York: W. W. Norton; M. S. Wylie
(1990), “Brief Therapy on the Couch,” Family Therapy Networker,
14(2), 26-35, 66.
P. 19, the client's two-sided commitment to both change a n d stability: See, for
example, P. Papp (1983), The Process o f Change, New York: Guilford.
P. 23, “predeterm ined explanatory co n ten t”: B. Held (1990), “What’s in
a Name? Some Confusions and Concerns About Constructivism,
fo u m a l o f M arital an d Family Therapy, 16, 179-186.
P. 24, “comprised o f a set o f m eanings . . . in consciousness, ”: T. H. Ogden
(1994), Subjects o f Analysis (p. 16), Northvale, NJ: Aronson.
P. 34, a p o in t already well known to brief therapists since the 1960s: See, for
example, Watzlawick, Weakland, and Fisch, Change.
P. 34, Most therapy clients, we fin d, are not nearly as fragile as is assumed in psy­
chodynamic approaches: See, for example, A. J. Horner (1994), Treat­
ing the Neurotic Patient in Brief Psychotherapy, Northvale, NJ: Aronson
(original work published 1985).
 C H A PTER 2

Resolving Emotional
Wounds
Our remedies oft in ourselves do lie.
W illiam S hakespeare, All's Well That Ends Well

One of the more daunting challenges facing a therapist is the sit­

uation in which a new client walks in with a deep, unresolved emo­
tional wound carried since childhood and generating symptoms
—and the client wishes or needs to resolve the problem briefly.
Unlike physical injuries, emotional injuries do not automati­
cally heal with time. They are peculiarly timeless. This, however,
has its advantages, in that the healing of em otional wounds also
does not necessarily take place in or require tim e.
It is here that the effectiveness of depth-oriented brief therapy
is most apparent. In this chapter we usher the reader step-by-step
through the therapy sessions of two clients—sessions in which the
discovery and resolution of major emotional wounds is central to
the work. The immersion in actual therapy sessions in this chapter
is intended to give the reader a direct view of DOBT in action and
to show how the conceptual picture chalked out in Chapter One
is put to clinical use.
These examples will also begin to show how clients’ constructs
that define reality are organized within a position, an im portant
conceptual feature of DOBT. In the clinical commentaries below
we will extend the well-known concept of second-order change by
defining third and fourth orders of change. This four-level scheme
of the structure of positions will prove to be a useful map of how
human beings construct and organize their experiential reality and

41
42 D epth -O rien ted B rief Therapy

of how therapeutic change takes place. (Chapter Three provides

a unified, comprehensive review and synthesis of this conceptual
framework.)
Em otional wounds are am ong the main com ponents of an
unconscious, pro-symptom position, the others being presuppo­
sitions and protective actions, as noted in C hapter One. A ther­
apy clie n t’s presenting symptom is likely to be the c lie n t’s
experience of either the emotional wound itself or the protective
action associated with it. Protective actions perceived as symp­
toms include obsessing, dissociation, raging, intellectualizing,
blaming, addictive and compulsive behaviors, screen em otions
(such as guilt, depression, shame, anger), and screen cognitions
(such as self-blame: “I was abused because I deserved it.”). Symp­
toms that are an aspect of the emotional-cognitive-somesthetic
construction of the wound itself include perceptual and somatic
memory flashbacks and feelings of helplessness, anguish, viola­
tion, dread, panic, loss, or depression incongruent with present
circumstances.
In both of the following cases we will see how radical inquiry
quickly reveals the em otional truth of the symptom, the view of
reality in the client’s unconscious, pro-symptom position that
makes the symptom m ore im portant to have than not to have.
Both cases also require direct resolution, that is, transformation of
the client’s unconscious, pro-symptom position, because even in
light of the revealed emotional truth of the symptom, the client
still wants the symptom to stop happening.

Cut to th e Core: T h irty Years o f Torm ented

Self-Regard_______________________________________
The client here is a married woman, age forty-five, and the setting
is a biweekly group that had recently formed and met several times.
What follows is the complete transcript (with m inor changes for
clarity) of this w om an’s first personal, therapeutic work in the
group, a thirty-minute interaction with the male therapist that deci­
sively dispelled a deep, painful, lifelong emotional wound of low
self-esteem.
This single-session exam ple is n o t m ean t to suggest th a t
DOBT is an easy miracle cure. However, it is im portant to show
 R eso lv in g E m o tio n a l W ounds 43
how extraordinarily effective DOBT can be. T he p o in t is no t
that req u irin g only one session is to be routinely expected.
What is routine in DOBT is the therap ist’s high level of inten-
tionality toward finding and m eeting the emotional truth of the
symptom, right now, in this very session, from the first session.
As a result of that stance, resolution is reached in the shortest
possible time. The example is intended to show how very real is
the possibility o f rapid resolution even o f lifelong em otional
wounds.
The client is herself a psychotherapist, which should not lead
the reader to assume that the work was therefore necessarily eas­
ier in any sense.

Client: I’m not sure if this problem is even workable, so let me

just say what it is and see if it makes sense. I got in
touch with a real old piece of really negative self-
esteem that’s very hard for me to—makes me real anx­
ious to even dance around it a little bit. It’s like a shard
of glass inside me, and every so often I get cut. But in
some senses I’m pretty conscious of this so I can sort of
not get cut on it, mostly. You know, I can sort of, “Oh,
that’s that old piece there. I’m not going to pay atten­
tion to it right now.” I can function around it.
Therapist: But it stays there.
Client: But it’s there, and I don’t know how to release it. I’ve
never been able to. I guess I’m sort of—I would love
to release it but I don’t have faith that it can be
released, so if there’s a possibility of releasing it—
Therapist: [Smiling] There is.
Client: —I’d like to risk doing it. [Laughs]
Therapist: T here’s a possibility, for sure.
Client: All right. All right. As long as you’re sure that it’s a
possibility.
Therapist: Yep, I am.
Client: So, so I’ll be more specific. [Laughs]
Therapist: Yes.

[In response to the client’s overt need for assurance, the therapist’s
first three responses have com m unicated his relaxed conviction
44 D epth-O rif.nted B rief Therapy

that profound change can certainly happen here in this deep, old
emotional wound. This conviction is a fundamental element of the
therapist’s stance in DOBT, and communicating it to the client,
w hether explicitly or implicitly, significantly fosters the client’s
capacity to work deeply and generate change.]

Client: All right. So, the way I got to it is realizing that I’ve
developed a pretty, um, coherent persona of being
competent and poised and intelligent and knowing
what I’m about and not being able to be rattled very
much. It works pretty well for me. And what I got in
touch with is, how come I needed to put this persona
in place? And what’s underneath it is—that I was—we
had moved when I was ten and then we moved again
when I was twelve. And from the time I was five to ten I
was sort of a real competent leader with younger kids. I
was the oldest one, and I was a leader of both boys and
kind of was a leader with girls in sewing. I sort of did
the gamut, and—and it was fun! I mean, I felt very self-
assured and had a lot of fun being the one who was in
charge of all these younger kids. And then the two
years after that not much happened, but then came
age twelve, and I remember this, this moment when I
went on the new school yard, and I still believed that I
could pull my weight with the boys, and I could sort of
be their equal or even be a little more than their equal.
And they like, “Go away!” You know, “Get out of our
territory!”Just absolutely a total brush-off. It was like a
real shock that I couldn’t do this num ber anymore.
And then, somewhere around there, puberty hap­
pened, and my sense of me now as a woman was that I
was really ugly and didn’t know how to do anything to
hide that. And, um, even ugly enough to be repulsive. I
mean, you know, the word that came up when I got in
touch with it, that fit this, is that physically I’m a very
repulsive person. And, um— [Silence] Um—
Therapist: Is that the shard?
Client: T hat’s the shard. What just went blank is the thing
that locked it in—the shard. [Pause]
 Rksoi.vinc; E m o tio n a l W ounds 45

[The therapist is going along with the client’s historical account

because he feels the content is giving him an understanding of the
current emotional truth of the symptom of an emotional and psy­
chogenic pain, a cutting shard of low self-esteem.]
Client: There was one afternoon I was walking to a drug
store, and I remember that I was a little pudgy, and I
had shorts on, and I never shaved my legs, and my
hair was sort of a mess, and I had pimples on my face
and no makeup, and I walked down to the drug
store—and I was about twelve or thirteen or so—and
this teenage boy, who I never saw before or after, said,
“Yuk!” Something like that, some word like that. And
it’s like it just—Uhhh! It went right in there. And it’s
like, I mean that’s really where in some way, as a femi­
nine presence, I’ve never in some way got past that. I
mean, I’m here, I’ve got success, but I know I get
caught there. And then what I did was put all this
accomplishment over it. I mean, that’s what I did
when I felt, “O hh-kay, I can’t run boys anymore” and
“O hh-kay, I can’t make it as a girl at all, not after that.”
So what I would do is make it as an intellectual. Pro­
fessional. Accomplished. So that’s what I did. I mean,
that’s what I plugged in. And so whenever I expect to
be really challenged intellectually—if I feel I can’t use
all this defensive stuff I put in place—then I feel I’m
going to be totally disarmed, I get very anxious, and
really I’m getting cut on the shard, actually. Oh! And
it’s not only the—and the belief about being so ugly
and so repulsive then puts me into a place where I get
totally tongue-tied and awfully self-conscious.
Therapist: Yes.
Client: So if I’m not in a professional mode, then I d o n ’t
have a way to relate to people, because I’m so self-
conscious. So that, that is the shard. I think that’s
most of it.
[Her sharply negative self-esteem and her lack of “a personal way
to relate to people” seem at this point deep-set and unlikely to
resolve quickly, despite her psychological sophistication. Since age
46 D epth -O rien ted B rief T herapy

twelve and possibly earlier, her self-concept, her social identity and
interaction, and her personality had formed around (1) the belief
that as a female she is utterly unacceptable to others and (2) the
strategy of using her competence and intelligence as a distracting
display in order to avoid humiliating exposure.]
Therapist: Yeah. Yeah. You know, listening to that story—I mean
it’s a very—it’s a powerful story.
Client: It is for me, still. I couldn’t believe they were saying it,
those boys: “I don’t want you.”
Therapist: Yes, those adolescent and preadolescent feelings of
self-consciousness and torm ent over how accepted or
unaccepted we are, are so intense. I mean, God
they’re passionate. And what strikes me in your
description of it all is that—how we do go through a
really awkward stage in development. I mean, I
looked so awful during that corresponding stage, it’s
just ridiculous how gawky and ugly—I mean, pimply,
and you d o n ’t know how to do your appearance, and
you can be ugly for a while. But you seem to have got­
ten the idea that that’s the bottom truth about you.
Client: Yes, exactly.
Therapist: And it stuck.
Client: T hat’s right.
Therapist: And it never became apparent to you that it’s a phase
you pass—I mean, down in your feelings, where it
counts—that that’s a stage, a developmental stage you
passed through.
Client: Right.
Therapist: And came out of.
[The therapist has begun by empathizing with the intensity of the
client’s experience of the problem, especially her feeling “I’m for­
ever ugly.” The therapist simultaneously noticed that his own, gen­
uine view of the larger, developm ental context could serve as a
reframe that might weaken her construction of herself as forever
ugly, so he shared this idea in a natural way, combined with some
self-disclosure. This developm ental perspective challenged the
m eaning of her adolescent ugliness, shifting it from an eternal,
mythic truth that excludes her from humanity to an ordinary, tern-
 R eso lv in g E m o tio n a l W ounds 47
porary stage that actually includes her in the hum an family. The
therapist saw this as only a first step in dispelling the apparent real­
ity of her “I’m ugly” position. Several weeks later she commented
on how effective this shifted perspective was in immediately start­
ing to loosen the hold of the old reality.]
Client: Right. It’s somehow that everything above it is defen­
sive so that I won’t pay attention to that’s the reality.
Therapist: Let me see if I understand what that means: At the
point where you felt you were ugly—and might have
been, at that point, the way we get as teenagers—you
completely pitched your attention into creating a per­
sona that was going to impress people, and you got
totally invested and involved in that, and it’s like you
never again reopened or reassessed the question of
how you actually look.
Client: Yes. When I look in the mirror it’s yuk!You know, the
old thing never—it never went away.
Therapist: What would be the bad thing, the dangerous thing,
the scary thing, the difficulty you’d have to face if
you—let go of that old view of yourself as ugly? If
you—let it in, that you moved through a developmen­
tal phase and—now you’re a lovely, grown woman.
[The therapist was struck by the clien t’s words “it never went
away.” These words express a victim position of powerlessness (the
symptom has a life of its own and happens to her), but if symptoms
are always coherently and purposefully generated, then the fact
that her view of herself as ugly “never went away” points to some
important if unconscious purpose for actively holding on to this
view. So the therapist next invites her to contact the value this “I’m
ugly” construction has for her by evoking, through voice tone, a
contrasting experience of being without this construction—that
is, an experience of being an agreeable-looking woman. This is a
step of radical inquiry, an experiential discovery of what makes
the symptom im portant to have.]

Client: Well, the thing that just came up without my having

any control over it [Laughs]—
Therapist: Good.
48 D epth-O rien ted B rief Therapy

Client: —was sexuality.

Therapist: Yes.
Client: So, since that’s not allowed, and since that’s—I’m
finally feeling control of it, I can choose what I’m
going to do with my sexuality after all these years.
Um—But, certainly, if I’m ugly, and if I’m convinced
that any man will be totally repulsed by me—aside
from the fact that I’m married and really love my hus­
band—but if I didn’t, and if that weren’t the case,
what I really want—this is very hard to say—but what I
would really like to do is be tremendously seductive.
And I never, ever—except with my husband—allow
myself to do that.
Therapist: Allow, and allowed.
Client: Allowed, allowed—because of this belief that I was out
of that league.
Therapist: The belief that you do n ’t qualify.
Client: Yes, I totally don’t. It would be repulsive.
Therapist: You would shame yourself further.
Client: Yes, I would be very humiliated, because obviously no
one would be turned on by a woman who looked like
me. So—so that works, because sexuality was scary for
me. It wasn’t permitted.
Therapist: Was it scary in itself? Even aside from the question of
“I’m ugly, so I shouldn’t be sexual because then I’ll
be even more hum iliated”?
Client: Well, I have to say one more point th a t’s even more
difficult to say. T h e re ’s some way that got locked in
at about the same time I was experiencing this
sense of being very ugly. I was also very religious.
T h at’s when I believed in this very present God, and
I had a lot of conversations with Him, and at the
same time I had this tremendous drive to m asturbate,
which I could not stop. So my belief system was that
the reason I was so ugly was that it was evil to mas­
turbate, and I was being punished by being made
ugly. That was my punishm ent. So, that also got
locked in.
Therapist: So that’s a big part of it. OK. I want to see if I under-
 R eso lv in g E m o tio n a l W ounds 49

stood that last part. It seems that believing you’re

ugly—still ugly, truly ugly, always—is a key part of how
you keep your sexuality in check, which is spiritually
necessary, within your spirituality.
Client: Archaic spirituality. I d o n ’t believe that any more.
Therapist: Well, up here, “don’t believe,” but below the neck it
might still be around. I don’t know.
Client: Right, right.
Therapist: So to cut loose sexually means you’re a sinner, and
you’re gonna be condem ned or whatever.
Client: Right. And I think probably—I mean, again not so
much now, but there was certainly a period in my life
where it would have been totally OK up here to be
really seductive and to play out—and I would have
wanted to, but what I told myself was no one who
looked like me had the right to do that.

[Radical inquiry has revealed two im p o rtan t parts of the em o­

tional truth of the symptom of staying in “I’m ugly” and viewing
herself as certain to be rejected: (1) it keeps her from risking any
more devastating humiliations as a female, and (2) it avoids spir­
itual disaster by keeping a lid on what otherwise felt like uncon­
trollable sexuality. It has becom e explicitly clear that the
symptom, her “I’m ugly” construction, is a protective action oper­
ating in the contexts of sexuality and spirituality. Bringing the
client into direct awareness of how the symptom is strategically
serving her will diminish the plausibility of the symptom’s con­
tent. In other words, this reframing to em otional truth puts the
client meta to the content level of the symptom, weakening the
apparent reality of the content, “I’m ugly.” In this case, focusing
on the past was a useful way to find the present, hidden, pro-
symptom constructions m aintaining the “I ’m ugly.” Having
accom plished that, the therapist now wants to shift the focus
from the past to the present and discover the degree to which the
symptom is currently needed to protect against being sexual. This
is crucial information to obtain before attem pting any experien­
tial shifts to fully dispel the symptom, since the client will not be
willing to live without “I’m ugly” if that belief still seems vital for
suppressing her sexuality.]
50 D epth-O riented B rief T herapy

Therapist: I find myself wondering if you’re in the classic posi­

tion of, you didn’t sow your wild oats, you didn’t
experiment with sexual energy and sexual experience
the way you wanted to and the way it’s in you to do,
and “I’m ugly” is a major if not the major way you keep
the lid on that. And to—I wonder if there’s a part of
you that’s frustrated or very much wanting to have
that missing experience of being overtly sexual in the
world, and having, you know, sowing your wild oats.
Client: Well—
Therapist: To stop thinking or feeling you’re ugly would be to
take the lid off of that, and you’d have to deal with
those desires—open Pandora’s box, in a way. And
you’re married, and you’ve got everything nice and
stable and put together. It would make a mess. It just
sounds like staying with “I’m ugly” is doing some very
important things for you.
Client: Well, you know, in a way, that’s—there’s some level
where that really isn’t true anymore, because—
Therapist: Yes, I believe that. But I’m interested in seeing if
there’s a level where it is true.
Client [Pause] At the level where it is true today, I think, I
think I could probably toy around at being more sex­
ual because I’m not really afraid any more of losing
control and being unfaithful. I really choose not to be
unfaithful in my marriage.
Therapist: Good. So would you be willing to do—
Client: But I could be a little more sexual, when I chose
to, if I d idn’t feel it would be ridiculous. I think th at’s
it. And that would not be—that would be clean.
T hat’s why I said at this point it’s different. There
were times when I did n ’t feel I had as much choice
about my sexual energy. If I let it out, boy, it was not
controllable.
Therapist: I see.
Client: And that was injurious for a lot of years. It really was.
It did almost destroy my marriage, actually.
Therapist: So it xuas important, then, to feel you’re ugly as a way
of keeping all that in check.
 Resolving E motional W ounds 51

Client: T hat’s really, I mean, how that ties together is, I was
married, and at the end of the first year I had an affair
with my boss, who was the boyfriend of my best friend.
The stupidest, most common, garden-variety kind of
affair. And when I was in the midst of it and trying to
decide what to do, my m other and I went for a walk to
talk about it, and we were walking by and we went into
a clothes shop or something, and she said to me, “You
know, I wouldn’t let your husband go by, because with
your kind of looks you’re not going to have a lot of
chances.” That was twenty-five years ago. So what it
meant—the message that I’ve been telling you hap­
pened at twelve—well, there’s a whole earlier piece
around that, that I got somewhere, because that—I
mean, that was a very strange thing for her to say. That
wasn’t the issue. I was trying to decide what to do with
my life at that point.
[As often happens once the client connects with parts of the emo­
tional truth of the symptom, other linked areas of emotional truth
begin to emerge.]
Therapist: So there’s this whole other area there, where if you get
it that you’re not ugly, there’s some old business with
mom that’s pretty intense.
Client: I don’t know. [Laughs]
Therapist: Sounds like it.
Client: Oh, yes. Because actually the first place that came
from was, she told me a man wasn’t going to like me
because I didn’t have enough to grab onto up here.
I mean I do have a lot of messages from her that I
wasn’t—
Therapist: Well, sounds like she needed you to be below her on
the ladder. Is that right?
Client: Well, I do n ’t know. What I’m thinking about—I mean,
that’s the amazing thing. The way I explain it to myself
is, she was very overweight for a big chunk of her ado­
lescence and young adulthood and had very low self­
esteem, and so in some ways she’s very identified with
me, and it was so im portant for me to have the perfect
52 D epth-O riented B rief T herapy

looks that she didn’t have, that instead of telling me,

as I do with my daughter, how wonderful I am, she was
always telling me how I fell short. But maybe it was just
my rationalization that she was doing it [Laughs] for
my own good, because [Laughs]—so that I would—
actually, I think I have to reassess.
Therapist: Yes. Because that’s part of what’s keeping this stuck, it
seems. It seems that it is. Because look, to get it that
you’re not ugly refutes all those messages from her.
Client: Yes, right. But see, I can’t really—even as you say that to
me, I can’t really—I can’t—you know, as you say that,
inside what I’m feeling is, mm-mm, that’s not true.
Therapist: About what?
Client: That I’m not ugly. See, I can’t really—I can’t take that
in.

[This is an im portant moment. “I can’t take that in” is a message

of a certain kind, an opportunity the therapist must recognize. The
client is not merely saying, “I don’t believe it that I’m not ugly.” As
a result of the previous work, the client is speaking from a position
meta to the content “I’m ugly.” She is saying, “I can tell there is
som ething not allowing me to harbo r the view of myself as not
ugly.” In other words, she is commenting on an experience of feel­
ing a mysterious, invisible barrier. This resistive barrier is the active
unwillingness of her unconscious, pro-symptom position to allow
the construction “I’m not ugly” to exist. She has no words for this
nameless experience of resistance other than “I can’t take that in.”
Although earlier she began to glimpse the emotional themes in
her pro-symptom position, she is not yet positioned in it, and it is
still unconscious. At this point, however, she is right up against that
pro-symptom position, and if the therapist recognizes this, it is a
simple m atter to have the client, like Alice, step across into a dif­
ferent reality and actually inhabit her pro-symptom position. Bring­
ing this about through suitable experiential intervention is what
we term position work. In depth-oriented brief therapy, the resis­
tance of the client’s pro-symptom position always serves as a valu­
able point of access to that position. To this end, the therapist is
going to invite her to voice a “trial sentence” that overtly expresses
what her pro-symptom position is doing right now.]
 Resolving E motional W ounds 53

Therapist: Would you right now try out saying, “It’s very impor­
tant to me to believe I’m ugly.”
Client: [Big, fast, loud sigh]
Therapist: lust try it out.
Client: OK. So—
Therapist: See how it feels. Without thinking about it. Just say it
and see how it feels.
Client: I’m trying—it’s very hard. Those words have—It’s very
im portant to me— [Long pause; visible squirming in
chair; eyes down]—to believe I’m ugly.
Therapist: How does that feel?
Client: I don’t know. I didn’t—I can’t make it real.
Therapist: Would, would you look right at me—
Client: [Bursts into shrill laugh] No!
Therapist: —and, yeah, just look at me and—You know the thing
that just happened? What you just felt? That big “No”?
Try looking right at me and saying it more fully in
words: “Bruce, I refuse to let it in, that I’m not ugly.”
Client: [Under her breath] OK. All right.
Therapist: Look right at me—
Client: [Exhales a spasm of laughter]
Therapist: —and say, “Bruce, I refuse to let it in that I’m not
ugly.”
[The therapist is using the concreteness of the person-to-person
interaction in the room to produce actual integration of the
unconscious position. If the client said the sentence in an autistic
reverie while gazing at the floor, the material would remain split
off, but to express it to another person, a male person, face to face
necessitates that her usual conscious position participate in the
“knowing” of this emotional truth.]
Client: [Long pause; laughs; pause] It’s too direct. If I say it
direct with you, I have to let it in a little bit.
Therapist: Say it because it’s your true position. This thing that
happened, these are the words for that. And that’s
simply the truth of what you’re expressing, and I want
you to do it overtly in words. [Pause] Not trying to
change anything.
Client: Well, I know that. It’s just that—it’s almost physically
54 D epth -O rien ted B rief T herapy

impossible! Even though I know that, to make myself

say it overtly— [Pause] It’s just too direct, too direct.
Therapist: I understand that you—
Client: And it’s like I hide that from the world. There’s no
one—I’ve never told anyone that that’s the truth,
because I don’t play that in the world. I pretend like
I’m fine about my looks. I d o n ’t ever ask anyone what
I should wear, and I seem very confident about my
looks.
[The therapist experiences her now as diverting from the unbear­
able exercise, and so brings her back to it.]
Therapist: Even though the directness feels off the charts—
Client: Yes.
Therapist: —you can now extend your range of directness to
include this degree of directness.
Client: [Laughs] Right. Right, because then I have to put
aside— [Laughs loudly]
[As she says “put aside,” she begins using h er hands to move an
invisible something that is right in front of her, off to one side. Evi­
dently her construction of the problem has a strong kinesthetic-
spatial component that has now also come into awareness, and she
is now spontaneously working with that.]
Client: I have to then put aside the piece that—actually, Bruce,
what I want to have you believe is that I’m actually confi­
dent about the way I look in the world and the commu­
nication I make, and it doesn’t even concern me; I
don’t have a lot of psychic energy on it; I don’t pay a lot
of attention to it, because I feel fine and confident
about it. So I have to take away that [Shoves it aside],
which is what I nonverbally tell people in the world all
the time, because it’s so painful for me to say anything
else and say, “OK, I’ll be divulged.”
Therapist: Mm-hm, there it is.
Client: Which makes me feel very cold. OK? I mean I’m feel­
ing really cold now.
Therapist: Yes.
Client: Yes. Because that’s my protection. [Laughs]
 Resolving E motional W ounds 55

Therapist: I see that. And you’ve just bravely put your protection
aside.
Client: Yes, and it’s really scary. T hat’s why it’s so hard to say
those words you asked me to say.
Therapist: Got it. I understand. You want a blanket before you
say it? I can get a blanket for you.
[The therapist keeps the focus on the task of saying those words.
From the client’s voice, facial expression, and overall manner, it is
clear that she has now willingly waded in and immersed herself in
the em otional waters that she earlier was describing from the
shore.]
Client: Yes. No. We do n ’t have time. OK. Um. So, I can barely
remember it, but I think what it is I’m supposed to say
is, Bruce, it’s really hard for me—
Therapist: “I’m unwilling—”
Client: Oh. I’m unwilling not to believe that I’m ugly.
Therapist: Good. OK, that’s very close to what I said. I want to say
it again to you—
Client: Yeah.
Therapist: —so you can try it out. “Bruce, I’m unwilling to let it
in that I’m not ugly.”
Client: [Pause; slowly] Bruce, I’m unwilling to let it in that
I’m not ugly. [Silence]
Therapist: How is it to acknowledge that to me?
Client: Well, it’s like I ’m fighting. It’s, it’s, it’s, it, it, it’s
actually—I have to [Laughs]—I’m fighting to keep
that other part [the “confident” persona that she
pushed aside] from com ing back in front of my
face. Because the other part is—OK, the first part is,
you know, this front that I’m really OK. T hen the
other thing th a t’s in there, that really we’re like not
even addressing, is that I feel ugly. N ot only do I
feel ugly, but I feel repulsive, repulsively ugly. So
then—we’re going to move that one a little bit that
way, because if th a t’s out there—See, I d id n ’t move
that one out of the way. T h at’s why I was still fight­
ing it. OK?
Therapist: Mm-hm.
56 D epth-O riented B rief Therapy

[In response to the therapist’s persistent request that she overtly

take her pro-symptom position in the form of saying a certain
sentence, the client became aware of the subjective obstacles to
her doing so, two obstacles that are distinct cognitive-emotional-
kinesthetic formations: the “I’m fine” construction of her per­
sona, and her strategic construal “I’m ugly.” To in h ab it the
position of the sentence “I refuse to let it in that I’m not ugly”
would be to take a position meta to both of these constructions,
separating her from them —which is exactly why the therapist
worded the sentence this way and why these two obstacles take
externalized form as she tries to say it. She is now in the process
of finding her own way of literally moving these obstacles aside.]

Client: So, right. So there are two there. So if I move this one
out of the way, then there’s some way that I have to
take this one—this really stupid but very strong one
that I am repulsively ugly—and get that one out of the
way. And then I might be able to even say—as my head
shakes, which means I’m unprotected. It’s the first
time I ever held it open. God, this physical stuff is so
true!
Therapist: Yes. Yeah. Let yourself really register how this feels.
Client: I mean, because before I was closed to it and—so you
thought I—If I put one over here and one over here—
and I’m open.
Therapist: Right.
Client: Man!
Therapist: Yeah. Stay with it.
Client: [Long silence; quietly] This feels very strange.
Therapist: Unfamiliar?
Client: Yeah, it’s very strange. [Pause] So, now we’re at a
place where I can say it.
Therapist: OK.
Client: Bruce, I’m unwilling to let in the possibility that I
might not be ugly. [Pause] I am! T hat’s true! T hat’s
true!
Therapist: You are unwilling.
Client: T hat’s pretty stupid, isn’t it!
Therapist: Well, I think we’ve already seen what it’s about,
 Resolving E motional W ounds 57

haven’t we. And it’s not about being stupid, is it. See­
ing yourself as ugly has been doing some very impor­
tant things for you, and to live without that would be a
big change, a big change in a num ber of im portant
ways. Change that seems scary.
Client: Now it seems really sad.
Therapist: Sad.
Client: In terms of not—if that really wasn’t true, suppose.
Therapist: Yes, yes.
Client: Then it would be really sad to realize that I felt so
awful all my life for nothing.
Therapist: Yes, I see. [Pause]
[The arising of this poignant feeling of sadness is a key indicator
that the client has owned and is integrating her pro-symptom posi­
tion, largely de-potentizing it and clearing the way for a sudden,
fuller view of her life experience—a shift from the emotional real­
ity of “I’m ugly” to the em otional reality of “How sad to have
thought of myself as ugly all my life, when I wasn’t.” Right now, for
the first time in over thirty years, the client is in a new position free
of the reality produced by the old pro-symptom construction. Rec­
ognizing the significance of this m om ent, the th erap ist’s next
words are intended to further vivify and establish this new view of
herself and her life.]
Therapist: Just think how sad it would be to keep feeling you’re
ugly from now until the day you die, if it’s not true.
Client: [Silence] Well, you know what it does.
Therapist: W hat’s “it”?
Client: Keeping in place the belief that I’m repulsively ugly
and that if anybody got through my persona they
would know that, and it would be humiliating. [Pause]
To have someone go, “Yuk!” again would be unbear­
able. So, in order to never—OK, that’s it, that’s it
exactly. If I hold onto that I never have the chance of
somebody ever saying, ‘Yuk!” to me again, because no
one is ever going to get close enough.
Therapist: Yes. So that’s—so you made a decision never to be vul­
nerable to somebody going, ‘Yuk” again.
Client: Mm-hm.
58 D epth-O riented B rief T herapy

[In saying, ‘You made a decision,” the therapist is now deliberately

using language that emphasizes the clien t’s role as the active
author of the symptom rather than its victim. He does this now
because the client’s immediately preceding statement showed the
therapist that she is now in a position to experientially recognize
her own potent role as the creator and purposeful implementor of
the reality “I’m ugly.” Therefore, the therapist knows that naming
her authorship of the symptom will now be empowering for her,
rather than implying blame or pathology.]

Therapist: And part of that decision was to never again trust that
you’re not ugly, because trusting that you’re not ugly
would mean you’d let somebody really see you.
Client: T hat’s right.
Therapist: And then they might go, “Yuk!”
Client: They would. [Laughs]
Therapist: And that was so painful—a big shard of glass in you. So
the pain of thinking you’re ugly is worth the safety it
gives you from any more shards.
Client: [With decisiveness] That’s right.

[The client has reached a point of being experientially so aware of

her pro-symptom position—her purposeful authorship of the
symptom—that once again, the therapist could say his last sentence
and know she would recognize it as h er own em otional truth,
rather than as an interpretation being imposed by him. That par­
ticular sentence is the apex of the position work, because it cap­
tures the essence of h er pro-symptom position and of h er new
awareness of that position. To establish a new reality based on that
exact awareness would certainly render the problem obsolete, so
the therapist reiterates it.]
Therapist: It’s very painful to think you’re ugly. Common sense
says you’d be happy to discover you’re not ugly, but
actually it’s protecting you so massively, you feel, to
feel you’re ugly. Everything hinges on that protection.
[Pause] Maybe even your relationship with your
m other is protected by thinking you’re ugly.
Client: My mother is probably a year from dying right now,
and sort of vulnerable.
 Resolving E motional W ounds 59

Therapist: It would not be comfortable to go into rage at her at

this point, for example.
Client: It wouldn’t make any sense to do it.
Therapist: No, I don’t mean actual confrontation.
Client: Well, it might make some sense.
Therapist: [Laughs] So, we’re out of time. Are you OK with stop­
ping there?
Client: Yes.

At the next group meeting, two weeks later, she made these
comments: “That was the most powerful piece of therapeutic work
I’ve ever experienced. The shard isn’t there any more. I feel dif­
ferent. I’m really amazed. O ur work allowed me to reach a sense
of profound clarity and to make a palpable, internal shift.”
Then no oth er com m ents were exchanged about this work
until ten weeks after the session, when the therapist asked how the
results of that session were holding. H er response: “It’s holding
remarkably well, and I’m really pleased about that. I really do have
a different inner position about the issue of how I look. Sometimes
I have to work at it to think it through again, but I think I’m really
able to let go of the idea that I am both ugly and repulsive and
have always been that way. I really have been able to mostly keep
some perspective on that.
“One of the things I did was go back through photo albums for
years and years and years, just to take another look from a differ­
ent perspective. That was helpful.
“The other, the major change is that I’m not—I d on’t have so
much negative chatter going on when I’m passing myself in the
mirror. T here’s quite a bit less negative chatter, and that’s really
nice. And I have been able, I think, to really drop a good chunk of
defensiveness that I have had between me and people, so that I
have less anxiety being around people, and I d o n ’t have as much
of a wall up. T hat’s a lot to say, but I—that’s the way I experience
it. It’s ju st easier to be with people, because I’m not guarding
against that unconscious belief that people are going somehow to
see, if I’m not very guarded. So, it’s wonderful, it’s really good! And,
I still am feeling very grateful and quite amazed.”
In another follow-up four months after the session, she reported
with great amusement that at an occasion with some friends who
60 D epth-O riented B rief T herapy

were talking about self-image, she had spontaneously thought of her­

self as “cute” and had actually said so. Explaining, she said, “‘Cute’
meant both physically and personality. I couldn’t believe I was saying
this to these people!”

Commentary
This work illustrates the direct accessibility, through radical inquiry,
of the client’s unconscious, pro-symptom construction, leading to
rapid resolution of a raw, lifelong emotional wound in self-regard.
Since the presenting symptom was low self-esteem that physi­
cally felt like a cutting shard of glass in her abdomen, it was clear
from the start that the problem involved an unresolved emotional
wound and therefore that direct resolution would be necessary.
That is, the symptom would indeed have to be eliminated (rather
than reconstrued and reclaimed as a strength), requiring a trans­
form ation of the pro-symptom position in which the em otional
wound was a central element.
The therapist did nothing but carry out the two top priorities
of depth-oriented brief therapy, namely, (1) radical inquiry in
search of the emotional truth of the symptom (the subjective real­
ity within the client’s pro-symptom position), followed by (2) expe­
riential shift, here in the form of position work, which means
having the client experientially inhabit and consciously integrate
her previously unconscious, pro-symptom position.
The transference aspect of this session warrants com m ent.
Transference-minded readers may be biased toward interpreting
the session as a “transference cure” rather than as showing the
effectiveness of the methodology of DOBT. The argum ent pre­
sumably would be that hearing the male therapist support a view
of her as lovely dispelled the client’s view of herself as ugly. How­
ever, the client herself showed that this was not occurring when,
following the therapist’s final comment on her being lovely or not
ugly, she had an experience that she described by saying, “See, I
can’t really—I can’t take that in.” Whatever positive transference
may have been occurring clearly did not sweep away her still
unconscious attachm ent to her view of herself as ugly. It was the
subsequent position work that enabled her to release this view. A
positive transference would, of course, have inclined her to coop-
 Resolving E motional W ounds 61

erate with this work, but it was not central to how resolution was
achieved. A lifelong, negative self-concept is virtually always accom­
panied by a tenacious, core belief that receiving any positive regard
only means the other person has been successfully fooled.
Through radical inquiry and position work, therapist and client
discovered, and the client experienced, the emotional truth of the
symptom, namely that “I’m ugly” was all along serving to protect
her in various im portant ways. In the arena of gender attractive­
ness she had received a cutting blow so deep and painful that she
would rather resign forever as a player than risk being slashed like
that again. She resigned by creating a construal of herself as a lost
cause, rationalizing her withdrawal from the field. Forming this
construal was a strategic protective action shielding the vulnera­
bility of the emotional wound. In addition, “I’m ugly” protected
her from spiritual and marital ruin due to uncontrollable sexual­
ity and from refuting her underm ining m other’s view of her and
possibly rupturing their relationship.
A governing or superordinate elem ent of h er pro-symptom
position was her purpose of maintaining safety from these dangers
through the strategic, protective construal, “I’m ugly.” Inviting her
to own and assert this purpose (in the form of a refusal to be with­
out her strategic, protective device) was the pivotal position work
of the session. Asserting this superordinate purpose allowed her to
extract her identity from all of the other, subordinate elements of
her pro-symptom construction including the belief “I’m ugly.” She
experienced that it was the protective value of this belief, not the
truth value, to which she was clinging. Exposing what the symptom
is covertly achieving is the deconstruction of the symptom—not
merely a conceptual deconstruction, as in literary criticism and
political and clinical analysis, but an experiential deconstruction,
the client’s living encounter with her symptom’s unseen but cru­
cial value to herself.
Already wounded in her view of herself by her m other’s mes­
sages of inadequacy, it was with stunning finality that she heard the
teenage boy’s “Yuk!” as confirming the objective visibility of her
shameful insufficiency. She experienced his view of her as sharply
cutting. The im portant point, however, is this: In all subsequent
moments it was her own view of herself as ugly that kept cutting. It
was she herself who continued unconsciously to insist on applying
62 D epth-O riented B rief T herapy

the cutting shard of “I’m ugly” for its protective value. In other
words, her own solution to the problem of vulnerability was to hold
tight to the very construction that was a shard in her body.
Through the position work of overdy owning her covert use of “I’m
ugly” for self-protection, she rendered it useless for that purpose
and so became willing to relinquish it. In removing “I’m ugly” from
her view of reality, she also removed its kinesthetic aspect, the
shard, from her body.
The therapist did not conceptualize her view of herself as ugly
as a cognitive error requiring “correction.” There is no such con­
ceptualization in depth-oriented brief therapy. Rather, the thera­
pist “knew” from the start that her view of herself as ugly existed as
part of a coherent, if hidden, unconscious construction of mean­
ing: her pro-symptom position. In the client’s world, whatever is,
is because some position of the client needs it to be that way.
The session is also useful to consider in terms of the orders
of change occurring. The therapist knew very well that his first-
order dem ur that she was not in fact ugly had very little thera­
peutic power (even though he genuinely m eant it), because her
“I’m ugly” position had second-, third-, and fourth-order com­
ponents that this first-order refutatio n would no t budge. A
second-order construction is the m eaning attributed to particular
perceptions and experiences. As a second-order process, the
th erap ist offered a developm ental perspective designed to
change the very m eaning of the client’s adolescent experience
of being ugly. The m eaning of her appearance at twelve shifted
from “assessment of perm anent, essential self” to “snapshot of
transient, developing self.”
Most of the session, however, was an execution of third-order
change. The third order of structure within a position is comprised,
by definition, of the constructs that determ ine which among all
possible second-order constructions of meaning will be applied to
particular perceptions or experiences. Specifically, the third order
is the domain of purposes served in selecting constructions of mean­
ing. It emerged that this woman had three different unconscious,
protective purposes for harboring the strategic, second-order con­
struction “I’m ugly”: prevent further trauma of slashing rejection,
prevent sexual sinning, prevent alienation from mother. When she
realized these purposes and relinquished them (a third-order
 Resolving E motional W ounds 63

change), then the “I ’m ugly” construction of m eaning itself

became free to change as well (a subordinate, second-order
change flowing from third-order change). Having relinquished her
protective purposes, she now can let it in that she’s not ugly. In
general, an unconscious, third-order purpose served cannot sur­
vive becoming fully conscious and integrated in position work, and
when that third-order purpose dissolves, the second-order strate­
gic construction it had been supporting is no longer viable.
Third-order constructs of purpose derive in turn from fourth-
order constructs of the fundamental nature of the self, others, and
the world, that is, constructs in the domain of ontology. Based on
my fourth-order constructs of the kind of being I presuppose
myself to be, and the kind of world I take myself to be in, I form
third-order purposes or priorities that govern how I will attribute
meaning in concrete situations (my second-order constructs). To
give a simple example, if I construe my being to be whole, lovable,
and well connected into the fabric of existence, I form purposes
of creative expression of wellness, interconnectedness, and trust,
and I then construe concrete situations as presenting specific
opportunities to enact such purposes. If unconsciously I construe
my being as w ounded, deficient, unlovable, and disconnected
from the fabric of existence, I form unconscious purposes of self­
protection, com petition, and survival, and I then construe con­
crete situations as venues where by necessity I must carry out those
purposes. The woman in the foregoing exam ple had a fourth-
order construction of herself as fundam entally deficient in her
essential qualities of gender and as being slashed to the core by
others’ harsh rejection of this deficiency. This fourth-order con­
struct generated the survival-oriented third-order purpose of pre­
venting any repeat of such cutting rejection, which she carried out
by maintaining the strategic construction “I’m ugly.”

Unhappy No M a tte r W h a t_________________________

The title we’ve given this vignette captures the essence of the prob­
lem presented by a thirty-seven-year-old, chronically depressed,
compulsively workaholic woman. Her melancholic depression had
dominated her emotional life since high school if not earlier, and
would soon darken any enthusiasm felt over new developments in
64 D epth-O riented B rief T herapy

her work or personal life. She remained functional but would fre­
quently lose momentum, begin “procrastinating,” and see herself
as incapable of succeeding at things she valued, such as her urban
planning projects at work or her relationships with men. She had
been m arried for three years in h er twenties and had ju st one
month earlier left a two-year relationship because of feeling hurt
and angry over the m an’s too-ambivalent feelings. However, she
and he were now tentatively resuming their involvement.
Despite previous episodes of psychotherapy in her life, she was
at a loss as to what was keeping her in a mood of unhappiness that
prevailed over all circumstances. These previous therapies were
open-ended and unfocused, and now she wanted brief, focused
work. H er ten sessions of depth-oriented brief therapy involve
addressing symptoms and pro-symptom positions of greater com­
plexity than we have previously considered.

Session One
Given that the client was unaware of what in her view of reality war­
ranted being depressed, the therapist in the first session made a
wide range of inquiries aimed at identifying a symptom-positive
context, a specific area of life experience in which her depression
was necessary and meaningful. Asked when she gets depressed, she
thought and said, “When I get excited and things are going well
and I feel successful and happy, a m om ent comes when I notice
that, and then immediately I get depressed.” To a therapist who
thinks in terms of DOBT, this last remark has a particularly strong
stamp of a hidden, pro-symptom position that is incompatible with
feeling successful and happy. In an attempt to invite more of that
pro-symptom emotional truth into awareness, the therapist gave
her as a between session task an index card on which she had writ­
ten the sentence fragm ent, “If I let myself stay successful and
happy—” The client was to look at the card daily and notice what
occurred to her.
Sentence completion tasks are often useful for radical inquiry
because an unconscious position generally cannot resist the oppor­
tunity to complete a sentence that is highly relevant to the posi­
tio n ’s central them e. The person experiences the com pleting
words autonomously suggesting themselves, revealing the views,
 Rksoi.vinc; Emotional W ounds 65

needs, or agenda of the hidden position, showing specifically

why the symptom is im portant to have. In this case the sentence
fragment was worded to set up an experience of viewing from a
symptom-free position. T hat is, the sen ten ce was w orded to
evoke the unwelcome consequences of being without the symp­
tom of rapidly going into depression when happiness arises.
Other noteworthy material to emerge was the following: The
clients’ parents always “drank a lot” socially. F ather’s anger was
“severe and unpredictable,” and he was unexpressive of affection,
never once saying the words, “I love you” to her (he’d say, “Like­
wise,” if she said she loved him). Father was now seventy-nine, and
she was aware of still feeling much anger at him for his blasts of
emotional harshness at family members. Father wanted her to be
either a business executive or a lawyer, so she worked for four years
in a management position but finally realized this did not suit her
and changed careers. Even though she would exhaust herself with
overachievement and overwork, “It’s been very, very hard for me
to feel I can do som ething well or carry through. . . . I have a
sneaky way of always managing to see myself as bad. I’m constantly
on my own case for not living up to my potential.”
The next session was scheduled for the following week. Based
on what she learned in session one, the therapist could at this
point make sense of the client’s depression most easily as an
unconscious state of hopelessness or despair over feeling unloved
by her father as well as over seeing herself, by his standards, as fun­
damentally a failure—m ore than enough to keep her endlessly
depressed. Although she was a fairly psychologically minded per­
son, her factual or intellectual awareness of the unloving m anner
of her father did not appear to be accompanied by a correspond­
ing emotional awareness of being depressed over this. The thera­
pist therefore approached session two intending to carry out
radical inquiry that would experiendaily test these themes for emo­
tional truth.

Session Two
At the start of the session the client reported that the only thing
that occurred to her in carrying out her task (completing the sen­
tence fragment, “If I let myself stay successful and happy . . .”) was
66 D ep th -O rien ted B rief Therapy

that “I turn into a m onster and become insatiable if I d o n ’t get

enough emotional understanding from the man I’m with.” To the
therapist, this response, a seeming non sequitur, indicated that her
unresolved wound of em otional neglect by h er father had an
urgency that overrode even a contemplation of being happy.
It also indicated that she might be trying to set right the painful
story of her relationship to father by connecting with similarly
emotionally insensitive men and pursuing the meaningful strug­
gle to get them to become emotionally sensitive and loving. In this
common pattern, rather than face, grieve, and accept the fact of
never having been given direct emotional love by her father, she
denies and avoids feeling this sizable loss by unconsciously strug­
gling to undo it: she will get an unloving male to become loving.
This never succeeds, and the struggle continues ad infinitum. What
Freud termed repetition compulsion is understood in DOBT to be the
strategic protective action of unconsciously construing an irre­
versible loss to be reversible and struggling to bring about that
(impossible) reversal.
To check on whether these constructions were actually present,
the therapist carried out radical inquiry using a form of viewing
from a symptom-free position, which took about three minutes.
The therapist asked her to imagine being in a relationship with a
man who from the very start readily and appropriately supplies the
emotional attention and sensitivity she so much wants. The thera­
pist had her visualize this, evoking a few different scenes of daily
life with such a man, and then asked her how it feels. The client
said, “It m ight be boring . . . . Somehow th e re ’s never been an
attraction for me with someone like that.”
This response confirmed to the therapist that despite having a
conscious position of wanting to be with an emotionally sensitive,
unambivalent man, unconsciously her top emotional priority was
not to be with such a man, but to be with an emotional replica of
h er father and win a change of heart in him. This was the com­
pelling, meaningful struggle for rapprochem ent that she uncon­
sciously expected would finally bring a very unhappy story to a
happy ending and, perhaps most importantly, reverse her view of
herself from an unlovable, insufficient person to a lovable, suffi­
cient one. (O f course, this is a doom ed strategy for resolution,
since the chances of any partner significantly changing his or her
 Resolving E motional Wounds 67

basic em otional style to suit the o th e r’s needs are rem ote. The
result is a rew ounding rath er than a resolution.) A man who is
emotionally sensitive and loving from the start is simply the wrong
man, totally irrelevant to her unconscious plan and therefore not
an emotionally interesting figure. This was the reality within her
unconscious, pro-symptom position on relationships with men.
Recall that one of her presenting symptoms was a strong pat­
tern of “always managing to see myself as bad.” It was clear at this
point that a classic construction of low self-esteem was operating.
Her unconscious com m itm ent to m aintaining h er fragile em o­
tional bond with a rejecting father required construing herself as
bad, insufficient, unlovable. The only way she had for sharing an
emotional reality with him was to agree with him about herself—
that is, to regard as objectively true all the feelings of in h eren t
unlovableness she had when with him. To let go of this negative
construction of herself would also be to let go of her familiar sense
of connection to him. In her pro-symptom position it was impor­
tant to preserve her negative self-sense in order to (1) stay in the
same experiential reality as her father and (2) keep pursuing her
plan to have him reverse her negative view of herself with his love.
If she were to unilaterally shift into regarding herself as worthy and
lovable, she would be letting go of her need for father without hav­
ing the happy ending she seeks. In short, the classic construction
of low self-worth is m aintained for the purpose of protecting
against irreplaceable loss of the em otional bond in the primary
relationship in which the negative view of self was learned. The
symptom of low self-worth, which to the client’s conscious mind is
a problem, is actually her solution to still-higher-priority problems,
such as how to preserve emotional connection to a rejecting par­
ent. Changing the client’s solution (symptom) is of course much
easier when the therapist knows what problem it is solving. (We
provide a review of the higher-priority problems “solved” by stay­
ing in low self-esteem in Chapter Six. Readers versed in object rela­
tions theory will recognize a similarity, though not an equivalence,
of these ideas with, for example, those of Fairbairn.)
Since being lovable is of the most fundamental importance to
each person, to construe oneself as inherently unlovable generates
a pervasive depression (whether consciously recognized or not) as
well as chronic fears of intimacy and rejection. These are the costs
68 D ep th -O rien ted B rief Therapy

of maintaining low self-worth in order to protect a primary emo­

tional bond. The fact that the client’s mind clings tenaciously to
this protective construction shows that the high price is worth pay­
ing. When the unconscious, pro-symptom position is “Dad feels
I’m unlovable, and agreeing with him is the only way to preserve
my emotional connection with him,” then the depression gener­
ated by agreeing that “I’m unlovable” is merely a side effect to be
endured. This illustrates an important general principle: The uncon­
scious mind pursues its present solutions to perceived, high-priority prob­
lems with indifference to the pain these solutions (symptoms) cause the
conscious personality. The presence of this pain or limitation does
not in itself motivate the unconscious, pro-symptom position to
change.
With this understanding of her pro-symptom position, the ther­
apist set out to do the position work of having her consciously real­
ize and own the purpose of her negative self-construal: protecting
her connection with dad. This type of position work is an experi­
ential shift that we often use in DOBT to unlock a low self-esteem
position. (It is third-order position work, because it consists of hav­
ing the client own a superordinate purpose served by how she is
construing the situation. The therapist, however, is not analytically
thinking “third order” but is aware of encountering the presence
of a governing purpose and is seeing the possibility of having the
client own it.)
As a first step, the therapist set up a simple experiential task
that would Socratically bring her attention to her own position.
She asked her to visualize her father and also, standing behind
him, all the past boyfriends and lovers who tu rn ed out to be
ambivalent or emotionally unexpressive. This image formed easily
and vividly. The therapist then asked her to speak to them by com­
pleting this sentence, without pre-thinking the ending: “If I know
that I’m O K . . .” After a few rounds of this, each with a new, spon­
taneous ending, one arose that she knew was it: “If I know that I’m
OK, I won’t need to try to get it from you anymore.” This immedi­
ately brought tears along with the realization that “being pleasing,”
especially to men, was organizing the whole emotional tone of her
daily life. This simple, Socratic position work of sentence comple­
tion had produced a significant breakthrough. She had reached
an initial awareness that she herself was actively maintaining the
 Rksolvinc. E motional Wounds 69

“I’m not OK” position for the purpose of preserving connection

and carrying out a plan of rapprochem ent. After the wave of feel­
ing passed she explained that with those words, she felt for the first
time in her adult life that, “I d o n ’t have to do it this way. I d o n ’t
have to try to please them.”
As a further step of owning her purpose for staying in low self-
worth, the therapist invited her to go fu rth er into viewing her
father from a symptom-free position. While she was still looking at
him in her m ind’s eye, the therapist asked her, evocatively, to “just
try on for a m inute or two, purely through im agination, as an
experiment, the identity of knowing—you are fully OK, fully a
good, lovable, worthy person. As you look at your father, you can
see what it’s like to look at him, from this imagined position of
knowing that—you are really OK, and sufficient, and lovable. Just
for a minute, as an experiment, allowing this positive sense of your­
self. And as you look at him from this position of well-being, just
notice if anything changes in how he seems to you, or in how it
feels between you. [Pause] What is it that you notice?”
She said, “He becomes smaller and less significant,” and
explained that she meant visually smaller and emotionally less sig­
nificant. This “incredible shrinking parent” effect, a useful diagnos­
tic indicator, experientially confirmed the therapist’s understanding
of her pro-symptom position. Her familiar construction of connec­
tion with her father—as represented in her visual image of him—
was incompatible with a positive view of herself, so his image
diminishes when she inhabits a positive construction of herself. She
had just experienced this for herself, which is crucial for the work
to be nonspeculative and brief.
While she was still seeing this diminished image of her father,
and in order to go beyond radical inquiry into position work—that
is, to have her consciously integrate the em otional m eaning of
what she had just perceived—the therapist then said, “Just notice
whether or not it feels OK to you to have a position of knowing
that you’re actually OK, fully OK, if the cost of being in this new
position of OK-ness is that your father becomes smaller and less
significant. [Pause] And what do you notice?”
She said, “It feels a little sad—but OK, actually. [Pause] You
know, what I’m noticing also is that not being OK is how I get my
friends to give me special attention. I didn’t realize that.” This, too,
70 D epth -O riented B rief T herapy

was accom panied by a series of recognitions of how she “used”

boyfriends and friends “to make me feel OK,” after which she said
with tears, “I’m so glad to be getting to this.”
Having her view her father from a symptom-free position was
not intended to shift her into that position permanently, but only
for a few m inutes, in ord er to have h er becom e aware of what
changes when she is operating without the symptom. In this expe­
riential way it becomes clear what the symptom is doing for her
that makes the symptom im portant to have. If, as in this case, the
client in addition begins to integrate and transform her (third-
order) purpose for m aintaining the symptom and h er (fourth-
order) construal of essential self from which that purpose springs,
then an even bigger step has been taken.
As a between-session task of position work, the therapist gave
the client for daily reading another index card on which she had
written, “Am I willing to know I’m actually OK, if the costs of know­
ing I’m OK are that Dad becomes smaller and less significant in
my life and that I’ll lose a familiar way of inviting caring concern
from my friends?”

Sessions Three, Four, and Five

One week later, at the start of the third session, she reported that
she had looked at the card every day, and though she had no spe­
cific new thoughts or feelings about what it said, to her surprise it
was now feeling significantly easier to choose to stay happy. She
said, “It’s not as hard as I thought it would be.” This again illus­
trates the capacity of position work alone to produce deep change
rapidly, here in only two sessions. That is, simply by consciously tak­
ing what in fact was a governing emotional position—“I see myself
as not OK in order to keep dad’s importance from diminishing”—
she spontaneously became free to move off of it.
She also reported having the realization that in her relation­
ship of the past two years she had been using her boyfriend as a
“sewer” into which to “pour out all my bad feelings so that I’d feel
better—but I d id n ’t, really. I suddenly saw that I d id n ’t have to
do th at— that what I w anted was to be happy— happy to begin
with.” To the therapist this new, unilateral intention to be happy
indicated a significant shift out of her unconscious plan to get an
 Rksolvinc; E motional Wounds 71

emotionally closed man to open up and heal h er unhappiness

with his love.
Asked by the therapist what she felt the most valuable focus for
the session would be, she addressed her problem with work and
career. She said she was still finding that while carrying out her
work—short-term consultation jobs—feelings of enthusiasm, pur­
pose, or motivation would soon dissipate and be replaced by a
sense of mechanical effort and pointlessness. To the therapist this
sounded like yet another aspect of her depression, and it reminded
her of the client’s previous description of shifting abruptly into
depression upon noticing that she feels “excited and things are
going well and I feel successful and happy.” Evidently there was an
unconscious, pro-symptom position incom patible with having
energy and forward movement in her work life, so to identify this
position the therapist formulated a more pointed form of an ear­
lier task of radical inquiry for her to carry out between sessions.
She was to find and feel whatever would be distinctly unwelcome,
difficult, or scary about living in her energetic state of enthusiasm
and success.
In session four she reported that as a result of the task, she now
felt “very troubled and conflicted” in a new way. She was experi­
encing a new level of excitement at work and had thoughts of get­
ting her Ph.D., but she couldn’t see how to follow these interests
and have children. At thirty-seven, she felt time was short. A key
construction then emerged: She construed “career” to be a “her­
metically sealed big thing that crowds everything else out,” includ­
ing family, friends, traveling, sitting and reading, and so on. In the
past she had indeed carried out all her academic and professional
endeavors this way. To allow excitement, purpose, and motivation
at work to persist and develop into a “career” was to agree to have
no other life, which had become unacceptable to her. She had
done the between-session task quite well, actually experiencing
how it was “unwelcome, difficult, or scary” to sustain enthusiasm
at work: to get at all serious about work was to lose control and
binge on it, becoming, as she said, “ridiculously workaholic.” This
now began to make sense of her quick suppression of these posi­
tive, energetic feelings.
It seemed to the therapist at this point that her pattern of total
immersion in career, to the exclusion of all else, was probably an
72 D epth-O riented B rief Therapy

important protective action against feeling her chronic depression.

If so, the way to dispel the workaholism and make “career” safe and
tolerable was to dispel the depression that made it necessary to be
totally im m ersed in work. A true resolution of that depression
should show up as a falling away of the workaholism.
The therapist’s interest was drawn toward her fa th e r’s own
compulsive behavior, his alcoholism. The therapist asked specif­
ically how it was for her, in her childhood, that her father drank.
The client said the problem wasn’t the drinking in itself, but her
fath er’s sudden explosions of anger when all seem ed well and
daddy was happy (after drinking). After an intense flare of
scorching anger at one or more of the children, he would be fine
again within m inutes, c o u ld n ’t u n derstan d why the children
w eren’t, and would get angry at them for that. She was always
afraid of him, she said, because of the unpredictability o f his
explosions.

Therapist: So how did you cope with always being afraid, that
danger of him exploding?
Client: I just became silent. If my parents were together and
either of them asked me anything about myself, I just
wouldn’t answer. I never felt dad listened to me any­
way, so I just didn’t offer anything. . . . We just stopped
talking to each other at all. Later his hearing deterio­
rated, and dad just receded, for me.
Therapist: Would you be willing to picture him, the way he
looked when you were younger, and say some things
to him?
Client: OK. [Closes eyes]
Therapist: Let me know when h e’s there. [Pause]
Client: Ready.
Therapist: As you look at him, try saying, “I’m really unhappy I
have a daddy I’m afraid of.”
Client: I’m really unhappy I have a daddy I ’m afraid of.
[Gets teary and sniffly] It’s also true that—I’m
really unhappy I have a father that d oesn’t u n d er­
stand me. And actually [Now nearly crying] what
I’m really saying when I say that is, a father that
doesn’t care about me, because I always felt that if
 Resolving E motional W ounds 73

he really cared about me or loved me, he would try

to understand me.
Therapist: So, the truth of the feeling you’ve been carrying in
your life is, “My father doesn’t really care about me.”
Client: He doesn’t love me.
Therapist: “He doesn’t love me.” You feel unloved by him.
Client: Yeah, uh-huh. Yes.
Therapist: And part of you is always in great downheartedness, or
depression, about that.
Client: I guess.
Therapist: So, that part isn't so clear. So let’s just stay with the
truth that you actually feel—that you feel unloved.
Client: Yes.
Therapist: And what I’m understanding from what you’ve said is
that, feeling uncared-about and unloved is the worst,
troubling part—worse than the fear of his anger.
Client: Yeah, mm-hm. To this day, the only way I can talk to
him is to talk about things that S c a re s about. I can’t
talk to him about things that matter to me.
Therapist: So it’s always all about him. And even though, as
you’ve told me before, h e’s a very dedicated family
man and does lots of things for people, what you’re so
unhappy about, and what’s hurt you, is that he doesn’t
show real interest in your world, a personal interest in
getting to know you in your own right, the self that you
are.
Client: Right. That’s it exactly. If the focus is on his agenda,
then we had something to talk about and could get
along. And that’s why I was in business.
Therapist: Now, feeling unloved by a dad is a big thing, a big
unhappiness. Maybe this is what makes sense of this
mystery that you’ve described to me of how your own
enthusiasm and happiness in life don’t hold up, don’t
sustain—you get them going but then they just col­
lapse, quickly. Seems like those current happinesses
are standing on a foundation that’s so unhappy. I won­
der if you’re carrying around a really big unhappiness
that in some parts of yourself seems a lot bigger than
these current happy developments.
74 D epth-O riented B rief Therapy

Client: [Cries softly]

Therapist: You look like you have a feeling when I say that. What
is it you’re feeling?
Client: [Speaking through tears] Well, I’m feeling the
unhappiness.
Therapist: Yeah, it’s a big unhappiness.
Client: I suppose it’s something to become aware of it, but—I
mean it’s not the kind of thing that goes away. [Cries]
I mean it’s me, it’s part of me.
Therapist: Well, I believe that your life is a broad enough river,
that there’s room for a current of sorrow over on one
side. A good life can include some sorrow, too. But to
reach that balance you have to first know the emo­
tional truth of how it is, and has been, for you.
Client: I suppose if I face it, then there are ways I can work
with it.
Therapist: Yes. So, how about if I give you a card to help keep
this emotional truth in plain view?
Client: OK.
[The therapist writes out and hands her a card that says, “The truth
is, up to now my unhappiness over feeling unloved by my dad is
bigger than any happiness I’ve been able to have.”]
Client: [Reads card; begins to cry, her face appearing to the
therapist deeply anguished] It’s true.
Therapist: Yes. [Pause] It’s true, and it’s so painful that I d o n ’t
know if you’ll be willing to live with the truth of that,
this week. Do you think you could read it twice a day,
morning and night?
Client: OK. I will.

Here in the fourth session, the therapist engaged her in the

position work of facing, feeling, and accepting this central emo­
tional truth of her depression, immediately upon discovering it. It
was now clear that for her to begin to feel distinctly happy over any­
thing in her current life only served to remind her, unconsciously,
of a much bigger unhappiness, collapsing her happy mood, as she
had described in the first session. The card was a simple device to
foster the position work of inhabiting the emotional truth of that
 Resolving E motional W ounds 75

bigger unhappiness without attempting to change it or get her out

of it in any way.
In session five, one week later, the client said that the words on
the card were profoundly true and had led her into reflections on
the lifelong sweep of this big unhappiness. She described feeling
abandoned by both mother and father at age six, when her brother
was born and her father began traveling often on business. She still
had her older sister, but at eleven her sister reached puberty and
sister’s interests went elsewhere, a final abandonm ent that “made
me hatefully angry at her, and that was a rift that lasted until only a
few years ago.”
The therapist asked her to visualize father, mother, and sister
and to try out saying to them, “I’m so angry at you for abandoning
me.” She tried the sentence two or three times. To the therapist’s
surprise, she said that she wasn’t connecting with it, but that
another sentence was insistently coming to mind. The therapist
encouraged her to try that one, and to her three family members
she said, “I’m right about the problem s in our family.” This
instantly came to life with em otion and tears, an upwelling of a
complex mixture of feelings. She repeatedly commented on how
satisfying it felt to her to say those words, so the therapist suggested
saying them a few more times, which she did. She explained that
she had always made sense of her unhappiness as caused by her
own “weakness of character” and emotional defectiveness, so to
take the position “I’m right about the problems in our family” was
simultaneously a major (fourth-order) change in her view of her­
self as well as a liberating step of separation from her parents’ view
of the family. The therapist gave her those words written on a card,
plus another phrase that the client welcomed in order to enable
her to hold this position even when she imagined her parents argu­
ing against it: “and I’m right even if you deny it.”

Sessions Six and Seven

Asked how it went for her with the words on the card, she said, “It
was actually pretty great. That card was a lot more than a card. I
had a real image. I didn’t have to keep remembering the words; I
could rem em ber the image and the feeling that went along with
it, and it was very powerful, and I guess pretty profound, because
76 D epth -O riented B rief T herapy

it was som ething I had been coming to for a while—I mean, for
twenty years or thirty years or so—and it’s something that I’ve been
wanting to say—you know, that I was right, I could see that things
were wrong. And it’s been having a very real effect, because know­
ing I’m right about how things were is actually giving me the con­
fidence to make decisions and do things that I might not have the
confidence to do. Yeah. O ther therapy I’ve had d id n ’t make the
same kind of progress.”
Since the improvement was so marked in both her mood and
her confidence in making the decisions facing her, she brought up
the possibility of ending therapy within a few more sessions and
suggested meeting less often than weekly, to which the therapist
readily agreed.
The ultimate stage of separating from o n e ’s family’s view of
reality is to hold a different reality while in their presence. To this
end the therapist invited her to do a simple rehearsal of being with
her family while in the symptom-free position of knowing she’s
right. This exercise would foster any further experiential shift that
might be necessary for sustaining this degree of autonomy.

Therapist: Can you imagine what it would feel like, to actually be

in the room with your family members, with you pri­
vately knowing that you’re right about the problems in
the family?
Client: Well, as you were just saying that, I had an image of
just laughing with them. I think what it does is, it
allows me to see where they’re healthy, too. Because
there’s also a lot of support and strength in my family.
[Cries softly]
Therapist: [Silence] What are these tears about?
Client: It’s a relief. I think it’s that, when you’re in a state of
confusion and you don’t trust what you’re right about,
and you don’t trust what you see as the problem, it’s
really hard to let yourself see what’s really good. But
then, the fact that there’s a lot of good there makes it
hard to know if you’re right about the bad. And it gets
all tangled up, so it’s a big relief to know that you can
acknowledge that it is healthy in some ways. In the
past I didn’t have room for that.
 Resolving E motional W o i nds 77

Therapist: I see, yes. After many years in that confusion, this is

quite a relief.

[The client has just described the transformative effect of simply

taking her emotionally true position in relation to her family mem­
bers. By doing so she spontaneously moved into an unexpected
new position of perceiving and appreciating what is positive in her
family relationships, a significant step of individuation. She had
been trying to see her family in a genuinely positive light for
decades and could not, because she had been striving to do this
from a position that was incongruent with her own em otional
truth.]

She then said she was in fact about to visit her family (on the
opposite coast). The therapist asked if, in light of the work she’d
done in these sessions, there was a specific goal she wanted to have
for this family visit. She said that “the hardest and most damaging
thing” about visiting her family was the depression she inevitably
goes into as a result of com paring her own life and the choices
she’s made with the affluence, career stability, and advanced levels
of achievement of her family and friends, and especially the fact
that her friends have children. She starts to feel “left out, and I
hate feeling left out and left behind. I start to feel that I’m not OK
and don’t belong.” The therapist asked if her choices in life, being
right for her (a deliberate invocation of her new clarity of know­
ing she’s right in her assessments), have entailed both certain
losses and certain differences from her family and friends, which
she vividly sees during a visit. She agreed with this description.
The therapist then gave her a task of position work. She sug­
gested she deliberately get depressed about these losses and dif­
ferences ahead of time, before the visit. She explained that since
her choices, though right, have entailed some actual loss and sep­
aration, sad feelings over the loss and separation are entirely fit­
ting, but she could face and feel these feelings knowingly, before
arriving, rather than unknowingly have her mood deteriorate due
to half-conscious comparisons triggered during a visit.
The task of deliberately getting depressed before the visit may
appear to be a paradoxical intervention because it prescribes the
symptom, but it was not a strategic, “trick” type of paradox. Position
78 D epth-O riented B rief T herapy

work in DOBT is exactly the process of having the client own her
symptom-affirming position. The therapist was inviting this woman
to preestablish herself in sharp awareness of the emotional truth of
her situation, which is that she is a choice-making person who
accepts, with some sadness, the costs of her choices and is not a vic­
tim of those costs. She said, “T hat sounds good—I mean, I’m
already feeling it that way—I think it comes from my dad and my
sister had a real tight relationship, and I was kind of left out. There’s
a long history of that feeling . . . . Can I have a blank card, to write
that down?” She said she would write, “My choices are right for me,
even if I’m sad about some of the consequences.”
She also wanted the therapist to know that she had ju st suc­
cessfully finished a major project at work, but that “it was almost
too easy. I didn’t have a lot of struggle and agony over it, which I’m
so used to thinking is a part of the formula for som ething to be
worthwhile, that it’s got to be agonizing.” More on h er worka­
holism now emerged. For all of her adult life she felt that “if work
isn’t an all-consuming, colossal effort, it can’t be very meaningful.”
She has always worked long hours, often until 10 p. m . She said,
“There’s a real high that you get” from that kind of strenuous, total
immersion in the effort. This portrait of a chronically depressed
person whose workaholism gives not just thorough distraction from
her personal life but an intense “high” corroborated the therapist’s
sense that this habit was her main protective action against feeling
that depression.
In session seven, three weeks later, she reported on her family
visit. She said, “At times it was pretty intense. . . . A couple of situ­
ations happened that were identical to the ‘I ’m right about the
problems in the family even if you deny it.’ It was really uncanny,
actually.”
She described an incident in which she was with her parents.
All were in a fine mood (dad had already had his afternoon mar­
tinis), and since her parents began discussing some of the emo­
tional tensions between dad and her sister, she offered her view of
the problem, which included how dad, and not just sister, was con­
tributing to the tension. This seemed to be going well, but at some
point dad told her she was crazy, and when in response she told
him not to do that, his mood abruptly changed and he was sud­
denly right in her face, yelling at her and waving his finger. After
 R eso lv in g E m o tio n a l W ounds 79

he stopped she was visibly shaken by his emotional assault, but for
the first time in her life, “I didn’t feel diminished by this, which is
the way I’d always felt. I didn’t feel small, physically small, or con­
fused; I didn’t feel at all confused.” Dad, now very defensive, said,
“Basically what you’re saying is that you hate me.” She told him that
actually she loved him very much, and then said, “You know what,
dad? Something that I’ve wanted to say for a long time is that you
have never said that you loved me. And that’s felt like a real gap in
my life.” Dad responded, “Well you know, that’s true. You’re prob­
ably right. I’m fairly certain that I haven’t. I thought that was just
something you said to your wife, and d id n ’t need to say to your
kids.” She said, “Well, it really does make a difference.” The sub­
ject then changed and normal activities resumed. Several minutes
later, as they were about to go their separate ways, her father said,
“Just a m inute,” walked over to her, hugged her, and said, “I love
you.” She said this was “a surprise, and really nice. I did n ’t think
there would be any impact, or that he would’ve rem em bered.”
By transforming her unconscious position from “h e’s unloving
to me; I’m unlovable” to a conscious position of “h e ’s unloving to
me; that’s very wrong,” she could then relate to her father in a new
way that required him to answer to her legitimate grievance. This
in itself was the transformative and healing shift, quite aside from
any favorable response from her father. In fact, we pointedly tell
clients in such circumstances not to expect a favorable response,
and that the purpose of taking a self-validating, self-affirming posi­
tion in relation to an abusive parent is to establish oneself as self-
affirming, regardless of response. It was a bonus that this woman’s
father responded, momentarily, with the loving behavior a dad
ought to express. No other such displays of feeling occurred.
The therapist asked if anything during the visit connected with
the central emotional truth that had emerged in a previous session
in the words, “My unhappiness over feeling unloved by my dad is
bigger than any happiness I’ve been able to have.”
She said, “Most of the time I felt a lot lighter than I’ve felt in
years, which comes from the awareness of that. I think that was a
real key thing for me to acknowledge. I was really aware o f how
much more buoyant I felt, just in general—how much easier it was
for me to be silly and to have fun and just to be positive. . . . Being
so much more able to have fun is to me a strong sign that despite
80 D epth-O riented B rief T herapy

the baggage I’ve been carrying around about my dad, I’m able to
get free of that now.”
While that central emotional truth was unconscious as a posi­
tion of hopelessness, she was depressed. Having consciously
embraced, validated, and begun to grieve it, she had moved out of
it and now described herself as buoyant, positive, readily silly and
having fun—strong indications of depression dispelled and the
position of hopelessness dism antled. C urrent happinesses now
stood on their own ground. Her newfound appreciation of and
capacity for fun was a manifestation of her new position of know­
ing she’s right and following her own (instead of dad’s) interests,
dissolving her old position of staying connected with dad by sub­
ordinating her reality to his.

Sessions Eight and Nine

In session eight, two weeks later, she said she wanted to focus next
on her uncertainty over how to develop her career. The session
was spent entirely on considering what for her actually is fun and
enjoyable in work and what isn’t, including the “shoulds” that she
told herself seemed meaningful but actually were not enriching.
She came to a definite knowledge that what she most wanted in
the immediate future, regardless of the details of what she chose
to do, was to “relax and have fun” in the course of choosing it and
doing it—a significant desire for a veteran workaholic.
In session nine, five weeks later, she shared a new development,
explaining, “I’ve met this guy, and in the course of conversations
with him, I began to realize that he really listened and he was inter­
ested and enthusiastic about me, and was really supportive of me.
He came to visit last week, and we had a wonderful time together.
For several days before he came, I would wake up in the middle of
the night and think about him and have this excitement. I’d be
lying there w ondering, ‘W hat’s going on? Am I ju st fantasizing
something I want that’s not really there? O r is this person really
wonderful?’ Ultimately I realized that this wasn’t so much about
him, but that I was having this feeling, a feeling of elation, or of
expanding and just sort of rising and getting bigger. And then I
rem em bered your asking, ‘What would it feel like if there was a
man in your life who was sensitive and supportive from the begin-
 Resolving E motional W ounds 81

rung?’ And I thought, ‘This is what it would feel like!* And I real­
ized that that was another thing that has come out of the sessions:
getting to where I expect to be taken seriously, and feel happy
about it happening instead of unhappy over not being important.
And there’s also the event that happened when I was visiting my
parents, and we had done visualizations and it had happened, and
it struck me how powerful this work is, because it gets to the heart
of what’s important to me.”
To the therapist it was significant that she felt excitement over
a man who from the start was emotionally open and mutual. Since
the client once stated, “T h ere’s never been an attraction for me
with someone like that” (session two), this excitement indicated a
fundamental transform ation of her unconscious, pro-symptom
position from com m itm ent to getting a man like dad to bestow
love and make her lovable, to knowing she is inherently lovable
and being with a man who already appreciates that.
Her focus now returned to the previous session’s themes of
work and career. She reported that despite remembering what she
wanted to do—relax and enjoy her work, whatever it would be—
she had immediately consumed herself in planning an ambitious
project, knowing all along that “this had nothing to do with relax­
ing at all.” However, after weeks of planning, she abruptly dropped
the project. Concerned about this bout of workaholism, with which
she coped by again abandoning serious work, she explained that
she wanted “to develop a pattern that allows me to accomplish
things in a scaled-back way, so that I d o n ’t have to have this big
push and long hours of work.”
She went on to say, “T h ere’s another thing th at’s going on ,”
and introduced som ething she suspected m ight be making her
reluctant or even fearful of getting fully reinvolved in work. It had
to do with a jo b she’d had for almost five years, ending two years
ago. “I think I have to face that my experience in Jack Sm ith’s
office [fictitious name] was really painful, and the idea of going
back into full-time work is very frightening to me, actually. I’m
afraid to go back to work for somebody because I’m afraid that I’ll
be a bad employee, basically—because things were so awful at
Jack’s, and it was never clear to me what I was doing wrong.
[Pause] I think I need to go over that [Beginning to cry] because
it’s still really painful.”
82 D epth-O riented B rief T herapy

The therapist asked what had actually happened. “Jack was in a

terrible mood for months on end, and he never would say what was
bothering him, so we were always trying to figure it out. Either
there wasn’t enough money because clients h adn’t paid or there
weren’t enough new projects. And he would start being critical of
everyone’s work, often mine. O r h e ’d be in a really good mood,
even though the projects were spinning out of control. I was called
the project manager, but I didn’t have any experience managing
big projects, and I didn’t actually have any control. I would do all
the work, and he would take all the credit; we’d go to the meetings
and h e ’d make all the presentations. I’d sit there and get these
awful backaches, and finally I couldn’t bear sitting in those meet­
ings anymore, because I felt invisible. Then there were a couple of
times at big meetings when, without warning me at all, h e’d tell me
to do the presentation, without having given me any chance to pre­
pare. To this day I d o n ’t know if he was being purposely cruel or
just totally thoughtless to spring that on me. Everything with him
was so chaotic, but I just assumed that that was the way work went,
and it was up to me to make the best of it.”
Asked if this resembled her experience with her father, she
said, “Oh, definitely. The good-mood/bad-mood thing, and never
knowing what was wrong. And being barked at without explana­
tion.” Clearly this boss and father figure further traumatized her
and taught her to expect emotional abuse and high anxiety in the
work setting, so that she now dreaded the prospect of full-time,
long-term employment and was avoiding it.
The therapist asked her what she would need in order to feel
ready to again take a full-time position. She thought and then said,
“To know that I wouldn’t take on all the guilt, that I wouldn’t feel
responsible, because I think what was more damaging than any­
thing else is that I felt responsible for the problem s.” This now
em erged for her as yet another facet of how she had construed
reality on that jo b in the same way that as a child she had con­
strued her father’s emotional abuse and neglect: as meaning she
was in the wrong, was wrong about her perceptions, and dad was
right. A revision of her history with Jack Smith clearly was needed,
and the therapist saw this as an opportunity for her to bring to bear
her new ways of making sense of such experiences.
The therapist made this suggestion: “How about picturing him,
 Rksolvinc; E m o tio n a l W ounds 83

and letting yourself say everything you need to say to him, every­
thing that wants to come out?”
Speaking through tears to her image of her former boss, she
said, “The fact is, Jack, it was mostly your fault for being such an
awful manager. [Pause] 1 tried really hard to make you a better
manager and to make it easier on both of us. I sat down with you
and told you what the project needed, and how I needed your
help, and you’d sit and listen and agree, and then nothing ever
changed after that—it just went right back to the way it always was.
Finally I just gave up. But I was wrong to feel guilty for everything
getting out of control, because it was your responsibility. [Cries
harder; sobs] And you know, I’m really sorry we couldn’t end our
relationship better, with more respect and appreciation, and I tried
hard to do that, too, but I could see that you just wanted to build
up a sense of resentm ent and victimization, because in your eyes
somehow I let you down. But I ju st c o u ld n ’t provide what you
needed, and I d id n ’t deliberately let you down. [Cries]” To the
therapist she then said, “You know, I depended on Jack a lot for an
image of myself\ and in the end, when he accused me of being a
bad team member, I really questioned what I was doing and what
was really going on.”
That she had replayed with this boss the emotional patterns
experienced with her father was now even more strikingly clear to
her. She said she felt better from saying these things and that she
needed them to be a mantra that she keeps repeating. Asked what
the specific words of the mantra should be, she said, “It’s not my
responsibility that the projects were over budget and out of con­
trol.” It was clear that these words were a reassertion of her earlier
breakthrough, “I’m right about the problems in the family.” The
therapist wrote the “m antra” on an index card and handed it to
her. Reading the card, she said, “It makes me feel really good just
to look at that.”

Session Ten
The next session occurred three weeks later. The client reported,
“I’ve actually been feeling a lot more relaxed about what’s going
on for me right now . . . I’ve been spending time figuring out what
I want to do with my time and what feels right for me, over the
84 D epth-O riented B rief T herapy

next several months. I’ve come around to thinking it’s OK for me

to just take it easy a little bit more, and just take a couple of classes
I’ve been wanting to take, and kind of scrape off a lot of the oblig­
ations I’ve created for myself, and try to simplify my life more, and
get more sleep.” That she had actually been tolerating and enjoy­
ing feeling relaxed and was intentional about reorganizing life to
sustain that, indicated that her intense, workaholic “high” was no
longer a needed alternative to depression. She was beginning to
replace the high with sober self-care.
She said she d id n ’t have a sense of there being anything to
work on in the session and was feeling that maybe it was time for
her to assimilate the effects of the sessions rather than work on any­
thing new. The therapist supportively agreed, making a point of
showing respect for her own knowledge of what’s right for herself.
If more therapeutic assistance were needed, she would be more
inclined to get it if the therapist now demonstrated respect for her
judgm ent.
She decided to use the rest of the session for a discussion of
the difficulty of choosing a direction for her work. After a while
she explained that one of the chief difficulties is “a nasty voice
inside” that accuses her of being “just a dilettante” who never sticks
with anything long enough or deeply enough and never chooses a
direction on a sound basis. It emerged that according to this voice,
it didn’t count for much that she had spent four years in business,
two years in graduate school, and then nearly five years in Jack’s
office. From the position of that voice, to change is to be a dilet­
tante, period. In the ten rem aining m inutes of the session, the
therapist focused the following process of radical inquiry and expe­
riential shift on the position this voice was expressing.

Therapist: Sounds like that part of you doesn’t give any value to
following your interest. Almost as though that part of
you says, “You should stay with what you’re doing,
whether you feel interested in it or not. T hat’s real
character. T hat’s a serious worker.”
Client: Yeah, yeah. It’s true.
Therapist: Stay in one place and build that career. T hat’s the only
measure of your character.
Client: Yeah. Completing the thing.
 R eso lv in g E m o tio n a l W ounds 85

Therapist: W hat’s “completing” mean in a career?

Client: I guess, getting to a point of feeling confident and rec­
ognized for being able to do the job.
Therapist: OK, so this part of you has these values, that much
more im portant than interest in the work is staying in
it long enough to achieve a certain level of confidence
and recognition.
Client: Actually—staying longer than that point is what’s been
damaging.
Therapist: When you say that, it sounds like a different voice
than the one that says, “Stay no matter what, or you’re
a dilettante.” What you just said recognizes that you
shouldn’t stay longer than is healthy for you.
Client: Yeah, that’s true. [Pause] I feel like just in this last
week, that “Stay no matter what” has shifted. I mean,
I’m not totally confident about it, but now it’s feeling
that what I’m doing—making a change again—is OK.
And it helps to talk about it this way. . . . I d on’t like
that voice that tells me that I have to keep doing what
I’ve been doing.
Therapist: That voice—I wonder what the emotional truth of that
voice is. “Stay no matter what.” Any sense of what
that’s really about?
Client: I think it’s responding to my father. I really think it’s
his approval that’s involved.
Therapist: In other words, do only what will make him want to
connect with you?
Client: Something he can respond to, yeah.
Therapist: So that voice is actually saying, “Stay with what dad can
relate to, or he won’t respond to you.”
Client: And as a kid I used to do things like trying to create
fossils and playing with worms, and h e’d never con­
nect with me in that. The support I got from him was
for being a lawyer or going into business. It never
occurred to me that I would do anything else.
Therapist: So, your lifelong experience is that following your own
real interest takes you further and further away from
anything dad might know how to connect with.
Client: Yeah, yeah, definitely.
86 D epth-O riented B rief T herapy

Therapist: So that might be the emotional truth of that voice. So

when that voice gets going, it would be so interesting,
I think, if you were to turn to it and respond by saying,
“I know how scared you are that dad won’t be able to
follow us, where we’re headed.”
Client: Yeah.
Therapist: You look as though something stirred in you just then.
Client: Yeah. That makes me feel very emotional.
Therapist: And what’s the specific feeling?
Client: Relief. [Cries]
Therapist: Relief over what?
Client: [Spoken through tears] Well, it’s the idea of taking
the child who would’ve liked to have heard that a long
time ago and giving her ways to have a lot of joy just
doing things that are fun and exciting.
Therapist: Yes.
Client: As long as I can remember, there wasn’t a single per­
son who could do those kinds of things with me. I did
them alone.
Therapist: I’m not sure if this is connected, but I get even more
of a sense now of how special it is—almost like,
“Could this be real?”—that you’re almost beginning
to have that kind of experience with this new man in
your life. “Could it really happen that someone rec­
ognizes and respects and supports what really inter­
ests m£?”
Client: Right. It seems very eerie.
Therapist: Eerie—stepping into a different reality.
Client: Yeah.

Time was now up. She said it still felt right not to schedule
another session, and that she would call if and when needed.

Commentary
The therapist was often at sea in the midst of the unfolding com­
plexity of this client’s pro-symptom positions but had a compass, a
direction: radical inquiry into the emotional truth of the specific
symptom currently in consideration. Persistence in radical inquiry
 R eso lv in g E m otional. W ounds 87

revealed the various facets of her pro-symptom emotional truth

until the full picture was in clear view.
At times, symptoms continued despite significant steps of rad­
ical inquiry and experiential shift. The therapist took this as indi­
cating that there were additional pro-symptom positions to find
and shift, so she reinitiated radical inquiry. By cycling back and
forth between processes of radical inquiry and experiential shift
as needed th ro u g h o u t these ten sessions spanning eighteen
weeks, all significant pro-symptom positions were identified and
changed sufficiently to relieve the symptoms, in depth, to the
client’s satisfaction: happy and enthusiastic feelings were now
readily accessible and persisted without sudden, mysterious rever­
sion to depression; she was now self-affirming rather than self­
invalidating as a basic interpersonal stance (and actually held her
self-validating position in the presence of h er father, eliciting
from him the never-before-heard words “I love you”); she was
elated at her involvement with the emotionally generous kind of
man for whom she had previously felt no attraction; she felt a
new freedom and willingness to follow her own actual interests
in her work life, regardless of h er fa th e r’s directives; she felt
highly intentional about working in a nondriven way, and was
now in a position to make this change because she no longer
needed a workaholic “high” to keep her out of depression; and
she was now extracting herself from a post-traumatic pattern of
avoiding full-time employment.
Residual flickers of old views and feelings could be expected
to occur at times, but she was now well positioned to deal with such
moments.
It is noteworthy that her symptom of abrupt, involuntary sup­
pression of any happy, energetic feelings was being generated by
three distinct pro-symptom positions concurrently. These three
positions, revealed by radical inquiry, can be linguistically charac­
terized as follows:

1. “Feeling happy about current things pales in comparison to

how unhappy I feel over som ething much bigger: my father
doesn’t love me; I’ve been left out and left behind.” (This cen­
tral emotional truth was dispelled by making it conscious, cry­
ing over it, establishing the new position “I’m right about the
88 D epth-O riented B rief T herapy

problems in the family,” and being willing to confront father

with his failure to say, “I love you.”)
2. “Sustained satisfaction and enthusiasm in work would lead to
a ‘career,’ which would eliminate everything else I love doing,
so enthusiasm is too threatening to allow.” (Presupposing that
“career” would be all-consuming reflected her own addictive
need for the “high” of being totally consumed in work. This
dissipated when she no longer needed that high to keep her
out of depression and no longer n eed ed to drive herself
to live up to dad’s standards, opening up the possibility of a
relaxed approach to work and making the prospect of career
safer.)
3. “Sustained satisfaction and enthusiasm in work would lead to
full-time, long-term em ploym ent u n d er some boss and to a
repeat of my traumatic failure to perform adequately in that
situation, so I m ustn’t let this good feeling stand.” (This was
diminished by developing a new construction of the meaning
of the earlier work situation, seeing not herself but the boss as
the cause of the problems and pain—an assertion of her new
position, “I’m right about the problems in the family.”)

As a protective action against actually feeling h er immense

loss and grief over her father, this woman had created and was
m aintaining a construction of hope or rectifiability, an uncon­
scious plan to recover what was lost and set right the story by get­
ting an unloving man (an em otional replica of h e r father) to
become loving. A construal of rectifiability functioning as a pro­
tective action against experiencing a wound of profound loss gen­
erates repetition com pulsion: an endlessly repeating, doom ed
attem pt to undo the loss.
Resolution of this w om an’s low self-esteem and depression
involved substantial fourth-order changes. She dissolved her con­
strual of herself as fundamentally bad, insufficient, and unlovable
and replaced it with knowledge of herself as fully worthy of love.
She dissolved another fourth-order construal of herself as having
a fundamentally deficient capacity to have accurate perceptions of
family relationships, along with the associated fourth-order con­
strual of intrinsic “weakness of character” as the explanation of why
she felt so unhappy in the family. These she replaced with the
 R eso lv in g E m o tio n a l W ounds 89

knowledge that her intrinsic capacity to know is sound and trust­

worthy (“I’m right about the problems in the family”).
With so much change occurring at a very high level of super-
ordinacy, it is not surprising that a wide range of spontaneous
changes accompanied the elimination of the symptoms. Higher-
order construct A was changed in order to change lower-order con­
struct B, but of course then most other constructs subordinate to
A also changed. The higher the superordinacy of A, the more
numerous, visible, and significant will be these accompanying
lower-order changes.
We can now define more precisely why DOBT’s methodology of
utilizing the emotional truth of the symptom rapidly produces
change beyond symptom relief. The emotional truth of the symptom
is a set of constructs that are superordinate to the symptom. Resolv­
ing the symptom through change at this superordinate level pro­
duces enhancem ent of well-being in the more deeply meaningful
domain of that level as well as in the domain of the level on which
the symptom exists and in the domains of all other levels in between.

Table 2.1. O rders of Position and Constructs of Woman Who

Was Unhappy No Matter What.
Order o f Position Construct

Fourth Order: I am incapable and unlovable. I lack the capacity

Nature of to understand what is happening in personal
self/others/world relationships. I cannot survive disconnected from
my original bond to my father.
Third Order: Prevent disconnection from father at all cost.
Purpose to be served Get father to love me and confer lovability on me.
by attributions
of meaning
Second Order: Men like dad are the attractive ones.
Attribution of Situations of work and love are sources of
meaning in evidence that I am unable, bad, wrong, unlovable.
concrete situations
First Order: Dad’s right— I’m a dilettante and a
Concrete thoughts, failure.
feelings, behaviors Chronic low self-esteem, depression, workaholism.
90 D ep th -O rien ted B rief Therapy

The hierarchy of constructs generating this w om an’s low

self-esteem and depression is depicted in Table 2.1. Therapy
transformed her fourth-order constructs, which produced change
in the fourth-order domain (a major enhancem ent of self-concept
and core sense of well-being), a third-order change of purpose to
be served by construing (the purpose changing from maintaining
connection with dad through self-invalidation, to self-expression
and separation-individuation), second-order changes (in how she
construes current problems, friends, family, career, and partner),
and many first-order changes (including elimination of workaholic
behavior, depressed mood, needy behavior with friends, and rep­
etition compulsion with men).

Sum m ary_________________________________________
We have studied exam ples o f rapidly resolving the presenting
symptoms of lifelong depression and low self-esteem as well as
the deep em otional wounds generating those symptoms. This
was accomplished by carrying out the two top priorities in depth-
oriented brief therapy: (1) radical inquiry to identify the hidden
emotional truths necessitating the symptom, and (2) experiential
shift to transform key constructions o f reality com prising the
c lie n t’s unconscious, pro-sym ptom position. These two key
processes alternate and interweave in the course of working with
a pro-symptom construction of some complexity. The therapist
freely pursues any part of the methodology of DOBT as needed,
in any sequence, and the process becomes a nonlinear one and
continues until all relevant pro-symptom positions are dispelled.
For dispelling low self-esteem, two types of experiential shift
are needed: (1) Through position work, the client directly feels
and knows his or h er (third-order) purposes served by m aintain­
ing the negative construal of self and becomes aware of being
unwilling to harbor positive self-worth, for the sake of those vital
purposes. The realization of actually being the purposeful imple­
m entor of the state of low self-worth dispels both the plausibil­
ity of that construction and its seemingly involuntary nature. As
a result, the client for the first time allows (2) changes in
(fourth-order) knowledge of the nature of self, such that the self
is no longer construed as hopelessly deficient.
 Resolving E motional. W ounds 91

As a way of conceptualizing how the construction of reality in a

pro-symptom position is organized and how therapy alters that con­
struction, we have applied and extended Bateson’s scheme of the
‘logical types” or orders of change. We conceive of the constructs
that make up a person’s models of reality as having a four-level, hier­
archical organization, with superordinate and subordinate roles in
defining reality. It becomes apparent that therapy is most effective when
change is carried out on levels superordinate to the level on which the pre­
senting symptom occurs. The two clients in this chapter changed as
rapidly as they did because the therapist focused radical inquiry and
experiential shift on creating change at high-order levels of the
clients’ pro-symptom positions. The perhaps exotic sound of “third-
order” and “fourth-order” change should not in any way obscure
the accessibility principle—the fact that unconscious constructions
on these levels are immediately discoverable and available for
change.
As the reader may have noticed in these first two chapters,
most of the specific interventions used for radical inquiry and
experiential shift are simple and transparent. How to inhabit the
conceptual framework and the therapeutic stance in which such
simple but exceedingly effective interventions naturally come to
mind is the subject of the next two chapters.

Notes
P. 4, Our remedies oft in ourselves do lie: W. Shakespeare (1988), All's Well
That Ends Well (Act I, Scene 2), New York: Bantam.
P. 67, a sim ilarity , though not an equivalence , o f these ideas with , fo r example,
those o f Fairbairn: W. Fairbairn (1974), Psychoanalytic Studies o f the
Personality, New York: Routledge, Chapman 8c Hall. (Original work
published 1952.)
P. 91, Bateson's scheme o f the “logical types" or orders o f change: G. Bateson
(1972), Steps to an Ecology o f M in d (pp. 2 7 9 -3 0 8 ), New York:
Ballantine.
 CHAPTER 3

The Emotional Truth

of the Symptom
But such is the irresistible nature of truth,
that all it asks, and all it wants,
is the liberty of appearing.
T homas Paink, The Rights of Man

When we use the phrase emotional truthvi'xth clients, they intuitively

know what it means. This kind of vocabulary is of value in achiev­
ing deeply effective therapeutic results in the shortest possible
time. It is evocative for clients, and using it actually helps them go
deeper into emotional truth, experientially, in the session.
We believe that the technical language therapists use to con­
ceptualize and to talk to each other about therapy should also be
therapeutic for clients and directly useful in therapists’ in-session
responses. For us, this is a criterion for a psychotherapy that is fully
congruent with its purpose of producing psychological well-being
and emotional healing. This criterion requires a nonpathologiz-
ing paradigm, because to communicate to the client even implic­
itly a pathologizing understanding of him or her is to have the
therapy work powerfully against itself.
The intuitive understanding of “the em otional truth of the
symptom” is the most important kind of understanding to have of
this central concept in depth-oriented brief therapy. However,
DOBT is not only the practice of a subjective art. In this chapter
we elaborate the conceptual definition and the structural mapping
of the symptom’s emotional truth, showing how it operates in the
client as an unconscious, pro-symptom position. It is the discovery

93
94 D epth-O riented B rief T herapy

of the emotional truth in the client’s pro-symptom position that is

the goal of radical inquiry, itself the subject of the next two chap­
ters. Having a clear understanding of what is being sought will
serve as a useful foundation for the coming discussion of how rad­
ical inquiry is carried out.
We begin this chapter with a description of the symptom’s emo­
tional truth as a construction of m eaning within a specific but
unconscious context in the client’s life. The nature of the pro­
symptom position is then further clarified by noting how it differs
fundamentally from the psychodynamic concept of secondary gain
and from the family-systems concept of the function of the symp­
tom. Next we describe a solution to a mayor epistemological prob­
lem that plagues constructivist psychologies: the problem of a
human being’s capacity for simultaneously knowing and not know­
ing something, which we propose to resolve with a conception of
the unconscious that provides a unified epistemology of conscious
(anti-symptom) and unconscious (pro-symptom) process.
This is followed by a systematic description of all of the types
of constructs comprising pro-symptom positions. Here we map out
the internal organization of positions in terms of the four orders
of structure introduced in previous chapters. Lastly, we review how
our clinically derived model of autonomously functioning, uncon­
scious positions receives striking corroboration from developments
in the fields of cognitive psychology, emotion theory, and, in par­
ticular, cognitive neuroscience, the experimentally derived map­
ping of brain structures involved in psychological functioning.

Em otional Truth and th e C o n textual

Construction o f R eality____________________________
You are a writer of science fiction. You are populating a world with
intelligent beings who have a truly bizarre mental makeup. You are
pondering the specific design of that m ental makeup. Would it
seem to you sufficiently strange to have each individual m ind
simultaneously harboring any num ber of different realities, dif­
ferent constructions of sense and meaning for any one perception
or item of experience? To us this would be more than sufficiently
bizarre for science fiction, but strangest of all is the fact that our
real-life human mind operates in exactly that way.
 T h e E m o tio n a l T r u th o f t h e Symptom 95

However, this only begins to hint at the m ind’s truly creative

troublemaking capacity. Trouble arises for several extraordinary
reasons.
First, the m ind not only harbors m ultiple meanings for the
same item but also may apply two or more of these differing mean­
ings sim ultaneously.
Second, it often happens that only one of these simultaneous
attributions of m eaning is conscious, while the other(s) are
unconscious.
Third, a meaning that is unconsciously construed and attrib­
uted triggers behavioral actions and mood states no less readily
than do consciously applied meanings.
N ow the possibilities for our science fiction plot are both unlim­
ited and truly strange. Welcome to planet earth.
An earthling in therapy is initially conscious only of how the pre­
senting symptom figures in contexts in which the symptom inter­
feres painfully and pointlessly with his or her functioning. We call
these sym ptom -negative contexts. The client is unconscious of the symp­
tom’s great p o s itiv e value in certain other contexts; these we call
sym ptom -positive contexts.
Let’s reconsider the agoraphobic woman whose therapy ses­
sions were described in C hapter One. D uring h er symptomatic
moments while walking alone to a store, she would experience the
delusion of having her caring form er therapist nearby, and she
would consciously construe only a s y m p to m -n e g a tiv e context of psy­
chiatric pathology to make sense of this delusion. In that context,
she naturally attributed to her symptom dire meanings such as “psy­
chotic,” and it was this interpretation that was so fear-producing
that she had started staying home. Through radical inquiry, the
therapist found the unconscious, symptom-/?05zto£context in which
the same symptom had great value to her: the context of emotional
connectedness or belongingness. In that context, which the woman
was unaware of also invoking as she walked along a street, the acti­
vation of a painful em otional wound of abandonm ent would
unconsciously begin to occur, and the symptom was for her a
much-needed and quite effective way of protecting herself from let­
ting this happen. The delusion was for this reason more important
to have than not to have, despite the considerable conscious dis­
tress that accompanied having it.
96 D epth-O riented B rief T herapy

In the client's conscious, anti-symptom position, awareness is limited

to symptom-negative contexts. From this position the client naturally
regards the symptom as completely undesirable, valueless, sense­
less, an absolute obstacle to well-being. This anti-symptom position
is not “wrong”; it is valid in relation to all contexts in which having
the symptom genuinely torments the client. The client genuinely
wishes to be free of the symptom in those contexts. It is vitally impor­
tant for the therapist to indicate to the client ample understand­
ing of, and accurate em pathy for, how the symptom hurts in
symptom-negative contexts.
However, the client harbors at least one o th er context, a
symptom-positive context, in which the picture is decidedly dif­
ferent, where the symptom has intensely positive value. Yet the
client is unconscious of this positive value and perhaps of the very
existence of this context in his or her life.
Only by viewing the symptom in the symptom-positive context(s) does it
become clear how the symptom is more important to have than not to have.
Within that context the client has a specific construction of mean­
ing, the pro-symptom position, that directly makes the presenting
symptom vitally valuable and meaningful.
For example, the symptom may be a solution (or an attempt at a
solution) to a problem existing in the symptom-positive context. In
the always-fighting couple cited in Chapter One, the hidden value
of each partner’s symptom of readiness to fight was found in the
symptom-positive context of autonomy or personal power. Within
that context the symptom was made compellingly necessary by a
construction consisting of the emotionally urgent, self-protective
rule “avoid being controlled in personal relationships” plus the
unconscious presupposition that “if I am in harmony with my part­
ner, I am being controlled.” This does not deny the fact that “being
happy together” was also an im portant priority for each of them,
but preserving autonomy was an even higher emotional priority,
though neither of them was aware of this at the start of therapy.
To summarize: W ithin the clien t’s em otional reality in the
unconscious, symptom-positive context, the symptom is critically
necessary and valued by the client, or it expresses imperative
needs, the specifics of which are the emotional truth of the symp­
tom, the unconscious, pro-symptom position of the client. Within
the client’s emotional reality in the conscious, symptom-negative
 T he E m o tio n a l T r u th o f t h e Symptom 97

contexts, the same symptom is hated and seen as a curse, an invol­

untary affliction to be cast away, the specifics of which are the
client’s conscious, anti-symptom position. All of our clinical cases
in earlier and later chapters can be understood in these terms.
In essence, then, living as though the symptom's emotional truth
isn't the case is what generates the symptom in the first place. Symptoms
arise precisely because of unawareness of the meaningful, coher­
ent personal them es that are gen eratin g them in the clie n t’s
symptom-positive contexts.
A context itself proves to be an internally held construction of
meaning that the individual invokes in response to perceptual cues
rather than an external, objective reality, as it is usually regarded
to be in the social sciences. A context is a large collection of spe­
cific meanings of situations, thematically related. Examples of dis­
tinct contexts include social relationships, work life, couple or
marital relationships, parent-child relationships, sibling relation­
ships, physical health, financial concerns, morality, sexuality, spiri­
tual life, physical survival, creativity, politics, recreation, athletics,
self-esteem, autonomy, belongingness, emotional safety, intellec­
tual ability, and so on. Obviously these contextual zones of experi­
ence may overlap or be nested within one another, as, for example,
when themes of autonomy are active in family-of-origin relation­
ships, or when self-esteem is entangled with creativity.
A person’s constructions of context can be his or her carbon
copies of cultural and family (that is, consensual) constructions, as
emphasized by the social constructionist movement, or may be
more idiosyncratically created by the individual, as emphasized by
the radical constructivist movement. In either case, whether a ver­
sion of reality is received or personally created, it is ultimately the
individual who installs it in his or her own mental makeup, imple­
ments it in concrete situations, and has the capacity to unmake it.
To implement or invoke a particular construction is to inhabit a
particular subjective reality, which then seems objective. Usually,
people are unconscious of the internal act of invoking humanly
invented constructions, and instead they have the (largely illusory)
experience of existing within externally imposed, nonarbitrary pat­
terns of living.
W hen we describe a therapy clien t’s governing, symptom­
generating construction subjectivistically—that is, when we are
98 D epth-O rien ted B rief Therapy

emphasizing the subjective experience of the meanings and feel­

ings comprising the construction—we refer to it as the emotional
truth of the symptom. When we describe the same construction
objectivistically, wishing to focus on it as a formation of certain psy­
chological components, we refer to it as the client’s pro-symptom
position, or the “hidden structure of the symptom,” or other such
phrases referring to structure. Except for this difference in empha­
sis, the two phrases emotional truth of the symptom and pro-symptom
position are synonymous.
The emphasis on emotional truth in depth-oriented brief ther­
apy is to be clearly distinguished from merely encouraging the
client’s emotionality. With many clients the symptom is their habit­
ual emotionality, and they need to be brought out of it. The emo­
tional truth of the symptom is not the emotional state the client
already consciously experiences, but rather the initially unconscious
form ation of em otional, cognitive, and somatic m eanings and
knowings that make the symptom (including symptomatic emo­
tionality) compellingly im portant to produce.
A fundam ental feature of this conceptual picture is the fact
that the client’s unconscious positions have autonomy. Despite
being unconscious, a pro-symptom position is highly responsive
to any current situation that appears to challenge its purposes,
and it autonom ously asserts its response. The response im ple­
mented by a pro-symptom position—such as delusion, depression,
self-depreciation, or compulsive working, to name examples we
have already considered in detail—always serves to protect the
client or strives to secure well-being in some specific way that is
construed necessary within the experiential reality of that posi­
tion. Since this autonomous response happens to be troublesome
or painful for the conscious self (or to others), it is termed a symp­
tom, and it mystifies the client because his or her conscious posi­
tion provides no way to make meaningful personal sense of it or
of why it cannot be stopped by an effort of will.
The autonomy of a person’s unconscious positions means that
he or she does not merely have such positions but is, in some real
sense, actively and simultaneously in all positions at once, though not
consciously. The individual is ever scrutinizing current circumstances
through the lens of each position simultaneously, and every position
is ready to activate should circumstances appear to warrant it.
 T h e E m o tio n a l T r u th o f t h e Symptom 99

The pro-symptom position is a kind of subself of the client, an

experiential reality narrowly and passionately preoccupied with cer­
tain highly focalized themes and possessing its own knowledges,
memories, em otions, attitudes, and actions relevant to those
themes. The “subpersonalities” or “parts” conceptualized by vari­
ous experiential psychotherapies (such as Gestalt and Jungian ther­
apies, transactional analysis, and neuro-linguistic programming)
correspond more or less to what we term unconscious positions.
In order to bring about an interaction and integration am ong
these unconscious formations and the conscious self, these thera­
pies employ many techniques that are directly applicable in DOBT.
We emphasize, however, that DOBT desists from stereotyping or
personifying unconscious positions or theoretically defining or
naming them for the client, relying rather on the fully phenom e­
nological approach of radical inquiry to discover from the client what
the specific characteristics of his or her pro-symptom position (s)
are, including such personifications as “inner child,” “critical par­
ent,” “warrior,” and so on.
Once a client has experienced and grasped the em otional
truth of the symptom, we generally prefer to speak about his or her
previously unacknowledged position, because it unmistakably yet
blamelessly connotes the client’s active, potent, purposeful involve­
ment in generating the symptom. For exam ple, by saying to a
client, “So it seems you also have this other position that you didn’t
realize you had, a position in which you feel very strongly th a t. .
the therapist fosters integration and an empowering experiential
realization of being the author-creator-implementor of the symp­
tom, rather than the victim of a reified “part” or “subpersonality.”
This is not a dogmatic point, however, and there are times when
the term part is useful, provided it is not used in reifying ways that
support the client’s victim position.

The Pro-Sym ptom Position and th e Concept o f

Secondary Gain___________________________________
The concepts of the pro-symptom position and the em otional
truth of the symptom are to be distinguished from the familiar
psychodynamic concept of secondary gain. This concept rests upon
the view that the presenting symptom in its primary nature is a
100 D epth-O riented B rief T herapy

form of defectiveness or pathology, but a pathology through which

the client secondarily is deriving benefit in certain ways. In Freud’s
own words, “These are the certain uses the patient can make of
his illness which have nothing to do with the origin of the neuro­
sis but which may attain the utmost practical im portance.” This
view is incom patible with the constructivist paradigm of depth-
oriented brief therapy. In DOBT the symptom’s aspect as a gain
is not secondary to some primary aspect as a pathology, because
the primary psychological significance of the symptom is the gain
or success it achieves for the client, within his or h er subjective
world of meaning, conscious and unconscious. The symptom is
never seen as a pathology or defect that can be identified accord­
ing to external, “objective” diagnostic criteria of mental health.
From the constructivist viewpoint, for a psychotherapist to “objec­
tively” assess the client’s symptom as a pathology or defect is vir­
tually the same as an anthropologist from the U nited States
regarding another people’s ways as defective because they deviate
so greatly from U.S. norms.
There may indeed be several types of gain associated with the
same symptom in various symptom-positive contexts, with some of
these gains being of less emotional weight than others. It may even
be necessary to find and transform the pro-symptom position
involved in each form of gain, in order for the symptom to cease
occurring. However, this situation is not to be confused with the
conceptual baggage of the phrase “secondary gain.”

The Pro-Sym ptom Position and th e Systemic

"Function o f th e S ym pto m "_______________________
The “function of the symptom” is a phrase used widely in systemic
family therapy to denote a situation in which the problem behav­
ior of one or some family members is hypothesized as protecting
the family from having a n o th er problem that the family would
experience as even worse, and that would develop if the problem
behavior were to stop.
The systems-theoretical function of the symptom cannot be
located in any particular individuals. In DOBT, however, the func­
tion of the symptom is viewed as located in the intrapsychic, pro­
symptom constructions of one or more individuals in the family
 T he E motional T r it ii ok the Symptom 101

and as being experientially discoverable and verifiable using stan­

dard DOBT methodology. (C hapter Six details a family session
illustrating this.)
The family system is viewed in DOBT as consisting of no more
and no less than an interaction among the family members’ indi­
vidual constructions of reality—essentially the “ecology of ideas”
approach of Gregory Bateson and the “perspective, m etap er­
spective, and meta-metaperspective” approach of R. D. Laing. In
these views, how any one family m em ber currently understands
the others appears to that family member to be confirmed by the
others’ behaviors. This locks the system into its current, symptom­
generating, mutually adversarial, reactive, or alienated configu­
ration. The critical emphasis that DOBT adds to the picture is the
fact that the “understanding” that one family mem ber has of the
behavior of another is often unconscious—an unconscious inter­
pretation of the meaning of the others’ behaviors, triggering an
unconsciously generated behavioral response. The others then
construe this behavior according to their own private and largely
unconscious worlds of m eaning, and they respond accordingly,
possibly in ways that inflame the problem further, and the cycle
of adversarial reactivity and miscommunication grows.
We prefer the phrase “ecology of meanings” to Bateson’s “ecol­
ogy of ideas.” “Ecology of meanings” avoids the assumption as well
as the im plication that cognition (“ideas”) is the sole hom e of
meaning. Since Bateson wrote, a virtual revolution has occurred
in cognitive psychology, establishing full parity between affect and
cognition as coequal and interdependent modes of knowing, and
recognizing even that “affective experiences and judgm ents take
place or can take place prior to any conscious conceptual pro­
cessing (thinking).” O ur adjustm ent of B ateson’s phrase is
intended simply to preserve its accuracy and not to change what
we believe was already his intended meaning.
However, as therapist Lynn Hoffman points out, “The weak­
ness of Batesonian systemic views is that they offer no language
in which to describe experiential events.” DOBT fills in this gap
with its central focus on clients’ experiential events and with its
methodology for actually discovering and verifying individuals’
unconscious constructions of meaning. This completely obviates
the need for inherently undetectable explanatory entities such as
102 D epth -O riented B rief T herapy

“the systemic function of the symptom.” If the family’s presenting

symptom is protective in some way, this protective purpose and
function cannot exist independently of the discoverable positions of indi­
viduals in the family.
The field of systemic family therapy, in shunning work with
emotions and the unconscious (see Introduction), divested itself
of the therapeutic approaches most effective for accessing and
transforming the family’s largely unconscious ecology of meanings.
The methodology of depth-oriented brief therapy, being designed
exactly for the purpose of rapidly discovering and reprocessing
unconscious emotional truths, is well suited for dispelling the diver­
gence of private, isolated realities and creating common ground
among family m em bers’ constructions of meaning, thereby dis­
pelling symptoms. The therapeutic potency of family members
accessing and revealing their symptom-related emotional truths or
constructions of meaning in the presence of each other cannot be
overestimated (see clinical examples in Chapter Six). If an unex­
pressed personal meaning and feeling is largely unconscious, as is
often the case, accessing it and bringing it into communication
between family members requires, on the part of the therapist, skill
with radical inquiry and comfort with emotional process.

Conscious and Unconscious K n o w in g______________

As easy as it may be after one hundred years of psychodynamic the­
ory to take for granted the existence and activity of the uncon­
scious m ind, we confess to being genuinely intrigued by its
autonomous intelligence. That the involvement of a conscious “I”
is wholly unnecessary for carrying out complex constructions and
strategies is a haunting mystery, made no less so by mechanistic,
reductionist analyses of behaviorist and cognitive theorists. It is this
freedom of the unconscious psyche from any constraint of coor­
dinating with a conscious “I” that allows for multiple autonomous
realities relevant to the same item of experience. W ithin the
domain of the conscious “I” the tolerance for inconsistent versions
of reality is relatively limited, but outside that domain there is no
limit on divergent, coexisting constructions.
When an unconscious, pro-symptom position gets activated
and is asserting its autonom ous response, it takes control away
 T h e E m o tio n a l T r u th o f t h e Symptom 103

from the conscious position. The reasons for this pro-symptom

“possession” are simple: First, within the experiential reality of
the pro-symptom position, circumstances now urgently require
the response that is this position’s jo b to carry out. Second, pro­
symptom positions invariably are, at core, em otionally u rg en t
constructions, because they involve crucial needs or desires. The
habitual conscious position is no match for this double dose of
intensity once a pro-symptom position is activated.
The extent of the displacement of the individual’s usual, con­
scious state by the pro-symptom position can range from the min­
imal degree o f simply noticing a discrete, fully dissociated
symptom (such as a facial tic); to the intermediate degree of being
subjectively drawn into some of the emotions, cognitions, kines­
thetic sensations, and overt behaviors of the pro-symptom posi­
tion (the familiar, conscious “I” is still present enough to be aware
of being strangely possessed, as in anxiety attacks or depression);
to the maximal degree of total immersion in the reality of the pro­
symptom position, with no trace of the usual conscious identity
remaining (as in fugue states or dissociative identity disorder).
If the mind harbors any num ber o f different realities having
very different views, feelings, and responses in relation to the same
event or perception, then what does it mean to say, for example,
“I feel angry” or “I now want a divorce”? Am “I” this experiential
reality or that one?
For purposes of the conceptual framework of DOBT, we cast
all these considerations in the following way: As both Bateson and
Maturana centrally emphasize in their biological theories, all activ­
ity of the psyche is epistemological, a “whole-being em bodim ent
of knowing,” in Mahoney’s evocative phrase. In o ther words, all
human psychological activity consistsfundamentally of the activity of know­
ing, which occurs with or without the involvement of the conscious “I. ”
Independently of any involvem ent of a conscious “I,” the
m ind’s fundam ental operation is to know (just as the hum an
infant continuously is engaged in active knowing even if there is
no “I” present). W here in addition there occurs an awareness or
knowing of this knowing, this extra or meta-level awareness con­
stitutes “I,” or reflective awareness. In other words, the conscious
“I” itself consists of a particular kind of knowing: the awareness of
being present as a knowing attention. For example, the graduate
104 D epth-O riented B rief T herapy

school procrastinator in C hapter One knew not to do his course

work in order to refuse an unwanted path in life, but he did not
know he knew this until the therapist called his conscious atten­
tion to this knowing. It is this meta-awareness, or knowing-of-
knowing, that is the “I ” not the content of what is consciously known.
This definition differs from the popular usage of the term “I”
in which it is the content of all conscious knowings that consti­
tutes the personal, subjective identity of the “I”—contents such
as “I own a car” and “I love my spouse.” Note, though, that an
amnesiac with total forgetfulness of the knowings comprising
personal identity still says “I,” showing that, actually and essen­
tially, ‘7 ” refers to the knower’s awareness of being present as a know­
ing attention, not to the content of what is knoxvn.
What is conventionally termed unconscious is, in this view, any­
thing a person knows without the involvement or awareness of the
conscious “I.” All such unattended knowing—including the for­
mation of elaborated, unconscious positions and their activities—
proceeds autonomously. To say that an emotional, cognitive, or
somatic item is unconscious means simply that the knowing con­
stituted by this item is present without the meta-level awareness of
this knowing. In contrast, to say that some item is conscious or is in
awareness means simply that the person knows the knowing consti­
tuted by this item—that is, has attended to it.
Psychotherapists and psychologists generally understand uncon­
scious inherently to mean a state of “unknowing.” That is, if some­
thing is unconscious, then the client is regarded as devoid of
knowing with respect to it. We take a different view and regard
unconscious constructs and processes of all types—unconscious
emotions, kinesthetics, and somesthetics—as being in fact know­
ings, though unattended by the conscious “I.”
In the course of daily life, one unconscious position after
another becomes activated and “seizes the microphone,” temporar­
ily bringing its particular set of meanings, feelings, and responses to
bear and, as we noted earlier, displacing the familiar version of self
(the habitual conscious position) to one degree or another. Know­
ings normally held in the conscious position as constituting “I,” such
as “I love my spouse,” can then be lost temporarily (as in “splitting”).
The “I” of popular usage, being the content of whichever position is
currendy active and at the microphone, therefore goes through dras-
 T h e E m o tio n a l T r u th o f t h e Symptom 105

tic changes and is experienced as unstable, unreliable, or defective,

because according to cultural norms one is supposed to be a single,
monolithic self. However, “the central ‘I’ is not a fact, it’s a longing—
the longing of all the selves within the psyche that are starving
because they are not recognized,” as writer Michael Ventura observes
in his insightful expose of the “fiction of monopersonality.” Assist­
ing a therapy client to come to grips with that fiction occurs natu­
rally within the methodology of depth-oriented brief therapy.
The above form ulation of the types of knowing—known or
attended-to knowings and unknown or unattended-to knowings—
provides a basis for a consistent, constructivist epistemology that
encompasses the heterogeneous (multi-reality) structure of human
psychology. The lack of such an inclusive epistemology has led to
both conceptual gaps and m ethodological errors am ong con­
structivist clinicians. Consider, for example, this classic situation:
“the case of a m other of a juvenile delinquent who displays two
very different attitudes towards her offspring: an ‘official,’ puni­
tive, censoring one, which verbally dem ands good behavior and
respect for society’s rules; and a non-verbal, seductive one, of which
she may honestly be unaware, but which is very noticeable to the out­
side observer and especially to the delinquent, who is only too alert
to the gleam in her eye and her secret adm iration for his ques­
tionable exploits” (italics in original).
Commenting on this description of the mother-son interaction,
theorist Jan Cambien writes, “People can simultaneously know and
not know something. In this case, mother ‘knows’ that she admires
her son’s questionable exploits, for there is a gleam in her eye and
she does seduce him to persist in his wickedness. If she d id n ’t
know, there would be no gleam and no seduction. Yet one can
accept that she may be honestly unaware of this. . . . How can we
be ‘blind,’ that is, both know and not know a certain reality? What
kind of epistemology could serve us if we are confronted with . . .
such mind-boggling problems?”
Cambien’s conundrum is created by his presupposing the con­
ventional notion that “unaware” means “devoid of knowing.” The
solution to this conundrum is the simple one we have defined
above—namely, adoption of the view that “unaw are” does not
mean “devoid of knowing,” because unconscious knowings are
indeed knowings, though unattended by the conscious “I.” In this
106 D epth -O riented B rief T herapy

view there is no paradox in the person having a conscious posi­

tion containing no knowledge of som ething that the p erso n ’s
behavior shows he or she knows. T hat is, unattended knowings
have direct access to the body and are not dependent upon coop­
eration from the conscious “I” in o rd er to express themselves
behaviorally (“seductiveness,” “gleam in the eye,” posture, voice
tones, and so on). Evidently, the psychophysical capacity to know
and to act is independent of the central executive function of the
conscious “I” to a far greater degree than is presumed in our ego-
and rationality-worshipping, scientifistic culture. C am bien’s
conundrum typifies how we underestim ate the sophistication of
the knowings that occur without any “help” from the “I” at all.
In this picture, the conscious “I” finds itself in the unique posi­
tion of noticing, over time, the discrepancies between the realities
of all the various positions, as detected through their autonomous
manifestations and their perturbation of the habitual conscious
state. The conscious “I” can become interested in fathom ing or
com ing to terms with these discrepancies (even if only in an
attempt to rid itself of the inconveniences or sufferings they cause
it), opening up the process of a true dialectical interaction of these
many versions of reality as they come into mutual contact through
the agency of the “I.”
This sort of consistent epistemology encompassing conscious
and unconscious constructions is needed as a corrective for the
tendency in some psychotherapeutic frameworks to view human
consciousness as unified and monolithic, as though all presenting
symptoms stem from material already accessible to and control­
lable by the conscious “I.” An im portant example of this error
(which has afflicted much of constructivist thinking in the 1980s
and 1990s as well as behaviorism, cognitive psychology, and family
systems theory since the 1950s) is the view, widespread among con­
structivist narrative psychotherapies, that all presenting problems
exist entirely within language, as creations of the client’s linguistic
self-narrative. An expert narrative psychotherapist who claims that
all problems are formed in language is much like an expert farmer
who claims that our planet is entirely covered by soil. The claim
only reveals an exclusive focus upon one domain and a remarkable
unawareness of the presence and influence of an even greater
dom ain. Many of a person’s em otional knowings and all of his
 T hk E motional T ruth of the Symptom 107

kinesthetic and som esthetic ones exist in o th er than linguistic

form.
Let's note m ore concretely how this is so. To fully heed an
experience of emotion is to be richly informed of im portant per­
sonal knowings, meanings, perceptions. If on an ordinary day I
notice myself feeling distinctly sad but have no idea why, I am
immediately informed by the heavy feeling itself that there exists
something I am sad about. The em otional region of my m ind
already knows what this something is—hence the sadness, which is
the felt knowing of a loss—but “I” do not. By attending to this feel­
ing and finding and cognizing the already-present knowings that
are generating this feeling of loss, “I” come to know these know­
ings and realize suddenly, for example, that I am having an
anniversary depression.
Emotion is, in its essence, the experience of knowing that something of
relevance to personal need, desire, or values is occurring The therapist
welcomes the emotion as a valuable carrier of important knowings
and meanings involved in the problem. We do not see emotion as
an aftereffect or an epiphenom enon of cognition, nor do we carry
out DOBT by using reason and evidence to “correct” cognitive
errors or irrational beliefs and thereby control emotion, as char­
acterized the early view in cognitive-behavioral approaches. Rather,
we regard emotion and cognition as complementary ways of know­
ing, operating concurrently. While fundam entally different in
experiential quality, emotion and cognition are not separately or
independently functioning, but rather often mutually influence
each o th e r’s form ation—a view we share with more advanced
developments in cognitive science and emotion theory.
Kinesthetic and somesthetic sensations and actions likewise
are knowings in the domains of physical movement in space and
immediate personal and interpersonal conditions, such as expan­
siveness or contractedness, violations of psychological bou n d ­
aries, and connection or disconnection with others. They are not
in themselves cognitive or emotional, though they may be accom­
panied by knowings of eith e r type. Specific kinesthetic and
somesthetic states may be im plem ented by the individual for var­
ious purposes. A forty-year-old woman described her problem as
intense, sharp pains in her throat whenever she began to strongly
feel and express anything of an em otional nature, negative or
108 D epth-O riented B rief T herapy

positive. She was describing the sensation created by h er own

unconscious contraction at the base of her throat, a somesthetic
act that was itself a knowing of how to rapidly prevent herself
from doing what would bring violent abuse—as occurred many
times throughout her childhood in response to showing her feel­
ings. An example of the kinesthetic knowing involved in symbi­
otic attachm ent is described in Chapter Five.
Cognitions are knowings that are internally represented either
in verbal form (sometimes as inner dialogue in the auditory per­
ceptual mode) a n d /o r in visual form (imagery in the visual per­
ceptual mode). The cognition of highly abstract relationships (as
in mathematics and physics) generally involves a joint effort or syn­
thesis of visual capabilities and a palpable, kinesthetic representa­
tion of the relationship in question.
Why is it im portant in depth-oriented brief therapy to appre­
ciate that all constructs are knowings? The therapist must appreci­
ate the epistemological nature of all constructs in o rd er to
recognize their emotional truth, their essential quality of being
coherent, cogent, and constructively purposeful and adaptive,
rather than seeing them as defects, errors, and pathologies.

The S tructure o f Positions_________________________

Next we turn to the specific types of knowings that comprise the
em otional truth of the symptom, the stuff that radical inquiry
reveals the client’s pro-symptom position to be made of. Here our
discussion will be largely structural or objectivistic rather than sub­
jectivistic, in the sense that we will describe constructs—the com­
ponents of positions—m ore as m ental objects having certain
properties than in terms of how the client subjectively experiences
them.

The Components of Positions

As clinical examples in previous chapters have illustrated, an
unconscious pro-symptom position is a formation of three major
components:

• Emotional wounds
 T h e E m o tio n a l T r u th o f t h e Symptom 109

• Presuppositions
• Protective actions

Each of these in turn is made up of any or all types of knowings:

emotional, cognitive, kine/somesthetic, and perceptual/m otor.
Emotional wounds or traumas, of course, consist primarily of
emotional (nonlinguistic) meanings stored somesthetically in the
body and linked to perceptual memory, and secondarily are also
comprised of any language-based cognitions by which the individ­
ual understood or made sense of the emotionally wounding or
traumatizing experience. Such cognitions include, for example,
views of what caused the experience and the formation of strate­
gies or intentions for preventing any future occurrences of this
kind. All of these elements may be unconscious. Therapists who
have been present as a client experiences the emergence of a pre­
viously unconscious, purely som esthetic/em otional memory of
trauma will have a vivid sense of the existence of such nonverbal
knowings. The term “m em ory” is somewhat m isleading here
because the body carries the trauma currently and unconsciously,
so that the accessing of an emotional memory is a true reexperi­
encing of the original emotional state in the present, not merely a
remembering of the past. Likewise, readers who have received psy­
chotherapeutic bodywork and have had the experience of a pow­
erful em otional state, pregnant with clear, co h eren t m eaning,
suddenly pouring into awareness nonverbally from the body, know
most directly how potent these nonverbal, noncognitive represen­
tations of reality are. Such experiences leave no doubt whatsoever
that emotional knowledge can be stored in nonlinguistic forms. All
emotional wounds involve emotional memories that act as non­
verbal presuppositions of how a certain type of situation will
develop once key behaviors have occurred.
Protective actions utilize any type of construct or behavioral act
to avoid the occurrence of any unw anted event or experience,
including the experience of emotional truth. Both examples in
Chapter Two involved key protective actions: one woman’s con-
strual of “I’m ugly” in both the cognitive form of inner dialogue
and the som esthetic form of a shard of glass cutting h er in the
abdomen, and the depressed woman’s workaholic “high” and rep­
etition compulsion with men, always choosing an emotional replica
110 D epth-O riented B rief T herapy

of her father instead of grieving his failure to express love. As these

examples show, very often the presenting problem is the client’s
protective action, disowned. Protective actions include interper­
sonal or family-systemic patterns of behavior that avoid dealing
directly and openly with the emotional truths in the family or that
covertly manipulate family members in order to prevent imagined
disasters. During a visit to his parents’ home, for example, an adult
therapy client may go into depression as a protective action against
the perceived dangers of confrontation, anger, or rejection that he
expects and fears would result from staying in touch with his pri­
mary feelings and relating on that basis.
Presuppositions are unconscious, unquestioned assumptions
about the nature of reality (the self, others, the world). The effec­
tiveness of working with presuppositions in therapy is due to the
fact that people’s problems are generally not about events or cir­
cumstances in themselves, but about what these mean or what the
possible choices are, as defined by their presuppositions.
Presuppositions are not necessarily cognitive-verbal in form.
They may also consist of representations of reality held in uncon­
scious emotional or kinesthetic memory, with little or no verbal-
conceptual representation.
For example, consider a child, eleven months old and prever­
bal, who has on twenty-eight occasions since birth heard daddy
angrily yelling and then heard mommy crying. This child’s knowl­
edge of how men are, how women are, and what is going to hap­
pen once a man starts speaking loudly is stored entirely in
emotional, perceptual, and kinesthetic memory. This completely
nonverbal knowledge constitutes reality-shaping presuppositions
about what to expect from, and even how to be, a man or woman.
In this example, the child’s preverbal stage makes obvious the
formation of nonverbal knowings. However, even after the stage of
verbal development is reached, emotionally powerful experiences
still create nonverbal representations in emotional memory, which
are stored in association with any verbal-cognitive representations
that may also be formed in the experience. These emotional mem­
ories function as nonverbal presuppositions that inform the indi­
vidual of the emotional meaning of what is taking place—or about
to—in concrete situations.
An indication that a presupposition is of the noncognitive type
 T he E motional T ruth of the Symptom 111

is the client’s very high degree of amazement and disorientation

when finally the presupposition comes into awareness. This inten­
sity of amazement and disorientation occurs because noncognitive
presuppositions are even more divergent from the client’s famil­
iar, cognitive view of self and world than are cognitively held pre­
suppositions.
An amusing example is a male client, age thirty, who came for
therapy feeling very upset and oppressed by his m other’s anxious
overinvolvement in his life. Early in the first session the therapist
became aware of this fellow’s presupposition that whenever his
mother goes into anxiety over him, it is immediately his emotional
job to somehow get her out of her anxiety. This was not a subtle
perception on the therapist’s part. It was easy to see that this man
was so oppressed by his m other’s anxiety because he took it as his
job to dispel it. But her anxiety was endless and certainly undis-
pellable by him.
The therapist began doing the position work of having this
man realize and own his position of having that job. Because of this
chap’s sturdy, spirited temperament, the therapist’s first step in this
direction was a challenging observation. She said, “It seems very
important to you not to let her deal with her own anxiety. You seem
very attached to having that job of getting rid of it for her. Is that a
job you want to keep having?”
For the client, this was the first time the possibility of not doing
that job had ever dawned on him, and it was a stunning insight. His
mouth actually dropped open, he just gazed at the therapist for a
few seconds, and then said, “That’s huge!”He was truly amazed and
visibly lifted by this undreamed-of possibility of liberation, and he
stayed amazed for the rest of the session. He said, “That’s huge!” at
least three more times. He felt no need for a second session.
The naming into awareness of this m an’s presupposition of the
emotional job he had to do for his m other had such an uncanny,
world-changing effect because the presupposition was of the
noncognitive, purely emotional type. As in the hypothetical exam­
ple of the toddler cited earlier, this presupposition probably was
learned preverbally from repeating patterns of family interaction.
O f course, bringing a presupposition into awareness and
verbalizing it will not necessarily divest it of its power to define
reality. A presupposition that “sticks” even after being rendered
112 D epth -O riented B rief T herapy

conscious is diagnostic of unconscious, higher-order purposes

being served by m aintaining the presupposition. Its existence is
strategic in the sense that its purpose is not apparent from its con­
tent. The classic example is a presupposition of low self-worth
unconsciously serving the purpose of preserving a positive image
of parents who were in fact grossly abusive. A strategic presuppo­
sition will dissolve only if the entire higher-order purpose necessi­
tating it is dissolved as well. The hidden purpose can be revealed
experientially by temporarily disabling the presupposition (such
as through the technique of viewing from a symptom-free posi­
tion), at which point the unm et purpose flares into awareness.
These points and methods are discussed further in Chapters Five
and Six.
W hatever modes of representation constitute it, a presup­
position is a standing, unquestioned assumption of how reality
is or works, and it is unconsciously invoked to make sense of cur­
rent perceptions to which it is relevant; it is a kind of hidden,
personal epistemology or rule for knowing. Presuppositions by
the hundreds are continually structuring our personal realities;
some of them becom e com ponents of positions th at generate
symptoms.
Here are the chief categories of personal knowledge that pre­
suppositions inform, as we have encountered them clinically, each
with an example of how an individual m ight verbally formulate
such a presupposition after it has been brought to awareness:

1. Teleology (construed intention or direction): “My husband’s lack of

goals means he is in a bottomless downward spiral like my
m other was.”
2. Roles (necessary behaviors, attitudes, and obligations): “If my wife
or m other shows em otional pain, I have to get h er out of it
immediately.”
3. Causality (what brings about or occurs with what): “It’s my fault he’s
been really closed and distant from me; I wonder what I did
wrong.” “She’s raising her voice; she’s going to reject me.”
4. Ontology (essential nature of self others, or world): “I’m fundamen­
tally deficient.” “There are two kinds of people: Creative, pro­
ductive ones who are never thrown by adversity, and uncreative
ones who let the world mire them down in adversity.”
 Thf. E m o tio n a l T r u th o f t h e Symptom 113

5. Epistemology (how to know): “The way to know if I’m being a good

person is to see if others approve of me.”
6. Values (what is good and what is bad): “Doing what others want or
need is unselfish and good; doing what I want or need is self­
ish and bad.”

It is obvious that unquestioned, unrecognized views such as these

can be centrally involved in generating a client s presenting symp­
toms. Presuppositions powerfully structure what one takes to be
reality, and they powerfully define what the possible choices are.
When operating from a presupposition, it is not at all apparent
that it is oneself who is supplying the m eaning that appears to
reside “out there,” in things themselves. This is why, when an impor­
tant, high-order presupposition is suddenly brought into experi­
ential awareness as being merely a changeable, personal assumption
about the world rather than its intrinsic nature, the experience is
uncanny. The individual is suddenly aware that she has invented
the world she took as real— or a significant part of that world, any­
way, and this puts all the rest in question. In addition, in such
moments the conscious “I” becomes to some degree aware of itself
as being distinct from the contents of its construings, a most unfa­
miliar and unsettling experience, and one we tend to extinguish
as quickly as possible.
When the presuppositions involved in the presenting problem
are altered or rendered obsolete, the entire nature and meaning
of even a long-standing, painful problem can sometimes be trans­
formed in seconds, or the problem can actually vanish.

The Internal Organization of a Position

Now that we have reviewed the components of the pro-symptom
position sought in radical inquiry— emotional wounds, protective
actions, presuppositions, and their constituent elem ents—we next
examine how these various com ponents are organized within a
position. General patterns of organization of constructs, or “core
ordering processes,” are important both in clinical practice and in
constructivist theory and research.
Actually, previous chapters have already sketched the scheme
we have developed for depth-oriented brief therapy. We have
114 D epth -O riented B rief Therapy

described our clients’ positions (particular constructions of real­

ity) as a set of interrelated constructs existing on four levels or
orders. These constructs may in general be conscious or uncon­
scious, although all orders of a /ra-symptom position are as a rule
unconscious (except, of course, for the presenting symptom itself,
this being the aspect of the pro-symptom position’s activity that has
been consciously noticed). We define these orders of position as
follows, with each exemplified by the corresponding construct
from the pro-symptom position of the woman with the cutting
shard of negative self-image described in Chapter Two:

• Fourth-order co n stru cts : The domain of ontology, the person’s

construings of the fundamental nature of the self, others, or
the world (“My essential deficiency as a female is plainly visible
and will inevitably bring slashing rejection”). Ontological con­
structs are the basis from which third-order governing pur­
poses arise.
• Third-order constructs: The domain of governing purposes (“I
must create an acceptable cover to prevent traumatic rejec­
tion”), in pursuit of which one generates second-order mean­
ings for what is occurring in specific situations.
• Second-order con structs : The domain of meanings attributed to
particular perceptions in concrete situations (“Social situa­
tions mean: I am repulsively ugly; I must never attem pt a
romantic or sexual overture; I must present my cover of intel­
lectual competence”), which then give rise to first-order cogni­
tions, emotions, kinesthetics, and actions.
• F irst-order constructs: The domain of concrete responses—
cognitions, emotions, kine/somesthetics, and actions, includ­
ing the presenting symptom—aimed at coping with the imme­
diate situation in light of its second-order construed meaning
(body language giving no signals of sexual candidacy; displays
of intellectual competence; psychogenic cutting shard in stom­
ach; inner dialogue expressing that “I’m ugly”; anxiety in
social settings).

The construction of a client’s positions can be captured in one

clear, unified picture by means of the p o sitio n chart we have devised
for this purpose, as shown in Figure 3.1. The chart depicts the four
 T he E motional T ruth of the Symptom 115

orders of position along its horizontal span, and along its vertical
span are the two major levels of awareness exam ined earlier:
unconscious pro-symptom constructs and conscious anti-symptom
constructs.
The specific constructs of the client listed above are entered
into the chart. In any one box the therapist enters a verbal indica­
tion of any and all constructs (emotional, cognitive, kinesthetic,
and behavioral; presuppositions, emotional wounds, and protec­
tive actions) that are involved in the presenting symptom at the
order of position and level of awareness of that box. The entries in
the four boxes of the lower horizontal row then together make up
the client’s pro-symptom position (which, subjectively experienced,
is the emotional truth of the symptom). The specific constructs in
the pro-symptom position make clear what the symptom-positive
context(s) are. Similarly, the upper horizontal row makes up the
client’s conscious, anti-symptom position; symptom-negative con­
texts are readily apparent.
The filled-in chart in Figure 3.1 is a static view or snapshot of
the therapist’s knowledge at the point in the work when radical
inquiry was complete enough to give the therapist the needed clar­
ity into the emotional truth of the symptom. Such snapshots can
also be created for other points in the process of therapy, showing,
for example, the subsequent process of change and the final, res­
olution position of the client. By filling in the chart session-by­
session from the start of therapy, adding newly discovered con­
structs, the therapist creates a comprehensive picture of the emerg­
ing structure of the client’s constructions relevant to the presenting
problem. Thus the chart provides an efficient, convenient way to
make case presentations or to summarize therapy-in-progress when
conferring with a consultant or supervisor. Such a picture is espe­
cially useful to the therapist in the process of learning depth-
oriented brief therapy. It helps the trainee to stay oriented in rela­
tion to the body of information gained at any point (some degree
of disorientation in the emerging material is natural) and to iden­
tify where in the four-level structure the therapist needs more clar­
ity and should focus radical inquiry. We hasten to emphasize,
however, that d u r in g a therapy session , it is n o t theoretical considerations
such a s order o f p o sitio n th a t g u id e the th era p ist in p u r s u in g the tw o top
p rio ritie s , r a d ic a l in q u ir y a n d e x p e rie n tia l sh ift. (How the therapist
 Figure 3.1. Sample Chart of Client’s Anti- and Pro-symptom Positions,
Showing Constructs at Various O rders of Position.

O R D E R S O F P O S IT IO N
FIRST ORDER SECOND ORDER THIRD ORDER FOURTH ORDER
Purpose enacted: Attribution Purpose to be Construal of ontology:
concrete thoughts/ of meaning served by nature of
feelings/behavior in concrete attributions of self/others/world
situations meaning

ANTI-SYMPTOM Inner dialogue: “I’m ‘‘I have no chance at

POSITION ugly.” Cutting shard all with men. I’ve got
</) Conscious in body. Anxiety in to be seen as
</> knowing social settings; impressively
UJ confidence felt only competent
2 in professional ^ intellectually, or
LU
oc setting. ^ my personal
< repulsiveness will
3 A no longer be
overlooked.”
LL
o T
PRO-SYMPTOM Automatic Meaning of s o c ia l^ ^ I must prevent: ^ My essential deficiency
</> POSITION behavior: interaction is th a t^ ^ ^ further trauma o f ^ ^ as a female is plainly
i
LU Unconscious no overtures of I am repulsively ugly, slashing rejection. visible. I am gashed to
> knowing sexual candidacy; I must not attempt to sexual sinning. the core by others’
LU displays of intellect be a romantic/sexual alienation from harsh rejection.
and competence entity, and I must use mother. I must create
intellectual cover. an acceptable cover.
 T he E motional T ruth of the Symptom 117

approaches these two priorities is the subject of the rem aining

chapters of this book.)
The chart also gives an especially clear view of the hierarchical
organization of the constructs comprising the position. Any con­
struct in the hierarchical network is by definition su b o rd in a te to
(existing within the context created by) higher-order ones and
su p ero rd in a te to (serving as the context and ground of) those of
lower order. A construct is simultaneously a co n tex t of m eaning
within which lower-order constructs have their existence, and a p a r­
ticu lar con tent within the context of higher-order constructs.
These com plex-sounding terms describe a principle that is
intuitively obvious: If I make an assumption about what’s so, this
initial assum ption directly gives birth to o th er assumptions or
actions that derive fro m the first one and that can exist only because
of the presence of the first one. In that sense, these derivative or
resulting assumptions are subordinate to the initial one, which is
superordinate to the derivative ones. For example, a client
assumed her older b ro th er was an unscrupulous m anipulator.
When he invited her to d in n er at a restaurant, h er derivative
assumption was that this dinner meeting would be in some hidden
way dangerous for her.
The principle operating here is the m ind’s fundamental need
to preserve consistency among constructs at all orders w ith in the
same p o sitio n , but not between positions. Characteristic of its extra­
ordinary richness of function, the mind both insists upon internal
consistency of reality (within a position) and simultaneously is com­
pletely free of that requirem ent (between positions), hence the
great disparity between anti- and pro-symptom positions.
We mentioned above that any construct serves as a context or
field of meaning within which lower-order constructs can exist. In
other words, higher-order constructs involve a more abstract and
inclusive scope of meaning than do lower-order constructs. Conse­
quently, changing a higher-order construct involves a far more
sweeping and fundamental change of the client’s familiar reality
than changing a lower-order construct. People automatically and
tenaciously resist high-order change. When perceptions contradict
our construction of reality, forcing a modification in that construc­
tion, we strive instinctively to accommodate the contradiction by
modifying constructs at the lowest possible order, so as to minimize
118 D epth-O riented B rief T herapy

the extent of change in our experiential reality. When new experi­

ence brings two of our own already-held constructs into irreconcil­
able conflict, “The idea that survives is the one that is more abstract
and has therefore been used successfully more often than the idea
that does not survive,” as psychotherapist Jeffrey Bogdan explains.
The construct that is relinquished is the lower-order one whose loss
does the least damage to the familiar structure of reality. One clin­
ical implication of these ideas, which we elaborate further in Chap­
ter Six, is that clients who are least likely to reach a lasting
resolution briefly are those whose presenting symptom is generated
by m u ltiple high-order constructs.
The conceptualization in DOBT of the four orders of position
structuring experiential reality is an extension of the seminal ideas
of Bateson, who has had a profound influence on the development
of constructivist as well as systemic psychotherapies. Calling attention
to the hierarchy of constructs (an application of Whitehead’s logical
types) is one of Bateson’s most important contributions to the field
of psychotherapy. However, it has been adopted by therapists in the
limited form of the concept of second-order change. As we described
in the Introduction, this phrase has become widely used to denote
any problem-dispelling change in the context that the client uses to
define the meaning of the presenting symptom. This stands in con­
trast to first-order change, in which attempts are made to dispel the
symptom with no such change in contextual meaning.
However, when orders of construction higher than the second
order are recognized and are involved in therapeutic changes—as
in depth-oriented brief therapy—then the phrase seco n d -o rd er
ch a n g e becomes inadequate and m isleading as a general label
denoting problem-dispelling transformations of context. Phrases
such as su perordin ate change , con tex tu a l change , and third- and fo u rth -
order ch an ge are more appropriate indicators of the full range of
change processes and of structure involved in a comprehensive
constructivist psychotherapy.

Unconscious Positions: C orro bo ration fro m

Scientific Disciplines_______________________________
In conceptualizing and working with the heterogeneity of the
client’s construction of reality—the presence of any num ber of
 T he E motional T ruth of the Symptom 119

unconscious, autonomous positions in addition to the conscious

one—DOBT is consistent with im portant developm ents in the
fields of cognitive psychology, emotion theory, and cognitive neu­
roscience (also known as psychoneurology, the field of experi­
mental research into how the structural, anatomical organization
of the brain corresponds to subjective psychological experience).
We will note the first two very briefly and focus more on the bio­
logical results supporting our clinical model.
In all three fields, a major conceptual and empirical develop­
ment over the past twenty years has been the discovery of the mod­
ular organization of m eaning and inform ation processing in
human psychology.
In cognitive science, mental functioning is being seen as occur­
ring through parallel distributed processing, in which many distinct
information-processing modules, each handling a particular, rela­
tively narrow domain of information, operate simultaneously with­
out requiring conscious attention. Furtherm ore, the view of
cognition and emotion as separate or even opposed functions has
become a quaint relic of an earlier era, replaced by an understand­
ing of the emotion scheme, a module of experiential knowledge con­
sisting of a multilevel integration of stored sensory, emotional, and
cognitive information regarding a particular type of situation or
theme of meaning. The activation of an emotion scheme by a per­
ceptual cue generates the felt meaning of the situation as well as a
predesigned response to it. In these formulations of cognitive sci­
ence and emotion theory we see a strong corroboration of DOBT’s
unconscious, autonomous, pro-symptom position, a conceptualiza­
tion that developed on the basis of our clinical experience.
The support from cognitive neuroscience is perhaps most strik­
ing. One of those at the forefront of this research is Michael Gaz-
zaniga, whose early work in the 1950s and 1960s first revealed
differences in functions carried out by left and right brain hemi­
spheres. His subsequent findings evolved this initial, simplistic
left/right model much further. Gazzaniga reviewed the extraordi­
nary results of many of his studies in his 1985 book, The Social
Brain. He explains:

Interpreting our behaviors would be a trivial matter if all behaviors

we engaged in were the product of verbal conscious action. In that
120 D epth-O riented Brief T herapy

case, the source of the behavior is known before the action occurs.
If all our actions consisted o f only these kinds of events, there
would be nothing to explain. . . . \T ]h e normal person does not possess
a unitary conscious mechanism in which the conscious system is privy to the
sources o f all his or her actions. . . . [T]he normal brain is organized
into modules and . . . most of these modules are capable o f actions , moods,
and responses. A ll except one work in nonverbal xoays such that their
modes of expression are solely through overt behaviors or more
covert actions [italics added].

In the picture that em erges from cognitive neuroscience, any

num ber of largely autonom ous brain modules, each a group of
neurons, operate outside of conscious awareness and “can com­
pute, remember, feel emotion, and act”—strongly resembling the
phenomenology of clients’ unconscious, pro-symptom positions.
The brain’s single verbal module is a key com ponent of the con­
scious self and “is committed to the task of interpreting our overt
behaviors as well as the more covert emotional responses produced
by these separate mental modules of our brain. It constructs theo­
ries of why these behaviors occurred and does so because of that
brain system’s need to maintain a sense of consistency for all of our
behaviors. It is a uniquely human endeavor.” The verbal module’s
concoction of conscious explanations in its effort to make sense of
behaviors generated by nonverbal modules operating out of aware­
ness corresponds precisely to the client’s initial, conscious, anti­
symptom position in DOBT. Likewise, our earlier definition of the
conscious “I” as consisting of knowings-of-knowing seems to cor­
respond to the interpretive activity of the verbal, reflectively con­
struing module Gazzaniga describes.
Gazzaniga emphasizes that “brain modularity is not just a psy­
chological concept. . . . T hrough [experim ental] studies . . . it
becomes clear that modularity has a real anatomical basis.” The
point is not the reductionistic one that consciousness has its source
in the physical brain, but only that brain structures carrying out the
operations of human psychology are being mapped with unprece­
dented precision. In m ore recent studies by o th er researchers
using new technologies that give high-resolution, real-time imag­
ing of brain activity, the performance of specific psychological tasks
has been found to involve highly localized regions of the brain, cor­
roborating Gazzaniga’s model and DOBT. ,
 T h e E m o tio n a l T r u th o f t h e Symptom 121

Sum mary_________________________________________
To conclude this chapter, we will use the position chart (Figure
3.1) as a teaching device to make some final points. First, the chart
makes it especially clear why DOBT’s utilization of emotional truth
tends to have the beneficial ontological effect mentioned earlier—
that is, restored sense of self-worth and core well-being, whatever
the presenting problem may be. In general, as our case examples
have shown, bringing a client into awareness and conscious own­
ership of the emotional truth of the symptom includes awareness
of his or her purposes for producing and m aintaining the symp­
tom—the third-order constructs in the pro-symptom position.
Becoming aware of these third-order purposes is a change whose
immediate ripple effect is the fourth-order realization by the client
that his or her own mind has been full of sense and coherent func­
tioning in producing the symptom, something that seemed at first
to be evidence of defectiveness or pathology. This accompanying
fourth-order realization of having a mind whose deep nature is of
such intrinsic intelligence and coherence restores the sense of self-
worth and well-being. This effect occurs even if the fourth-order
realization remains entirely implicit and there is no explicit change
in fourth-order content (such as a change from “I am unlovable”
to “I am lovable”).
Second, the filled-in chart (shown in Figure 3.1) serves as a
map that gives visible form to a region of the client’s architecture
of reality that the therapist has induced the client to discover.
Mental constructs are, of course, created out of human imagina­
tion, but once installed by the owner in his or h er experiential
reality, they operate as enduring, detectable, identifiable mental
objects with particular properties. In other words, a construct may
be said to be invented when it is first formed and installed by the
individual, but subsequently it is discovered by the owner to be pre­
sent in his or her mental world. (The mental objects that we our­
selves invent may be the only kinds of objects that we can know
directly enough to discover.) In depth-oriented brief therapy, rad­
ical inquiry is a process of discovering, not inventing, the client’s
already-present network of constructs relevant to the presenting
symptom. Any com petent therapist should discover the same set
of constructs (allowing for superficial, stylistic differences in how
122 D ep th -O rien ted B rief Therapy

the constructs are verbalized, which should be determined by the

client anyway). Processes of dissolving old constructs or creating
new ones then may follow as part of the work of inducing experi­
ential shifts.
Finally, we note that the inclusion in the chart of four orders
of position, and not five or more, is based on the fact that con­
structs and changes of fifth and higher order are rarely involved
in psychotherapy. These orders represent ontological constructs
and states that are neither included nor, on the whole, recognized
within present-day Western psychology. However, an important pat­
tern organizing the orders of position is illuminated by consider­
ing the nature of the fifth and sixth orders, and for this reason we
will briefly do that.
To define the fifth order of constructs of experiential reality,
we must identify what we are presupposing as the tacit basis or con­
text for our definition of the fo u r th order, and th a t will be the con -
te n t of the fifth order. The fourth ord er of constructs is itself
ontological, as we have already seen, but it consists of the particu­
lar ontological possibilities that are widely recognized in our cul­
ture. For example, regarding the ontology of the self, these
conventional fourth-order possibilities are that the essential self is
good or bad, lovable or unlovable, whole or fragmented, intact or
defective, connected to or disconnected from a greater whole,
pure or sinful, wise or ignorant, eternal or mortal, and so on. What
all such ontological possibilities share as a presupposition is the
existence of the essential self as a separate , lim ite d en tity that there­
fore can be viewed as having this quality or that. Thus the fourth
order represents the d o m a in o f s e p a ra te -se lf c o n str u a ls. The fifth
order, it then follows, is the d o m a in o f pu rp o ses f o r c o n stru in g oneself
a separate being. Specific fifth-order purposes determine which spe­
cific fourth-order attributes of separate self are activated out of the
latent background of all possible self-construals.
Here the reader might notice the pattern that is emerging in
the sequence of orders of position: an alternation of d o m a in s o f dis­
c r im in a tio n and d o m a in s o f p u rp o se f o r d isc rim in a tin g . The discrimi­
native construals made in one domain derive from (are motivated
and defined by) the p u rp o se s that comprise the next higher
domain, which in turn derive from the discriminative construals
in the next higher domain, which derive from pu rp o ses at the next
 T he E motional T ruth of the Symptom 123

level, and so on. By extending this pattern, we can see that the sixth
order is a domain of discrimination that is prior to any separate-
self-construal but that gives birth to fifth-order purposes for con­
struing a separate self. This sixth-order experiential reality involves
no sense of separate self, but it does involve a type of knowledge
that spawns purposes for construing separate existence.
Although some conceptual definition can be given to the fifth
and sixth levels, their unitive experiential nature is hardly imagin­
able by conventional standards of reality. Actually, even through­
out the first four orders of position relevant to psychotherapy, each
step up (or down) is a very big one, an exponential expansion (or
contraction) of the field of meaning—a kind of Richter scale of
reality.
Some clients describe significant change-prom oting effects
from numinous or transcendent experiences in dreams or waking
life, which may represent experiential contact with fifth- or sixth-
order constructs. Note that the unconscious constructs at any order
of position can, in the autonom ous m anner of such material, at
any time transiently and partially come into the awareness of the
conscious “I” as imagery a n d /o r as direct, lucid apprehension of
meaning.
Having considered the fuller meaning of the emotional truth
of the symptom as described in this chapter, the reader is ready to
explore the m ethodology of DOBT for discovering it: radical
inquiry.

Notes
P. 93, But such is the irresistahle nature o f truth . . T. Paine, “The Rights of
Man (Part 2 ),” in E. Foner (Ed.) (1995), The Collected W ritings of
Thomas Paine (p. 548), New York: Library of America.
P. 97, the social con stru ction ist m ovem ent: See, for exam ple, P. Berger
and T. Luckman (1966), The Social C on stru ction o f R eality, New
York: Doubleday; K. Gergen (1985), “The Social Construction­
ist Movement in Modern Psychology,” Am erican Psychologist, 40,
266-275.
P. 97, the radical constructivist movement: See, for example, E. von Glasers-
feld (1984), “An Introduction to Radical Constructivism,” in P Wat-
zlawick (Ed.), The Invented Reality (pp. 17-40), New York: W. W.
Norton; E. von Glasersfeld (1987), The Construction of Knowledge, Sali­
nas, CA: Intersystems.
124 D ep th -O rien ted B rief Therapy

P. 99, “p a r ts ” conceptualized by various experiential psychotherapies: See, for

example, R. Schwartz (1987), “Our Multiple Selves,” Family Therapy
Networker, 77(2), 25-31; R. Schwartz (1994), Internal Family Systems
Therapy, New York: Guilford.
P. 100, “These are . . . utmost practical im portance”: Quoted in O. Fenichel
(1945), The P sychoanalytic Theory o f Neurosis (p. 126), New York:
W. W. Norton.
P. 100, The “function of the symptom”: See, for example, L. Hoffman (1981),
Foundations o f Family Therapy, New York: Basic Books; M. Selvini-
Palazzoli, L. Boscolo, G. Cecchin, and G. Prata (1978), Paradox and
Counterparadox, New York: Jason Aronson.
P. 101, the “ecology o f ideas” approach of Gregory Bateson: G. Bateson (1972),
Steps to an Ecology o f M ind, New York: Ballantine; J. Bogdan (1984),
“Family Organization as an Ecology of Ideas: An Alternative to the
Reification of Family Systems,” Family Process, 23, 375-388.
P. 101, the “perspective, metaperspective, an d meta-metaperspective” approach of
R. D. Laing: R. D. Laing, H. Phillipson, and A. Lee (1966), Interper­
sonal Perception, New York: Perennial Library.
P. 101, “affective experiences . . . prior to any conscious conceptual processing
(th in k in g )”: L. S. Greenberg and J. D. Safran (1984), “Hot Cogni­
tion—Emotion Coming In from the Cold: A Reply to Rachman and
Mahoney,” C ognitive Therapy a n d Research, 5(6), 592. See also R.
Zajonc (1980), “Feeling and Thinking: Preferences Need No Infer­
ences,” American Psychologist, 35, 151-175; R. Zajonc (1984), “On the
Primacy of Affect,” American Psychologist, 39, 117-123; S. Rachman
(1984), “A Reassessment of the ‘Primacy of Affect,*” Cognitive Ther­
apy an d Research, 5(6), 579-584; L. S. Greenberg and J. D. Safran
(1987), Emotion in Psychotherapy: Affect an d Cognition in the Process of
Change. New York: Guilford.
P. 101, “The weakness o f Batesonian . . . no language in which to describe expe­
riential events”: L. Hoffman (1990), “Constructing Realities: An Art
of Lenses,” Family Process, 29, 7.
P. 103, As both Bateson and M aturana centrally emphasize: G. Bateson (1972),
Steps to an Ecology of M ind, New York: Ballantine; G. Bateson (1979),
M in d an d Nature: A Necessary Unity, New York: Dutton; H. R. Matu­
rana (1980), “The Biology of Cognition,” in H. R. Maturana 8c F. J.
Varela, Autopoiesis an d Cognition: The Realization o f the Living, Boston:
D. Reidel.
P. 103, a “whole-being embodiment of knowing, ” in M ahoney’s evocative phrase:
M.J. Mahoney (1991), H um an Change Processes: The Scientific Foun­
dations o f Psychotherapy (p. 395), New York: Basic Books.
 T he E motional T ruth of the Symptom 125

P. 105, insightful expose of the ‘fiction of monopersonality”: M. Ventura (1985),

Shadow D ancing in the USA, Los Angeles: Tarcher.
P. 105, “the case of a mother. . . for his questionable exploits ”: B. Speed (1984),
“How Really Real Is Real? Rejoinder: Mountainous Seas Are Also
Wet,” Family Process, 23, 514.
P. 105, “People can . . . such mind-boggling problems ? ”: J . Cambien (1989),
“Reality in Psychotherapy,”Journal of Family Psychology, 5(1), 34-35.
P. 107, as characterized the early view in cognitive behavioral approaches: See,
for example, A. T. Beck (1976), Cognitive Therapy and the Emotional
Disorders, New York: International Universities Press; A. Ellis (1962),
Reason and Emotion in Psychotherapy, New York: Lyle Stuart.
P. 107, a vieio we share with more advanced developments in cognitive science and
emotion theory: See, for exam ple, L. S. Greenberg, L. Rice, and R.
Elliott (1993), Facilitating Emotional Change: The Moment-by-Moment
Process, New York: Guilford; H. Leventhal (1984), “A Perceptual-
Motor Theory of Emotion,” in L. Berkowitz (Ed.), Advances in Exper­
imental Social Psychology (pp. 117-182), New York: Academic Press.
P. 110, emotionally powerful experiences still create nonverbal representations in
emotional memory: See, for example, L. S. Greenberg and J. D. Safran
(1984), “Integrating Affect and Cognition: A Perspective on the
Process o f Therapeutic C hange,” Cognitive Therapy a n d Research,
8 ( 6), 559-578; H. Leventhal (1982), “The Integration of Emotion
and Cognition: A View from the Perceptual-Motor Theory of Emo­
tion,” in M. S. Clarke and S. T. Fiske (Eds.), Affect and Cognition: The
17th A n n u a l Carnegie Symposium on Cognition (pp. 121-156), Hills­
dale, NJ: Erlbaum.
P. 113, General patterns of organization of constructs, or “core ordering processes,”
are im portant both in clinical practice a n d in constructivist theory a n d
research: See, for example, V. F. Guidano and G. A. Liotti (1983), Cog­
n itive Processes a n d E m otional Disorders, New York: Guilford; V. F.
Guidano and G. A. Liotti (1985), “A Constructivist Foundation for
Cognitive Therapy,” in M. J. Mahoney and A. Freeman (Eds.), Cog­
nition and Psychotherapy (pp. 101-142), New York: Plenum.
P. 118, uThe idea that survives . . . that does not survive, ”: J. Bogdan, “Family
Organization as an Ecology of Ideas,” p. 387.
P. 118, an extension of the seminal ideas of Bateson: G. Bateson, Steps to an Ecol­
ogy of M in d (pp. 279-308), New York: Ballantine.
P. 118, an application of Whitehead's logical types: A. N. Whitehead and B.
Russell (1913), Principia Mathematics , 3 vols., Cambridge, Cambridge
University Press.
P. 118, the concept o f second-order change: P. Watzlawick, J. Wcakland, and
126 D epth -O rien ted B rief T herapy

R. Fisch (1974), Change: Principles o f Problem Formation an d Problem

Resolution , New York: W. W. Norton. It was these writers who influ­
entially applied the phrases “first-order change” and “second-order
change” to psychotherapy, having transferred them from the sys­
tems theory of W. R. Ashby. See W. R. Ashby (1952), Design fo r a
Brain , New York: Wiley.
R 119, parallel distributed processing: See, for example, J. A. Fodor (1983),
The M odularity o f M in d , Cambridge, MA: MIT/Bradford Books; R
Johnson-Laird (1988), The Computer an d the M ind, Cambridge, MA:
Harvard University Press.
P. 119, replaced by an understanding of the emotion scheme: See, for exam­
ple, U. Neisser (1976), Cognition an d Reality, San Francisco: W. H.
Freeman; J. Pascual-Leone (1991), “Emotions, Development, and
Psychotherapy,” inj. D. Safran and L. S. Greenberg (Eds.), Emotion,
Psychotherapy an d Change (pp. 302-335), New York: Guilford; F. C.
Bartlett (1932), Remembering, Cambridge, MA: Cambridge Univer­
sity Press; J. Piaget (1970), Structuralism, New York: Basic Books; J.
Piaget (1985), The Equilibration of Cognitive Structures: The Central Prob­
lem o f Intellectual Development, Chicago: University of Chicago Press.
P. 119, Gazzaniga reviewed . . . in his 1985 book, The Social Brain: M. Gaz-
zaniga (1985), The Social Brain, New York: Basic Books.
PP. 119-120, “Interpreting our behaviors . . . or more covert actions1*: Gazzaniga,
The Social Brain, p. 74.
P. 120, “can compute, remember, feel emotion, an d a c t”: Gazzaniga, The Social
Brain, p. 86.
P. 120, “is com mitted to the task o f interpreting . . . It is a uniquely human
endeavor. ”: Gazzaniga, The Social Brain, p. 80.
P. 120, “brain m odularity . . . has a real anatom ical b a sis”: Gazzaniga, The
Social Brain, p. 128.
P. 120, In more recent studies by other researchers: See, for example, M. I. Pos­
ner and M. E. Raichle (1994), Images o f M ind, San Francisco: W. H.
Freeman; M. E. Raichle (1994), “Visualizing the Mind,” Scientific
American, 2 4 0 (4 ), 58-64.
 CHAPTER 4

Radical Inquiry: The Stance

. . . the inquiry of truth, which is the love-making, or
wooing of it,
the knowledge of truth, which is the presence of it,
and the belief of truth, which is the enjoying of it,
is the sovereign good of human nature.
Francis Bacon , O f Truth

The goal of radical inquiry is for the therapist to very efficiently

gain lucid clarity into the emotional truth of the symptom—that
is, the client’s unconscious, pro-symptom position. With that clar­
ity comes clarity into how the problem can be experientially trans­
formed and resolved. The positions studied in earlier chapters
were those of the client, now it is the position or stance from which
the therapist works that is our focus. C hapter Five then details a
wide range of specific techniques that presuppose the stance
described here.
Stance refers to the presuppositions and in ten tio n s th at a
therapist brings to each session, defining what therapy is, what it
can achieve, how to carry it out, and how long it will take. The
therapist’s stance is, in other words, his or h er construction of
psychotherapy.
The stance of radical inquiry has a number of defining features
that operate together as a methodology:

• Assumption of immediate accessibility

• Active intentionality
• Powerlessness
• Assumption of coherence

127
128 D epth-O riented B rief T herapy

• Experiential-phenomenological discovery and verification of

constructs
• Anthropologist’s view
• Freedom to clarify

These com ponents of stance developed in o ur work as an

evolving synthesis of many influences. The first three of these
items, as well as the attention to stance itself, reflect most impor­
tantly the influence of Robert Shaw, M.D., director of the Family
Institute of Berkeley. His insistence upon responding to clients
from self rather than from theory, upon grappling with the ther­
apist’s own limiting presuppositions, and upon the possibility of
rapidly restructuring the client’s experience of the problem, along
with his view that therapy should be noneffortful and nurturing
for the therapist, helped shape our early therapeutic vision into
one that developed over time into the approach we now call
depth-oriented brief therapy.

Assum ption o f Im m e d ia te Accessibility____________

Unconscious material and unconscious process are much more
close at hand and accessible than is commonly believed—even by
many therapists. The fact that a person always avoids looking at
something does not mean that this something is inaccessible or far
away. Fully unconscious constructions that have been generating
symptoms for decades can be brought to light quite rapidly, often
in a single session of highly focused, experiential work, as exam­
ples in previous chapters have shown.
However, a therapist will not try to accomplish something that
he or she does not believe is possible. The therapist will do what it
takes to gain rapid experiential access to a deeply unconscious pro­
symptom position only if the therapist presupposes the immediate
accessibility of this unconscious construction. The rapid resolu­
tions demonstrated in earlier chapters were possible only because
of the therapist’s assumption of immediate accessibility.
The traditional view in depth psychotherapy is that the cause
of the client’s symptoms are experiences and conditions in the
dark past, in childhood, and that successful therapy therefore
requires an objective, factual reconstruction and analysis of these
 Radical Inquiry: T he Stance 129

conditions. The constructivist view in depth-oriented brief therapy

is that in response to childhood experiences, the client form ed
constructions of reality that he or she still carries and applies, so
they are present constructions of reality, and they are therefore
accessible. In this view there is nothing underlying a client’s prob­
lems but a phenom enology of present cognitions, emotions, and
somesthetics, conscious and unconscious. The therapist does not
need to find out factually what happened in the past in order to
accurately elicit these current constructs.
In DOBT this is not just a semantic or philosophical position. It
is a view that profoundly expands the therapist’s perception of
what is actually within reach right here, right now, in this very ses­
sion. From this perspective it becomes natural to approach every
session—in fact, every response to the client—as having the very
real and immediate potential to produce deep change in the prob­
lem, because the psychological elements necessary for such a trans­
formation are always present and available. The th erap ist’s
conviction regarding this principle of immediate accessibility is perhaps
the most fundamental basis for carrying out radical inquiry.
With this stance, what the therapist is assuming can happen in
the present session will be much more, and of a much deeper or sub­
stantive nature, than what the client is assuming can happen. In gen­
tle but persistent ways the therapist invites the client to take another
step, and then another, down into previously unattended emotional
truths and constructions of personal meaning relevant to the prob­
lem, at all times rem aining highly sensitive to any signs from the
client that his or her tolerance for contacting new or difficult mate­
rial is being reached. What we stated in Chapter Two bears repeat­
ing: it should always be the client’s current capacity, not the therapist’s
assumptions, that limits what can happen in the session.
From the start of therapy, then, the therapist is always on the
lookout for possible signs of a pro-symptom position and actively
inquires into each possibility that appears. The therapist’s assump­
tion of im m ediate accessibility operates as though he or she is
constantly guided by these questions: Given what I now know of
the client’s worlds of meaning, what is the unacknowledged area
or theme of m eaning that seems most likely to be requiring the
existence of the symptom? W hat next move could I make that
would most directly draw the client into attending to that area of
130 D epth-O riented B rief T herapy

meaning, experiencing it consciously, and finding out for himself

whether, and how, that region of m eaning makes the symptom
im portant to have?
An exam ple is the therapist’s response to a thirty-year-old
woman who was plagued by continuous restlessness and compul­
sive activity, which always destroyed any sense of satisfaction in her
interests or relationships. The therapist learned in passing in the
first session that at age six there was the sudden death of her father,
whom she dearly loved and who was her only source of palpable
affectional warmth. No outward process or expression of grieving
occurred in the family. At eight she gained a stepfather who was
em otionally abusive, and in her teens she nearly killed herself
through drug abuse. The therapist, thinking from the start in
terms of finding the pro-symptom reality in which the symptom is
purposeful and necessary to have, immediately understood this
woman’s resdessness and manic activity as a protective action—but
protecting against what em otional wound or vulnerability? The
strongest candidate, given what had so far emerged, certainly was
the death of h er beloved father, though the client in no way
emphasized this or identified it as a focus of therapy. The therapist
felt most interested in seeing if her manic patterns were her life­
long protective action against feeling her enormous, disallowed
pain over the loss of her father. Guided by the spirit o f the ques­
tions in the preceding paragraph, the therapist devised a simple
experiential probe, intended to bring her direcdy to the emotional
truth of the symptom: he asked h er to visualize h er father and,
when his image was sufficiently evoked, to try out saying to him,
simply, “Daddy, I miss you.”
Doing this, the client immediately precipitated the most intense
feelings of grief, anguish, and anger, the avoidance of which had
formed her personality and divorced her from her interior life for
twenty-five years. In the next session she described unexpected
relief in a long-standing jaw problem, saying, “I’ve always just had
that pain and figured, just learn to live with it. I never had an even
bite. Well, in this last week I finally have an even bite. It’s amazing
. . . my jaw has released.” The full processing of the father-related
feelings and meanings, and the reorientation to sweeping changes
in her experience of self as a feeling self, required twelve sessions
spanning almost nine months. Her tormenting restlessness and com-
 Radical Inquiry: T he Stance 131

pulsive activity completely subsided (manifesting, for example, in

the emergence of a genuine desire—instead of the prior manic
disinclination—to spend “quality tim e” with h er two-year-old
daughter). In addition, a wide range of unexpected changes spon­
taneously occurred, including the emergence of a “rock-solid self-
confidence” at work, the cessation of extrem e and childish
moodiness and neediness with her husband, and an entirely new
empathy and emotional responsiveness to her two sisters.
As this example shows, assuming immediate accessibility means
knowing that seemingly buried constructions are actually close at
hand, and seemingly locked constructions open easily and imme­
diately when a fitting key is used.

Active In te n tio n a lity ______________________________

Beyond assuming that powerful, unconscious, symptom-generat­
ing material can actually be contacted and transformed in this very
session—from the first session— active intentionality is the therapist’s
total readiness and intention for this to happen.
The reason this needs to be stated explicitly is that within the
practice of psychotherapy there are numerous sources of motiva­
tion not to bring rapidly to light the full emotional truths generat­
ing the client’s symptoms. The fact is, many therapists are deeply
ambivalent over the prospect of doing rapidly effective work that
ends in five, ten, or fifteen sessions.
Contrary to the widespread assumption in many schools of psy­
chotherapy that emotional work necessarily makes therapy long
and messy, our experience is that engaging the emotional aspects
of the presenting problem accelerates the work and helps rapidly
produce effective, lasting results. Conversely, not working with the
emotional construction of the problem can result in therapy that
is prolonged and not decisively effective.
Therapists have many different kinds of blocks to doing rapid,
deep, effective work with clients. We have listed them below (our
elaboration of other such lists previously published) to assist the
reader in undertaking the position work of identifying and own­
ing any unwillingness to work deeply and briefly.

• Belief that a therapeutic alliance cannot be formed rapidly

132 D epth -O rien ted B rief T herapy

• Belief that working with the client’s emotional wounds is a

necessarily lengthy process
• Fear of the client’s emotions
• Belief that having the client attend fully to painful emotion
would be harmful
• The assumption, shared with the client, that the presenting
symptom is completely valueless and undesirable, and that
therapy should focus on empathically fostering the client’s
wish and ability to keep the symptom from happening
• Belief that longer therapy is intrinsically more effective than
shorter therapy (“more is better”) because brief is necessarily
superficial and incomplete
• Belief that success in psychotherapy means thorough restruc­
turing of character
• Overestimation of the role of character disorder in the client’s
presenting problems, combined with the belief that character
disorders can never be changed quickly
• Overreliance on analysis and interpretation and underutiliza­
tion of other therapeutic methodologies; overestimation of
the therapeutic value of cognitive insight
• Belief that pathologizing is therapeutic, that categorizing the
client according to pathology schemas can be healing
• Attachment to the aura of esoteric knowledge and power and
to the stature conferred upon the therapist-priest, who is pre­
sumed to hold the keys to the “dark mysteries” of mental
pathology
• Belief that patterns of cognition, emotion, and behavior that
were formed over many years of developmental history neces­
sarily take years to undo
• Belief that the unconscious is by its very nature too inaccessi­
ble and impenetrable to allow significant change to occur in
brief therapy
• Unwillingness to let go of the client for financial reasons
• Unwillingness to let go of the client for emotional-counter-
transferential reasons (e.g., the therapist’s need to be needed,
fondness of client, desire to know the client’s whole story, per-
fectionistic need to “finish” the work, fear of being seen as
rejecting, and so on)
 Radical Inquiry: T he Stance 133

• Unwillingness to make the greater effort of sustaining the level

of therapist activity and focus required in brief treatm ent
• Aversion to the greater visibility in brief treatm ent of the ther­
apist’s skill or lack of skill in assisting the client to alleviate the
presenting symptom (s)
• Loyalty to mentors and training experiences supporting a
longer-term paradigm
• Belief that being active and directive is necessarily too leading
and impinging and results only in transferential compliance,
hostility, or resistance
• Belief that without the therapist’s mostly silent, impassive,
nondirective acceptance, the client cannot project a full trans­
ference, and therefore there can be no corrective emotional
experience
• Belief that the transference and its interpretation provide the
only reliable way to access the client’s real issues
• Belief that clients do not already possess the capacities or
resources needed to dispel the presenting problem and that
the therapist must supply them

We will not elaborate here on the fallacious nature of many items

in the list, because the material we present throughout this book
serves as our refutation of them. However, one of the items—fear
of clients’ intensely felt emotional states—warrants comment here
because of its prevalence.
If you fear your clients’ emotions, you will not conduct radical
inquiry. You will not head straight for emotional truth. That is what
radical inquiry is: heading straight for the full emotional truth of
the symptom. Emotional truth does not necessarily show up in the
form of florid, overpowering em otion, but it might, or it might
contain extremely dire, seemingly unworkable content having to
do with themes of hopelessness, hate, intensely felt worthlessness,
anger, grief, terror, despair, and loneliness.
If you fear your clients’ emotions, you will also not do position
work. In position work, when an im portant elem ent of emotional
truth is found and felt by the client, the therapist keeps the client
right there, rooted to the spot, and stays in it with the client, with­
out trying to make anything else happen. The therapist does nothing
134 D ep th -O rien ted B rief Therapy

except saturate the client’s awareness with the meanings, atmos­

phere, and feelings of this previously unconscious position. What
to do next in the work becomes clear by staying there and taking
stock of the em otional landscape from this new position, not by
dashing off of it. To allow the client’s attention to come up and
away from a newly contacted emotional truth too soon is to have a
lapse in active intentionality and to collude with the client’s wish
to avoid the experience.
For some therapists, dread of clients’ emotions stems from the
presupposition that intense, dire emotions are irrational and too
refractory to change and would therefore be more powerful than
the therapy is. The therapist fears not being able to respond effec­
tively to such emotions and failing as therapist. Also, the therapist
may carry the prevailing cultural view that attending fully to
painful em otion is destructive, when in fact it is healing when
done properly.
All such fears indicate that the therapist needs focused train­
ing in experiential emotional process. Many therapeutic modali­
ties that developed in reaction (we would say overreaction) to
psychoanalytic and psychodynamic approaches threw out the gold
with the sludge and removed em otion from the focus of thera­
peutic attention. Consequently, many therapists, prepared neither
by professional training nor by their own families of origin to be
at home in the emotional process, are understandably anxious and
avoidant in relation to it. However, to work without facility and
comfort with the emotional com ponent of therapeutic change is
to severely limit the efficiency and effectiveness of the work, as well
as the depth of resolution achieved. This deficit of skill is not only
remediable but also most rewarding to remedy, both profession­
ally and personally.
We are aware of only one adverse effect that could follow rad­
ical inquiry. This occurs with some clients who are survivors of
severe childhood abuse and who have an unconscious position that
is fiercely dedicated to preventing awareness of the memory of the
traumas. To protect against these terrifying and extremely painful
memories becoming accessible, this position may respond to ini­
tial steps of inquiry (whether radical or conventional) by inflicting
severe disincentives to any further incursion toward the emotional
truth, in the form of intense psychogenic pain, self-mutilation, or
 Radical Inquiry: T he Stance 135

compulsive behaviors that produce emotional oblivion (binge eat­

ing, drinking, manic activity, and so forth). Any such responses to
radical inquiry are important signals to the therapist to first estab­
lish com m unication and a working alliance with the protective
position before proceeding further toward the central emotional
truth of the abuse.
Bear in m ind that radical inquiry does not mean aggressive
inquiry, as is quite clear in our many clinical examples. It is active
and persistent but never pushes beyond the client’s current capac­
ities or limits. The therapist is fully responsive to all such signals.
(In Chapter Five we focus on how the therapist responds to client
resistance during radical inquiry.)
Many clinicians are skeptical of the two basic requirements for
making in-depth use of the emotional features of the problem in
brief therapy: rapid trust building and rapid evocation and trans­
formation of relevant emotional states. Many do not believe that
trust can develop in the therapist-client relationship quickly
enough for brief therapy to include meaningful emotional work,
and many believe that even if trust could be developed quickly,
there still is not enough time in brief therapy to carry out a process
of deep emotional work.
Arguing theoretically about these biases is futile. With the great
majority of clients who come through our doors, neither of these
conditions is a problem . Chapters O ne and Two gave detailed
examples of emotionally deep work occurring very rapidly. Cer­
tainly, with some clients this will not be possible, but for the great
majority it is possible to do deep, transformative emotional work
briefly. For the therapist’s beliefs to rule this out is a great disser­
vice to clients.
We know of only two ways to make sense of any therapist’s insis­
tence that, in general, it is not possible for trust to develop fast
enough to allow for deep emotional work in brief therapy: either
the therapist is a hyperpathologizer who believes all clients in fact
have character disorders, or the therapist’s personal qualities and
manner are exceptionally anticonducive to emotional openness
and trust, resulting in the observation that it regularly takes many
sessions before clients trust enough to get near their feelings. (In a
remarkably candid and valuable self-expose, psychotherapist
Richard Schwartz describes his discovery of how his therapeutic
136 D epth-O riented B rief T herapy

stance was having ju st such a trust-inhibiting effect; it is recom­

mended reading.)
Clients are exquisitely sensitive to therapist fears. In DOBT, rad­
ical inquiry itself is the trust builder, the clear signal that we are
ready to go to the emotional truth and have it emerge, whatever it
is, and that we are safe presences for that to occur. In radical
inquiry, the therapist’s attitude is so respectful of the client’s
expression and dem onstrates such palpable interest in the more
deeply felt aspects of the client’s lived experience that emotional
trust develops readily in most cases.
As with the assumption of immediate accessibility, the purpose
of active intentionality is to eliminate the barriers that the therapist
might unknowingly place in the way of deep, transformative work
occurring as rapidly as it could.
With active intentionality, the therapist forms every next
response as a best effort at shaping the key that could access the
emotional truth of the symptom and create a breakthrough.
The assumption that each session has the potential to trans­
form the problem significantly—and the intention for this to actu­
ally take place—has a direct im plication for the m anner of
scheduling sessions. When and whether to schedule a subsequent
session can be decided only at the end of the present session, once
therapist and client see what best suits the client’s state and process
in effect at that point. The therapist schedules no more than the
next session, one session at a time, and at the end of each session
makes a jo in t decision with the client w hether to m eet again in
one, two, or more weeks or on an as-needed basis when and if the
client calls, or to declare the problem resolved with no view toward
future meetings. This arrangement helps prepare the client for the
end of therapy from the start, and it communicates to the client
the therapist’s stance that every session can produce an important
result that changes the situation substantially.

Powerlessness____________________________________
Paradoxically, the therapist’s base of effectiveness in DOBT lies in
knowing that he or she has zero power to make the client change.
It is the client who is the real agent of change, and for therapeu­
tic efficacy the therapist is totally reliant on client motivation.
 R adical. Inquiry: T he Stance 137

Therefore, requiring the client to be the source of his or her own

motivation for change is another fundamental element of the ther­
apist’s stance.
The therapist shows full interest and involvement in the clients
work but does not attem pt to supply initiative or motivation. If a
client appears to lack motivation for change, the therapist can
overtly use his or her own powerlessness to therapeutic advantage
with such comments as “A therapist can’t bring about a change for
someone who doesn’t actually want it for himself. I have no power
at all to create a change for you. You have that power, not me. I can
help you make a change you actually want, but I can't help you
make a change you don't actually want. I feel that whatever you
want or d o n ’t w ant is a valid, legitimate choice. But we need to
look at whether it makes sense for you to be here, seeing me.”
Therapy will fail if a client does not have real motivation to
change. The therapist must be absolutely clear about this and must
require real motivation from the client as a precondition for begin­
ning and then for continuing the therapy process. The therapist
should be ready to resign, without blaming or judging the client,
if he or she fundamentally lacks motivation to change—even if a
couple’s marriage falls apart, or somebody might start drinking
again, or someone might go back to jail.
Furthermore, by staying on his or her own side of the motiva­
tional boundary—that is, by not trying to supply motivation that
should be coming from the client—the therapist consistendy main­
tains a noneffortful stance that avoids strain and burnout. If the
therapist is unwilling to assume and maintain a zero-power posi­
tion and is straining to supply the motivation for the work, this
indicates that the therapist’s own needs or anxieties are shaping
the therapy in counterproductive ways.

Assum ption o f Coherence_________________________

The practical m ethodology for carrying out radical inquiry
derives from this fundam ental assumption of coherence: Every
activity of the mind, conscious and unconscious, occurs coherently,
according to the mind's own current constructions of meaning, in a pur­
poseful attempt to satisfy desires and interests established by those con­
structions of meaning.
138 D epth -O rientf.d B rief T herapy

Here “every activity of the m ind” means everything we expe­

rience and do, including, of course, clients’ presenting symp­
toms. This assumption of coherence is the lens through which
the therapist views the em erging picture of the client’s various
constructions of reality; it guides and organizes the therapist’s
understanding of the client’s positions and how they operate.
The assumption of coherence provides the central logic for
radical inquiry, as follows: To rapidly and accurately find the
unconscious, pro-symptom position generating the presenting
symptom, the shortest path lies through the central question, What
position or construction of meaning exists that makes the symptom more
important to have than not to have?
In this view, the presenting symptom does not signify that the
client’s psyche is out of control or defective. The psyche all along
remains coherent and completely in control of producing or not
producing the symptom. Furthermore, the nature and form of the
symptom itself is coherently determined by the psyche; it is not ran­
dom or chaotic in the least. The symptom seems senseless, out of
control, and chaotic only from the client’s conscious position. With
real clarity into the version of reality in the client’s unconscious,
pro-symptom position, the symptom is revealed to be a coherent
feature of that version of reality, and to be more important to have
than not to have, even with the pain or limitation it brings. For the
therapist to approach the client’s problem with this understand­
ing from the outset proves to be a “master key” for unlocking it.
The psyche behaves quite contrary to common sense, in that it
adheres to its present solutions to perceived problems with indif­
ference to the pain these solutions (symptoms) cause the conscious
personality. The client’s suffering due to the symptom should not
in itself lead the therapist into believing that client’s governing emo­
tional position is to be rid of the symptom. The therapist, while
empathizing accurately with the painfulness of the symptom for the
client, knows a priori that a powerful part of the client’s uncon­
scious mind regards the symptom as good, needed, meaningful.
Once the emotional truth and coherent personal meaning of
the symptom are in plain view, the therapist accords full validity
and dignity to the newly recognized needs and themes involved.
In thus reframing to the emotional truth of the symptom, the ther­
apist reframes to sense and valid personal meaning—the hidden
 Radical Inquiry: T he Stance 139

sense of how the symptom has been the client’s way of striving to
meet those important needs and themes, though at a cost that moti­
vates him or her to finding a new way to do this. Throughout this
work, the therapist, knowing that it is the client’s own formidable
power to create, hold, and change positions that determ ines
whether the symptom is m aintained or changed, never views an
adult client as actually helpless, even when empathizing with the
client as feeling helpless.
We recognize one im portant exception to the stance ju st
described—the case in which the presenting symptom involves
overt harm done to another and an attitude consisting of malevo­
lent intent, flagrant exploitation of a power differential, a n d /o r
absence of empathy for suffering inflicted. When these antisocial
positions are involved, we do hold a value judgm ent of them as fun­
damentally unacceptable, although the degree and m anner of
expressing this to the client is decided on a case-by-case basis.
The concept of the symptom’s coherence within the operation
of the psyche is not a new idea in the history of psychotherapy. In
various forms it can be traced back to Freud. More recently, fam­
ily therapist and systems theorist Paul Dell made the case that a
constructivist view of coherence should replace the conceptually
flawed and ad hoc concepts of homeostasis and resistance. What is
new in depth-oriented brief therapy is the very deliberate, perva­
sive, persistent, and precise use we make of o u r assum ption of
coherence, in every session, for working in depth to find the ele­
ments of meaning that are generating the presenting problem, and
for getting rapid results.
In practice, the central question for radical inquiry into a pro­
symptom position ( What construction exists that makes the symptom more
important to have than not to have?) gets more specific and branches
into three guiding forms or variations:

1. W hat does the symptom do for the client th at is valued or

needed in the client’s world? How, and in what context, does
the symptom express or pursue a valid, important need or pri­
ority?
2. How is the symptom an actual success for the client, rather
than a failure? To what problem is the symptom a solution, or
an attempt at a solution?
140 D ep th -O rien ted B rief Therapy

3. What are the unwelcome or dreaded consequences that would

result from living without the symptom? What happens if the
symptom doesn’t?

Seeing the symptom as having deep emotional value, as meeting

important needs, as being a success or a solution to an important
problem, or as preventing something unwelcome from happening
is not a trick. This is seeing and acknowledging the symptom in its
truest significance within the coherent psychic life of the client,
which is why this approach accesses, engages, and transforms the
deeper sources of the symptom so directly and effectively.
Collectively, these three lines of inquiry embody the assump­
tion of coherence and they define, and keep the therapist on, the
shortest path to the emotional truth of the symptom. Their utility
cannot be overstated. All radical inquiry into pro-symptom positions con­
sists of the experiential pursuit of one of these lines of inquiry, adapted to
the immediate therapeutic situation in any way the therapist deems
expeditious (specific techniques for this are the subject of the next
chapter). The therapist starts from the presenting symptom and
tracks down its pro-symptom emotional truth through one or more
of these three lines of radical inquiry.

E xperiential-P henom enological Discovery and

V erificatio n o f Constructs_________________________
As the clinical material in earlier chapters has indicated, there are
many different techniques and types of therapist-client interaction
that elicit the pro-symptom material that answers the above three
guiding questions of radical inquiry, w ithout ever asking those
questions explicidy. W hether or not these key questions are explic­
itly asked, and regardless of which specific techniques are used to
pursue them, what is necessary is to work experientially and phenom­
enologically. In DOBT, this commitment to working experientially
and phenomenologically is as much a matter of basic stance as of
technique.
To have a client experientially find an answer to any one of the
three guiding questions is to have the client discover and reveal
some part of the emotional truth of the symptom—not speculadvely
and not by talking about the problem, but through the client’s direct,
 Radical Inquiry: T he Stance 141

subjective encounter with his own previously unattended presup­

positions, emotional wounds, and protective actions. As described
in Chapter One, a step of radical inquiry is designed so that the only
wayfor the client to respond is to have an experience of some aspect of the
hidden constructions of meaning—the unrecognized emotional
truths—involved in creating and maintaining the problem.
Experiential does not necessarily mean that something dramatic
or emotional happens. In radical inquiry it means simply that the
client encounters, experiences, and reveals his or her own con­
structs of reality involved in the presenting problem, as our clini­
cal examples have illustrated. Even to en co u n ter and own a
predominantly cognitive construct, such as a previously unrecog­
nized “belief,” is an experiential event, because any such belief is
not a dry, impersonal fact but is seeped with personal meaning and
emotional significance.
In working with trainees who are making the transition to
DOBT from a more traditional, interpretation-oriented approach,
we find that a special emphasis on working experientially tends to
be needed. To work experientially is to draw the client into focus­
ing and keeping attention on his or h er actual, in-the-m om ent
experiencing, as distinct from having attention on ideas about pre­
sent (or past) experiencing of the problem . For example, if a
woman in therapy is talking about her problem of interacting with
her boss at work, the therapist can ask her to imagine being there
at work and to notice and describe what she is experiencing, in her
body as well as emotionally and cognitively, as the boss walks into
her office and the problematic pattern occurs. Doing this, she says,
“I’m starting to feel small and scared.” She and the therapist now
begin to have access to the problem itself. In the same way that a
sculptor needs to have the block of stone in the room in order to
work with it, and cannot do so by talking or thinking about the
stone, a therapist needs to have the client’s experience of the prob­
lem actually present in the room. This is what working experien­
tially does. It is only through experiencing that the client actually
accesses the constructions of reality involved in generating the problem.
Constructions of reality are accessed by experiencing them, not by
talking about them.
The key to being a therapist who can effectively evoke experience
in clients is to stay very close to the cu rren t point of maximal
142 D epth-O riented B rief T herapy

poignance or felt meaning in the client’s account of the problem.

In attem pting to follow as direct a trajectory as possible into the
heart of the emotional truth of the symptom, at each step the ther­
apist sensitively places attention into the most meaning-laden
a n d /o r feeling-laden elem ents of the problem currently in the
field of view. A client with a presenting symptom of uncontrollable,
violent rage mentions in passing in the first session that in child­
hood, the way parents and teachers always reacted made her feel
she was “hit by a meteor.” The therapist recognizes the intensity
and importance of the emotional themes tacitly referenced by that
casual phrase and begins to unpack them and make them explicit
and central, saying, “A meteor comes with tremendous suddenness
and force. O ne m om ent everything seems fine, and the next,
you’re violently smashed, cratered. Is that how it feels to you?”
Then follows a pointed recognition that meteors out in space are
random, but meteors between people seem aimed and hurled, so it
feels like attack. Finally the therapist summarizes what he under­
stands, saying, “So, as a girl you experienced the world of people
as a very hostile, dangerous, frightening world of sudden, violent
attacks that kept smashing you deeply.” The client is significantly
moved; even this much recognition of unattended emotional truth
might in itself be a healing validation (and self-validation) for her.
The therapist deliberately uses a vividness, even a starkness, of
phrasing that does justice to—yet does not exaggerate—the actual
intensity and passion of the emotional truth of the client’s lived
experience. The client has a habit of attenuating and diluting these
deeply dimensional emotional meanings in her life, and she needs
the therapist to be unstinting in recognizing and bluntly naming
the emotional truth of her experience. This close-in tracking of
the themes of maximum meaning or poignance is experienced by
the client as a deeply empathic interest on the part of the thera­
pist, and it naturally moves the client toward experiencing important
emotional realities rather than merely conceptualizing or talking
about the problem.
A useful exercise for trainees is to undertake the practice of
converting each in-session understanding or interpretation that
they would normally state conceptually to the client into an evoca­
tive response that will elicit direct experience of emotional mean­
ing in the client.
 Radical Inquiry: T hk Stanch 143

A somewhat more subtle requirem ent than the need for expe­
riential work, but an equally stringent one, is the requirem ent that
the work also be phenomenological. This means that the therapist
works entirely within the terms of the client’s own constructions of
meaning and does not subordinate the client’s constructions to
any that the therapist brings, including psychological theories and
diagnostic labels. DOBT’s conceptual scheme—a scheme only of
how the client’s construction is internally organized—has no exter­
nal explanatory content claimed to be senior to anything the client
can experience as true for himself.
The therapist’s attention during a session is fully absorbed in
the client’s present experiencing and in the moment-to-moment
task of responding to the client in ways that bring about radical
inquiry (revelation of structures of meaning) or experiential shift
(transformation of structures of m eaning). The clarity into the
client’s constructions of reality that is gained by the therapist in
this absorbed mode of attention is not to be confused with the for­
mulation of hypotheses from an “objective” theoretical standpoint.
Jealousy of a sibling would not, for example, be interpreted as a
competitive striving or as having a family-systemic function; instead,
it is worked with strictly in terms of the person’s actual feelings,
images, losses, gains, and other construed meanings in relation to
the sibling.
Of course, as we have said, there are moments in therapy when
it is supremely valuable to the client for the therapist to voice what
he or she understands of the client’s emotional truth. Whether this
is done for the simple purpose of verification or as a way of invit­
ing the client to place awareness into particular constructs of mean­
ing, this articulation is always presented (1) free of any references
to theoretical or diagnostic categories and labels and (2) in a way
that makes it clear that the th erapist is su b m ittin g th is v i m to the client
fo r his or her experiential verification o f accuracy. In depth-oriented brief
therapy, it is the client who is always the judge and jury regarding
emotional truth. The therapist never imposes his or her concept
of the client’s emotional truth. It is the c lie n t s governing construc­
tion that the therapist is attempting to articulate, and so it is only
the client who can experientially recognize the accuracy of that
description and subjectively endorse it as “true.” Therefore, the
therapist checks with the client frequently regarding the accuracy
144 D ep th -O rien ted B rief Therapy

of the therapist’s understanding and the fit or tailoring of in­

session activities suggested by the therapist. When the client indi­
cates that the therapist has the wrong idea, the therapist is glad to
be set on the right track by the client’s corrective feedback. The
therapist’s willingness to be corrected is very important to clients,
because it signals respect for the fact that only the client could pos­
sibly be the final authority as to what is true for him or her.
To rely on interpretation is to rely on the client’s capacity for
conceptual insight, which can be a severely limiting factor. Expe­
riential-phenomenological work, in contrast, does not encounter
this barrier. While only some people are conceptually insightful,
everyone lives and moves in some experiential reality and is subjec­
tively reachable through the medium of that experiential reality.
Everyone who has a symptom also has a pro-symptom position, and
the client’s own pro-symptom position is already, through the symp­
tom itself, in an experiential relationship with his or her conscious
position and can be further elicited experientially.
Working phenomenologically means becoming comfortable
with the expectation that “everybody is an exception,” in therapist
William O ’H anlon’s words, that idiosyncrasy of symptom produc­
tion is the rule, that good psychotherapy is never formulaic. To
embrace the fully phenomenological approach of DOBT is always
to expect to have the client show you, the therapist, where the emo­
tional truth of the symptom lies—not the other way around.
In DOBT it therefore becomes quite clear to the client that the
therapist regards the client’s own inner knowings as both reliable
and highly important for resolving the problem. This in itself has
much therapeutic im pact for some clients, ushering them into
trusting their own experience and their natural intelligence, and
creating a sense that for them simply to be themselves in relation­
ship is sufficient, viable, and gratifying.

A nthropologist's V ie w ____________________________
In therapy, the client’s behavior—including verbal expression—
always contains hidden doorways that open quite directly onto the
unconscious, pro-symptom position (s) sought through radical
inquiry. However, these doorways are perceptible to the therapist
only if he or she is observing in the way an anthropologist does:
 R a d ica l Inquiry: T h e S tan ce 145
with no assum ption of already knowing what anything means.
Maintaining the stance of anthropologist's view means that when you
first hear your client utter familiar-sounding words and phrases
such as “angry,” “happy,” “having a shared direction,” or “depres­
sion” you do not assume that you know what these words mean to
your client, or that the m eaning is inferable. You are aware that
you must pursue more specific information about what your client
means by these familiar-sounding words. That is an anthropolo­
gist’s view, and it is vitally im portant for radical inquiry. A simple
example will illustrate why.
In a session of couples therapy, a woman client describes her
husband’s behavior and then says, “When he talks to me like that,
it really hurts.” Suppose that as therapist, I then have a vivid sense
that how he talks to her would really hurt me, too. Now I am assum­
ing I know what she means by “hurt,” and because I am assuming I
know what she means, right there my inquiry stops going deeper.
Actually, I am now just one question away from a breakthrough in
the problem , but I never ask that next question because I am
assuming I know what she means by “hurt.”
However, if I am m aintaining an anthropologist’s view, I am
aware that I do not yet know what she means by “hurt,” despite how
strongly / relate to that word in this situation. So I ask her what she
means. I say, for example, “What about the way he talks to you is
hurtful for you?” My aim in asking this question is this: Right
behind that familiar-sounding word are the specific cognitive, emo­
tional, and somes the tic structures that comprise the state she calls
“hurt.” Suppose in unconscious, perceptual-emotional memory she
has a construction of reality in which a man talking to a woman
that way means he will then leave her. Suppose this emotional tem­
plate is closely linked to unhealed, unconscious emotional wounds
in relation to her father, wounds that flare with pain and fear when
her husband talks to her that way.
All this being the case, this woman used h er word “h u rt” to
refer to exactly those hidden structures of meaning and feeling, as
if everyone has those particular constructs and as if everyone is
referring to those when they use the word “hurt” in this sort of sit­
uation. As the therapist I do not yet know what constructs she is
implicitly indicating when she says “hurt,” but I do know that she
is referring to a private world of meaning in that utterance. And I
146 D ep th -O rien ted B rief Therapy

know that revealing those hidden constructs and their operation

is usually the beginning of a breakthrough or resolution. The ques­
tion “What about the way he talks to you is hurtful for you?” directs
her to find and reveal those hidden keys to what she experiences.
I persist in that inquiry until it is completely clear to me what
goes on in her in response to her husband’s words that results in
the state she calls “hurt.” Then I work directly with these emotional
and other constructs driving her response to her husband.
In order to resolve a presenting problem rapidly, deeply, and
effectively, the initially hidden substructure of the problem needs
to be made clear very quickly. To that end, maintaining an anthro­
pologist’s view is crucial, because then the therapist is in a position
to open doors that appear, fleetingly, in the guise of familiar­
sounding words like “hurt” and then unpack the important, reality­
forming constructs from the dark room right behind that door.
Anthropologist’s view is the sine qua non for accurate empathy.
Without this, the therapist is experiencing a pseudo-empathy based
on projecting his own meanings onto the client’s nominalizations
and is empathizing only with these therapist-generated meanings.
This actually is the therapist’s 5^//cempathy, a kind of counter­
transference in the guise of empathy for the client’s experience,
an actuality still unknown to the therapist.
Anthropologist’s view is based on the therapist holding a con­
structivist conception of how people know to say what they say. In
the example ju st considered, the therapist’s entire approach is
based on understanding that there is n othing to be taken for
granted in how the woman arrives at saying “h u rt” from hearing
her husband speak to her in a certain way. She (unconsciously)
processes that perception in specific, idiosyncratic ways that add
up to how she knows to feel “hurt.” This use of language to provide
access to how a presupposition is creating perception is a distinc­
tive feature of constructivist approaches, as theorist Robert
Neimeyer observes:

For the orthodox cognitive therapist, the meanings of the client’s

verbalizations are typically treated as unproblematic and literal. . . .
Emotions are understood in equally straightforward fashion, as the
result o f on e’s cognitive appraisal o f situations. . . . Influenced by
a hermeneutic, phenom enological perspective, constructivists
 Radical Inquiry: T he Stance 147

characteristically inquire closely into personal meanings that form

the subtext of the client’s explicit statements (Kelly, 1955), making
extensive use of metaphor .. . and idiosyncratic imagery.

Anthropologist’s view may be summed up as a defining feature of

radical inquiry in this way: During a therapy session, if that which is
presented seems easy to understand and familiar, do not assume
you already know what it is. Look closer. Have “beginner’s mind.”
Do not assume your client’s words mean what they mean to you.
Burrow into meanings; get specific; require the client to get very
specific, until the client’s own meanings are clear, with nothing
being read into them by you.
Anthropologist’s view operates in close conjunction with the next
and last element in the stance of radical inquiry: freedom to clarify.

Freedom to C larify________________________________
As we begin describing each of the defining features of radical
inquiry, we are tempted to write, “It’s this one that is most impor­
tant,” which must mean that each is indeed indispensable. Freedom
to clarify, however, is the most important, at least for therapists new
to DOBT, because if the therapist does not assume this element of
stance, none of the o th er aspects of radical inquiry will get a
chance to operate.
Freedom to clarify means simply that in doing radical inquiry,
you feel free to do nothing but seek the clarity you need—clarity
into the hidden emotional truth that will make lucid sense of how
and why the symptom or problem (1) makes complete psycholog­
ical sense to have and (2) remains needed and therefore stuck.
Freedom to clarify means that as you persistently seek clarity,
you are unconcerned with changing the client, fixing the problem, or mak­
ing the symptom stop happening. You are attempting none of that. You
are only going after the clarity you need into the hidden structure
generating the presenting symptom. You are getting the client to
lead you into his or her hidden architecture of meaning, and you
are not trying to change that architecture, only to know it. Attempt­
ing to make the symptom stop happening before reaching clarity
into its emotional truth short-circuits both radical inquiry and the
achievement of experiential shift (a process that becomes a blind,
148 D epth-O riented B rief T herapy

hit-and-miss, lengthy, and ineffective attem pt to change or over­

ride the client’s pro-symptom position). In short, freedom to clar­
ify is freedom from preoccupation with changing the client or the
problem.
The client has already been trying hard to make the symptom
stop happening without knowing why or how it happens. The proof
that any overt, direct attempt to make the symptom stop isn’t likely
to work is the fact that the client is in your office. As was discovered
over twenty years ago at the Mental Research Institute in Palo Alto,
California, doing “more of the same” in that sense will actually have
the effect of maintaining the symptom you are trying to help dis­
pel. When the therapist fully accepts and embraces the fact that
the path of greatest efficacy is not through trying to make the symp­
tom stop, he or she goes a long way toward firmly establishing the
freedom to clarify.
In DOBT the therapist regards the symptom as the visible point
of access to some very im portant, very m eaningful area in the
client’s experience. DOBT is highly effective at rapidly dispelling
symptoms, yet the therapist’s attitude is never one of rushing to get
rid of the symptom but rather of wanting very much to receive the
im portant message that the symptom is sending—the message
being its emotional truth. So there is never an inclination to use a
technique as a blind attem pt to stop or block the symptom. (In
cases involving real danger of great harm—violence, child abuse,
or suicide—where a symptom must be stopped at once, we take
gross, overt measures that are not “techniques,” including when
necessary physical separation, hospitalization, involvement of
police or a child protective service, or massive intervention with
extended family and friends.)
The underlying principle here is that by pursuing real clarity
into the precise structure of the problem, effective ways to induce
change will become apparent at the earliest possible moment.
When learning this approach, one of the main things that frees
therapists to drop their habitual stance of attempting to make the
symptom stop, and to take instead the stance of freedom to clarify,
is the discovery of the richly therapeutic effects of the radical
inquiry itself. Even though the therapist is not yet intending to pro­
duce important shifts for the client, radical inquiry is profoundly
therapeutic. We conduct an extended dyadic exercise in freedom
 Radical Inquiry: T he Stance 149

to clarify in some of our DOBT workshops, and in the debriefing

after the practicum, invariably the comments from participants
include surprised accounts of the therapeutic impact experienced
by the “client” in being on the receiving end of the therapist’s pur­
suit of nothing but his or her own clarity.
We find in our consultation work with therapists that the most
common cause of the therapist feeling the work with a client is
somehow stuck is the therapist’s attempt to produce a change and
get rid of symptoms without having first obtained enough clarity
into the client’s hidden position driving the symptom. When the
therapist then shifts gears and focuses simply on getting sufficient
clarity, that is the breakthrough, and the work with the client takes
on a whole new character. The following short excerpt from a ther­
apist’s DOBT consultation session shows the contrasting stances
very clearly. The therapist, consulting about her work with a cou­
ple, first described how the woman spent most of one session in an
“emotional tantrum ,” which to the therapist seemed to be a very
childish state. The consultant then had the therapist resume the
session in imagination, with the couple in chairs in front of her.
The consultant then coached the therapist.

Consultant: Ask her how old she feels.

Therapist: She says four.
Consultant: What do you want to say next?
Therapist: [Pause] I do n ’t know. I’m at a loss.
Consultant: What are you feeling right now?
Therapist: A tense, almost urgent need to get her to be able not
to go into being four. I want to stop her from doing
that.
Consultant: W hat’s it to you?
Therapist: I’m her therapist! I’m somehow failing if she keeps
being four and acting like that!
Consultant: No you’re not.
Therapist: I’m not}
Consultant: How about asking her if that pattern of reacting and
feeling like she’s four is something she wants to
change?
Therapist: Oh. Right. God, what a relief.
Consultant: W hat’s the relief?
150 D epth-O riented B rief Therapy

Therapist: To remember that it’s not up to me to make her

change, or to want to. I was trying to get her away
from her emotional truth of being four as fast as I
could, but you reminded me just to stay right there
with that emotional truth, and let hereome to terms
with it.
Consultant: Yes. Let’s do a short role-play. You be her, I’ll be the
therapist. [To therapist who is now in the role of the
female client] So, since you say that when you feel
this way it feels like four, does it seem true to say that
there’s a four-year-old side of you that sometimes
emotionally comes to the front?
Therapist: Well, I’ve never thought about it that way, but it seems
true.
Consultant: Is that something you can live with, or is it something
you want to change?
Therapist: I guess I ought to change it.
Consultant: Well, I’m asking if you want to change this pattern of
how you sometimes react.
Therapist: Well, I don’t know; it’s such a new idea. I’ve never
looked at this and seen it like this, or thought it could
change.
Consultant: So then let’s try something. Like many people do,
you seem to have some old emotional hurts from
childhood, from around four, that sometimes flare
up in the present. I’m wondering if th ere’s some­
thing im portant you’ve believed or hoped your rela­
tionship would do for this side of you. So, would you
be willing to just imagine something for a m inute or
two? Imagine that you never again went into being
four with your husband. Imagine that you stayed at
your actual age, even when arguing and being very
upset.
Therapist: [Pause] Ugg. T hat’s hard. I couldn’t carry on. Then
it’s between grown-ups.
Consultant: Good. Keep going. Keep seeing your husband. H e’s
just said or done something that you’re pretty upset
about, and you stay grown-up as you feel this and
respond to him.
 Radical Inquiry: T he Stanch 151

Therapist: [Slowly, with eyes squinting] If—I stay grown-up—then

he’s—as right as I am, or I have to listen to his side, and
he might be right, or at least as right as I am, and then I
won’t get to have my way. That’s it: I don’t want to let
there be any opening at all for him having his way and
me not having mine. I don’t want it to be between
equals.
Consultant: What makes that really important for you, to have
him do just what you want?
Therapist: [Pause] ‘Cause nobody ever did. Nobody ever did,
and it’s not fair, and actually I’m really angry about
that.
Consultant: Does that mean that something you’ve really hoped
for from your marriage is for your husband to set
right that unfairness that you feel so angry about, that
you suffered as a child, by him taking seriously what
you want and doing what you want?
Therapist: [Popping out of the client role] You know, at that
point, I couldn’t keep being her. What you just said
completely undid her ability to stay in her familiar
view of reality.
Consultant: Yes. And what did I do, as the therapist, that had that
effect?
Therapist: Let’s see. [Pause] You know, I think all you did was
ask me to see what it’s like for me if I don't go into
being four. And then what came up was—why I do it,
because I could tell what I’m losing if I don't do it.
And then you asked about setting right what hap­
pened as a child, and I felt like you’d gotten under
me, like I was being scooped up.
Consultant: Yes, exactly. And I was just freely inquiring. I wasn’t
trying to make her change any of this, and yet look at
how effective that was.
Therapist: But didn’t you ask her to stop being four by asking
her to stay grown-up?
Consultant: No. I was never trying to get her to be finished with
the symptom. I was doing nothing but trying to make
sense for myself of why the symptom is im portant to
have. For that purpose I asked her to see what
152 D epth-O riented B rief T herapy

happens if she temporarily suspends it. So my experi­

ence was of zeroing in on what might be going on. If
she then said, “Look, I insist on trying to get some
man to give this four-year-old what she never got,”
that’s OK with me, because it’s her experiment with
life, isn’t it? I wouldn’t feel I’d failed to change some­
thing I should’ve changed.

This transcript shows the difference between the stance of effort-

fully trying to stop the symptom and the stance of freedom to clar­
ify, as well as the therapeutic effect of the therapist’s clarity-seeking
in itself.
Freedom to clarify allows the therapist to retu rn to clarity­
seeking as needed throughout the work with a client. The fact
that the therapist is persistent and purposeful in pursuing the
needed clarity in no way implies a hurried, aggressive, or busi­
nesslike manner. Usually our own styles are relaxed and gentle,
but we stay very m uch on purpose. W hen clients ram ble into
detailed narrations that are not serving our need for clarity and
are of unclear personal significance or relevance, we soon ask
how this information is im portant or connects to the work. If it
does not, we bring the focus back to genuine relevance, or focus
on identifying the client’s current need to ramble.
Freedom to clarify involves a kind of open space of inquiry, a
capacity to approach and move through the session in a state of
not-yet-knowing, or at least free of any fixed preconception of what
will happen or how to understand the symptom. There is a degree
of existential uncertainty in this not-yet-knowing that the therapist
needs to be able to tolerate. The therapist’s not-knowing is only
on the level of content and is not a state of directionlessness, since
the therapist is always working within DOBT’s directional frame­
work of moving from the symptom to the pro-symptom position
that certainly is there to be found. D uring radical inquiry, the
three shortest-path questions always serve as the therapist’s ori­
enting framework. However, the therapist does not pursue them
in a linear attempt to change anything. They are the route to clar­
ity only—insight into how the symptom is in fact more important
to have than not to have.
The therapist also needs to feel comfortable in letting his or
 Radical Inquiry: T he Stance 153

her not-yet-knowing be plainly visible to the client. The therapist’s

expertise does not depend on maintaining an image of all-knowing
doctor or sage, but on being expert at discovering. For the thera­
pist to allow his or her own efforts to achieve clarity to be visible to
the client is in itself highly therapeutic in many cases, as an exam­
ple of being fully at home with being only human. Overall, DOBT is
a highly transparent psychotherapy. With few exceptions, generally
all of the therapist’s conceptualizations and methodology are visi­
ble or can be made visible to the client with no detriment to thera­
peutic efficacy, which is in m arked contrast to strategic and
transference-centered therapies.
Depending upon the work setting, the therapist may be work­
ing with a treatment plan or some diagnosis or theoretical view of
the problem . This need not actually conflict with an in-session
stance of not-yet-knowing. The therapist simply makes use of his
or her own innate capacity to hold several different positions at
once, and holds all such plans and labels lightly enough so that
they do not prevent the pursuit and the emergence of a new clar­
ity in this very session—a clarity that could revise everything and
lead directly to a breakthrough.
What about moments when the therapist has no idea what to
do next? If you do not know what to do next, it means only one
thing: you are lacking clarity about som ething. T herefore, you
drop down into your freedom to clarify: you sit back in your chair,
you relax and pay attention to your own subjective sense of where
you need more clarity. There is a faculty of your own mind that is
always feeding you a felt sense of where to focus for the clarity you
need—a kind of homing signal, a sense of psychological direction.
However, that prom pt or signal is lost in the noise of anxiety over
finding a way to stop the symptom from happening, or over per­
forming impressively as therapist.
About twenty years ago one of us attended a two-day workshop
with James Simkin, one of the founding figures in Gestalt therapy.
Right after he worked with som eone on a very long, complex
dream, another participant asked how he chose which among the
many elements of the dream to work with. One expected Simkin
to give some Gestalt-theoretic scheme for identifying the impor­
tant elements. What he actually said was completely unexpected,
producing a kind of shock, a litde revolution in the mind. He said
154 D epth -O rien ted B rief Therapy

he followed his sense of interest. He managed somehow to convey

that as the therapist, you can trust your own psyche to sense and
let you know where the real action is in the client’s process. You feel
your interest, your attention, go to certain elements, and you fol­
low that.
So, when at a loss in a session, that directional antenna, that
nameless feeling of interest, will point you right into the area
where it is im portant for you to get more clarity. It is necessary,
though, to have full freedom to clarify, in order to be relaxed and
attentive to this internal compass.
The therapist’s subjective experience of interest, pointing his
or her attention to certain areas of inquiry, can be understood as
the therapist’s use of self in the relationship with the client. This
is an integral aspect of the freedom to clarify in radical inquiry. In
this way the therapist can sometimes know to focus radical inquiry
on key areas without cognitively knowing how he knows to focus
there and can then converge very rapidly upon the emotional truth
of the symptom.
There are two criteria for knowing when the needed degree of
clarity, the terminus of radical inquiry, has been reached: (1) the
emotional truth and psychological sense of the presenting symp­
tom within the client’s world is now transparent, and the creation
of the symptom is no longer a mystery; (2) based on this clarity
into the network of constructs that make the symptom important
to have, one or more ways by which the client could resolve the
problem are also now clear, and the stage is set for a process of
experiential shift.

Sum m ary_________________________________________
Without the assumption of immediate accessibility, the therapist would
not attem pt the rapid discovery of the client’s hidden, symptom­
generating constructions.
Without active intentionality, the therapist would not in fact do
what it takes to meet the client in the emotional truth of the symp­
tom time-effectively.
W ithout the stance of powerlessness, the therapist would
attem pt to provide motivation that must come from the client,
interfering with the client’s own relationship to change—a setup
 Ramcai . Inqi ;i ry: T hk S i an<:k 155

for ineffectual therapy and a sense of “failure” on the part of the

client.
W ithout the assumption of coherence, the therapist would
have to resort to external theories to make sense of the client’s
material and would miss its truest significance in the client’s life.
Likewise, without experiential-phenom enological discovery
and verification of constructs, the therapist would impose mean­
ings from without, complicating and obstructing the therapeutic
process in many ways, and would not usher the client into felt
knowledge and direct possession of the meanings within.
Without anthropologist’s view, the therapist would miss many
easy openings and opportunities for quickly accessing the hidden
constructions of meaning involved in the symptom.
Without freedom to clarify, the therapist would attempt to fix,
cure, and change the client before reaching clear knowledge of
how to do so, resulting in ineffectual, drifting, or coercive therapy,
based more on therapist guesswork, theorizing, or countertrans­
ference than on having an accurate map of the client’s construc­
tion of the problem.
With all these defining features of the stance of radical inquiry,
the techniques detailed in the next chapter em erge as natural
actions.

Notes
P. 127, The inquiry of truth . . F. Bacon, Francis Bacon: The Essays or Coun­
sels, C ivil an d Moral', o f Francis Ed. Verulam, Viscount St. Albans (p. 9),
White Plains, NY: Peter Pauper Press.
P. 131, other such lists previously published: See, for exam ple, M. F. Hoyt
(1985), “Therapist Resistances to Short-Term Dynamic Psy­
chotherapy,” Jou rnal of the American Academy o f Psychoanalysts , 13,
93-112.
P. 134, focused training in experiential emotional process: Live training in the
basic techniques of Gestalt therapy is of inestimable value for expe­
riential emotional work.
P. 135, before proceeding further toward the central emotional truth o f the abuse:
See R. Schwartz (1992), “Rescuing the Exiles,” Family Therapy Net-
worker, 16(3), 33-37, 75.
P 135, In a remarkably candid an d valuable self-expose, psychotherapist Richard
Schwartz . . .: See previous citation.
P. 139, coherence should replace the... concepts o f homeostasis a n d resistance:
156 D epth-O riented B rief Therapy

P. Dell (1982), “Beyond Homeostasis: Toward a Concept of Coher­

ence,” Family Process, 21, 21-41. A more controversial, “radical con­
structivist” view o f coherence is the concept of structure determinism,
which is central to the biological theory of Humberto Maturana and
Francisco Varela. Structure determinism emphasizes that the par­
ticular, coherent structure of the individual’s knowledge-organizing
system is the sole determinant of the individual’s experience and
response in all interactions with the environment. See, for example,
H. R. Maturana 8c F. J. Varela (1987), The Tree of Knowledge: The Bio­
logical Roots of H um an Understanding, Boston: New Science Library;
and P. Dell (1985), “Understanding Bateson and Maturana: Toward
a Biological Foundation for the Social Sciences,”fo u rn a l o f M arital
an d Family Therapy, 77(1), 1-20.
P. 144, the expectation that “everybody is an exception W. H. O ’Hanlon
(1990), “Debriefing Myself,” Family Therapy Networker, 1 4 (2 ), 68.
PP. 146-147, “For the orthodox cognitive therapist . . . and idiosyncratic imagery n:
R. A. Neimeyer (1993), “An Appraisal of Constructivist Psychother­
apies,”Journal of Consulting an d Clinical Psychology, 61(2), 224.
P. 147, (Kelly, 1955): G. Kelly (1955), The Psychology o f Personal Constructs,
New York: W. W. Norton.
P. 148, m aintaining the symptom you are trying to help dispel: P. Watzlawick, J.
Weakland, and R. Fisch (1974), Change: Principles o f Problem Forma­
tion and Problem Resolution , New York: W. W. Norton.
 CHAPTER 5

Radical Inquiry: Techniques

In sooth I know not why I am so sad.
It wearies me, you say it wearies you;
But hoxv I caught it, found it, or came by it,
What stuff ‘tis made of, xohereof it is bom,
I am to learn . . .
W illiam S hakespeare, The Merchant of Venice

The client’s presenting symptom is itself the first point of access to

the unconscious constructions of m eaning creating it. Radical
inquiry therefore starts from the symptom as the chief “clue” or
signpost of em ergent meaning and tracks down the hidden posi­
tion producing it.
The techniques that we describe in this chapter are those we
have found, within our own styles of working, to be most often
useful and effective for radical inquiry. Some of these techniques
have been invented specifically for depth-oriented brief therapy;
others are applications or variations of m ethods developed in
other m odalities of psychotherapy. As is true of constructivist
approaches in general, depth-oriented brief therapy can integrate
and coordinate the use of a wide range of th erap eu tic tech­
niques. We emphasize, however, that taking the stance of radical
inquiry (discussed in Chapter Four) is a far more im portant con­
dition for success with DOBT than applying any specific tech­
niques. We will often com m ent on how the use of a technique
em bodies the stance. T here is no lim it to the ways in which a
therapist who has positioned him- or herself in the stance of rad­
ical inquiry can work for rapid, experiential discovery of hidden
constructions of meaning.

157
158 D epth-O riented B rief T herapy

In this chapter we also address resistance—how it is conceptu­

alized in DOBT and how the therapist utilizes its occurrence as a
valuable opening for radical inquiry.
By definition, all techniques for radical inquiry into a pro-
symptom position are specific ways of finding answers to radical
inquiry’s central question or to any of its three concrete variations,
which comprise the shortest path to the em otional truth of the
symptom, and which we reproduce here for easy reference.
The central question or central logic is, What position or con­
struction exists that makes the symptom more im portant to have
than not to have? Its three variations are as follows:

1. W hat does the symptom do for the client that is valued or

needed in the client’s world? How, and in what context, does
the symptom express or pursue a valid, important need or pri­
ority?
2. How is the symptom an actual success for the client, rather
than a failure? To what problem is the symptom a solution, or
an attempt at a solution?
3. What are the unwelcome or dreaded consequences that would
result from living luithout the symptom? W hat happens if the
symptom doesn’t?

These questions serve more as internal guides for the therapist’s

attention and understanding than as point-blank questions to ask
clients. The client’s problem exists for the very reason that the
answers to these questions are unconscious, and so clients tend to
flounder or offer unuseful responses if asked such questions too
soon, too directly, and too cognitively. If the therapist does wish at
some point to ask one or m ore o f these questions explicitly, it
should be done in broadly suggestive terms, avoiding any one slant
of meaning that rules out many others. For example, in a mock ses­
sion a therapist-in-training asked question three of the client in this
narrow form: “If you no longer got depressed, what tuould go
wrong?”T he arbitrary and too-specific phrasing “what would go
wrong” did not capture the particular way being without depres­
sion would pose a difficulty for this client, and so she could not
relate to the question. It proved more fruitful when the therapist
revised the wording to “It will feel much better when you no longer
 Radical Inquiry: T echniques 159

feel depressed anymore, but at the same time, is there any way
there might be some new, unwelcome effects, or some difficult side
to it, when you no longer go into being depressed anymore?”
(Notice that the therapist said “when you no longer” rather than “if
you no longer,” because xvhen m ore effectively evokes imaginal
experiencing, while if tends to invite intellectual speculation.) The
client reflected and said, “Well, actually, now that you put it that
way, I guess I’ll have to do all kinds of hard things that now people
don’t expect me to do.” The question in this form allows her pro­
symptom position to begin to emerge. The therapist would now
continue with radical inquiry to find out what about keeping oth­
ers from expecting her to do “hard things” is so vital that it is worth
being depressed.
However, most of the techniques described throughout this
chapter are implicit ways to experientially evoke the answers to the
shortest-path questions above. The names of these techniques and
methods are:

• Creating collaboration
• Experiential questioning
• Serial accessing
• Imaginal interactive techniques
• Experiential dreamwork
• Sentence completion
• Viewing from a symptom-free position
• Inviting resistance
• Utilizing unexpected resistance
• Utilizing the client-therapist relationship
• Mind-body communication
• Focused examination of personal history

Creating C ollaboration____________________________
In order to gain a new client’s readiness and willingness to col­
laborate in radical inquiry, the most effective first step the thera­
pist can take is to attend sensitively to the clien t’s conscious,
anti-symptom position. To the client it is crucially important to feel
that the therapist precisely understands and empathizes with her
experience of the problem and the features of her anti-symptom
160 D kpth-O riented B rief T herapy

position—why or how the problem is troublesome, painful, unde­

sirable, irrational, not controllable, involuntary; and what it means
about self or others, as the client views it. This anti-symptom posi­
tion is the arena in which the therapist must demonstrate that she
will actively, sensitively, and reliably attend to what truly matters
most to the client. Only then will the client tolerate the vulnera­
bility of moving into feelings and contacting unconscious mater­
ial. When the therapist begins radical inquiry, this will be from the
client’s point of view a natural continuation o f the therapist
actively placing attention upon what is of crucial im portance to
the client.
Attending to the client’s anti-symptom position does not mean
giving the client carte blanche to consume the available time with
long narrations or descriptions. For working deeply and briefly, the
therapist must keep the session efficient from the beginning. For
example, to a talkative client who is rambling into a convoluted
narrative, the therapist might interrupt by saying, “You know, I see
how m uch you’re wanting to help me understand the problem,
and I am going to need your help as we work together, but right
now, in order to get my bearings, I need to ask you about some spe­
cific things.” In such ways the therapist actively maintains control
of the session when necessary in order to keep it on purpose at all
times. This also implicitly informs the client to expect the thera­
pist to be quite active in shaping the work.
As indicated in previous chapters, it is always the client’s capac­
ities that limit the pace of radical inquiry, rather than the thera­
pist’s assumptions or fears. With clients who show extrem e
defensiveness, vulnerability, and m arked instability or lability in
their construction of interpersonal reality (the abrupt changes in
experiential reality associated with “splitting”), the therapist’s inter­
est in finding a pro-symptom position may be interpreted as imply­
ing blame, badness, and pathology, and therefore radical inquiry
needs to be broached more delicately than with other clients. One
way we do this and still keep the therapy time-effective is by first
sharing a story such as this one:

I once knew a person who owned a small business and very much
wanted to make the business grow successfully into a much larger
business, and yet, she [he] wasn’t doing that, and over time she
 Radical Inquiry: T echniques 161

became very self-critical about what she viewed as her failure to do

that. It felt very bad to blame herself this way, but it seemed true.
But then one day she realized that, even though she wanted her
business to grow, there was another part of her that didn't want the
business to grow, because this part of her believed that, if it grew as
she wanted, she’d be so overwhelmed with work that she wouldn’t
have nearly enough time for anything else, such as her family or
her other interests and enjoyments. She realized that she had this
other side of her feelings, this other set of feelings that had its own
very good reasons for not wanting the business to grow, and this was
why she wasn’t doing it. Previously she saw it as only a bad thing
that she wasn’t making her business grow, but then, when she real­
ized this other side o f her own views and feelings, she saw that in
fact there was something very good about not making the business
grow. And this made sense in a whole new way of why she wasn’t
doing it. It certainly wasn’t just a failure on her part, as she had
thought at first. And it’s often this way with people. We generally do
have different sets of views and feelings operating at the same time.
That’s the normal way our minds work, and that’s why I’m inter­
ested in looking at whether there might be something good to dis­
cover about having the problem you re describing, something that
might never have occurred to you before.

Experiential Q u estionin g__________________________

There is a class of questions that induce actual experiential dis­
covery of constructs rather than speculative intellectualizing. Our
term for the use of such questions is experiential questioning. In
DOBT such questions are particularly designed to prom pt the
client to place attention where he or she has habitually not done
so, focusing directly on previously unconscious constructs involved
in the problem, bringing into awareness presuppositions, emo­
tional wounds, and protective actions along with the specific emo­
tional, cognitive, kine/som esthetic, and behavioral elem ents
comprising them. It is the experience of the discovery or coming-to-
awareness of a meaning-laden construct that makes these questions
experiential in their effect.
On the written page the questions may seem deceptively sim­
ple, and in many cases their potency for experientially carrying out
radical inquiry is not immediately apparent. However, if pursued
162 D epth-O riented Brief T herapy

phenomenologically and with full freedom to clarify, they can reach

directly into the hidden structure of the presenting problem.

Experiential Questions fo r Radical Inquiry

• “What would it mean about you [or your life, your marriage,
and so on] if the problem never changes?”
• ‘You’ve said that the change you want from therapy is [X].
What is it that makes having [X] as important to you as it is?
What would having [X] mean about you, or about your life?”
• “To whom else does it matter most that this problem change,
and why?”
• “Is there something im portant that [the symptom] does for
someone else?”
• “Specifically, what about that is [client’s term: hopeless, fright­
ening, hurtful, angering, saddening, depressing, and so on]
for you?” [Iterate with each new item produced by client until
presuppositions a n d /o r emotional wound are identified.]
• “How would you teach me to have the problem exactly as you
do?” Variation: “How do you know exactly when, or with
whom, to start having the symptom happen?”
• “Why have you chosen to get help on this problem now?”
• “What would you actually have to do, or feel, or believe, for
this to change?”
• “What does it mean to you about [A] that [B] is the case?” [For
example, “What does it mean to you about your husband that
he refuses to have a child?”]

An experiential question is implicitly both a request and an instruc­

tion to the client to have a specific experience in which the living
answer to the question is subjectively encountered, not intellectu­
ally figured out. The therapist’s m anner and voice tones in asking
these questions should indicate that merely conceptual, specula­
tive answers are not being sought, and they are not accepted if
offered.
Below, we illustrate the use of several o f these questions in
detail, in order to make it unmistakably clear how the asking of
any one of these questions is, in every instance, a unique event, a
creative interaction with the client in which the wording and the
 Radical, Inquiry: T echniques 163

pursuit of the question is sensitively tailored to the moment. To

ask any of these questions in a routine, mechanical way would cer­
tainly fail.

“You’ve said that the change you want from therapy is [X].
What is it that makes having [X] as im portant to you as it is?
What would having [X] mean about you, or about your life?”

This question draws the client’s attention to unconscious mean­

ings that he or she attributes to the hoped-for change. The appli­
cation of the “What makes [change X] im portant?” question was
pivotal in the work with a thirty-eight-year-old woman who
sought help because she intensely wished to have a child while
her husband, who in a previous marriage had two children (now
adolescents living with their m other), ju st as intensely wanted
not to have another child. She initially said she wanted therapy
to help her decide w hether or not to divorce her husband, but
she then said this w ouldn’t really be a solution, since “I still
wouldn’t have a child.” She said she wished the therapist could
tell her how to get her husband to want a child. She was, finally,
painfully unable to answer the th e ra p ist’s o p en in g question,
“W hat difference do you want therapy to make for you?” The
therapist then began to use the “What makes [change X] impor­
tant?” question.

Therapist: I can see what a painful quandary this is for you. What
I don’t yet understand as fully as I’d like to is this:
W h at m akes h a v in g a baby as im p o rta n t to y o u a s it is?
Client: I just feel very, very strongly that I want to be a mother.
My husband and I aren’t a real family by ourselves. It
doesn’t feel solid somehow; we’re just floating.
T here’s no center.
Therapist: So, what I’m starting to understand is that you’re
describing a certain problem , which is that you have
this feeling of unrealness and unsolidness, like you’re
floating in a way, in your marriage and in general.
And you’re also describing what you see as the so lu ­
tio n to that problem, which is to have a baby. But per­
haps the problem itself is that you experience this
164 D epth-O riented B rief Therapy

lack of realness in your couple relationship and in

your life. Is that accurate so far?
Client: [Pause] Well, I mean, I do want a baby, too, but actu­
ally, yes, what you’re saying is true, too. I h adn’t
thought about it quite that way.
Therapist: Mm-hm. And this problem of feeling a lack of solid­
ness and realness in your life, has it been around for a
short time or a long time?
Client: Oh, that’s been around for quite a while.
Therapist: And for dispelling that problem you have this plan—
which I can see you’ve put so much hope into—a very
definite plan for how to create this realness and solid­
ness that you feel is so lacking. And your plan is to
have a baby, because you see that as bringing the real­
ness and solidness you want. Is that right?
Client: Well, now that I hear it said out loud, I guess that is my
plan.
Therapist: [Pause] You know, I’m curious about whether you’re
feeling that lack of realness and solidness right now.
Client: [Pause] Actually, I do feel realer and solider right
now, from talking like this.
Therapist: What’s “like this” mean?
Client: Well, I don’t often tell what’s so personal like this.
Therapist: So it sounds like you’re noticing that from talking
really personally like this and from saying what you
truly feel, you start to have some of that realness and
solidness that you want.
Client: Yes, but I could feel like this all the time with a child—
my own child.
[The therapist at this moment understands that her unconscious
“plan” is to relieve the unrealness and the floating unconnected­
ness she feels through a connection with a baby with whom she
could safely be herself, and that she has been hiding emotionally
from adults and plans to continue to do so.]
Therapist: I see. Yes.
Client: [Laughs] A baby’s always real. They’re always just
themselves. A baby’s the best! [Laughs]
Therapist: Yes, a baby’s the best. [Pause] Remember we talked
 Radical Inquiry: T echniques 165

about the problem , on the one hand, and the so lu tio n ,

on the other? I’m getting a sense that the problem that
you’re dealing with is that there’s nobody in the world
you feel safe enough to really be yourself with, and
you very much want and need to be your real self with
someone , so you feel you have to actually create a safe
person, a baby, as the solution.
[Until now the client’s knowledge of the real problem —the
unsafety of being emotionally real with adults—was located only in
her unconscious, pro-symptom position, which has all along been
carrying out its solution to that problem: suppression of her real­
ness. This resulted in the unreal, unsolid feeling in her ongoing
experience, itself a problem that she naturally was trying to solve
by arranging for the only conditions she knew that would safely
allow for realness: relationship with a baby. H er husband’s refusal
to have a baby therefore appeared to be the problem. Using the
“What makes (change X) important?” question and viewing the sit­
uation through the constructivist lens of DOBT, the therapist has
been able to identify these structural components during the first
twenty minutes of the session.]
Client: Well, wanting to be a m other is such a normal thing,
isn’t it? I mean, this is something I really want. You’re
a woman—you can understand that.
Therapist: Yes, it’s a completely normal thing, completely normal
for you to want to be a m other and for you to have a
baby. But what we’re finding is that an im portant part
of the problem that brings you here, if I understand
you correctly, is that it doesn't fee l safe to be y o u r real se lf
w ith the groxvn-ups in y o u r life .
C lient: [Softer, lowered voice] I guess it doesn’t. T hat’s true.
And it never has.
T herapist: You know, if something doesn’t seem safe to me, then
naturally I hold back from doing it. I wonder if that’s
how this works for you . Feeling and expressing your
real self has always felt unsafe, so you hold back from
doing it, and as a result you go around feeling unreal
and unsolid in your life.
C lient: [Nods. Eyes tear up.]
166 D fp th -O rifn tfd B riff T hfrapy

T herapist: Yes, it’s felt necessary to hold back from being real in
order to be safe, even though the cost is this terrible
lack of realness in how it feels to be you.
[The therapist has just named the emotional truth of the symptom.]
C lient: [Cries] So how do I get back to feeling real?
T herapist: What are those tears telling you about that?
Client: [Pause] That I need to somehow be real whether or
not I have a baby with Dan [fictitious name]. [Cries]
T herapist: [Pause] Is th a t the difference you want our sessions to
make for you, so that you finally get some of that real­
ness and solidness you want?
C lient: Yes, but it seems so big. It’s pretty overwhelming,
actually.
T herapist: Well, if that’s the difference you want from our ses­
sions, then we’ll make sure that at every point the
steps we take are just the size that seem right to you.
Client: OK.

“To whom else does it matter most

that this problem change, and why?”

This question, well known to systemically oriented therapists, is

adapted in DOBT to probe for how the client’s relationship to
another person may be the symptom-positive context—the domain
in which the symptom is more important to have than not to have.
For example, early in the first session with a woman whose pre­
senting symptom was her weight, which she very much wanted to
reduce, the therapist asked this question and learned that her hus­
band had for a long time been exerting considerable pressure on
her to lose weight. Probing further into how she construed their
interaction on this issue, it emerged that as she perceived it, to lose
weight under that kind of pressure is to submit to being profoundly
controlled and to feel herself “cease to exist.” This in turn brought
out the fact that this same intense, determined struggle for auton­
omy was a dominant theme throughout her childhood, in relation
to both her mother and her older sister. By the end of this first ses­
sion it was transparently clear that autonomy in primary relation­
ships was the symptom-positive context, and that within that context,
 Radicai. I n qu i ry: Tf.(:hniq i 'ks 167

the emotional truth of the symptom was that not losing weight was
a vital success and expressed her “determination to preserve me.”

“How would you teach me to have the problem

exactly as you do?” Variation: “How do you know
exactly when, or with whom,
to start having the symptom happen?”

A nother question that can be highly useful for identifying the

unconscious structure of the problem is this one, devised by the
creators of neuro-linguistic programming. This question begins a
detailed phenomenological scrutiny of the elements that together
constitute “the problem ’s” happening, without recourse to specu­
lation, interpretation, or history about the problem. The question
implicitly communicates to the client that the problem is a con­
structed or assembled configuration of elements, which therefore
can be unconstructed.
The indicated variation on this question was used in the fol­
lowing example to reveal and dispel the unconscious phenom e­
nology of a compulsive symbiotic attachment problem. The client
was a thirty-three-year-old woman whose presenting problem was
a repeating pattern of relationships in which she became, in her
own words, “obsessive” and “dependent” on someone extremely
charming, smart, and self-confident. She reported losing her
capacity to know and assert her own feelings and views and becom­
ing completely preoccupied with getting this person to regard her
as “special.” Radical inquiry and position work in previous sessions
had revealed that the emotional truth of this overpowering pattern
had much to do with suffering a perm anent emotional abandon­
ment by her mother at age three, when an infant brother was still­
born. M other’s emotional withdrawal left her forevermore feeling
that her very survival depended on her father’s love. Later, per­
ceiving her father become emotionally rejecting toward her older
sister was highly anxiety producing. Father was, yes, extremely
charming, smart, and self-confident—and alcoholic, and had had
a psychotic break when the client was thirteen, during which he
raged around the house brandishing a butcher knife.
In the session before the one from which the following tran­
scription comes, she said her m other’s emotional disconnection
168 D epth-O riented B rief T herapy

from her was like losing a kidney, and that her fath er’s love was
h er only rem aining kidney, her only rem aining life support.
Throughout childhood she was therefore desperate to be special
to him, so that she would not lose this vital connection. Her
unconscious, pro-symptom position was one of spotting an em o­
tional replica of her father (male or female) and instantly, pow­
erfully form ing an um bilical connection with that person,
enjoining the familiar struggle to be seen as special. Consciously,
she had been baffled over the compulsion to obsess, merge, and
lose herself in this way.
In the following transcript the therapist makes much use of
experiential questions that have her discover how she constructs
and skillfully carries out her method for symbiotically connecting
with a father replica, “Alex,” she recently met. (This was followed
by position work [see pp. 212-214] to complete her conscious own­
ership of this protective action.) The main experiential questions
used in this session are, “How do you know exactly when, or with
whom, to start having the symptom happen?” and “Is there some­
thing important that the symptom does for someone else?” Expe­
riential questions are preceded by the symbol >.
Therapist: > If you can picture Alex when you first saw him, how
did you know that he was the kind of person who can
give you life support?
Client: I don’t know. I was sure it wouldn’t happen again, that
I wouldn’t become a heat-seeking missile again for
that kind of person.
Therapist: Let’s look at how this marvelously perceptive part of
you recognizes the target so well.
Client: Well, it can’t be ju st that h e ’s so attractive and bril­
liant. It’s more than ju st that. It has som ething to do
with the way he talks. [Pause] I feel like I’m being
given the role of an audience, with him. It’s not a
balanced give-and-take, like with other friends that I
feel relaxed with.
Therapist: > How does that very quality make him the im portant
person who can be your kidney?
[This question appears merely cognitive on the written page, but
 Radical Inquiry: T echniques 169

in the room it had the quality of a request for a fully experiential

scan of her own early response to Alex. The client’s facial expres­
sions and her voice tone in her next response distinctly indicated
that she was trying to find words for the nonverbal experience she
was accessing in order to answer the question.]

Client: [Pause] Something about me feeling needed and

valuable to him, as his audience.
Therapist: > And what are you doing for him, by being his rapt
audience?
Client: [Pause] Somehow I can tell that he needs to be heard
and seen. My balanced friends d o n ’t need me to see
and hear them in order for them to be OK. But Alex
does need it in order to be OK.
Therapist: Sounds like what you are describing is your sense of a
wound in him.
Client: Yes! Aha! Right! OK, OK, right. ’Cause I’m attracted
to fixing somebody, like I did with Jeff. “I’ll heal you
with my love.”
Therapist: So you sense his woundedness, his neediness.
Client: Right.
Therapist: Was it anything like this for you with your father?
Client: Oh yes, yes. I mean, the details were different, but that
doesn’t matter.
Therapist: Because what does matter is . . . what?
Client: [With a distinct, pleasurable tone of relishing the
idea] That I can fix them, and I want to.
Therapist: So it’s that wonderfully attractive wound that’s how
you knew Alex was the right person?
Client: Yes.
Therapist: > So can you feel any connection between fixing the
person’s wound and the person being a kidney for you
so you’ll stay alive?
Client: [Pause] They’ll need me, and if they need me, they’ll
stay around.
Therapist: They’ll be dependent on you, very dependent on you.
Client: Yes, right.
Therapist: Would you be willing, right now, to imagine being at
170 D kpth-O rikn I KI) B rikf T hkrapy

the moment of first spotting someone who’s the right

kind of person?
Client: OK. [Closes eyes; silence] I keep having this image I
talked about two weeks ago, of me having this hole in
my middle, and so I see somebody else who has this
hole in their middle. And like I can instantly shape-
shift—ffffft!—and I’m magnetized to that hole in him.
I zoom over and fill it. Yes, I can sense this hole in the
middle of the other person’s being, and it’s a mag­
netic field. I’m sucked into it—ffffft!—really fast. And
that’s why it feels like there’s no choice, because it
feels so magnetic. And also it feels quite pleasurable,
at least initially.

The preceding transcript shows how experiential questions are

used in such a way that in order to answer them, the client has
to do experiential inquiry into his or her previously unexamined
constructs and positions. The questions, combined with the ther­
apist’s active intentionality, do not perm it a merely speculative
or cognitive answer. The client answered these experiential ques­
tions by accessing several im portant em otional and kinesthetic
knowings, initially nonverbal whole-body knowings that were key
facets of the symptom’s emotional truth. Later in the same ses­
sion, position work was carried out in order for the client to inte­
grate these newly conscious feelings and knowings (see
continuing transcript on pp. 212-214 in Chapter Six). The result
was a perm anent change in her previously automatic attachment
response.

Serial Accessing___________________________________
As we described in C hapter T hree, the em otional truth of the
symptom—the client’s pro-symptom position—is in general a mul­
ticomponent construction, a set of coherently linked, unconscious
constructs of meaning that we can describe as spanning various
orders of position. If the therapist guides the client into subjective
immersion in the experiential reality of any one of these compo­
nent constructs, a process of serial accessing can readily unfold, in
which each construct in turn is experienced and serves as a station
 Radical Inquiry: T echniques 171

of awareness from which the next directly linked construct

becomes subjectively evident and accessible.
(Serial accessing is to be distinguished from the constructivist
technique known as laddering devised by Hinkle. Laddering, as we
understand it, consists of sequentially eliciting linked constructs
that are already familiar to or at least readily identifiable by the
client, being compatible with the client’s conscious awareness. Ser­
ial accessing is a more deeply experiential process that elicits uncon­
scious constructs that are not already familiar to the client, are not
accessible to the client’s unassisted conscious awareness, and may
be markedly incompatible with the client’s conscious position.)
Serial accessing is possible because of the fully phenom eno­
logical n atu re o f radical inquiry and because of the in tern al
coherence of the pro-symptom position. The therapist, while
m aintaining a grounded sense of separate identity, extends his
or her psychological vision em pathically into the c lien t’s pro­
symptom construction of reality as currently known to the ther­
apist. This vicarious reach into the client’s experiential world has
been referred to in some psychotherapeutic literature as “shared
trance.” In this em pathic state the therapist, while carrying out
radical inquiry, has a distinct, experiential sense of accompany­
ing the client in subjectively encountering his or her constructs
and of trying on the client’s reality.
This ultra-phenomenological (yet nonpassive, non-Rogerian)
way of working is advantageous because it gives the therapist an
especially clear, almost firsthand knowledge of the experiential real­
ity in the client’s pro-symptom position. It enables the therapist to
explore the client’s constructions of reality from within—a kind of
psychological spelunking, in which the therapist brings the search­
light of his or her own awareness into the client’s unlit architecture
of meanings and literally perceives how this reality is assembled.
What we are describing here can be clarified with the help of
the position chart (introduced in Figure 3.1 in Chapter Three) for
depicting the full architecture of clients’ positions. The chart shows
numerous, specific compartments of meaning linked like adjoin­
ing rooms in the client’s unconscious, pro-symptom construction
of reality. Just as within physical architecture, one can see into and
step into certain rooms only by first positioning oneself in a nearby,
adjoining spot. That is, positioning one’s awareness subjectively in
172 D epth -O riented B rief T herapy

any one construct of reality within the client’s psychological archi­

tecture brings other, linked structures of meaning into subjective
accessibility, elements that could not be known from other vantage
points. This state-specific accessibility o f con structs becomes a very real
and practical matter as the client and therapist are working their
way from one linked construct to another, spending as many min­
utes in each newly discovered construct as needed to assimilate the
experience emotionally and cognitively, reorient, and move on.
The therapist can closely accompany the client in this subjec­
tive discovery of one compartment of meaning after another by let­
ting go, temporarily but completely, of all “objective,” theoretical
knowledge—which pins the therapist to a position external to the
client—and by trusting his or her own inherent capacity to recog­
nize the coherence of meaning, sense, and structure of the client’s
experiential world. The therapist, being less emotionally involved
in each emerging construct, is often first to broaden the field of
attention and become aware of other structures of meaning that
are now subjectively accessible, and so is in a position to prom pt
the client’s attention toward whatever important construct is linked
to the presently realized one.
As an example, the following list summarizes the set of linked,
unconscious elem ents of em otional truth that were serially
accessed by the woman in the preceding transcript, working on her
problem of compulsive symbiotic attachment in a previous session.

1. To the image of three men with whom she previ­

B e g in n in g :
ously became attached and dependent, she overtly voices for
the first time her feeling of desperately needing a man like her
father to bestow aliveness on her by regarding her as special.
2. S pon tan eou sly accessed: A felt state of being at age seven.
3. A ccessed w ith p r o m p tin g by the th e ra p ist: “I feel d ead ” (at age
seven). (This is accessed by being seven and confronting her
image of her father with the em otional truth, “If you d o n ’t
make me feel special, I don’t feel alive.”)
4. S p o n tan eou sly accessed: A sudden, intense fear about the possi­
bility that feeling dead means feeling depressed, which is
sharply incompatible with her habitual, conscious position of
being the happy-go-lucky bright spot in the family.
5. Spontaneously accessed: Being depressed means being “damaged.”
 Radical Inquiry: T echniques 173

6. S p on tan eou sly accessed: A childhood memory of wanting to die

in her sleep.
7. S pon tan eou sly accessed: The urgent, anxious position of “I can 't
be damaged.”
8. S p on tan eou sly accessed: The experience of desperately needing
to appear “perfectly fine” in her family of origin in order not
to be the same as her depressed, unstable sister, who (as per­
ceived by the client) w a s regarded as damaged by her parents
and consequently lost her father’s love.
9. Spontaneously accessed: New imagery of her father relating to her
as being fundamentally different from her sister and accepting
her unconditionally. (This is accessed by a tte n d in g to the
a u to n o m o u s response o f the im age after confronting the image of
her father with intense, spontaneous emotion: “If I’m not really
good and special and happy and really on, then you’ll a b a n d o n
me—and that’s terrifyin g / ”)
10. S p o n ta n eo u sly accessed: A sudden, new knowledge of herself as
being fundamentally distinct from her sister even if depressed,
and as lovable even if depressed.

In this serial accessing sequence, items one through eight repre­

sent encounters with fully unconscious (not merely preconscious)
material. The immersion of her awareness in these constructs, one
after another, was a significantly altered state, and integration of
these new experiences required additional, subsequent work. As a
result of arriving at item eight, the experiential shift of items nine
and ten spontaneously occurred, a transformation at the ontolog­
ical (fourth-order) heart of the whole father-symbiotic construc­
tion. A transcript of steps nine and ten is provided in the next
section as an example of attending to the response of the image.

Im aginal In teractive Techniques___________________

The session transcripts earlier in this chapter illustrate techniques
from Gestalt and Jungian therapies that utilize a person’s ability to
visualize people, objects, or scenes as well as aspects of one’s own
mind and to engage in a spontaneous interaction with what is visu­
alized. The original Jungian term for this is a ctive im a g in a tio n , and
the basic technique has been applied in any number of subsequent
174 D epth -O riented B rief T herapy

psychotherapies in various forms. These include Gestalt empty-

chair dialogues and two-chair work, experiential dreamwork, inner
child work, all techniques in which some aspect of the client’s psy­
che is personified and visualized, and all techniques of guided visu­
alization. These can all be applied very fruitfully within the
methodology of depth-oriented brief therapy.
Having the knack for this kind of process consists of relating
to what is visualized as though it has com plete autonom y of
response, making no attem pt to exercise control over what hap­
pens, but only watching to see and sense what response the image
makes after each of the client’s communications to it. The image
itself forms in the same way: autonomously, not consciously
designed by the visualizer. W hen allowed such autonom y of
response, the visualized image is a direct, in-the-moment manifes­
tation of an unconscious position or construction of meaning, and
it provides direct contact between that unconscious formation and
the client’s conscious position. In the same way that the therapist’s
work with the client is completely experiential and phenom eno­
logical, so, too, is the work with the image. All understanding of
the image is derived from what the image itself reveals or from the
client’s direct apprehensions of its meaning. Any stereotyping or
manipulation of such images based upon externally applied inter­
pretations merely signals to the unconscious position involved that
it will not be heard on its own terms, and the process closes down.
The interaction between the client’s conscious position and the
image is a two-way communication: the unconscious realities get
an opportunity to express themselves directly to the client; the
client gets an opportunity to express emotionally im portant but
never-before-voiced material to whomever or whatever is visualized,
as in confronting a visualized parent with his or her abusiveness.
Such two-way interactions are real in that they transform the rela­
tionship of conscious and unconscious constructions involved in
the problem. This is the basis of the therapeutic effectiveness of
these techniques. O f course, skillful execution is required. Some
of these techniques have become popular m ethods of self-help,
and in that context their effectiveness is unpredictable.
In o rd er to apply these techniques for radical inquiry, the
therapist coaches the client in creating and then interacting with
the visualized image in two ways described below: (1) confronting
 Radical Inquiry: T echniques 175

with em otional truth and (2) attending to the response of the

image.
In confronting with emotional truth, the client explicitly and blundy
voices previously unexpressed em otional truths to the relevant,
imaged figures. The emotional truth voiced may have arisen in a
previous piece of work with the therapist, after which the therapist
suggested this imaginal encounter, o r it may em erge in the
moment, during the encounter, in response to the imaged figure.
For example, the therapist might say, “And as you see your two sis­
ters there in front of you, you might let yourself begin to feel, and to
know, things that you never said to them, things that need saying,
feelings that need expressing. [Pause] And what do you begin to
feel, that wants to be expressed?” The therapist then coaches the
client in articulating a very explicit, emotionally complete, accurate,
and vivid statement of the client’s emergent emotional truth.
Once the client opens in this way to the subjective experience
of any new elem ent of emotional truth, a process of serial access­
ing then often spontaneously occurs in which other, linked emo­
tional truths that had been unconscious come into awareness and
can be expressed. Confronting with emotional truth creates a kind
of radical inquiry snowball effect.
In attending to the response of the image, the client perceives the
image autonomously responding to her statements, expressing the
specific unconscious position that it personifies, revealing em o­
tional themes or wounds, views of reality, a n d /o r protective actions.
The position represented by the image is part of the client’s own
heterogeneous construction of reality, and becoming aware of its
content can be pivotal. A striking instance of this occurred at the
end of the example of serial accessing provided in the previous sec­
tion. Recall that in childhood this woman perceived her father as
emotionally rejecting her overtly depressed, emotionally unstable
older sister “Jeanne.” The implicit possibility that father could cut
off from her, too, was a source of great and chronic anxiety, since
he was her “only rem aining kidney,” her only possible supply of
love since m other’s emotional shutdown when the client was three
years old. During serial accessing, one of the constructs that she
entered into and vividly felt and realized was the protective action
that she was urgently struggling to carry out in her family of origin
(item eight in the previous section’s list), a strategy of appearing
176 D epth-O riented B rief T herapy

“perfectly fine” in order not to be seen as being the same as her

depressed and unloved sister. The therapist then had her visualize
her father and bluntly tell him the emotional truth of her desper­
ate need of his love and her terror of losing it (item nine). The fol­
lowing two-minute transcript segment begins in the midst of the
ensuing, intensely emotional process, which centers on what hap­
pens when she attends to the response of the image.
C lient: [To visualized father, and crying copiously] If I’m not
really good and special and happy and really o n , then
you’ll essentially a b a n d o n me—and that’s terrifying!
T herapist: And how does he respond?
C lient: [Sobbing] Sort of like, “T hat’s not true, you are spe­
cial, I love you no matter what.”Just very comforting
and “I love you whatever you are. I would never aban­
don you.” H e’s very soft.
T herapist: It seems authentic to you?
Client: Yes, but—I don’t know if I believe it.
T herapist: OK, so what do you need to say to him about th a t?
C lient: [To father] You say that, but if I were like Jeanne, look
how you treat her,:
Therapist: And what does he say to that?
C lient: “That’s different. Don’t mix apples and oranges.”
T herapist: Do you know what he means? Do you know what dif­
ference he means?
C lient: [Pause] Actually, I do. He means I’m not Jeanne.
Actually, I do sense—I’m not her. So I do sense a
difference.
T herapist: And does your awareness of that difference give you a
new sense of trust in his affection?
Client: T hat’s a good question. Why d o n ’t I trust in his affec­
tion? It kind of does, actually, ’cause I’m not—I’m not
her. His relationship with Jeanne is independent of
me.
T herapist: Yes.
Client: And even if I were depressed, I still wouldn’t be
Jeanne.
[This sudden new awareness of being “not Jeanne” is a significant
breakthrough, an experiential shift of individuation and separa-
 Radical Inquiry: T echniques 177

tion from the identity of her sister. Throughout childhood she was
attem pting to prove to father that she was not Jeanne, all along
feeling as though in essence she was the same as Jeanne because
she was secretly depressed and could be found out and rejected at
any time. Note that what triggered this ontological (fourth-order)
shift was the unexpected, autonomous response of the visualized
image of her father.]

T herapist: Yes.
Client: What makes her, her, is not just that she’s depressed.
Therapist: Good, good. I’d like you to again now see the other
three men [with whom she had become obsessed and
dependent] and tell each of them, “I’m not Jeanne,
even if I’m depressed.”
C lient: Say that to each? All right. I’m not Jeanne, even if I’m
depressed. They kind of say, “Well, we know that.”
Which is sort of what dad says: ‘Yeah, you’re not.”
Therapist: Would you try saying to them, “I d o n ’t have to prove
to you that I’m not Jeanne, do I?”
C lient: I don’t have to prove to you that I’m not Jeanne, do I?
They say, “No, you do n ’t.”
Therapist: And how did it feel to you to say that?
C lient: Sort of liberating.

Serial accessing had brought her consciously into her emotionally

true position of being depressed at age seven (as well as at thirty-
three), which until now was too frightening to recognize because it
had the fourth-order meaning, “I am damaged and unlovable, like
Jeanne.” Positioning herself consciously for the first time in this emo­
tional truth of depression, however, immediately stimulated a spon­
taneous and surprising creation of new, fourth-order meaning that
arose by attending to the response of the autonomous image of her
father. What developed was a construction of herself as an individ­
ual who has her own distinct identity and is lovable even if depressed.
This is a transformation in her superordinate, fourth-order, core con­
struction of self. Since these constructs had been deeply unconscious,
she was in a thoroughly altered state while subjectively experiencing
them, and so she would not easily retain awareness of any of these
themes of meaning. The therapist therefore gave her an index card
178 Depth-Oriented Brief Therapy

o n w h ich h e had w ritten, “I now know that I’m n o t th e sam e

as J ea n n e, even if I’m d ep ressed .” She was to read this twice daily,
m orning and night, to foster the position work o f retention and inte­
gration . T his w om an su b seq u en tly b egan reversin g patterns o f
d ep en d en cy and subm issiveness in relation to her highly intrusive
and d ep en d en cy-d em an d in g father, actively and very substantially
asserting healthy boundaries even though d oing so risked her sizable
inheritance.
T h e full versatility and p oten cy o f th ese im aginal tech n iq u es
are ta p p ed by a p p recia tin g that in th e in te r a c tio n b etw een the
c lie n t a n d an im a g in a l fig u r e , th e c lie n t can lo c a te h e r c o n ­
s c io u s n e s s in , a n d e x p e r ie n c e b e in g , e it h e r p a r tic ip a n t. For
e x a m p le , in th e s e ssio n tr a n sc r ib e d j u s t a b o v e , th e th e ra p ist
co u ld have had the w om an be h er fath er and visualize an d inter­
act w ith th e c lie n t, his d a u g h ter. In this way th e c lie n t e x p e r i­
en ces firsthand the subjective con stru ction o f reality rep resen ted
by e ith e r figure.

E xperiential D re am w o rk__________________________
T h e sam e principles used in im aginal interactive tech n iq u es form
th e basis o f e x p e r ie n tia l d ream w ork in DO BT. T h e te c h n iq u e
in volves ask in g th e c lie n t to r e en v isio n a sp e c ific sc e n e o f the
dream , n ot as a m em ory o f the dream but as a p resen t ex p erien ce
o f again b ein g in that sam e scen e. T h e therapist directs the client
to in h a b it an d e x p e r ie n c e b e in g a p articu lar fig u re or ob ject
involved in the scen e and, as that figure or object, to interact with
o th er figures or objects in th e sc en e, in c lu d in g th e figure o f the
client. T h e clien t is able to inhabit and access the experiential real­
ity o f anyone or anything she im agines, from w aking life or from a
dream , because every such figure is actually the visual appearance
o f a construction in the clien t’s own m ind. Experiential dreamwork
can b e a very fru itfu l a ren a for radical inquiry, b e c a u se u n c o n ­
scious p osition s often appear in dream s in p erson ified or objecti­
fied form . T h ere is far m ore accuracy an d far m o re th erap eu tic
power in the clien t’s own, direct, experiential discovery o f the e m o ­
tional truth (s) rep resen ted by th e dream than in speculatively or
th eoretically in terp retin g th e m ea n in g o f the dream with, or for,
the client.
 Radical Inquiry: Techniques 179

Sentence C om pletion______________________________
S en ten ce c o m p letio n is an extrem ely sim p le and straightforward
technique that can be surprisingly effective at eliciting h idden posi­
tions an d th eir c o m p o n e n t con stru cts. We will review an earlier
exam p le and add a new o n e.
In C h a p ter Two th e th era p ist ask ed th e w om an w h o was
“unhappy n o m atter what” to visualize her father alon g with all the
past b o y frien d s a n d lovers w h o tu rn ed o u t to b e a m b iv a len t or
em otionally unexpressive like her father. T h e therapist th en asked
her to speak directly to them by com p letin g this sen ten ce, w ithout
pre-thinking the ending: “If I know that I’m OK . . .” After several
rou n d s o f this, e a c h tim e with a s p o n ta n e o u s n ew e n d in g , o n e
arose that was the su rfacin g o f a crucially im p ortan t, third-order
purpose: “If I know that I’m OK, I w o n ’t n e e d to try to g et it from
you anym ore.” A ccom p an ied by an em otion al release o f tears, this
was a sign ificant breakthrough in to an awareness that sh e h erself
was actively m aintaining the “I’m not OK” position in order to pre­
serve h er o ld role r ela tio n sh ip with h er fa th er an d carry o u t an
unconsciously h eld plan o f rap p roch em en t.
T h e fact that u n c o n sc io u s, h id d e n p o sitio n s readily su rface
through sen ten ce co m p letio n is a striking p h e n o m e n o n , and it is
one o f the m ost direct form s o f evid en ce su p p ortin g the view that
u n co n scio u s p o sitio n s and constructs have an in trin sic d esire or
n eed to b e c o m e co n scio u s. T h ey certain ly seem u n ab le to resist
the tem ptation to co m p lete a relevant sen te n c e fragm ent.
To set u p se n te n c e c o m p le tio n , th e th erap ist tells th e c lie n t
there is n o right or w rong resp on se, n o t to pre-think the e n d in g
o f th e s e n te n c e (r e p e a tin g th is p o in t as n e e d e d d u r in g th e
process), and just to say the fragm ent supplied, reach ing the blank
at the en d o f it and se e in g w hat e n d in g arises by itself. From the
b eg in n in g the therapist w elcom es every e n d in g that arises, never
indicating ju d gm en ts o f irrelevance or unsuitability. W hatever en d ­
ing the client first generates, the therapist says, “G ood. K eep going;
say it again and see what co m es up n e x t.” Usually several rounds
occur before unfamiliar, em otionally significant material begins to
em erge. As a rule we d o sen ten ce c o m p letio n with the sam e frag­
m en t until n o new en d in gs arise, w hich differs from how the tech ­
nique has been described by som e other writers. It is this repetition
180 Depth-Oriented Brief Therapy

o f the sam e fragm ent, clearing away en d in gs com prised o f already-

co n scio u s m aterial, that allows u n con sciou s constructs to em erge.
It is so m etim es necessary to ask the clien t to co n tin u e, especially
w h en h e or sh e p rem atu rely th in k s th ere are n o o th e r e n d in g s
availab le. T h e o n ly way to b e su re th e p ro cess is c o m p le te is to
reach the blank two or three tim es and con sisten tly fin d n oth in g
arising. O ccasionally it is necessary to prom pt the clien t’s attention
toward certain g en era l classes o f resp o n se, su ch as, “I w o n d er if
there are any en d in gs that m igh t have to d o with your m oth er.”
T h e therapist can switch to a new sen ten ce fragm en t in order
to pursue a newly em erg en t lin e o f m ea n in g that appears prom is­
ing, b u t d o es so at the risk o f leaving the origin al lin e b efo re the
m ost im portant m aterial has appeared. For exam p le, h earin g the
clien t say, “If I know that I’m OK, I w o n ’t n eed to try to g et it from
y o u a n y m o re,” th e th erap ist m ig h t th en ask h er to c o m p le te the
fragm ent, “If I d o n ’t n e e d to get it from you anym ore . . .”
At tim es the clien t may ex p erien ce a nonverbal c o m p letio n o f
the sen ten ce in the form o f em o tio n or a bodily sen sation with n o
cognitive con ten t. T h e therapist th en assists th e clien t to cogn ize
and verbalize the felt m ea n in g in such a resp onse.
T h e offered sen ten ce fragm ent sh ou ld be custom -m ade by the
therapist based on her or his m ost curren t k n ow led ge o f th e p h e­
n o m en o lo g y o f the c lie n t’s problem . T h e sen te n c e fragm en t is an
ex p ressio n o f the th erap ist’s active in ten tion ality, a b est effort to
elicit the em otional truth o f the sym ptom right now. W orking from
lists o f prefabricated sen ten ce “stem s,” as pub lished in som e books
o n this tech n iq u e, is inappropriate, becau se it am ounts to a policy
o f n o t lea rn in g to d ev elo p the all-im portant subjective facility for
m eetin g , en g a g in g , an d in q u irin g in to th e c lie n t’s con stru ction s
directly, m o m e n t by m om en t.
T h e va lu e o f s e n te n c e c o m p le tio n in radical in q u iry is w ell
illustrated by how it was used in th e sixth session with a thirty-year-
o ld m an w h ose prob lem was an alm ost ever-present, sharp fear o f
failu re in all his creative efforts in his artistic career. D esp ite his
artistic sensitivity and creativity, h e was very m u ch an intellectual-
izer, and h e was profou n d ly e n sco n ced in a con stru ction o f reality
in w h ich th e core p rob lem is th e k n ow led ge that to exist is to be
h a ted an d attack ed an d th e o n ly so lu tio n is to b e in visib le— the
d efin in g features o f what we term a schizoid con stru ction . At the start
 Radical Inquiry: Techniques 181

o f this session th e c lie n t h ad c o m m e n te d that th e therap y work

se em e d th o r o u g h ly relevan t, yet h e fe lt as th o u g h it was a b o u t
som eone else. T h e therapist used sen ten ce com p letion for the next
steps o f radical inquiry as a way to b rin g him in to m ore in tim ate
contact with his own elem en ts o f em otion al truth.
T h e therapist had learn ed in the p reviou s session that this fel­
low had a rigid p r e su p p o sitio n a b o u t h ow th e w orld w orks, an
u nq uestioned b e lie f that hard work and talent lead directly to suc­
cess, as reliab ly an d p red icta b ly as gravity lea d s o b jects to fall
straight d ow n . W ith this p r e su p p o sitio n , lack o f su c c ess in any
effort m ea n t in h e r e n t lack o f ta le n t (sin c e h e k n ew h e w ork ed
hard). Since, like the rest o f us, h e was often having the exp erien ce
o f th e w orld in o n e way or a n o th e r o b stru ctin g su ccess in so m e
pursuit, sm all or large, over tim e his c o n fid e n c e in his talen t had
been quite u n d erm in ed . T h is se em e d to th e therap ist a factor in
the p resen tin g prob lem o f chronically fearin g an d e x p e c tin g fail­
ure. That presupposition, despite its costly effect o n his con fid en ce,
presum ably was an im portant, c o h e r en t part o f so m e larger posi­
tion or con stru ction o f reality.
In order to prob e that con stru ction , the therapist first invited
this m an, h ere in the sixth session, to con sid er the possibility that
the world works differently than h e th ou gh t— that m any o th er fac­
tors in ad d ition to talen t an d effort are involved in th e o u tco m e.
He said that w h ile o f cou rse h e was w illin g to en terta in this id ea
in tellectu ally, it m ea n t n o th in g to him ; it was an utterly fo re ig n
idea. H ere the therapist used sen ten ce com p letion in order to have
him entertain the idea experientially. T h e therapist said, “Well, ju st
suppose for a m inute that it’s true that success is not determ in ed only
by talen t and effo r t.” T h en , after givin g th e in stru ction s for sen ­
ten ce c o m p le tio n , th e th erap ist asked h im to c o m p le te th e se n ­
tence, “If th at is how the world is . . .” T h e clien t sat forward, closed
his eyes, and the follow in g en d in gs em erg ed with each successive
utterance o f those words:

“ . . . th en there is n o ju stic e.”

“ . . . then I can d o everything right and still things can go w ron g.”
“ . . . th en is there any way I can guarantee success for m yself?”
“ . . . th e n th e o n ly th in g to d o is to d o my b est at any g iv en
m o m e n t.”
182 Depth-Oriented Brief Therapy

. then there is n o path that I sh o u ld take.”

. th en n o o n e ’s g o in g to ju d g e m e as harshly as m aybe I think
they w ou ld .”
. then anyone w ho understands that w ould look at m e and say,
‘H e had a run o f bad lu ck ,’ w ithout ju d g in g m e.”

As ev id en ced by soft sniffling, m oist eyes, and nostrils flaring with

feelin g, at som e p oint during this process he drop p ed into his feel­
ings, som eth in g he did n ot readily d o in general. W hat is especially
striking is that in spite o f saying h e saw n o way at all to step o u t o f
his rigid, long-standing p resu p p osition , in m inu tes h e did step out
o f it and began con tactin g the new possib ilities that o p e n up in a
world n o t d efin ed by that presupposition—ju st from com p letin g a
w e ll-c h o se n s e n te n c e fra g m en t. O f c o u r se , fu rth er w ork was
n e e d e d to integrate those new possibilities, but h ere were the piv­
otal m o m en ts o f his con tactin g them .
T h e therapist anticipated that even if this m an w ere receptive
to these new know ings, h e w ou ld also necessarily have a position
o f u n w illin gn ess to let his familiar, w orld -organ izin g p resu p p osi­
tion be ch an ged . In o th er words, th e therapist su p p o sed that this
p resu p p o sitio n was part o f a pro-sym ptom p o sitio n that had n ot
b e e n fully a d d ressed as yet. In o rd er to e lic it m ore o f that p osi­
tio n , a b o u t five m in u te s la ter in th e se ssio n th e th e ra p ist said,
“C o u ld I h ea r from th e sid e o f you th a t’s u n w illin g to se e th e
world in this new way?” O n his own th e m an sp on tan eou sly used
the se n te n c e co m p le tio n form at to find his answers to this ques­
tio n . H e a gain le a n e d forw ard , c lo s e d h is ey es, a n d said , “I ’m
u n w illin g to see the w orld this way b ecau se . . .” and h e cam e up
with th e follow in g endings:

“ . . . it m eans I have to adm it m yself vu ln erab le.”

“ . . . I c a n ’t take as m uch pride in my su ccesses, b ecau se I w asn’t
100 p ercen t o f what was b e h in d them ; I have to acknow ledge
the luck that w ent in to th ose, to o .”
“ . . . I’m unw illing to feel like a pinball b e in g b u ffeted arou n d by
forces I ca n n o t co n tro l.”
“ . . . if the world is that way, it m akes m e feel a lot sm aller.”
 Radical Inquiry: Techniques 183

H ere im portant em otion al and presuppositional structure, as well

as new alternatives to that structure, cam e to ligh t in less than ten
m inu tes o f work, and with very little effort.

V ie w in g fro m a Sym ptom -Free Position,

or In vitin g Resistance_____________________________
T h e tech n iq u e we term view ing from a sym ptom -free position was
in tr o d u ce d in C h ap ter O n e an d was also u tilize d in a variety o f
ways in the case studies in C hapter Two. Actually, this is n ot a sin­
gle tech n iq u e but a strategy that can b e carried o u t th rou gh any
num ber o f specific exp erien tial tech n iq u es. S en ten ce com p letion ,
gu id ed visualization, and exp erien tial q u estion s can all be used.
T h e purpose o f view in g from a sym ptom -free position is not to
get the clien t to be free o f the sym ptom perm anently, b ut only to
ex p e r ie n c e for a few m in u tes w hat h a p p en s if th e sym ptom d oes
n o t o ccu r in a situ ation w h ere norm ally it w ou ld . B e in g w ith ou t
the sym ptom in a situation w here actually it is n e e d e d results in a
co n scio u s e x p e r ie n c e o f d iscom fort or difficulty that reveals how
the sym ptom is im portant to have.
T h e strategy o f viewing from a sym ptom -free position is a quin­
tessen tia l^ constructivist o n e , b ecau se it m akes d irect use o f the
c lie n t’s fu n d a m en ta l ability to c o n stru ct an e x p e r ie n tia l reality,
inhabit it, and know firsthand how it works.
As the earlier clinical exam p les show ed, the therapist instructs
the client very explicitly to (1) im agine being in a situation in which
the sym ptom predictably w ould occur, (2) im agin e b ein g w ithout
the sym ptom in that situation, and (3) n otice the new ex p erien ce
that then develops. T h e therapist ushers the client through this cre­
ative, exp erien tial p rocess, rep ea tin g th e in stru ction s as n e e d e d ,
and prom pts the client if necessary to notice the cost, disadvantage,
or discom fort that results from b ein g w ithout the sym ptom . If the
client has difficulty im agin in g b ein g free o f the sym ptom , the ther­
apist sim ply coach es the clien t by verbally evoking very con cretely
the specific features o f n o t having the sym ptom . In this way, even
clients with lifelon g low self-esteem can tem porarily inhabit a posi­
tion o f knowing they are good , worthy, lovable beings and from that
position view their parents or partner, for instance, and exp erien ce
what h a p p en s to the felt e m o tio n a l b o n d . In nearly all cases the
184 D epth-O riented B rief Therapy

clien t will spontaneously n otice and describe a previously u n recog­

nized, valued effect o f the sym ptom that has b een lost (such as the
“incredible shrinking parent” ex p e r ie n c e — the atten u ation o f the
e m o tio n a l b o n d that is o fte n re p o r te d by c lie n ts w ith low self­
esteem ).
We illustrate the tech n iq u e here with a short ex a m p le involv­
in g the m oth er o f a m olested child. At the tim e o f learn in g about
the m olestation seven years earlier, she resp onded very protectively
and called the p olice, pressed charges, and arranged for years o f
therapy for her th en eight-year-old d au gh ter and for herself. She
did everything at the tim e that cou ld be d o n e , and yet:

Client: I feel so stuck in sufferin g over my d a u g h ter’s m olest.

Years and years are g o in g by, and s h e ’s now fifteen,
and I’m still u n d er a dark clou d alm ost as m u ch as
ever. Is this how a m oth er has to feel forever? I n e e d
to g et my life back. I d o n ’t know if th e re ’s really any
way ou t o f feelin g torm en ted .
Therapist: I w on der what you w ould start to ex p erien ce if you
w eren ’t parked there, in that u n h ap p in ess. I m ean ,
imagine ap p roach in g a sin gle aftern oon with a d elib er­
ate in ten tion o f seein g what happens, if y o u ’re n o t stay­
in g in that fam iliar base o f suffering, u n d er that
clou d . W hat if you released you rself from that for a
w h ole aftern oon , and you w ent through your day actu­
ally fin d in g ou t what it’s like to live w ithout it?
Client: W hile you were saying that, so m eh o w I cou ld tell what
w ould hap p en . It ju st becam e very clear. W hat got
clear is that if I stop suffering, th e re ’d be n o ch an ce
for me o f ever gettin g the caring I never got, as a child
or ever. It’s like I stay in m isery so that m aybe so m e­
body will co m e and take care o f m e. It’s like I d o n ’t
want to give that up. [Pause] I never saw this b efore.
Therapist: Are you saying that it feels to you that to stop sufferin g
is to give up a secret h o p e you have, a h o p e o f gettin g
som e o f that real nurturin g you never got?
Client: [Softly crying] Yes.
Therapist: [Pause] Yes, I see that. [Pause] W hat I’m u n d erstan d ­
in g is that you have both feelin gs or b oth positions: you
 Radical Inquiry: Techniques 185

want very m uch to g et o u t from u n d er this dark suffer­

ing, but at the sam e tim e, you have what m igh t be an
even stronger desire to stay in it as your key way to
attract so m eth in g you p rofou n d ly want, w hich is to
e x p erien ce b e in g truly cared for and taken care of, in
th e way you sh o u ld have b e e n w h en you w ere a girl,
b u t you w eren ’t.
C lient: [Crying] Yes.

H ere a tw o-m inute p rocess o f view ing from a sym p tom -free p osi­
tion, applied directly to th e clien t’s presen tin g sym ptom o f u n en d ­
ing misery over her daughter’s b ein g m olested, brought to light the
unconscious pro-sym ptom position m aintaining that misery, a posi­
tion cen tered o n an em otion al w ou nd o f severe em otion al n eg lect
in childh ood. (T he therapist then engaged her in the position work
o f having h er k now in gly take h er stan ce o f “I n e e d to stay m iser­
ab le in o r d e r to g e t so m e b o d y to finally take care o f m e. If I ’m
happy, n o b o d y ever w ill.” T h ese words w ere w ritten o n an in d e x
card given to h er as part o f a betw een-session task o f staying aware
o f trying to carry o u t this plan in h er daily life. In th e n ex t session
she reported that b ein g so aware o f how she was trying to “extract
m oth erin g from the universe” m ade her feel fed up with this strat­
egy. “T his will never work,” sh e said. “I’ve g o t to start fin d in g ways
to really feel better.” S h e b egan u sin g therapy for real h e a lin g o f
her o ld w ou nd. H er pro-sym ptom p osition had dissolved an d she
was n ow w illin g to grieve fo r th e low lev el o f n u rtu ra n ce in h er
ch ild h o o d rather than covertly m aneuver for its reparation.)
V iew in g from a sym p tom -free p o sitio n is n o t to b e c o n fu se d
with th e “m iracle q u e stio n ” tech n iq u e that is central to solu tion -
o rien ted b rief therapy. A lth o u g h b oth tech n iq u es initially direct
the c lie n t’s a tten tio n to a sym p tom -free state, th e e n su in g thera­
peutic processes and strategies are com p letely differen t.
N ow , w hat h a p p e n s if th e th e ra p ist in o n e way o r a n o th e r
invites an d prom pts th e c lie n t to view from a sym p tom -free posi­
tion, and then the clien t goes blank, gets confused , intellectualizes,
or looks up and says, “S o m eth in g inside w o n ’t go alon g with this”?
In o th er words, what if th e c lie n t’s resp on se is resistance?
R esistance h ere turns o u t to be as useful a resp onse as c o o p e r ­
ation. An exam ple follows. First, consid er this: W hich o f the clien t’s
186 D epth -O riented B rief Therapy

positions is it that is unw illing to allow her to take a sym ptom -free
position and so resists? It is, o f course, her j!?re>-symptom position, in
w h ich th e sym p tom is vitally im p o rta n t to h a ve. T h at p o sitio n is
likely to protest or m anifest resistance w h en the clien t attem pts to
assume the symptom-free position. T he resistance, in whatever form
it takes, is a protective action b ein g execu ted in the m o m en t by the
a u ton om ou s pro-sym ptom position. M om ents w hen the resistance
is occurring are m om ents when the pro-symptom position is directly
asserting itself in the room and can therefore be en g a g ed and fur­
ther elicited and drawn in to aw areness and exp ression . In effect,
the c lie n t’s pro-sym ptom p o sitio n is “ca u g h t” w h en it show s itself
through its resistance, as the follow ing case exam p le clearly shows.
T h e final result is the sam e as if the clien t had instead coop erated
and view ed from a sym ptom -free position: her pro-sym ptom posi­
tion is fo u n d out.
Since resistance is as likely as co o p era tio n w h en th e therapist
is se ttin g o u t to have th e c lie n t view from a sym p tom -free p osi­
tion, the nam e o f the tech n iq u e cou ld instead ju st as well be in v it­
in g re sista n c e . T h e two n a m e s— v iew in g fro m a sy m p to m -free
p o s itio n a n d in v itin g r e sis ta n c e — d e n o t e th e two e n d s o f th e
sam e stick.
W hat follows is a transcript o f segm ents totaling twelve m inutes
from a sin gle session. Gaps in the transcript are in d icated by four
d ots. T h e c lie n t is a fifty-year-old w o m a n , a h istory te a c h e r in a
large urban h igh sc h o o l, p r e sen tin g a new p ro b lem for th e first
tim e to a therapist sh e had seen previou sly for o th e r m atters. All
o f the hidden, pro-sym ptom structure fou n d in this session was also
new to the therapist. T h e clien t first exp ressed h er anti-sym ptom
p osition , with w hich the therapist em p ath ized . As a way to pursue
radical inquiry into the em otion al truth o f the sym ptom — her pro­
sym ptom p osition — the therapist cau gh t an op p ortu n ity to invite
h er to view from a sym ptom -free p osition , w hich h ere tu rn ed out
to be inviting resistance.

C lient: [U p set and angry] I’ve reach ed a level o f real high

an ger because I’m b ein g provoked by o n e o f my stu­
d en ts w h o has a lot o f anger. A n d G od, I c a n ’t say a
word to him , b ut h e flies o ff th e h a n d le and starts
sh ou tin g at m e and h e ’s ju st unbelievably u n con -
 Radical Inquiry: Techniques 187

trolled. . . . I d o n ’t know what was said— I ca n ’t

rem em b er exactly— but, um , his rem ark was, “1 know
som eb od y w ho sh ou ld g et hit in th e m o u th .” H e was
talking to me. H e m ean t me. So I turned to him and I
said, “D o you m ean m e?” A n d he said, “N o, I w asn’t
talking to you .”. . . I’m ju st fee lin g really, really angry,
b ecau se I feel like, you know, h e r e ’s so m eb o d y threat­
e n in g m e and I gotta have him in my class, and I gotta
sit and listen to this shit every day?
Therapist: Yes.
Client: I g o tta have this kid m o u th in g o f f at m e a n d talk in g
to m e like I ’m so m e th in g h e ’d lik e to sq u ash u n d e r
his fo o t ’cau se I’m in his way? You know ? I’m g e t­
tin g sick o f that k in d o f stu ff that we have to p u t up
with!
Therapist: Really.
Client: I ju st feel like over m e kid I’m lo sin g my tem p er every
day?. . . A nd th ese kids ju st tear a sch o o l apart, ’cause
they d o n ’t care what they d o . . . . I m ean , this kid
cou ld drive m e in to a heart attack, ’cause I g et really
angry, and I’m trying to con trol my anger, you know. I
w ould really like to take him and ch o k e him . I m ean , I
really w ould like to g et physical, b ecau se I feel like in a
way th at’s what n eed s to h a p p en to h im , is som eb od y
ju st p u n ch es him o u t— till h e sees that h e ju st ca n ’t d o
this? But I ca n ’t d o that, o f course. So I g o h o m e with
all this fury, you know, or I sp en d th e day fee lin g furi­
ous, and th en I d o n ’t know what to d o to deal with
i t . . . . A n d w h en I feel this angry I eat m ore, ’cause I
feel really d efeated . I feel m ade im p oten t, and I get
really angry w h en som eb od y tries to m ake m e im p o­
tent. . . . I d o n ’t feel g o o d ab ou t b e in g h o o k e d in to
som eb od y e lse ’s anger.
Therapist: D o you want to focu s h ere for a few m in u tes now on
that hook? A nd see if we can d o so m e work with that?
Client: Yeah, that’s what I should do. ’Cause I wasn’t sure, you
know— I ju st felt, w ell, I cou ld bring that m uch in ten se
an ger in h ere, ’cause that’s w hat’s im p o r ta n t.. . .
Therapist: So again now, how to u n h o o k . . . .
188 D epth-O riented B rief T herapy

C lient: It seem s like, you know, I ju st c a n ’t perceive p e o p le

like him the way I’m p erceivin g them .
T herapist: W hat’s the new track, w hat’s the new fr a m e or way o f
p erceivin g him?

[W hen th e c lie n t said, “I ju st c a n ’t p erceive p e o p le like him the

way I ’m p e r c eiv in g th e m ,” m e a n in g th at sh e c o u ld sto p fee lin g
rage if sh e fo u n d a d iffe r en t p o in t o f view, th e th era p ist saw an
opportunity for inviting her to view from a sym ptom -free position.
T h e therapist is aware that in response to the experiential quesdon
h e th e n asked, e ith e r sh e will fin d su ch a n ew p o s itio n , o r her
attem p t to take that sym ptom -free p osition will trigger resistance
or protest from h er u n con sciou s, pro-sym ptom p osition , bringing
that position into awareness. N ote that this is an experiential inter­
vention; the th erap ist’s m a n n er m ad e it plain that h e was asking
her n o t m erely to sp ecu late intellectu ally but to actually construct
and assum e a sym ptom -free p osition .]

C lient: [C loses eyes, reflects internally for several secon d s,

then o p en s eyes and speaks with an ironic to n e] I’ve
got a lot invested in k eep in g this o p in io n . You know, I
ju st tried to see if I cou ld shift it, an d it w ent, “N n -n n !
G otta h ang on to this.”
T herapist: A nd w h at’s that ‘N n -n n !’ protecting? W hat d o you lose
if you let go o f that? Really, w hat’s at stake, if you let
go o f that?
C lient: [Pause; th en speaks in a m o n o to n e as sh e gazes at the
therapist] I c o u ld n ’t k eep living in kind o f a crisis
m entality. I’d have to give that up— an d it’s adventur­
ous, and it’s excitin g.
T herapist: I see. I see. A dventurous an d excitin g.

[T his is the turnin g p o in t o f th e session . T h e therapist asked her

to take a sym ptom -free p osition . As sh e tried to d o that, sh e exp e­
r ie n c e d th e fe e lin g , “N n -nn ! G otta h a n g o n to th is.” T h is is h er
p ro -sy m p to m p o sitio n su d d e n ly c o m in g in to h e r aw areness
th r o u g h its resista n ce a n d r e v ea lin g its e lf as v a lu in g b e in g
“h o o k ed ” into this boy’s anger an d unw illing to have that stop. She
ex p erien ces this directly, n o t through interpretation . T his sudden
activity o f her pro-sym ptom p osition is an im p ortan t opportunity
 Radical Inquiry: Techniques 189

for en g a g in g it, and from the m o m en t it m akes its appearance the

therapist rivets atten tion on it through inviting it to exp ress itself
further, o n its own term s, in o rd er to find w hat th ose term s are.
And in resp o n se, that h id d e n p o sitio n c o m e s righ t o u t in to th e
open. Since it is un con sciou s material that the clien t is now access­
ing, her voice b ecom es noticeably m o n o to n ic and h er eye contact
becom es m ore o f a gaze as she voices the hid d en position and says,
“I c o u ld n ’t keep living in kind o f a crisis m entality. I’d have to give
that u p — an d it ’s a d v en tu ro u s, an d it’s e x c it in g .” In this sh e is
b e g in n in g to c o n ta c t an d articu late th e e m o tio n a l tru th o f th e
symptom . T h e therapist will now co n tin u e to elicit the sym p tom ’s
em otional truth— the pro-symptom position— until it is com pletely
clear why the sym p tom o f staying in a n g er is m o re im p ortan t to
have than n ot to have.]

T herapist: So d oes the part that w ent, “N n-nn! G otta k eep this!”
fear a bland, b orin g ex isten ce if you give that up and
d isen gage from this boy?
Client: Yeah, because that also m ean s that I’m in con trol to
som e exten t, too, I think. You know, I have a part to
play in this adventure then? T h e o th er m ust m ean
m ore surren der and kind o f —m aybe m ore fem in in e
way o f lo o k in g at things. You know, this part o f m e
d o e sn ’t like that.
Therapist: Likes to jo in the battle— en gage the battle.
Client: [Laughs] Likes to be a warrior. I m ean , really likes to
go o u t there and fig h t.

[For th e th e ra p ist, th e c li e n t ’s last w ord s c lin c h e d th e ca se,

u n m istak ab ly c o n fir m in g th e n atu re o f h er p ro-sym p tom p o si­
tion. T h e th erap ist now fee ls fin ish e d with radical inquiry. It is
also cle a r to h im th a t reverse r e so lu tio n w ill o ccu r, sin c e th e
client strongly values her pro-sym ptom position. H e therefore will
now focus entirely o n the position work o f drawing the clien t into
in h a b itin g h er p ro-sym p tom p o sitio n in r e la tio n to th e b oy in
q u e s tio n , w h ich will reso lv e th e p r o b le m by tra n sfo r m in g th e
m ea n in g o f h er sym p tom o f stayin g e m o tio n a lly e n g a g e d with
him (refra m in g to th e e m o tio n a l truth o f th e sy m p to m ). N o te
how th e th e ra p ist arrived at h is last w ord s, w h ich d e c isiv e ly
elicited the pro-sym ptom position: h e was already listen in g to the
190 D epth-O riented B rief Therapy

c lie n t’s previous words with the o n e -p o in te d in ten tio n o f fin d in g

signs o f h er pro-sym ptom p o sitio n . S h e h ad ju st said, with spunk
in h e r v o ic e , th a t th e part o f h e r th at was r e sistin g b e in g
u n h o o k e d is o p p o se d to “su r r en d e r ” an d loves th e “a d v en tu re”
an d “e x c ite m e n t” o f th e struggle with this boy. T h e therapist, lis­
te n in g with pro-sym ptom ears, h eard in this a love o f battle and
sim p ly v o ic e d that im p r e ssio n — an d was ready to d r o p it if dis-
co n firm ed by the client; but sh e fully c o n fir m ed it.]

Therapist: So it sou n d s like from the p o in t o f view o f that part o f

you, this problem is n o t a prob lem . In o th er words,
it’s—
Client: Yeah, it’s provoking a fight! [Laughs]
Therapist: It’s good to be in a battle. It gives a warrior— you know,
a warrior lives to be in battle, right?
Client: Yeah.
Therapist: T h at’s what a warrior’s about.
Client: [With great spunk] I m ean , th e r e ’s always b een a part
o f m e that w ou ld like physical battle, w h ere, you know,
you en d up shaking hand s afterwards or so m eth in g —
you know, “W ell, that was a good tussle, w asn’t it!” You
know? T h ere is that part o f m e. ’Cause I can rem em ­
ber w h en I was in C leveland a frien d o f m in e said h e
used to like to wrestle with m e. H e said, ‘Y ou really
fight!” You know, and th en — I w ould really put a lot o f
energy into it!
Therapist: [Slowly] So from this part o f you, w ould you try ou t
saying to m e, right now, this sen ten ce: “I / ^ b a t t l in g
with this kid every day.”
Client: [Laughs hard]
Therapist: From this part o f you.
Client: All right. All right. This part o f m e. [Striking ch an ge o f
facial expression; face now appears suffused with plea­
sure and m ischief.] I really like to battle with this kid,
every day. It’s exciting.
Therapist: Yes.
Client: A nd it’s on the fringe. A nd it’s on the verge o f danger.
Therapist: Yes. I get it.
Client: A nd I like danger.
 Radical Inquiry: Tkchniquks 191

Therapist: I get it.

Client: I like adventure.
Therapist: G ood. I see that look in your face. You really— this
part o f you really gets so m eth in g o u t o f that. Loves
that.
Client: [Laughs]
Therapist: Yes. So there are parts o f you that really hate the way
this feels, but there is a m ore pow erful part o f you that
really thrives in som e sense on this battle. G oes for it.
Client: Well, th ere’s a w h ole code in m e o f warriorship. You
know, it’s the w h ole th in g of, you d o n ’t back o ff o f a
battle with som ebody. . . .
Therapist: I’d like you to try so m eth in g now. I’d like you to visu­
alize him , this kid. In fact, I’d like you to visualize
k eep in g him after class. So everybody else has left the
class.
Client: U h-huh. [C loses eyes]
Therapist: T h at’s it. A nd h e ’s stan din g there. A nd you walk over
to him , and right in to his face, you say [slowly spo­
k en ], “I want you to know— that I look forward—”
Client: [Laughs hard]
Therapist: “— to co m in g here every day— ”
Client: [Laughs]
Therapist: “— and w restling with you. I love it. A nd I really don't
want you to leave my class, becau se th en I w o n ’t have
this to look forward to every day.”
Client: [Laughs]
Therapist: “You m ake my day.”
Client: [Laughs]
Therapist: Go ahead.
Client: Mmm.
Therapist: A nd see how h e resp onds, as you say th ese things.
Client: [C loses eyes, is silen t for a few secon d s, th en laughs] I
think it w ou ld e n d up in lau gh in g. Yeah, like, “T h a t’s a
good fight. T h at’s worth d o in g .” [L on g pause with eyes
still closed ] T h e r e ’s this part inside m e that’s sort o f
cow ering w atching this: “A aah h h !”
Therapist: T h at’s an oth er part that hates the figh tin g and is
scared o f it?
192 D kpth-O riknted B rief Therapy

Client: It’s kind o f scared o f it. N ot hating it, but kind of,
“T h at’s a really big person up there, tow ering over m e.”
Therapist: Scared o f it, but n o t h atin g it.
Client: N o, becau se I d o n ’t think the figh tin g en erg y is really
m alicious. It’s n ot a m alicious figh tin g energy, because
it w ould take on the o th er person as an equal foe, I
think, and— you know, the w h ole idea o f a warrior.
Therapist: So d oes that m ean it’s m ore o f a sporting energy?
Client: In the sen se that you were talking about, yeah, I think
it is. You know, it’s like g o in g to the jo u st, or so m e­
thing? See if I can knock you o ff your horse, or you
knock m e off. . . .
Therapist: So listen, I w on d er if you cou ld d o an exp erim en t,
co m e M onday m orn in g. I w on d er if you cou ld go into
sch o o l d eliberately p o sitio n ed in the warrior part o f
you th at’s lo o k in g forward to today’s jou st. You walk
in to the room w here you know h e is, or h e walks into
the room w here you are, and your sen ses ju st are wide
o p e n , wide awake— you gotta watch every m ove your
o p p o n e n t m akes.
Client: [Laughs]
Therapist: You know, it’s an in ten se, high thing, right from that
point.
Client: [With a conspiratorial look and low ered voice] T hat
w ould be fine if n ob od y else was involved. T h a t’s the
problem, isn ’t it? T h a t’s exactly what I said earlier is, this
kid is consuming all my time.

[In saying that “this kid is consum ing all my tim e” she has suddenly
retu rn ed to h er origin al anti-sym p tom , victim p o sitio n , as if it is
this boy w ho co n su m es h er a tten tio n , rather than h er ow n great
attraction to the jou st. T h e therapist has to resp on d im m ediately
a n d c h a lle n g e this sw itch o f p o sitio n s, b e c a u se th e th era p eu tic
strategy at this p oint is to arrange for her to stay in her joust-loving
(pro-sym ptom ) position and n o lo n g er be u n co n scio u s o f it. T h e
therapist will therefore im m ediately ask her to switch back to her
warrior p o sitio n ’s view point.]

Therapist: I’d like you to again go in to your warrior part and find
ou t about this from that angle.
 Radical Inquiry: T fx:hniques 193

Client: It d o e sn ’t fu ck in ’ care if it takes up all the tim e with

o n e kid! [Laughs hard] I m ean after all, that’s the
jou st.
Therapist: T h a t’s right, the jo u st.
Client: It’s very sin gle-m in d ed , con cen trated . A nd m ean w hile
all th ese o th er p o o r kids d o n ’t know w hat th e h e ll’s
g o in g on! [Laughs]
Therapist: S o how ab ou t d o in g this ju st for o n e day, or o n e class
with him? In o th er words, to really, deliberately co m e
in to it from this p osition , this warrior p osition , and
fully ex p e r ie n c e it, from that p osition . Savoring the
jo u st—
Client: M m-hm.
Therapist: — as your world. T h e m ain event. A n d accep tin g this
part o f you in o n e class with him . ’Cause you may n ot
have m any m ore classes with him .
Client: [Pause w hile gazin g at therapist] W hat a pity, eh?
[L aughs hard]

H ere we have se e n radical in q u iry via th e d u al te c h n iq u e o f

viewing from a sym ptom -free p osition an d inviting resistance; the
session also involved an exp erien tial shift via position work. In the
n ext sessio n , two w eeks later, th e c lie n t rep o rted w hat th e n hap­
p en ed . T h e session above was o n a Saturday. She w ent in to sch ool
Monday m orn in g in her “warrior” position and felt com p letely free
o f the o ld victim ization or anger. She also spoke with the guidance
counselor and got the cou n selor to agree to take the boy o u t o f her
class— so m eth in g she said she cou ld have d o n e, but had n ot d o n e,
for many weeks, but now sh e did it o n the n ext sch ool day after the
session. She cou ld now choose to give up this boy as a jo u stin g part­
ner because she was now consciously ow ning her enjoym ent o f joust­
in g with him . As we have seen in several o th er instances, having a
client consciously take the position generating a symptom is the best
way to en ab le her to vacate that position perm anently. It had b een
so difficu lt to stay in her role as an effective teach er with this boy,
not so m uch because o f him , but because o f her own great desire to
go into her warrior position and jou st with this kid— and to hell with
teaching the oth er kids! But her warrior position and her desire to
be in it had b een unconscious, so the only way she could make sense
194 DEPTH-ORIENTED BRIEF THERAPY

o f her difficulty staying in the teacher role was by seein g this boy as
pulling her o u t o f it and seein g h erself as his victim.

U tilizing U n exp ected Resistance___________________

In depth-oriented brief therapy, as in other n onp ath ologizing, con­
structivist therapies, resistance is viewed sim ply as an expression of
th e c o h e r e n c e o f th e c lie n t’s co n stru ctio n s o f reality. As systems
theorist Paul D ell p o in ted out, “T h e ind ivid u al’s . . . c o h eren ce is
th e lock — and th e th era p ist’s in terv en tio n s are th e keys. . . . It is
always the lock that determ in es w hich keys will work.” A w rong key
in d eed en cou n ters resistance, but for the reason that it is a wrong
key, n o t b eca u se th e lock is “r e sistin g .” T h e lo ck sim p ly has the
structure it has and coherently behaves according to that structure.
In p recisely th e sam e way, th e th era p ist’s e x p e r ie n c e o f e n c o u n ­
terin g resistan ce m ean s o n e th in g and o n e th in g only: what the
therapist is trying to d o d oes n ot fit with the structure o f the client’s
construction o f reality. T herefore, the therapist should change keys
rather than blam e the lock. T hat is, rather than view the clien t as
n on co o p erative, path ologically o p p o sin g h ealth , or n o t yet ready
for trea tm en t, “It w o u ld b e m o re accu rate (a n d m o re h o n e s t)”
according to Dell, “to say that the treatm ent is n ot yet ready for the
p atien t.”
M ore specifically, the therapist has the e x p erien ce o f en co u n ­
tering resistance w h en the c lie n t’s c o h e r e n c e g en erates a protec­
tive action in response to the therapist’s actions. T h e readiness for
im p le m e n tin g this p r o tec tiv e a c tio n is alread y p r e se n t in the
c lie n t’s c o h eren t con stru ction o f reality. R esistance is a protective
a c tio n o c c u r rin g in rela tio n to th e th era p ist, an d it is a ro u tin e
resp onse o f the clien t in the sen se that it already exists within the
repertoire o f the co h eren ce with which the clien t com es into ther­
apy. In DO BT the therapist’s gen u in e attitude toward the resistance
is therefore to w elcom e it in the sam e spirit in w hich the therapist
regards a p rotective action p resen ted as a sym p tom , nam ely as a
valuable p o in t o f access to key em o tio n a l truths and h id d en posi­
tions, exactly in the m anner illustrated in the p reced in g transcript.
R esistance is the live appearance in the room o f an im portant hid­
d e n p o sitio n . S p o ttin g resista n ce an d v iew in g it as a p rotective
activity o f a hid d en position gives the therapist an ex cellen t oppor-
 Radical Inquiry: Techniques 19 5

tunity to work from that p rotective action directly to that h id d en

position and to that which is b ein g protected— usually an u n h ealed
em o tio n a l w ou n d an d associated e m o tio n a l th em es and p resu p ­
p ositions. So th e therap ist im m ed iately d o e s radical inquiry in to
the resistance w hile it is occurring, w ithout ever p sych ologizin g or
subtly b lam ing th e clien t for it.
L et’s lo ok at how the therapist works from th e resistance in to
its h id d en structure. As a working exam p le o f resistance occurring
in a therap y sessio n , le t ’s c o n sid e r d isso cia tio n . T h e p attern s o f
work we will d escrib e apply eq u ally to o th e r form s o f resistan ce,
such as intellectu alizing, em otion alizin g, arriving late for sessions,
and so on.
Many clients dissociate during sessions w hen the work gets near
an em otional w ound or trauma. T he clien t’s attention becom es dif­
fuse an d d iverted from th e r e q u e ste d fo cu s, a ffe c t flatten s, th e
voice b ecom es m o n o to n e, con fu sion sets in, a blank look develops,
and so on . S o m e clien ts d escrib e a k in esth etic “w all” that co m es
up or down around them , or a “fo g ” that rolls in suddenly, an em o ­
tional num bness, a sense o f rem oteness in w hich the them es u nd er
scrutiny seem to b e lo n g to s o m e o n e e lse , or a cozy fa tig u e an d
overw helm ing desire to sleep .
W hen a client m anifests any o f these signs o f dissociation, a first
step o f resp on se from the therapist is to c o m m e n t o n the c lie n t’s
sp ecific m a n ife sta tio n an d e x p e r ie n c e o f d isso c ia tio n , e lic itin g
explicit acknow ledgm ent o f this from the client. A secon d step is to
ask the client to deliberately increase the dissociation somewhat. This
is a form o f p osition work that both red u ces th e a u ton om y o f the
dissociated state and com m u n icates th e th erap ist’s a ccep tan ce o f
this state as b ein g what is em otion ally true for the clien t right now.
T h e th erap ist th en again a ck n o w led g es an d a ccep ts that the
client is in the safety and the em otion al distance o f the dissociated
state, and he or she proceed s to work with this state through either
position work or what we call d is ta n t view in g .
T h e distant view in g technique consists o f having the dissociated
client stay d issociated and from that em otion ally distant, safe state
ex a m in e w hat it is p ro tectin g him or h er from e x p e r ie n c in g — in
other words, what w ould have h ap p en ed if the dissociation h a d n ’t.
T h ere are various ways to d o this. O n e is through saying to the
client, for exam p le, “I’d like you to stay right w here you are in that
196 D epth-O riented Brief T herapy

safe place in the fo g and only im a g in e what w ou ld have h a p p en ed

h ere with m e if you h a d n 't g o n e in to that fog. Stay in the fo g and
only im agine how the scen e was go in g to d evelop w ithout the fog.”
In this approach, the clien t in the d issociated state visualizes him ­
self having whatever exp erien ce was goin g to happ en in the nondis-
sociated state. C lients can actually d o this and d escribe what they
were goin g to exp erien ce if they h a d n ’t dissociated. (In som e cases,
a c lie n t w ho dissociates will im m ed iately be able to reen g a g e the
s c e n e that activated th e e m o tio n a l w o u n d an d to lera te it if the
therapist directs th e c lie n t to view th e scen e from a d istan ce and
see h e r self “over th e re ” in th e sc en e, rather than view in g from a
location w ith in the scen e.)
A n other way a client can tolerate finding ou t what h e w ould be
ex p erien cin g w ithout the dissociative protective action is through
se n te n c e c o m p le tio n — for ex a m p le, “If I h a d n 't cu t o ff w h en you
asked m e to p ictu re my m o th e r in that room . . .” H ave him say
a n d c o m p le te th at s e n te n c e e n o u g h tim es a n d h e w ill b e c o m e
aware o f what h e w ould have ex p erien ced and why it was necessary
to keep that from h ap p en in g.
For clients w hose dissociated state d uring a session involves an
im age or fee lin g o f a w a ll c o m in g dow n a rou n d th em , th e thera­
pist can fram e that wall as a v alu ab le, loyal frien d that p rotects
th em w h en ev er n e e d e d , w h ich is an e m o tio n a l tru th an d n o t a
trick m etaphor. T h e therapist en cou rages the clien t to stay inside
the safety o f that wall but invites her to step up on a rock or bench
and ju st have a glim pse over it, or find a p eep h o le through it, to see
w h at’s o n the oth er side that sh e m igh t n e e d sh ield in g from .
O n c e th e c lie n t has id e n tifie d th e e x p e r ie n c e h e or sh e is
a v o id in g , th e th era p ist asks, “W hat m ak es th at so im p o rta n t to
avoid?” and the work focu ses there, to bring o u t w hatever feelings
or p resuppositions necessitate and trigger the d issociation.
Position work is the oth er general m eth o d that can be applied
to w orking with a d issociated state d u rin g a session. T his consists
o f inviting the client to overtly assert his or her unw illingness to stay
p resen t for the work that the therapist was ab ou t to do.
T h e easiest way to d o this is by offering the client a tria l sentence.
For ex a m p le, th e therap ist says to th e clien t, “W ould you try out
saying directly to m e, in order to see if it’s true, this sentence: ‘I’m
n o t w illing to find ou t what you were asking m e to think a b o u t.’”
 Radical Inqiiry: T kciiniqi f.s 197

(T he reader may recall that a request o f exactly this form was what
p rod u ced the breakthrough in C hapter Two with the w om an w ho
viewed h erself as repulsively ugly.) Since the therapist has already
ex p ressed c o m p le te a cc ep ta n c e o f th e d isso cia ted state that has
d e v e lo p e d , usually it is n o t to o hard to g e t th e c l i ent to o v e rtly
acknow ledge the unw illingness that covertly show ed up as dissocia­
tion. Furtherm ore, in the trial sen ten ce tech n iq u e the therapist is
asking the clien t only to “try o n ” the sen ten ce to see “if” it fits.
H aving th e c lie n t try o u t saying, “I’m n o t w illin g to find o u t
what you were asking m e to think a b ou t” is p osition work because
it has the clien t actually shift in to that em otion ally true p osition .
T h e clien t says the sen ten ce, th en says it feels true, and what then
usually hap p en s is that as a result o f openly, overtly expressing the
unwillingness, the dissociated state im m ediately starts to disappear.
T he covert expression o f the unwillingness— the dissociated state—
is starting n ot to be n e e d e d at that point.
If the sen ten ce rings true for the client but the dissociated state
d o es n ot d issip a te, th e n e x t step is for th e th era p ist to ex p ress
acceptance o f th at by saying, for exam ple, “OK, I accept that you ’re
unw illing to find o u t what I was asking you about. We w o n ’t pur­
sue what I was asking you since you ’re telling m e, ‘N o, n ot yet.’ But
tell m e, hoiu come that’s so m eth in g that’s im portant for you to stay
away from ?” T his is the sam e lin e o f inquiry reach ed through the
m ethod o f distant viewing, and this question usually gives the client
a gradual, acceptable way to contact the material that h e or she felt
the n eed to avoid.

U tilizing th e C lien t-T herap ist R elationship_________

In d ep th -o rien ted b rief therapy the therapist utilizes clien t trans­
feren ce m uch as h e or sh e utilizes clien t resistance, as an expres­
sion o f an u n c o n sc io u s p o sitio n . S in ce a state o f activated
transference, positive or negative, ten ds to be richly im b u ed with
feelin g , it can be m in e d as an esp ecially a ccessib le vein in to the
un con sciou s position g en eratin g it.
F u n d am en tally, tra n sfe r en ce is n o d iffe r e n t than any o th e r
uncon sciou s construal o f m ean in g. All con stru in g and attributing
o f m ea n in g is p rojection . G eorge Kelly, th e origin ator o f clinical
constructivism, wrote, “A nything a person d oes can be interpreted
198 Depth-Oriented Brief Therapy

as a p ro jection o f his p erson al constructs. In d e e d , th e w h ole sys­

tem o f the psychology o f person al constructs m igh t possibly have
b e e n c a lle d ‘th e p sy c h o lo g y o f p r o je c tio n .”’ T ra n sfe re n c e is o f
course co n sid ered by m any to be th e m aster projection . However,
D O B T d o e s n o t h in g e o n its u se. N o n e th e le s s , th e in te n tio n a l
d e p th -o rie n ted b r ie f th erap ist, always w atch in g for corrid ors o f
m ea n in g lea d in g to th e pro-sym ptom p o sitio n , will capitalize on
its exp ression , usin g the sam e m eth o d o lo g y as for any o th er con ­
struction o f m eaning: radical inquiry and exp erien tial shift.

M in d -B o d y C om m unication_______________________
It is also valuable in radical inquiry to focus on clients’ somatic symp­
tom s, in c lu d in g p sych osom atic a ilm en ts, p sy ch o g en ic p ain , and
kinesthetic sensations. T h e latter two— som etim es in the form o f a
headache; sharp pains in the throat, chest, or stom ach; or a local­
ized sen sa tion o f pressu re, co n tra ctio n , or en erg y — occasion ally
arise d u rin g a session in resp on se to th e exp erien tial work u nd er
way. T h e fo llo w in g te c h n iq u e o f b od y-m in d c o m m u n ic a tio n ,
adapted from Gestalt therapy m ethods, is in our exp erien ce reliably
effective for gaining access to the em otional truth o f such symptoms.

1. Have the clien t fully focu s a tten tion o n th e sen sation , with no
attem pt to ch an ge or stop it.
2. Still fully attending to the sensation, the client then visualizes the
three-dim ensional shape o f the bodily region o f the sensation.
3. Ask the clien t to describe this shape, in clu d in g the type o f sur­
face it has (w ell-d efin ed or fuzzy), w h eth er it is stationary or
m oving and ch an gin g, and its coloration .
4. H ave the c lien t say to this visu alized form in th e body, eith er
o u t lo u d or in silen t in tern al d ia lo g u e (leavin g th e c h o ice to
the clien t), “I am very aware o f you there. You have g o tten my
attention. Is there som eth in g you are trying to tell m e?” Alm ost
w ithout excep tion , the client will exp erien ce an inner response
from the body region, eith er in clear words or in an attitudinal
or em o tion al m ea n in g that the clien t can p u t in to words.
5. If n o resp on se, invite th e clien t to say to the region , “Are you
q u iet because you d o n ’t trust m e to und erstand or care about
what you want to say?”
 Radical Inquiry: Techniques 199

6. If still n o response, ask how the clien t is actually feelin g toward

this region right now. D oes th e clien t feel g en u in ely w illin g or
primarily u n w illin g to hear w hat that region has to say? If the
clien t is unw illing or closed , ask him or h er to verbally express
th a t to the region and th en to exp lain to it specifically why. In
resp o n se to this e m o tio n a l honesty, th e reg io n will now trust
the c lie n t’s con sciou s p osition e n o u g h to m ake a resp onse.
7. C oach th e c lie n t th r o u g h fu r th e r d ia lo g u e w ith th e b od y
reg io n in w h ich th e e m o tio n a l m essage o f that reg io n is w el­
co m ed , received, clarified, an d ack n ow led ged .

This tec h n iq u e can provid e d irect access to key m aterial. In psy­

chosom atic con d ition s, often the afflicted b ody region locally can
provide access to m uch or all o f the em otional truth o f the problem .

Focused E xam ination o f Personal H istory__________

In D O B T th e therapist ex p lo res th e c lie n t’s view o f th e past only
as n eed ed to discover the nature o f p resen t constructions o f m ean­
ing. In so m e cases, all con stru ction s relevant to th e sym ptom are
discovered w ithout referen ce to th e past at all. However, for m any
clien ts th e e m o tio n s , c o g n itio n s , a n d so m a tics c o m p r isin g th e
em otional truth o f th e sym ptom are u nconsciously stored and rep­
resented m ost essentially in im ages and sc en es o f th e past. Work­
in g d irectly w ith th o se c u r r e n t r e p r e se n ta tio n s th a t th e c lie n t
regards as “m em ory o f th e past” is o ften th e m ost d irect and pro­
fou n d way to transform th ose con stru ction s o f reality an d perm a­
nently elim in ate the sym ptom s they gen erate.
T h e case exam p les in C hapter Two d ea lin g with painfully n eg­
ative self-im age an d with life lo n g d ep ressio n b u ffered by w orka­
holism in clu d ed this kind o f work, so we will n o t further illustrate
it h ere. We n ote only that in d ep th -orien ted b rief therapy it has to
be the therapist, n o t th e clien t, w h o con trols how in form ation o n
the past is o b ta in ed , a cco rd in g to th e th erap ist’s sp ecific n e e d to
identify th e sym ptom -positive c o n tex t an d th e pro-sym ptom p osi­
tion in that co n tex t. S p ecific q u estio n s w e u se to b eg in to p rob e
for relevant past exp erien ce are the obvious on es, such as: “D id you
e x p e r ie n c e a n y th in g ea rlier in your life th at fe lt sim ilar to h ow
you ’re n ow e x p erien cin g this?” “D id so m e o n e in th e past resp on d
200 D kptii-O rikntkd Brikf Thkrapv

to you in this way that you now ex p ect others to do?” Subsequent
work on relevant past e x p e r ie n c e is then ex p erien tia l, with such
q u estion s as: “W ould you be w illing to im agin e b ein g seven, visu­
alizin g your m other, an d se e in g if this fe e lin g is part o f how you
ex p erien ce her?” “W hat d o you want to say to him , that you never
said at the tim e?”

Sum m ary_________________________________________
Clarity into the c lie n t’s pro-sym ptom em otion al truth is what tech­
n iq u es o f radical inquiry are d esig n ed to ach ieve rapidly for the
therapist. We have reviewed m any such techniques, in clu d in g both
lin gu istic and e x p erien tia l m eth o d s that have con stru ct-evok in g
impact, as well as techn iqu es for utilizing clien t resistance, dreams,
som atic sym ptom s, and the client-therapist relationship.
In k e e p in g with th e u n d erly in g stan ce o f radical inquiry, all
these tech n iq u es are experiential and phenomenological Likewise, all
operate as expressions o f the therapist’s active intentionality to m eet
the em o tio n a l truth o f the p rob lem and the th erap ist’s freedom to
clarify that e m o tio n a l tru th. T h e te c h n iq u e s are o n ly m ea n s by
w hich the therap ist m oves to en a ct the u n d erly in g stan ce. O n ce
the tec h n iq u es have b e c o m e fam iliar an d natural, th e therapist
d o es n o t think, “N ow w hich tech n iq u e sh ou ld I use here?” ju st as
h e or sh e d o e s n o t th in k , “N ow w h ich arm sh o u ld I u se to o p en
this d o o r ? ” If th e th era p ist is in h a b itin g th e sta n ce o f radical
inquiry— h old in g the conviction that a pro-sym ptom position exists
and can be significantly if n o t wholly accessed in this very session—
the tech n iq u e best suited to th e m o m en t sim ply com es to m ind or
can be in ven ted o n th e spot.
Radical inquiry is o n e o f the th erap ist’s two m ain operational
priorities for effectiveness in depth-oriented brief therapy. T he other
is experiential shift, the activity o f transforming constructions o f real­
ity, and it is to these processes that we n ext turn our attention.

Notes
P. 157, In sooth I know not why I am so sad . . W. Shakespeare (1988), The
Merchant of Venice (Act I, Scene 1), New York: Bantam.
P. 162, reach directly into the hidden structure of the presenting problem: We want
to acknowledge Dr. Robert Shaw of the Family Institute of Berkeley,
 Radical Inquiry: Techniques 201

California, for developing and teaching a way of questioning that

elicits the implicit presuppositional structure of the presented prob­
lem, and that we have fruitfully adapted to the purposes of radical
inquiry in DOBT.
P. 167, devised by the creators of neuro-linguistic programming: R. Bandler and
J. Grinder (1979), Frogs into Princes: Neuro Linguistic Programming,
Moab, UT: Real People Press.
P. 171, the constructivist technique known as laddering: D. N. Hinkle (1965),
The Change of Personal Constructsfrom the Viewpoint of a Theory of Impli­
cations, unpublished doctoral dissertation, Ohio University.
P. 171, “shared trance”: C. Tart (1969), “Psychedelic Experiences Associ­
ated with a Novel Hypnotic Induction Procedure: Mutual Hypno­
sis,” in C. Tart (Ed.), Altered States of Consciousness, San Francisco:
Harper. For a review of later literature, see G. Gleason (1992),
“Mutual Hypnosis,” Whole Earth Review, 75, 28-29.
P. 173, active imagination: See, for example, B. Hannah (1981), Encounters
with the Soul: Active Imagination as Developed by C. G.fung Boston: Sigo
Press.
P. 174, Gestalt empty-chair dialogues and two-chair work: See, for example, F.
S. Peris (1969), Gestalt Therapy Verbatim, Lafayette, GA: Real People
Press.
P. 179, which differsfrom how the technique has been described by some other writ­
ers: See, for example, N. Branden (1971), The Disowned Self, Los
Angeles: Nash; for an application of sentence completion in work­
ing with couples, see J. M. Gumina (1980), “Sentence Completion
as an Aid to Sex Therapy,”Journal of Marital and Family Therapy, 62,
201-206.
P. 194, “ . . . It is always the lock that determines which keys will work”: P. Dell
(1982), “Beyond Homeostasis: Toward a Concept of Coherence,”
Family Process, 21, 35.
P. 194, “. . . the treatment is not yet readyfor the patient”: Dell, “Beyond Home­
ostasis,” 30.
PP. 197-198, uAnything a person does. . . Hhepsychology ofprojection*”: G. Kelly
(1955), The Psychology of Personal Constructs (p. 202), New York:
W. W. Norton.
 C H A PTER 6

Experiential Shift:
Changing Reality
People wish to be settled:
only as fa r as they are unsettled
is there any hope for them.
Ralph Waldo Emerson, Circles

A ctual c h a n g e in th e c lie n t ’s c o n str u c tio n o f reality, d isp e llin g

the p resen tin g sym p tom , is the subject o f this chapter. In d ep th -
oriented b rief therapy, the m eth od ology o f prod u cin g such actual
ch a n g e is term ed e x p e rie n tia l sh ift , o n e o f th e th era p ist’s two top
p r io ritie s. T h e r e a d e r has a lread y e n c o u n t e r e d m any sp e c ific
exam p les o f exp erien tial shift in previous chapters. O ur purpose
here is to provide a m ore system atic overview, with clinical exam ­
ples, o f how the therapist g u id es the clien t in to accessing, in h a b ­
itin g , a n d tr a n sfo r m in g th e v e r sio n o f reality in h is or h er
u n co n scio u s, pro-sym ptom p osition .
As we have previously seen , sym ptom s are g en era ted by living
as th o u g h th eir em o tio n a l truth isn ’t the case. W hen th e u n c o n ­
scious, pro-sym ptom position b ecom es know n to the client, o n e o f
two kinds o f resolution will occur. O n e possibility is that the client
will want to be rid o f both this position and the sym ptom it insists
u p o n p ro d u cin g (d irect reso lu tio n , as illustrated by the cases o f
low self-esteem and dep ression in C hapter Tw o). T h e o th er possi­
bility is that the clien t will affirm b oth this pro-sym ptom p osition
and th e new ly rea lized value o f th e sym p tom , in w h ich case th e
status o f th e sym p tom im m ed ia tely c h a n g e s from u n w a n ted to
w an ted an d th e an ti-sym p tom p o sitio n sp o n ta n e o u sly d issolves

203
204 D epth -O riented B rief T herapv

(reverse resolution, as illustrated in Chapter O n e by the case o f the

graduate stu d en t w hose “procrastination” was d iscovered to be his
d eterm in ation n o t to pursue an unw anted career).

The A b ility to C hange_____________________________

In o u r co n stru ctivist view, p sych oth erap y can c h a n g e a p e r so n ’s
sy m p to m a tic e x p e r ie n c e a n d b eh a v io r b e c a u se ea c h p erson
natively has the follow in g two fu n d am en tal constructivist abilities:

1. Control of illumination of constructs: th e ability to b estow c o n ­

sciousness on, or withdraw it from, a given construct. Since every
co n stru ct is, as d escrib ed in C h ap ter T h ree, a know n or co n ­
scious knowing, or an unknow n or unconscious know ing, this is
the individual’s ability to change the status o f any construct from
an unconscious to a con sciou s know in g and vice versa.
2. Control of existence of constructs: th e ability to create, preserve,
an d dissolve con stru ction s o f reality. A con stru ct is preserved
by b ein g regarded in any position as real, and it is dissolved by
b ein g regarded in all p osition s as unreal.

We d e fin e p sy ch o th era p y — any k in d o f p sy ch o th era p y — as an

im p licit or e x p lic it a g r e em e n t b etw een c lie n t an d th erap ist that
they are interacting for the purpose o f en ab lin g the clien t to exer­
cise his or h er con stru ctivist ab ilities so as to transform habitual
co n str u c tio n s o f m e a n in g an d th ereb y c h a n g e satisfactorily the
c lie n t’s e x p e r ie n c e of, and resp on se to, th e p resen tin g problem .
T h e two fundam ental constructivist abilities o f hum an bein gs usu­
ally fu n ctio n in an u n co n scio u s, autom atic, and reactive way and
rem ain u n reco g n ized and n o t ch oicefu lly utilized. Yet w hen cued
or p r o m p te d by th e th erap ist, m o st c lie n ts can readily perform
constructivist feats that prove invaluable to them , th ou gh d oin g so
w ou ld never have occurred to th em o n their own.
O n ce radical inquiry has given the therapist an understanding
or m ap o f th e c lie n t ’s p ro-sym ptom p o sitio n or co n str u c tio n o f
reality within w hich the sym ptom is necessary, the process o f exp e­
riential shift th en consists o f two basic aspects:

1. Position work, or g u id in g th e c lie n t in to in h a b itin g an d inte-

 Experiential Shift: Changing Reality 205

gratin g th e e m o tio n a l reality in his o r h er u n c o n sc io u s, pro­

sym ptom p osition . T his process m akes use o f th e c lie n t’s abil­
ity to co n trol th e illu m in ation o f constructs.
2. C oach in g the tran sform ation o f pro-sym ptom constructs. T his process
makes use o f the clien t’s ability to control the existen ce o f con ­
structs.

T h e n ex t section s o f this ch ap ter d escribe an d d em on strate these

processes in detail.

Position W o rk _____________________________________
In position work, the therapist ushers the clien t in to inhabiting the
pro-sym ptom p o sitio n , so that th e c lie n t is actually e x p e r ie n c in g
the e m o tio n a l an d co g n itiv e reality d e fin e d by it an d is, in ad d i­
tion, integrating this reality— that is, accep tin g an d in clu d in g it as
an e m o tio n a l truth in th e c lie n t’s life. T h e in ten tio n is to perm a­
nently ch a n ge the status o f the pro-sym ptom position from u n con ­
scious know ing to con sciou s know ing. T his in itself is a substantial
experiential shift, an d it is this shift that refram es the sym ptom to
its em o tio n al truth. In m any cases this refram e, this lu cid realiza­
tion o f th e full em otion al m ea n in g or value o f th e sym ptom , itself
ach ieves reso lu tio n . T h is refram e arises from w ith in th e c lie n t’s
own w orld o f m ea n in g an d is th e re fo r e fu n d a m en ta lly d ifferen t
from th e extern ally a p p lied refram es u sed in certain o th e r b r ief
therapies.
R adical inquiry, in con trast, is an in itia l, m o re rapid pass
through this sam e construction . It ordinarily d o es n o t integrate or
ren d er stably c o n sc io u s th e pro-sym p tom reality, servin g o n ly to
reveal it to the therapist. T h e distinction betw een position work and
radical inquiry may at first se e m su b tle. If w e lik en th e c lie n t ’s
unconscious, pro-symptom position to an arrangem ent o f furniture
and o b jects in a very dark r o o m , radical in q u iry is lik e lo o k in g
around the dark room with a narrow-beam flashlight, m om entarily
illum inating o n e item at a tim e until the overall layout has b ecom e
clear to th e therapist. O n c e th e flash ligh t is withdrawn, th e room
again g o es dark for the client, even th ou gh each item was perfectly
clear w hile it was illu m in ated . Later in th e session , or in th e n ex t
session, the clien t may again be u n con sciou s o f th e very ex isten ce
206 Depth-Oriented Brief Therapy

o f that room , but th e therapist rem em b ers what has b e e n found.

P osition work th en gen erates for the clien t a con sciou sn ess o f the
w hole configuration, like turning o n the overhead lights o f the dark
room , perm anently illu m in atin g th e w h ole. In radical inquiry the
client has only briefly visited his unconscious constructs; in position
work h e m oves in and lives with them .
T h e vital im p ortan ce o f p o sitio n work for b rin g in g ab ou t an
exp erien tial shift is that m akin g th e pro-sym ptom p osition a fully
e x p e r ie n c e d , co n scio u s k n ow in g gives th e c lie n t d irect access to
the constructs (feelin gs, beliefs, scen es, and so o n ) com p risin g it.
T his is the m ost pow erful p osition th e clien t can take for creating
d e e p , lastin g ch a n g e , an d yet it is usually th e p o sitio n th e clien t
least wants to take.
For clien ts (and for m any therapists, to o ), th e “in tu itive” way
to m ove toward freed o m from th e sym ptom is to follow th e a n ti-
s y m p t o m p o sitio n ’s in clin ation to m ove a w a y from the sym ptom as
so o n and as decisively as p ossib le. T h is m o v em en t away from the
sym ptom is an attem pt to withdraw atten tio n from th e painful or
trou bling ex p erien ce o f the sym ptom , d isclaim in g an d disow ning
the sym ptom and th e em o tio n a l truths associated with it. Motivat­
ing this approach is the im plicit and profoundly fallacious assum p­
tion that the clien t’s dislike o f or sham e over the sym ptom in itself
has the potency to prevent the sym ptom from occurring. With this
a ssu m p tio n , th e th era p ist fo llo w s th e c lie n t ’s fo cu s o n h is anti­
sy m p tom p o sitio n , an d gives em p a th y a n d su p p o r t to w h at the
clien t feels and sees in that p osition as an escap e route from pain,
and tries to develop that anti-symptom position to the p oin t o f pre­
vailing over the sym ptom .
T his is a strategy that p rod u ces in effectu al work. As natural as
this kind o f attem p t may be, th e focu s o n th e anti-sym ptom posi­
tion is precisely what locks the sym ptom in place: it m axim izes the
u n c o n sc io u sn e ss o f th e pro-sym ptom p o sitio n , w h ich also m axi­
m izes its a u to n o m y , its fr e e d o m to p r o d u c e th e sym p tom . T h e
c lie n t’s anti-sym ptom position is not, in itself, the future symptom-
fre e p o s itio n , th o u g h in itia lly th e c lie n t th in k s it is. T h e very
attem pt to be nonsym ptom atic, rid o f the sym ptom , is actually not
a ch a n g e at all, but is in fact m ore o f th e sam e u n con sciou sn ess o f
th e em o tio n a l truth o f the sym ptom that set u p th e p rod u ction o f
th e sym ptom in th e first place. “As lo n g as I atten d to what I wish
 Experiential Shift: Changing Reality 207

to b e I n e e d n o t a tte n d to w hat I a m ,” w rites th era p ist N an cy

Shuler. “As lo n g as I d o n ot attend to what I am , ch an ge is n ot pos­
sible. . . . [C o n c e n t r a t in g [on ly] o n c h a n g e o n ly serves to k eep
ch an ge from occu rrin g.”
P o sitio n w ork is a m o v e m e n t in th e o p p o s ite d ir e c tio n , an
exp erien tial m ovem en t to w a rd and dow n in to th e em o tio n a l truth
o f the sym ptom . For som e clients and therapists, this at first seem s
counterintuitive, like ru n n in g in to a burn in g h ou se instead o f ou t
o f it. However, as our m any clinical exam p les in previou s chapters
have shown, by bringin g the clien t consciously in to his or her pro-
sym p tom p o sitio n , p o sitio n work rapidly gives th e c lie n t d irect
access to the previously hidden-away p h e n o m e n o lo g y gen eratin g
the sym ptom , m aking p rofou n d ch an ge an im m ed iate possibility.
T h e g u id in g prin cip le o f position work, th en , is this:

Change is blocked when the client tries to move from a position

that he or she doesn’t actually have as a governing emotional truth.
Therefore, for the client to be free to move to a new position that is
free of the symptom, first have the client take the emotionally gov­
erning, pro-symptom position he or she actually has.

L et’s quickly review a few instances o f this that we have already

seen:
T h e a g o r a p h o b ic w o m a n in C h a p ter O n e was tryin g n o t to
have “p sych otic” d elu sio n s from th e p o sitio n that sh e d id n 't want
to have them , and so the sym ptom w ould n o t ch an ge, because that
was n o t h er em o tio n a l truth o f th e m atter. W h en sh e reco g n ized
and took h er position that sh e d id ch o o se to have this d elu sion as
an effectiv e way to avoid fe e lin g a d e e p o ld w o u n d o f a b a n d o n ­
m ent, sh e then fo u n d it easy to stop havin g the d elu sion .
T h e w om an in C hapter Two with the cu ttin g shard o f low self­
worth as a fem ale becam e able to ch an ge this lifelong, painful view
o f h e r se lf as so o n as sh e co n scio u sly to o k h er u n c o n sc io u s, pro­
tective p o sitio n o f b e in g actively u n w illin g to se e h e r se lf as nor­
mally attractive.
T h e w om an h igh sc h o o l tea ch er in C h ap ter Five was trying
unsuccessfully to stop reacting daily with im potent rage at an aggres­
sive student. She was trying to m ake this ch an ge from the position
that sh e d id n 't w ant to fig h t with h im , w h en h er u n c o n sc io u s
208 D epth -O riented B rief T herapy

em otional truth was that she d id want to fight with him as a “warrior.”
By consciously taking that position, she im m ediately becam e able to
change. She stopped reacting and d isen gaged from him .
Reality in the clien t’s pro-sym ptom position— includ ing the age
an d e x p e r ie n tia l id en tity o f th e self, th e im agin al physical envi­
ron m en t or h om e, and so forth— is the sam e reality that was being
ex p erien ced at the historical tim e o f the original form ation o f the
em otion al w ound or trauma p resen t in the position. T h e reality in
the pro-sym ptom p osition d oes n o t con tain any representation o f
o th e r realities that th e c lie n t later d e v e lo p e d . In this se n se, the
clien t is unconsciously still living in the w ou n d in g or traum atizing
situation. T im e has n ot m oved on there. T h e version o f reality and
the in ten tio n s and strategies form ed by the c lie n t in th e original
w o u n d in g situ ation are still o p e r a tin g in th e pro-sym ptom p osi­
tion; in d eed , they co n stitu te that p osition . T h e clien t may think o f
th e o r ig in a l w o u n d in g situ a tio n as b e in g in th e past, b u t it is
u n co n scio u sly a presen t reality in the psyche. T h e therapist n eed s
to be sensitively aware o f the em otion al realness o f what the client
ex p erien ces on in h ab itin g a pro-sym ptom p osition .
W hen a clien t b eco m es aware o f the version o f reality and the
purposes and strategies h e hold s in his pro-sym ptom p osition , he
can b e c o m e aware also o f his ow n creative act o f fo r m in g and
im p lem en tin g that p osition . T his occurs w h en the clien t accesses
an d co n scio u sly e x p e r ie n c e s th e very co n fig u r a tio n o f m ea n in g
and feelin g that was (and still is) the m otivating p o in t o f origin for
fo rm in g th e pro-sym ptom p o sitio n . T h is p o in t o f o rig in may or
m ay n o t b e a sso cia ted in m em o ry w ith a sp e c ific h istorical
m om ent; m ore primarily, it is a specific con figu ration o f m ean in g
and feelin g, and in b eco m in g conscious o f it the clien t rem em bers
crea tin g his pro-sym ptom p o sitio n an d why h e d id it. T h e clien t
co m es in to con sciou s possession o f his actual capacity to create or
un create that p osition , like fin d in g con trol o f a m en tal m uscle he
d id n ’t know existed.
T h e goal o f position work is for the clien t to assert to the ther­
apist a statem en t o f a p r o /a n ti syn th esis having th e follow in g form ,
as his or h er own direct kn ow led ge and em o tio n a l truth:

I implement the symptom o f ________for the specific purpose of

________, and for me, achieving this purpose is worth the specific
pain and troubles that accompany the symptom.
 Experiential S hift: C han(;ing Reality 209

For e x a m p le : “I th in k o f m y se lf as r e p u lsiv ely u gly in o r d e r to

k e e p m y se lf from ev er a g a in b e in g a r o m a n tic c a n d id a te w h o
co u ld b e utterly devastated by rejection , and for m e, staying safe
in th is way is w orth th e e m o tio n a l p a in a n d sh a m e o f s e e in g
m yself as ugly.”
In this form o f statem en t there is a co n scio u s synthesis o f the
clien t’s pro-sym ptom position (“I im p lem en t the sym ptom for the
sp ecific p u rp o se o f . . .”) an d anti-sym p tom p o sitio n (“th e pain
and tro u b les that a cco m p a n y th e sy m p to m ”). T h e g o a l o f p o si­
tio n w ork is for th e c lie n t to e x p e r ie n c e a n d a c k n o w le d g e n o t
only his pro-sym ptom p osition b ut this c o m p le te synthesis o f the
pro- an d anti-sym ptom realities. It is th e c lie n t’s clear, e x p e r ie n ­
tial aw areness o f th e e m o tio n a l truth o f this syn th esis th at p er­
m a n e n tly alters th e c o n s tr u c te d rea lity o f th e p r o b le m an d
creates an exp erien tial shift. By overtly lin k in g th e pro- an d anti­
sym ptom p osition s in this em o tio n a lly true way, n e ith e r can c o n ­
tin u e to fu n ction au ton om ou sly from the other, an d th e c lien t in
e ffe c t b e c o m e s lo d g e d in a n ew state o f c o n sc io u s, p u r p o se fu l
im p lem en ta tio n o f th e sym ptom .

Techniques o f Position Work

It is w ithin this u n d er sta n d in g o f th e go a l o f p o sitio n work as a
p r o /a n ti synthesis that th e tech n iq u es d eta iled b elow are usefu l.
First are five in-session techniques:

• O vert statem en t o f position

• Cycling in and o u t o f a sym ptom -free position
• Follow ing the clien t a little bit ahead
• C on fron tin g with em otion al truth
• Traumatic in cid en t red u ction

T h ese are follow ed by three betw een-session techniques:

• In d ex card tasks
• Daily review tasks
• U sing the sym ptom as a signal to take the pro-sym ptom position

T h ese tech n iq u es are ways o f u sh erin g the c lie n t in to in h ab itin g

his or h er pro-sym ptom p o sitio n , r e n d e r in g it vividly c o n sc io u s
210 Depth-Oriented Brief Therapy

and experientially known, and forming a full pro/anti synthesis as

described above.

O vert Statement o f Position

Following the detection of an unconscious, pro-symptom posi­
tion through radical inquiry, one of the simplest and most direct
ways for the client to inhabit that position is for the client to
deliberately make a simple, declarative verbal statem ent that
voices the position in a blunt, clear way. Since this is an act of
expressing meanings that until this m om ent have been uncon­
scious, the first verbal version formulated is a trial statement: the
client “tries it o n ” as an approxim ation th at will be fu rth er
refined for emotional accuracy, or discarded if too inaccurate. As
always in depth-oriented brief therapy, accuracy is determ ined
subjectively by the client, not by the therapist.
The therapist invites the client to come up with a succinct overt
statem ent, but it often happens that the client is in confusion
am ong the various com ponents of m eaning com prising the
detected position, despite having experientially identified and ver­
ified the separate components piece by piece as they were discov­
ered in radical inquiry. The client may be simply unable to
synthesize the coherent meaning of the whole position. In such a
case, in the interest of time-effectiveness, it is expedient for the
therapist to formulate an overt sentence and invite the client to try
out saying it. The statement summarizes and unifies what has been
found during radical inquiry, and it begins position work. For
example, the therapist says to the client, “Let’s see if what we have
found so far really is emotionally true for you. Would you try out
actually saying it to me, in order to feel for yourself if it’s true?
Would you try out saying, ‘When I start to feel all alone and aban­
doned while I’m walking down the street, it’s so painful and so
scary that dream ing up my old therapist to be with me is worth
doing, even though I think that’s crazy’?”
If the sentence is sufficiently accurate, or if the client modifies
it to be accurate, after one or two voicings he or she will begin to
experience the em otional truth of the sentence. This is not a
merely cognitive exercise, despite being a verbal one. Once the
client says, “Yes, this feels true,” the therapist invites a deepening
repetition by saying something like, “OK, since this feels true for
 Experiential Shift: Changing Reality 211

you, would you say it again now, as being com pletely your own
emotional truth?” Usually this brings the client quite fully into
experiencing the emotional position expressed by the sentence. It
is quite common for an important release of deep feelings to occur
at this moment. This occurred, for example, with the “unhappy no
matter what” client (described in Chapter Two) when the thera­
pist gave her the sentence, “The truth is, up to now my unhappi­
ness over feeling unloved by my father is bigger than any happiness
I’ve been able to have.” The im m ediate upwelling of deep,
poignant grief and sorrow that this woman experienced upon say­
ing this sentence unlocked her chronic depression and restored
her connection to a deep region in h er own being that she had
sealed off.
Once the client has emotionally dropped fully into the posi­
tion verbalized in the statement, additional elements of emotional
truth may very likely come into awareness spontaneously—the
process of serial accessing. Then either further radical inquiry or
further position work is pursued, as needed.
The following transcript illustrates position work carried out
using overt statements. This is a continuation of a session (see pp.
168-170) with a woman whose symptom was a repeating pattern
of compulsively becoming obsessive and emotionally dependent
upon a certain type of man (a problem of symbiotic attachment).
Radical inquiry had revealed how she knows to whom to attach
(someone charismatic with an emotional wound or hole needing
healing) and what her attachm ent does for that person (relieves
his wound) and for herself (“They’ll need me, and if they need me,
they’ll stay around” and be the one remaining “kidney” that keeps
her alive).
From the therapist’s point of view, each of the overt sentences
offered to the client is merely a handing back of an elem ent of
emotional truth that the client had already made known to the
therapist. The therapist chooses a wording, though, that is so
blunt and vivid that in reencountering her own truth in this form,
the client enjoys a small shock of new awareness of her own posi­
tion. The transcript begins as the therapist is about to have her
openly declare her pro-symptom position directly to her image of
three men from her past with whom she enacted this unconscious
position:
212 Depth-Oriented Brief Therapy

Therapist: So would you picture Alex—and Jeff—and your

father—standing there in front of you?
Client: OK. [Pause] There they are.
Therapist: And try out saying to them some sentences I’ll give
you, to see if they’re true for you. Change the words to
make them more accurate, or let me know if they’re
just not true. First, try out saying to the three of them,
“I know how to fill your hole—”
Client: I know how to fill your hole—
Therapist: “—and make you feel like you re really special.”
Client: —and make you feel like you re really special—and
really whole.
Therapist: “And I can spot you a mile away.”
Client: [Laughs] And I can spot you a mile away.
Therapist: “And I move in faster than the speed of light.”
Client: [Laughs harder] And I move in faster than the
speed of light. It’s true. [Pause] But then, I lose
myself. It totally wipes out my own power.
Therapist: Yes, so say that, too. Tell them the whole thing: “Get­
ting a strong connection with you is so im portant to
me that it’s worth wiping out my own power.”
Client: Connecting with you is worth wiping out my own
power. [Pause] Yes, that is true for some part of me.
Therapist: That's the part that matters here. I know you have
other parts that feel differently, but stay with this one
for now.
Client: OK.
Therapist: So try saying it again.
Client: Connecting with you is worth wiping out my own
power. [With zeal] ‘Cause it’s like I have to have it—it’s
the only thing.
Therapist: W hat’s “it”? More im portant than having your own
power is having—
Client: This connection. I’ve got to have this connection more
than anything.
Therapist: And tell them what this connection is going to do for
you, why it’s so im portant to you.
Client: This connection with you allows me to feel alive—
that's the thing. And without it I feel dead, and that’s
 Expkrikntiai. S hifr C hanging Rkalitv 213

why I need it. It’s like life or death. One way I feel
alive and the other way I feel dead.
Therapist: Like having no kidneys?
Client: Right.
Therapist: And what good is having your own power if you’re
dead?
Client: Right, exactly. T hat’s right.
Therapist: So why wouldn’t you go for that connection instantly,
whenever you see that right kind of person?
Client: Right. It’s like a drowning person seeing the surface of
the water from underneath. T here’s only one thing
you’re gonna try for.
[The client is now lucidly inhabiting her pro-symptom position, in
which spotting a willing attachee and symbiotically attaching is
nothing short of lifesaving.]
Therapist: Stay with that, and let it show you more about what
happened for you with your mother.
Client: [Pause] T here’s a way I couldn’t get air from my
mother, so these other people are like air sockets.
Therapist: So you feel that your m other stopped giving you
something vital, and without it you feel dead.
Client: Yes.
Therapist: And what is that vital something that she didn’t give
you?
Client: Love. Something like love.
Therapist: And this dead feeling—what’s the common word for
that state of feeling dead, lifeless?
Client: [Pause] Depressed.
Therapist: Yes.
Client: Right, right. Without it I feel depressed . . . I think
that’s true, that there’s this underlying depression
that’s there all the time. Sometimes it seems not to be.
[The idea of depression arose for the first time in a previous ses­
sion but was too threatening and frightening for her to feel and
know as true about herself, so this is something of a breakthrough.]
Therapist: One way to look at that is to ask yourself, do you ever
not make that speed-of-light reach for the right kind of
214 D epth-O riented Brief T herapy

person with a hole in the middle, when he or she

appears on the radar?
Client: I probably always go for it.
Therapist: So the depressed, dead side of you is—
Client: —actually always happening. Right, right.
Therapist: So I’d like you to try on this sentence: “I’m always
depressed over not getting love from my mother,
whether or not I’m actually feeling it.”
Client: [Big exhale] I’m always depressed over not getting
love from my mother. It’s true. It feels really—it’s that
quality of deadness. Grey. It just makes me want to go
to sleep. That's the depression—I just want to go to
sleep, or die.
Therapist: [Referring to a spontaneous memory in a previous ses­
sion] Just like you sometimes wanted never again to
wake up from sleep, as a little girl.

The position work recorded above enabled the client to voice the
p ro /a n ti synthesis, “Getting [someone like] dad to attach to me
and give me life by needing me and loving me is urgently impor­
tant and is worth the obsessing and the em otional dependency,
because without that I’m dead.” Her depression became the next
focus of therapy, but after this session she never again lost herself
in a compulsion to attach symbiotically and soon became involved
with the “balanced” sort of person she had never found exciting.

Cycling In and Out o f a Symptom-Free Position

This is a repetitive use of the technique of viewing from a symp­
tom-free position described in Chapter Five. In this technique the
therapist evokes the client into an imaginal experience of being in
a situation in which the symptom normally happens strongly, and
then further guides the client to construct an experience of her­
self as being without the symptom in this situation. For the pur­
pose of position work, the technique can simply be applied in a
repetitive manner, evoking the client alternately into and out of a
symptom-free position, guiding the client to attend to what is lost
when symptom-free and what is gained when the symptom is
allowed to return, and asking the client to notice and verbalize the
value of having the symptom. The alternation is done as many
 Experiential S hift: Changing Reality 215

times as is necessary for the client to achieve her own experiential

clarity as to the value of having the symptom. The exercise is then
ended, but the therapist must then deliberately, repeatedly, and
explicitly make the identified value of the symptom a focus of
attention in one way and another, continually requiring the client
to accommodate his conscious position to this new knowledge.

Following the Client a Little B it Ahead

O ur name for this technique of position work is an apt phrase
coined by psychotherapist Kenneth Rhea. What this phrase means
in DOBT is that the therapist verbally sums up the client’s p ro ­
symptom position in a concise, unified, em phatic way, bringing
together what the client has already revealed of it in bits and
pieces without realizing their pro-symptom significance. This is
done again as additional pro-symptom m aterial em erges until
finally the therapist repeats back key elements of pro-symptom and
anti-symptom meaning in a way that calls attention to and makes
plain the linkages between them, form ing a p ro /a n ti synthesis,
and does so with a condensed, sharply etched phrasing that makes
a strong impression and is easily rem em bered. The final step, of
course, is to have the client voice the synthesis to the therapist as
his own emotional truth.
A short example: Having done enough radical inquiry to grasp
the pro-symptom significance of a thirty-three-year-old male client’s
pervasive pattern of underachievement, the therapist took a first
step of position work by empathically reviewing this m an’s dual
positions in a way that drew him into a p ro /a n ti synthesis. The
therapist said, “I want to make sure I’m accurately understanding
what I’ve learned from you. Please tell me if I’ve got this right. You
want very much to ‘am ount to som ething,’ and you’re genuinely
troubled over how little you’re achieving or building in your life
so far, and you want this pattern to change. At the same time, in
another area of your feelings, you have another concern, also a pas­
sionate concern—a concern that your father shouldn’t get away
with how he treated you. You have an intense feeling of outrage
and injustice that after treating you ‘like absolute shit for sixteen
years,’ he thinks he did fine as a dad and is respected as a family
man by his well-to-do friends. And you figure that if he sees your
life coming together just fine, with solid achievements and success,
216 D kpth-O rikntkd Brikf Tmkrapy

it will prove to him irreversibly that he did do fine as a dad. And

you’re determ ined not to let that happen. In this area of your
inner feelings you feel you have to keep your life a shambles to
show him how badly he ‘damaged’ you. And even though it really
does cost you dearly to keep your life in shambles, and even
though you would want for yourself to be achieving things, even
more urgently important to you is this need to present your father
with a shambles, as the proof of how bad a jo b he actually did. Is
that right? Is that the emotional truth for you?”
It is well known that for the therapist to repeat back the key
constructs or elements of meaning already identified by the client
has an awareness-enhancing effect for the client, particularly if no
interpretive meaning is added by the therapist. Hearing the ther­
apist state the client’s own im portant meanings places the client
momentarily outside of them and separate from them, allowing
the client to attend reflectively to those meanings as objects within
a larger field of consideration, rather than remain subjectively
absorbed in those meanings with little or no awareness of them, as
was previously always the form of contact with them. Achieving a
reflective awareness of these meanings brings them into material
contact with other meanings, knowings, and purposes in the
client’s conscious world, an interaction likely to be transformative.

Confronting with Emotional Truth

This is a technique also used for radical inquiry as described in
Chapter Five, where we saw how a first-time assertion to visualized
figures of previously unspeakable emotional truths can begin a ser­
ial accessing of a chain of deeply unconscious meanings and mem­
ories, illuminating the core of the pro-symptom construction. In
confronting with em otional truth for position work, the client
explicitly and very bluntly voices to the relevant person (either
imaginally or in vivo) his previously hidden pro-symptom position
or the pro/anti synthesis, whichever is appropriate. While for rad­
ical inquiry the client is only initially trying out an expression of
emotional truth to see if it feels true, in position work the client is
now squarely asserting his emotional truth as an actuality and as a
basis of future decisions, actions, and relations. For the client to
access and strongly express his pro-symptom position in this way
tends to be a conclusive step toward integrating this material. Con-
 Experiential Shift: C hanging Reality 217

fronting with em otional truth means saying all that needs to be

said, all the words of emotional truth that the client never dared
say or couldn’t conceive of saying. To this end, a useful task is that
of the client writing a never-to-be-sent letter fully expressing the
uncensored emotional truth to the appropriate person (s), even if
deceased. O ther examples follow later in this chapter in a tran­
script from couples therapy.
This is a deceptively simple technique. To confront with em o­
tional truth is a deep affirmation of self because it expresses a fun­
damental ontological (fourth-order) position: I am a being capable
of sound knowing; I am a being who is worthy of being taken seri­
ously and treated with respect; my own knowledge is separate from
your knowledge; and so on. If taking this ontological position is a
significant change for the client, it will, because of its high level of
superordinacy, immediately challenge and displace various old con­
structs of (third-order) purpose, (second-order) m eaning and
(first-order) behavior. If this shift involves more disorientation or
loss than the client is ready to experience, he or she will either
revert to the old constructions a n d /o r m anifest resistance (go
blank, dissociate, intellectualize, get distracted, and so on). In that
case the therapist accepts and acknowledges to the client that the
therapist had invited the client to take too big a step; the therapist
then pursues radical inquiry into the emotional truth of specifi­
cally which consequences of that new self-affirming position would
be intolerable and why. Position work and other experiential shift
work can then be carried ou t as necessary to dispel each such
obstacle until the client succeeds at holding the new position from
which to confront with emotional truth.

Traumatic Incident Reduction (HR)

Traumatic incident reduction (TIR) is a technique developed by
psychotherapists Frank G erbode and Gerald French for funda­
mentally resolving (rather than merely managing or controlling)
post-traumatic stress symptomatology. It is a process for rapidly
accessing and dispelling the unconscious traumatic memory and
the associated unconscious constructions of reality set up by the
client during a traumatic event.
In DOBT terms, the TIR technique efficiently carries out rad­
ical inquiry and position work in relation to a particular type of
218 Depth-Oriented Brief Therapy

pro-symptom position, one in which the (ongoing) em otional

reality was formed by a traumatic incident. The technique involves
a very specific protocol for ushering the client repetitively through
the memory of the traumatic event. This repetitive, detailed, sub­
jective review instigates a thorough emotional processing of this
memory, progressively filling in lost details and unfolding the cru­
cial moments of meaning-formation that occurred during the inci­
dent. This brings about a spontaneous emergence into awareness
of the symptom-generating meanings, construals, intentions, and
protective actions that were unconsciously formed. Thus, the TIR
process fits very well within the DOBT framework of psychotherapy.
The note at the end of the chapter will guide interested read­
ers to further details.
So far we have been considering in-session techniques of posi­
tion work. Now we turn to between-session techniques, which are
fully as important for achieving time-effective results.
No matter how well position work is carried out in the therapy
hour, integration of the pro-symptom position’s altered, unfamil­
iar reality is neither complete nor stable until the client consistently
accesses the pro-symptom position and p ro /an ti synthesis during
ordinary life between sessions. The following three techniques are
designed to extend position work beyond the therapist’s office door
at the end of the session. W ithout such between-session tasks, the
integration achieved by the in-session work may quickly disintegrate
as the client walks onto the street, where the cues of the therapist’s
office-world recede and the cues of everyday life densely arise.
In position work, Alice steps through the looking glass into
the unfamiliar reality in her pro-symptom position, and then she
m ust bring back what she has found, all the xvay home, and live
with it. Without special measures this is unlikely to occur, and the
client may arrive at the next session not even aware of having lost
what she had found. Her pro-symptom position has submerged
again into unconsciousness and autonomy, allowing for contin­
ued production of the symptom and for a separate, conscious
anti-symptom position in which the symptom again seems invol­
untary, completely undesirable, and devoid of sense or meaning.
When unconsciousness of the pro-symptom position recurs,
the therapist simply repeats position work as necessary to retrieve
it. Actually, the process of integration often involves a transitional
 Experiential S hift: C hanging Reality 219

period of alternating between the p ro /a n ti synthesis and the

p ro /a n ti split for a few days to a few weeks. During this period,
whenever the client drops the reality of the synthesis and speaks
from the anti-symptom position, the therapist immediately
requests the client to retake the synthesis position, for example by
asking, “How would you say that from the point of view of your
emotional truth about this?”
As a rule we prescribe a between-session task of position work
at the end of every session.

Index Card Tasks

Simplest is to assign daily reading of an index card on which the
therapist has written a succinct formulation of a key, fresh-caught
emotional truth. The pro/anti synthesis is of course the emotional
truth most important to catch and hold in a verbal net. The ther­
apist and client collaborate on finding the wording that most ade­
quately and accurately captures the client’s felt sense of meaning,
but it should be the therapist who writes the words on the card.
Within the client’s view, the therapist also writes down his or her
own copy of exactly what is on the card. The therapist recommends
the client read the card each morning and evening, or tape it to
their m irror or dashboard, so as to en co u n ter it frequently but
unexpectedly. At or near the beginning of the next session, the
therapist asks what the client experienced in relating to the emo­
tional truth on the card. This follow-up is essential.

D aily Review Tasks

Another simple between-session task is a nightly, five-minute review
of the day in which the client identifies and jots down any situation
in which a newly discovered pro-symptom position was in fact oper­
ating, noting specifically what made the symptom im portant to
have in that situation. The client brings this record to the next ses­
sion to review with the therapist.

Using the Symptom as a Signal to Take the Pro-Symptom Position

In the ultimate technique of between-session position work, the
therapist explains to the client that as a result of experiencing and
recognizing the symptom’s emotional truth, the meaning of the
occurrence of the symptom has changed. Whenever the symptom
220 D epth -O riented B rief Therapy

now begins to occur, it can now be experienced as a signal to the

client to knowingly take the (pro-symptom) position of his emo­
tional truth and to let himself feel the emotional truth of in fact
currently needing or wanting the symptom, despite its very real
costs. The therapist gives the client the between-session task of
watching for the symptom to occur so that he can use it in this way.
As part of this task the therapist assigns the client to have the
symptom happen at predictable times when it would happen any­
way, but to do so knowingly and purposefully for its now-conscious
value, accepting the pain or trouble that it brings. The therapist
explains that this means there will be a change not in behavior but
in the client’s awareness and appreciation of the emotional truth
of what the symptom is doing for him at such times, and of actu­
ally implementing it for that purpose.
This task, coming after position work has been done in session,
is not the same as the paradoxical intervention of prescribing the
symptom in strategic therapy, because it is carrying out a different
therapeutic strategy and has different effects on the client. Doing
this task in DOBT more fully integrates the previously unconscious
pro-symptom position. This dissolves the client’s anti-symptom
construal of the symptom as involuntary and of the self as help­
lessly afflicted with a pathology. The task also causes the client to
become more aware of the symptom-positive context and of when
and how it arises. All of this further sharpens the client’s direct
knowledge of how the symptom is im portant to have and of the
loss that will have to be accepted in living without it.
In form ulating this task, the client and the therapist should
very explicitly identify specifically what constitutes having the
symptom happen. It is also m ost im p o rtan t th a t an im aginal
rehearsal of the symptom happening and of recognizing it as
a signal be done in session. The therapist also gives the client
an index card on which is written the em otional truth and pur­
pose of the symptom, to be read im m ediately upo n noticing
the signal—the symptom—occurring.

Systemic Position W ork w ith Couples and Families

Locating and making conscious a pro-symptom position is as ther­
apeutically potent in couple and family therapy as it is for individ-
 Expkrikntial Shift: Changing Rf.au iy 221
ual therapy. We find that carrying out position work with one or
more participants during a couple or family session is one of the
most effective ways to unlock a symptom -generating pattern of
interaction.
The key notion, already introduced in Chapter Three, is that
of the couple or family’s ecology of meanings (our extension of
Gregory Bateson’s “ecology of ideas”). The relationship system is
viewed rather concretely as an interaction between the current
constructions of meaning of the individual family members. What
depth-oriented brief therapy emphasizes is that the “understand­
ing” that each family member has of the others’ behavior is often
unconscious. This unconscious construal of meaning lives within
an unconscious position that then expresses itself with a behavior
that is the presenting symptom, or part of it. This problem behav­
ior indecipherably expresses some hidden emotional truth but is
construed by others as showing bad intentions or bad character,
and they react accordingly, which only further wounds the first one
and proves to him how bad the others are, and so on. The others,
of course, had responded in terms of their private and largely
unconscious worlds of meaning, making their own contribution to
the circulation of reactivity and misconstrued signals, all compris­
ing the family’s unrecognized ecology of meanings. This circular
self-consistency of behaviors and of construed meanings of behav­
iors locks the ecology into its current, symptom-generating, mutu­
ally adversarial, reactive, or alienated configuration, because each
member views her or his own interpretations and behaviors as per­
fectly justified.
In DOBT, systemic position work interrupts and permanently
dissolves whole segments of this symptom-producing ecology of
unconscious meanings, ending it. This position work consists of
having family members access and reveal their emotional truth or
pro-symptom position in the presence of each other.
In the following example from family therapy, the therapist
spots an opening for position work and then focuses the session on
this process, which produces a breakthrough that resolves the prob­
lem. The presenting symptom is the ten-year-old son’s behavior of
hitting other children at school, which had recently been happen­
ing several times each week. The parents, Beth and Jack, described
their son, Bobby, as having been diagnosed with attention deficit
222 D epth-O riented B rief T herapy

disorder and as always having been difficult, temperamental, and

aggressive, “losing control” and hitting, biting, and scratching ever
since he was a toddler. Their daughter Molly, twelve, was in contrast
the good child who felt neglected because of how focused on Bobby
both parents continually were. All four of them were in the sessions.
Both parents regarded the boy’s hitting as the problem , but
it was the father, the stricter, more controlling parent, who was
emotionally battling with the boy over this behavior, taking it per­
sonally as a defiance of both his express wishes and his paternal
authority. He was at this p o in t em otionally rubbed raw by the
stress of frequent parent-teacher conferences and by the contin­
ual tension at hom e due to an endless series of new incidents.
Shortly before therapy began, a psychologist at the family’s HMO
recom m ended putting Bobby on Ritalin.
What follows is a transcript of fourteen minutes from this fam­
ily’s eighth session. Previous sessions had focused largely on the
father’s obsession with controlling his son, which, it emerged, was
actually father’s imagined solution to another problem—the prob­
lem of avoiding incurring his octogenarian m other’s shaming crit­
icism for being unable to control his children. The therapist, in
other words, had been viewing father’s continual attem pt to con­
trol the son as “the symptom,” perceiving the father as having a
pro-symptom position consisting of an emotional wound of inad­
equacy in relation to his m other and a protective action of shield­
ing this wound by suppressing his son in o rd er to avoid his
m other’s attacks. The therapist had done much position work of
having the father acknowledge his emotional vulnerability to his
m o th e r’s criticism and had worked with the family to support
father in solving that problem in a new way: by wrestling with his
m other instead of with his son. This work had seemed im portant
and fruitful, but in the eighth session fath er was again full of
blame and anger at Bobby for a record-setting week of hitting.
In this session an entirely new and unsuspected pro-symptom
position of the father emerges, and the therapist immediately and
persistently does position work that transform s the ecology of
meanings and resolves the problem.

Father: [With a weary and castigating tone] Bobby, when

mom comes home from work at the end of the day,
 Experiential S hift: C hanging Reality 223

there isn’t a note from her supervisor telling me that

she’s been in a fight. When your sister comes home
from school at the end of the day, there isn’t a note
from her teacher telling me that she’s been in a fight.
When I come home from work at night, I d o n ’t bring
a note from my boss telling mom or you or Molly that
I’ve been in a fight. Who in this family brings home
the notes?
[The son appears to take his father’s last few words as an emotional
blow: he visibly crumples in his chair, slumping sideways to hide
his face.]
Therapist: Jack, what’s your intention right now? What is it you
want Bobby to—
Son: To make me feel bad.
Therapist: To make you feel bad?
Father: [Angrily] I want him to hear the truth!
Therapist: You think he doesn’t already know that h e’s the one
who gets in trouble?
Father: I think he’s in incredible denial.
Therapist: Well, maybe that’s so, but look at the effect that’s actu­
ally being created by your words.
Father: It’s not an effect I’m unfamiliar with. I’m at an absolute
loss how to try and convey this message to him.
Therapist: W hat’s the message?
Father: [Silence; looks down; appears to be reflecting]
Therapist: So far the message is, “You’re different than all the
rest of us; you do bad things and you’re different.
You’re bad.” And he’s definitely feeling very bad.
Son: [Sits upright suddenly and asks father] So what would
you—what do you want me to do about it? Leave the
family? Go somewhere else?
Therapist: [To father] T hat’s the feeling he winds up getting
from that form of the message.
Father: [To son] I’m glad that you can say that to me. I want
you to keep saying things to me. OK?
Son: OK.
Father: I love you, Bobby. I don’t want you to go away. You’re
a very important part of my life and you’re a very
224 D epth-O rif.nted B rief Therapy

important part of this family. What 1 want is very plain

and simple. I want the notes to stop coming home. I
want to be able to go to your classroom at the end of
the day and not have your teacher call me and say
Bobby has been in another fight. That’s very stressful
for me, Bobby. It hurts. I want to come home at night
and not have your sister come to me, the first thing I
come home, and complain to me, “Bobby did this and
Bobby did that.” I want to go and find your mother in
the kitchen smiling and happy, and not stressed and
yelling because there’s been another conflict. [Long
pause] I know, Bobby, that this is not such a simple
thing that I can just say to you, “Stop doing this,” and it
stops and it ends and it changes. I mean, I know it’s not
that simple. Because if it xvas that simple it would have
happened already, wouldn’t it?
Son: Well, there wouldn’t be any notes.
Father: Bobby, you’re a terrific kid. [Reaches arm to daughter
and says to her] You're a terrific kid. We have terrific
kids.
Son: Not so terrific.
Father: You are terrific; we’re all of us terrific. T hat’s the truth.
[The father, three years a recovered alcoholic, seems to the thera­
pist at this point to be careening from one kind of em otional
theme and mood to another.]

Father: None of this stuff that has happened is the end of the
world. In a way, I’m actually rather pleased—that
you’re standing up for yourself with your friends.
‘Cause I knew a little boy one time who didn’t stand
up. Who couldn’t strike back. Who didn’t know how
to stop the taunting and the teasing. And I’m glad
that isn’t happening to you. Nobody—
Therapist: Who was that little boy?
Father: —messes with you.

[This is a previously undisclosed theme that strikes the therapist

as revealing a pro-symptom position held by the father.]
 Experiential. Shift: Changing Reality 225

Son: [Answering the therapist’s question by pointing at

father] Him.
Father: That little boy was me, yes.
Son: Dad used to tell me that whenever there was a conflict
h e’d find a way to get out of it and hide.
Therapist: So, would it be true, Jack, for you to tell Bobby, that
there’s a part of you, just a part of you, that’s glad that
he hits the other kids when they mess with him? Is
that—is that true?
Father: Yes. I did say that. Part of me is very pleased, in a way,
that you d o n ’t get pushed around.
Son: But part of you wants me to stop. Practically all of you.
Father: [Now with an annoyed tone again] It’s very hard for
me, Bobby. Every day last week I got called into your
classroom by your teacher.
Therapist: Jack, would you be willing to say to him, “I wish I
could have made as much trouble as you’re doing.”
Father: [Nodding his head in assent and speaking with obvi­
ous, open earnestness] I wish I could have made as
much trouble as you. Dam right—wish I could have.
Son: But I never hear you say that.
Mother: But each is a different way of not taking responsibility
either.
Therapist: Beth, can I ask you to hold on to that? Something
important is happening right there that I want to allow
to flow. Try to remember what you’re saying. Thanks.

[As soon as the therapist blocks the m other’s interruption of the

father-son interaction, the son, who had comfortingly taken
father’s hand when father spoke of his childhood woes, with his
other hand now reaches to take his m other’s hand; smiles lovingly
at her; says, “Group hug,” with a sweet voice; and leans his head
down onto m other’s forearm. The son is now emotionally com­
forting both parents at once.]
Therapist: Jack, would you say that to him again?

[The son now rises from his chair, lets go of his parents’ hands, and
steps over to be in front of his father, facing him, as if to receive
226 D epth-O rientkd B rief Therapy

very directly the words that the therapist has asked father to say to
him.]
Father: Bobby, I wish I could have made as much trouble. I wish
I could have gotten into as much trouble.
[The son now leans down into a full hug with his father, who
responds warmly, rubbing the son’s back. The daughter fidgets
unhappily. After ten seconds, the son again stands and speaks to
father.]
Son: Sometimes I wish I could have not gotten into as
much trouble as you. Everybody wants to be like some­
body else—
Daughter: Maybe we should just have them trade bodies.
Therapist: It sounds like that, doesn’t it?
Son: —and that somebody else usually wants to be that
everybody. [Pause] So everybody wants to be some­
body; somebody wants to be everybody.
Therapist: It’s true, Bobby.
Father: Sometimes you know [at this m om ent the son looks at
the video camera and starts clowning for it] you
amaze me with how wise you are—and silly.
Son: Helloo, helloo.
Mother: They’re both at such a wonderful age.
Therapist: So Bobby, you seemed surprised to hear—it seemed
like a new thing for you to hear from dad that part of
him is glad you have the strength to hit other kids
[daughter now stands, puts hands on father’s shoul­
ders, gently massaging them] and not let them mess
with you, and—
Son: —First time ever.
Therapist: Yeah, first time you’ve ever heard that he wishes, he
wishes he could have been like that himself. . . .
Mother: Bobby takes no responsibility for his actions; he just
acts. He doesn’t consider—
Son: —I used to.
Mother: You used to what? Consider?
Son: Consider what the heck would happen. But now I just
do it.
 Expkrif.ntiai. S hift: C hanging Rkai.ity 227

Mother: Anyway.
Son: Even though I didn’t want to.
Father: I would really like to ask Bobby a question which at
least to me is important that I try and get an answer
about. I think we both agree this was a difficult week.
Can you tell me why this was a difficult week for you?
Not just, I mean, in the context of the troubles in the
yard but the troubles in the classroom as well.
Son: Well, you see, I think it was Tuesday that my teacher
told me I made a mistake and she didn’t like what I
did, and then from there on it kept happening. She
kept saying that, and I kept on getting angry, and then
the next day I’d do it again. I think it was like a chal­
lenge to see how mad I could get her. How mad I
could get her?
Therapist: And Bobby, I’m wondering if you could say those same
words—if that would be true—to say the same words
to dad: “Sometimes I want to see how mad I can get
you.” Try saying it to him.
Son: Sure. How mad can I get you, dad? Soooo mad.
Father: Did you think I was mad at you this week?
Son: Yeah.
Therapist: So is it like this: sometimes dad says or does things
and you feel really mad at him, and you want to get him
mad back at you? Is it like that?
Son: Yup.
Therapist: Yup. And you know how to do it. What do you have to
do to get dad mad?
Son: I don’t really mean to make dad mad. I d o n ’t ever
want to make my parents mad, except when they make
me mad.
[Bobby, in describing his views and patterns of managing anger in
relation to his teacher and parents, has now revealed a key pro­
symptom position he holds, a very purposeful and self-affirming
position of not being anyone’s powerless victim, which he carries
out by returning perceived provocation in equal measure.]
Therapist: So Jack, I think you’re doing very successfully—and
I’m not being facetious—at teaching your boy not to
228 Depth-Oriented Brief Therapy

be the defenseless little kid that you were. The side

effect is that you have to deal with that same spirit. It’s,
you know, it’s not just out there in the school yard. It
comes home and then is a parent problem.
Father: I did not want him to be a defenseless little kid.
Therapist: Well, you’ve succeeded!
Father: [Smiling broadly] In spades.
Son: But isn’t there still a part of you, dad, that still wants
me to be, kind of, not a defenseless little kid but not a
bully?
Father: I would worry just as much about you being a bully,
Bobby, as I would about you being a defenseless little
kid.
Mother: But you’re not a bully.
Father: You’re not a bully. I’ve seen you, and you’re not a
bully, and I’m very pleased about that, too. [Father
reaches over, ruffles his son’s hair affectionately, and
then takes the son’s hand in his.]
Therapist: Jack, would it be going too far for me to ask you to say
to Bobby—by “too far” I mean not true—you know, to
say to Bobby something like this: “Bobby, even though
it’s a lot of trouble for me, I’m gladyou can hit those
other kids when you need to.”
Son: W e ll-
Therapist: Wait Bobby, let’s see if that’s true for dad.
Father: Bobby, even though it’s a lot of trouble for me—and it
is a lot of trouble for me—I’m glad that you can take
care of yourself, and when you feel it’s necessary, I’m
glad that you can hit back.
Therapist: Bobby, how does it feel to hear that from him?
Son: [Joyfully flings an arm wide] Wonderful! I feel I’ve
gotta hit everybody in the world at least once!
Father: [Looks down into his lap somberly]
Mother: [Hand goes to forehead.] Oh, swell.
Therapist: I think m om’s having a hard time with this.
Son: I once saw this Ren and Stimpy show [father lets go of
son’s hand; appears to be suffering son’s enthusiasm
for aggression]; it was a cartoon about this kid who
was a bully and his father who was a bully also. And his
 Experiential S hift: Changing Reality 229
father, um—they stop by this—Ren and Stimpy were
at this little kid’s house when Victor, the bully, came,
and they were in the car and his dad was driving it,
and he—the dad waited in the car while the son got
out, and the son beat up Ren and Stimpy, and the kid
then got back in the car, and you heard the dad say,
“Nice job, son!”
Therapist: And you’re hearing that from dad right now! It’sjust
like in that cartoon! And it feels wonderful.
Son: I never knew cartoons could be so educating.
Therapist: How you doing, Jack? It’s like you’ve given an airing to
another side of yourself that’s been quite hidden in all
this. And it’s emerged that maybe your struggle isn’t
so much really with Bobby as with your own two sides.
You’re of two minds—
Father: Oh, absolutely.

After this session there was an immediate falling away of Bobby’s

prior lifelong disposition to be easily provoked to aggression. The
hitting disappeared. There was one more family session in which
Molly was made part of the breakthrough, and then four couple
sessions in which the focus was on marital issues rather than par­
enting problems. In a follow-up inquiry by telephone, Jack, the
father, described with great pleasure that during the next four
months of school there had been only one m inor incident involv­
ing some pushing and that Bobby’s grades had improved signifi­
cantly. Ritalin was no longer being considered.
The symptom-maintaining ecology of meanings in this family
was transform ed when the father expressed sincere adm iration
and approval of his son’s hitting, the symptom that he had until
then so stridently attacked. Getting the father to openly take his
pro-symptom position was the position work that brought about
the breakthrough. The father’s expression of his emotional truth
of the symptom, combined with the boy’s new awareness of dad’s
approval, completely changed the meanings operating between
the two of them. Dad’s continual, castigating disapproval had been
for Bobby a trigger of continual anger at dad, which, as Bobby so
openly explained, made him want to make dad angry, too, and hit­
ting other children was clearly the best way to do that.
230 D epth-O riented B rief T herapy

We find in general that if the symptom bearer in a family is a

child, then in most cases at least one of the parents, in addition to
the child, has an unconscious, pro-symptom position, just as this
father did. We consider the pro-symptom positions of elders in the
family to be the most superordinate or governing feature of the
system and the most im portant focus of attention (which is why,
once the father’s pro-symptom position em erged in the session
above, the therapist did not deviate from position work to respond
to other systemic phenom ena occurring in the room, such as chil­
dren emotionally caretaking parents, and so on).
Note that the therapist’s m anner with the father was devoid of
blame. Blame would have been implied, for example, if the thera­
pist had offered an interpretation that the father had needed and
induced his son to be aggressive as a vicarious undoing of father’s
own childhood behavior of fearful flight. No such interpretation
was used or needed in order to carry out the position work that dis­
mantled the old ecology of meanings operating here. Only in cases
of overt exploitation or violation does it become appropriate for
the therapist to negatively connote a client’s behavior, and when
possible this is done even then in the context of the em otional
truth of those behaviors.

Position Work and the Loss of a Familiar Reality

The client’s emotional truth regarding the presenting symptom
is unconscious because awareness of that emotional truth would
entail some degree of disorientation, emotional disturbance, or
pain that the client wants forever to avoid. The therapist must not
collude with this avoidant stance o f the client. T he therapist
needs the conviction that integrating the emotional truth of the
symptom will be liberating and healing even if initially and tem­
porarily disturbing, and he or she m ust be ready to assist the
client with any disorientation or em otional pain that the client
may temporarily experience.
Position work entails disorientation because the client suddenly
inhabits the pro-symptom position’s unfamiliar reality. In our clin­
ical experience, preserving the familiarity of one’s experiential real­
ity is one of the most powerful and highly superordinate purposes
operating in the human psyche. “Familiarity is far more desirable
 Experiential S hift: Changing Reality 231

than comfort” said Virginia Satir at a 1983 San Francisco workshop.

However, the familiarity of some part of the client’s habitual real­
ity is squarely challenged when the client owns the reality in the
em otional truth of the symptom. Aspects of the nature of the
world, of significant others such as parents, or of the self may sud­
denly appear substantially altered. This shift may be sudden not
because of hurriedness or clumsiness on the part of the therapist,
but because reality in the emotional truth of the symptom may be
so qualitatively different than the familiar, conscious reality that
even if parceled down to a small-as-possible first encounter, the
shift will still feel sudden.
H ere is an example of position work generating a m odest
degree of disorientation and emotional distress. A woman lawyer
explained in her first session that sculpting is what matters most to
her and has always been her first love, but that her legal work keeps
crowding it out, sometimes to the point of nonexistence for
extended periods of time. She was now forty-five, and because this
pattern was out of control, she was concerned that her life would
pass by with her neglecting what she wanted most to be doing.
The therapist, assuming coherence, tentatively inferred that
this woman’s behavior pattern was produced by a pro-symptom
position in which pursuing her legal work was more important than
her art, despite her conscious belief that sculpting was more impor­
tant. After about twenty minutes of radical inquiry the therapist
wrote down what she understood this woman’s pro-symptom posi­
tion to be and gave this to her to read aloud as a way of “trying on”
this position for emotional truth, and as a task of position work.
The client read, “The truth is, my legal practice is actually more
important to me than my sculpting because it more fully carries out
my values. I’m actually willing to endure the painful loss I feel when
expanding my legal work eliminates my sculpting. My values come
first; the joy of art comes second. I’m a lawyer first, then a sculp­
tor.” This was not an interpretation offered by the therapist but a
summing-up or synthesis of what she had learned from the client.
After reading this out loud the woman said, “I have to say this
feels absolutely true,” but she now seemed shaken and added that
this was “very disorienting” and that she felt “a kind of stab of fear
in realizing this.”
In her conscious position, her identity during all of her adult
232 D epth-O riented B rief Therapy

life had been very strongly based on the image of herself as an

artist, and she viewed her legal work as something she did to earn
a living and support herself as a sculptor. To experience suddenly
that in her emotional truth she was “a lawyer first, then a sculptor”
involved both a sizable change in identity and an emotional loss of
some fond expectations of how her work life would unfold, bring­
ing a stab of fear. (She could, of course, now reassess and revise
her priorities in order to pursue those fond hopes as a sculptor. In
fact, only by the client’s having faced her emotionally true position
were those hopes salvageable.)

M u ltig lo b a l Constructions and th e Length

o f T h erapy_______________________________

Significant as these changes in the client’s experiential reality were,

they affected a limited region of it. She could therefore tolerate
the full, rapid encounter with the changes of reality needed for res­
olution. Difficulties in keeping the therapy time-effective develop
when the position work required to dispel the presenting symptom
challenges and would change a far greater expanse of the person’s
entire experiential reality. This occurs most commonly with clients
who in childhood suffered severe, sustained abuse (em otional,
physical, or sexual) and whose presenting symptoms are features
of abuse-related constructions.
With such clients, the emotional truth of the symptom is a con­
struction of reality that not only makes the particular presenting
symptoms necessary but also defines in a global way virtually all of
the person’s experiential reality and does so through numerous,
highly superordinate constructions and pro-symptom positions.
Let’s take as an example low self-esteem, which is perhaps the
abuse-related symptom most frequently en co u n tered by thera­
pists. The following lists spell out some of the unconscious pur­
poses (th ird -o rd er constructs) served by m ain tain in g the
(second-order) strategic construal of low self-worth, that is, the
construal of self as inadequate, defective and unlovable, and
therefore deserving of the rejection, criticism, or abuse received.
(A strategic construal is one whose value is in serving an uncon­
scious, third-order purpose—a hidden agenda—rath er than in
the truth of its content.)
 Experiential Shift: Changing Reality 233

I n i t i a l P u r p o s e s S e r v e d in C h ild h o o d by I n v e n t i n g a n d A d h e r in g
to S e lf-B la m e

• Avoid an em otional disconnection from the parents, which

would be a massive threat to survival and create unbearable
anxiety. Self-blame avoids disconnection because it
(1) avoids the alienation and disloyalty o f perceiving the
parents as the bad ones and (2) keeps oneself in a shared
reality with the parents, a reality in which all agree that I ’m
the bad one.
• Preserve the illusion of possible control over stopping the
abuse and avoid the terror of powerlessness and helplessness:
If it’s my fault, then I can stop it by becoming good enough to
deserve love.
• Preserve safety by disentiding oneself to any aspect of self-
expression that triggers the abuse (including rage, which would
be especially dangerous, and any other predictable triggers).

P u r p o s e s S e r v e d by M a i n t a i n i n g L o w S e lf-W o rth in A d u lth o o d

• Preserve the emotional connection with one’s family of origin

by (1) avoiding the alienation and disloyalty of perceiving the
parents as having been abusive and (2) maintaining the origi­
nal sense of being in a shared reality with the family.
• Avoid immensely painful grief over a wasted life and sense of
betrayal by parents that would arise if one realized, “I am, and
was all along, a perfectly lovable, adequate being.”
• Avoid further blows: If I d o n ’t stand up in any way, I can’t be
knocked down again in any way.
• Retribution: My failure to amount to anything is my proof of
how badly you treated me.
• Restoration: Only my unwellness will attract the nurturing
attention I never got but should have gotten and still hope to
get from someone.
• Restoration: As a child I didn’t get to be carefree, as I should
have been, and now that I’m big it’s my turn to feel uncon­
trolled and free. I d o n ’t want anyone to see me as capable, and
I do n ’t want to feel capable, so I’ll be free of demands and
pressures.
234 D epth-O riented Brief T herapy

Someone who was severely abused may habitually harbor most or

all of the third-order purposes listed. Note the extremely large
region of experiential reality encompassed by a collection of pur­
poses and meanings such as this. If any one of these purposes
remains intact, so does the experiential state of low self-esteem. For
the client to relinquish the low self-esteem construction requires
the dissolution of all such unconscious, third-order purposes that
are operating. This entails an essentially global transformation of
identity, motivation, and relationship to others that few people can
allow to occur within a few sessions (but which can occur in far less
time than is assumed in traditional long-term therapies).
A child who experiences recurring abuse or negativity from his
parent(s) consciously dislikes it intensely but nevertheless uncon­
sciously construes the parent as being right to treat the child so
hurtfully, in effect going into agreem ent with the parent’s appar­
ent view of the child as unlovable. This construal or assumption
about the parent’s rightness is a second-order construct, a mean­
ing attributed to a particular perception. (The child makes this
second-order construal, rather than the opposite one that the par­
ent is wrong to behave thus, as a protective action in consequence
of his third- and fourth-order constructs, “I am a helpless being
totally dependent for survival on these large others” [fourth-order
ontology] and “I must preserve my connection with them at all
cost” [third-order purpose], respectively. If the child did not go
into agreem ent with the p a re n t’s ap p aren t attitude, the child
would feel emotionally disconnected from the parent and intoler­
ably vulnerable to annihilation.) This second-order construal that
the parent is correct to be treating the child harmfully inevitably
doubles as a superordinate fourth-order ontological construction,
“I am a bad, unlovable, repellant being”—the basis of the emotion
of shame that figures so strongly in the lives of such clients.
Thus low self-worth stemming from abuse has a unique con­
struction in which fourth, third, and second orders circularly rein­
force each other, making the state of low self-esteem especially
tenacious and locked, as therapists well know it to be.
As we saw in Chapter Two, it is by rendering a third-order pur­
pose conscious and exposed that the second-order, strategic con­
struction carrying it out can most effectively be dispelled. The
 Expkriential Shift: Changing Reality 235

purposes presented in the list above maintain such second-order

construals as the following:

If I show any imperfection I’ll be rejected or attacked.

If I express any feelings I’ll be severely burdening others.
I’m not worthy of attention.
I’m bad and dirty, and it was my fault he would have sex with me
again and again.
If I was any good they wouldn’t have beat me so much.
If anyone saw the real me they’d leave me.
A raised voice means I’m about to be beaten.
I hate myself for being so unlovable.

As always in depth-oriented brief therapy, it is the client’s capaci­

ties that set the rate of the work. When there are multiple, global
pro-symptom constructions structuring virtually all of the client’s
reality, the client may require a slower pace of change.
We term such clients multiglobal. These are the clients with
whom effective work in every session may not be brief, because of
both the slower pace that may be required by the client in order
to tolerate the necessary, sweeping changes in reality, and because
each of the many global, pro-symptom constructions requires ther­
apeutic attention. Even a self-avowed “brief therapy evangelist”
such as therapist and trainer William O ’Hanlon acknowledges the
need for longer work with some clients and that ultimately, “the
real question is not how long therapy takes, but how effective it is
and whether it serves those who seek it. I believe effective therapy
is usually brief, but not in every case.” Still the therapist should
never think statistically or stereotype any one person as a “long­
term client,” which would dull the therapist’s active intentional-
ity, inevitably making therapy longer than it need be. No m atter
how many sessions are required, every session is always regarded
as one of depth-oriented b rief therapy and as one in which a
major breakthrough could occur. Then the work will prove to be
brief (less than twenty sessions) in many multiglobal cases, and in
others it will be as brief as possible (seldom exceeding forty to fifty
sessions).
236 D epth-O riented Brief T herapy

In addition to adults heavily abused as children, multiglobal

clients include those who would be described psychodynamically
as having distinct character disorders. All of the methodology of
DOBT still applies, namely, discovering and working directly with
the client’s pro-symptom constructs through carrying out DOBT’s
two top priorities for effectiveness, radical inquiry or experiential
shift in every session.

Transform ation o f th e Pro-Sym ptom Position______

Coaching the transformation of constructs is the fu rth er process of
experiential shift used when the problem is not resolved solely by
position work. Essentially the therapist prompts the client to use
his or her control of the existence of constructs (the native ability to
create, preserve, or dissolve constructions of reality) in order to
transform the pro-symptom position so that there is no longer a
view of reality in which the symptom is necessary to have.
To bring about a transformation of the client’s pro-symptom
reality, the therapist utilizes this fundamental principle: Within any
one of the versions of reality it harbors, the mind does not tolerate inconsis­
tent representations of reality.
From this principle follows this methodology: (1) Have the
client access the pro-symptom emotional reality by vivifying and
experiencing it, and then, in the same field of awareness, (2) Evoca­
tively coach the client to create and experience a new, devictimized
reality, inconsistent with the victimization, powerlessness, or wound-
edness in the old one, motivating the client to dissolve the old one.
In this state, with both the old, pro-symptom construction and
the newly created, incompatible constructs vivified, the client actu­
ally experiences the inconsistency or disconfirmation and resolves
the conflict by dissolving the old construction in favor of the new
(accommodation in Piagetian terms). Note that as a rule people dis­
solve old constructions of reality only if an acceptable replacement
already is at hand, in order to avoid the anxiety that would arise from
a void of meaning. If the new constructs are created while the old
position is not activated, the client does not actually experience an
inconsistency or disconfirmation. The simultaneous vivifying of the old
and the neiv constructs in the samefield of awareness is the essential condition
far the transformation of position to occur. This process is fundamentally
 Expkrikntial S hift: C hanging Reai.itv 237

different from a mere cognitive refuting or “correcting” of the client’s

beliefs, as was practiced in the early history of cognitive therapy.

Techniques for Transformation

of the Pro-Symptom Position
To carry out this process of transforming the pro-symptom posi­
tion, we principally use three well-known techniques:

1. Reenactment
2. Creating connection between positions
3. Construct substitution

Reenactment
The technique of reenactment is used widely by experiential ther­
apists for fostering recovery from the sequelae of traumatic events
that occurred at any point in life, such as symptoms experienced
by adults abused as children and by victims of assault. The ther­
apist orchestrates a revision of reality in the client’s pro-symptom
position by first evoking the client into accessing the original, sub­
jective experiences during which he or she installed that reality
and then having the client vividly replay these pivotal experiences
in a new way (hence the other name for this type of work, revis­
ing personal history). As described earlier, the reality that was
being experienced at the time of the original form ation of an
em otional w ound or traum a is the reality in the pro-symptom
position containing that wound or traum a. This means that in
doing position work—in drawing the client into experientially
inhabiting her pro-symptom position (such as, “I’m seven, and I
wish I would die in my sleep”)—the stage is automatically set for
the vivid replay and revision.
For successful reenactm ent it is essential for the therapist to
understand that an unresolved em otional traum a is an uncon­
scious knowing that is largely kinesthetic and somesthetic—that is,
more neuromuscular in construction than verbal-cognitive. Major
emotional wounds and traumas are held as a specific pattern of
unconscious emotional-somatic tensions that continue for decades
to restimulate a state of fear and helplessness.
For reenactment, then, the client first does the position work
238 D epth-O riented Brief T herapy

of attending in detail to the unfolding of the original emotionally

w ounding or traum atic situation. This involves as m uch k in e /
somesthetic experience and expression of the body’s knowings of
the event as possible, using breathing, vocalization, expressions of
terror or rage, and so on. When the emotional truth of the expe­
rience is well accessed, the client again visualizes this situation
developing in the original manner almost up to the point at which
the trauma occurs. This time, however, the client is guided, encour­
aged, and supported by the therapist in imaginally responding to
the situation in some strongly assertive, effective new way that pre­
vents the harm and the trauma from ever occurring. This creates
a new construction of reality that substantially dissolves and revises
the old one, dispelling ongoing feelings of victimization and dis-
empowerment and releasing the neuromuscular tensions that were
set up and locked in during the original event.
In a subsequent session, the therapist has the client again view
the original scene and notice what his or her emotional response is
now. If the client is sufficiently devoid of original reactions, the
process is complete; otherwise, another round or two of reenact­
ment is indicated, based on the client’s current model of the scene.
An example of reenactm ent within couples therapy follows
later in this chapter.

Creating Connection Between Positions

This is a class of techniques in which the c lien t’s w ounded or
deprived state in the pro-sym ptom position receives a trans­
form ing contact from another position in which the client has
em otional and cognitive assets n e ed e d in th e pro-sym ptom
position.
Perhaps the best-known example of this is what is widely
termed inner child work, applicable whenever the client’s experien­
tial identity in the pro-symptom position is that of being a child
needing a safe, caring adult to provide love, attention, u nder­
standing, help, or rescue. The child position is brought into the
needed kind of relationship with an adult position of the client,
which for both positions is an emotionally real and transformative
experience. Jungian active imagination, described in Chapter Five,
also creates transformative interaction and relationship between
 Experiential Shift: Changing Reality 239
conscious and unconscious positions of all sorts, personified in
visual imagery. The imaginal-interactive techniques of Gestalt ther­
apy do likewise, as does the more recently developed voice dia­
logue approach.
All such m ethods are useful within DOBT if applied in the
completely phenom enological m anner of DOBT—that is, the
therapist always elicits and follows the client's emotional truth and
never imposes the existence of, say, a presumed “inner child” posi­
tion on the client. If a child position figures im portantly in the
client’s construction of the problem, then as a rule the visualized
image of that child-self and the state of being that child will be
easily accessible and quite real to the client and will have a distinct
voice and character of its own, autonom ous from the clien t’s
familiar ego-identity. If not, then the therapist should drop the
“inner child” or any other motif and work in some other way that
feels emotionally real for the client.

Construct Substitution
A client can substitute a new construct for an old one—revising a
piece of reality—if the therapist sets up the conditions for this to
occur. The new construct or view of reality must be clearly and
compellingly inconsistent with the view of reality in the client’s
pro-symptom position. It can come in the form of a perception, a
new experience, a communication of information from someone,
an image, or an idea. The task of the therapist is to arrange for
the client to take in this new construct while inhabiting and vividly
experiencing the pro-symptom position, so that both the new and the
old constructs are vivified and experientially real to the client at
the same time. A previous example of this arose in Chapter Two,
in which the client, while accessing her cutting shard of believing
herself repulsively ugly, was guided by the therapist into simulta­
neously experiencing the totally incom patible construct of her
third-order protective purpose for viewing herself as ugly. This
interaction of incompatible constructs dissolved the capacity of
the “I’m ugly” construct to define reality. Later in this chapter we
consider construct substitution in which the new, incompatible
construct comes from the client’s partner as a result of position
work during couples therapy.
240 D epth-O riented Brief Therapy

Case Example: Couple Abused as Children

Since C hapter Two provided detailed examples of the transfor­
mation of pro-symptom positions in individual therapy, we will
illustrate the transformation of pro-symptom positions here with
the first th ree sessions of a six-session couples therapy. This
example will show the entire methodology of DOBT, including
radical inquiry, position work, and transformation of an ecology
of meanings, as well as transformation of pro-symptom positions.
T echniques of radical inquiry illustrated are viewing from a
symptom-free position, sentence completion, experiential ques­
tioning, and m ind-body com m unication. Illustrated also are
techniques of position work, including following a little bit
ahead, overt statements of position, confronting with emotional
truth, cycling between symptom and symptom-free positions, and
using the symptom as signal. Transform ation of pro-symptom
positions is carried out in these sessions both by construct sub­
stitution and through reenactm ent.
Kate and Alan, in their mid-thirties and married for five years,
came for therapy on Kate’s initiative because of her anguish over
the relationship. She described the problem as “lack of commu­
nication,” as so many couple therapy clients do. She said she felt
painfully alone in the relationship because Alan is so regularly
“closed down” emotionally and doesn’t interact with h er about
personally meaningful things. The therapist asked Alan if Kate’s
description of him as “closed down” made any sense to him. He
said it did because he does go into a state in which he knows he is
closed down and “uncomfortably tight,” but that was how he had
always felt in a relationship, and so it h ad n ’t occurred to him that
he could be any different. Asked if he wanted to be any different,
he said, “Yes, sure. But I have no idea how.”
At this point the therapist, viewing through the conceptual lens
of depth-oriented brief therapy, was beginning to see the two pro­
symptom positions in an ecology of meanings: Alan evidently had
a position that made it im portant to be closed down emotionally,
and Kate had a position that made it im portant to be with a man
who wouldn’t be a close, intimate participant in the relationship. It
is these unconscious, pro-symptom positions that fit together eco­
logically, hand in glove. The therapist could begin to infer these
 Experiential S hift: Changing Reality 241

positions simply on the basis of how the two partners had structured
their pattern of relating. As always, in DOBT the therapist views the
presenting symptom as being exactly what some position of the
client wants or needs to be doing. The gist of a pro-symptom posi­
tion often becomes apparent simply by noting what people actually
do, as distinct from how they think and feel about what they actu­
ally do. Kate was genuinely suffering the costs of being with a closed-
down man, and so had an anti-symptom position that she presented
in therapy, but evidendy these costs were less important than what­
ever made it im portant to be with such a partner. O f course, the
therapist’s early inferences about these pro-symptom positions
merely serve as an inidal guide for beginning the process of radical
inquiry, to be followed by position work and transformation.

T herapist: [To Kate] You’ve described this im portant experience

that’s missing for you in the relationship. You want to
experience Alan as being emotionally open and com­
ing to w a rd you emotionally, really tuning in to you
instead of tuning out. Is that right?
K ate: Mm-hm.
[To test his inference about her pro-symptom position, the therapist
is beginning to do radical inquiry by evoking in Kate a symptom-free
position of receiving close attention from her husband.]
T herapist: How does it actually feel to you when you d o have that
experience of him?
K ate: Well, it hasn’t happened in so long that I’m not sure.
On and off he was sometimes more open in the first
year after we were married.
T herapist: So would you be willing to turn your chair a bit more
toward Alan right now, and just look at him—yes—
and just im a g in e for a few moments having him actu­
ally coming to w a rd you emotionally, actually w a n tin g to
kn ow w h a t’s g o in g on in y o u rfe e lin g s ? [Pause] And as you
imagine him a ll fo c u se d on y o u like that, also imagine
yourself being a bou t to reveal to h im some very personal
feelings and thoughts that are im portant to you.
[Pause] And how does this feel to you?
K ate: Not good.
242 D epth -O riented B rief Therapy

Therapist: How do you know it’s not good?

Kate: Well, the moment you said those words, “what’s going
on in your feelings,” I just felt my stomach lurch and
clench up.
[Kate is now accessing a pro-symptom position of needing Alan to
be emotionally distant. This confirms experientially the therapist’s
initial inference.]
Therapist: Uh-huh. Anything else?
Kate: Well, then when you said h e ’s “all focused” on me, I
felt, “No, get away.” And because of that feeling, I
couldn’t do the last part—I couldn’t imagine really
feeling ready to reveal something real personal.
Therapist: I see. OK. You did that exercise very well, actually, just
by letting yourself feel whatever actually happened, so
thank you. Would you be willing to do one more step
of this?
Kate: OK, if it will help.
Therapist: I think it will. What I’d like you to do is to say this sen­
tence to Alan: “If I do let you come close and see who
I really am . . . ” and then when you reach the blank at
the end, just let it complete itself, without pre-think­
ing the ending. Willing to do that?
[The therapist is using sentence com pletion to carry radical
inquiry further and elicit the emotional truth of why it is impor­
tant to her to maintain emotional distance.]
Kate: Well, I’ll try. [Looking at Alan] If I do let you see who
I really am— [Pause; looks down in her lap, face flush­
ing, eyes getting teary; seems unable to speak]
Therapist: What are you feeling right now?
Kate: Well, the sentence didn’t finish with words, I ju st kept
getting a picture.
Therapist: W hat’s the picture?
Kate: [Through sniffles and tears] It’s a picture of me. I’m
like covered with tar. And h e’d see that.
Therapist: Did something happen to you that covered you with
tar?
Kate: [Begins crying] Yes.
 Experiential Shift: Changing R eality 243

Therapist: Do you know what it was?

Kate: Yes. [She now gives a general account o f the “night­
mare” of living with an uncle for several summers in
her early teenage years: This uncle, “Henry,” continu­
ally predated after her sexually, always pointedly blam­
ing her for making him talk sexually to her, peep at
her in the bathroom, and commit other violations.
This resulted in a deep sense that it was all her fault
and that the “dark, dirty feeling” she experienced—as
represented by the image of herself covered with tar—
was a quality of her self. Henry finally physically
molested her when she was fifteen. She awoke in the
middle of the night to find him fondling her, but she
pretended not to be awake and endured this violation
for what felt like a very long time.]
Therapist: What an ordeal you went through—really a night­
mare. And the way he made it seem led you to feel
that it was your fault, and that the real you is this dark,
dirty thing.
Kate: Mm-hm.
[Important parts of Kate’s pro-symptom position are now clear to
the therapist.]
Therapist: So let’s do one more small step for now. Could you
look for the connection— W hat’s the connection
between this secret feeling or view of yourself as a
dark, dirty being and having this lack of close
emotional attention in your couple relationship?
W hat’s the connection?
Kate: [Pause] O h—he won’t find out.
Therapist: Yes. You said Alan knows a little about what happened
with that uncle, but he doesn’t know about “dark and
dirty,” does he?
Kale: No.
Therapist: [Pause] So, even though it hurts to feel so alone in the
relationship, you expect it would feel even worse to be
really seen and found out?

[This is an initial step of position work: following the client a little

244 D epth -O riented B rief Therapy

bit ahead, the therapist empathically voices his understanding of

her p ro/anti synthesis.]
Kate: [Looking into her lap] Yes.
Therapist: And is that what makes it im portant to be with a man
who’s safe because he won’t pay close attention and
see who you really are?
Kate: Yes. [Pause] I had no idea that that’s behind all this,
but yes—I mean, right now I can feel how true that is.
Therapist: Mm-hm. [Pause] There may be things we can do to
change how this is for you, if you want. Not necessarily
in this session, but “dark and dirty” could change for
you.
Kate: Yeah, I’d really like that.
Therapist: OK, so we’ll see how to fit that into our work. So,
Alan, are you feeling left out?
Alan: No. That was really something. But now you’re com­
ing after me\ [All laugh]
Therapist: Well, we’ve learned something really important, I
think. We’ve learned that even though Kate is very dis­
satisfied with your pattern of interacting with her, and
feels very unconnected-with by you, that same pattern
is keeping her feeling safe in a way she really values.
I’m wondering if knowing that is something new, for
you.
Alan: Yeah. I’m amazed to see that. I thought it was all bad.
[The therapist is making sure that the changed m eaning of the
problem has entered into Alan’s side of the couple’s ecology of
meanings.]
Therapist: So did she. I think she may be at least as surprised as
you are. But what about you? Didn’t you say earlier
that you do n ’t like feeling all closed down and tight so
much of the time?
Alan: Yeah, it feels lousy, but it’s like something comes over
me.
Therapist: I’d like to know what that experience is like, for you.
How would you teach me to have it?
Alan: [Laughs] How would I teach you to have it?
 Expkrif.ntiai. Sinrr: Chancwnc; Rkaliiy 245

Therapist: Yeah. Tell me exactly what I’d have to feel in my body

and think in my head and feel emotionally, to experi­
ence it exactly as you do.
Alan: Well, OK. I’ll try. I’ve never thought about it this way.
Umm—it feels like I’m in a dense fog—like my head
and shoulders are in a dense fog. O r all stuffed with
cotton.
Therapist: OK, got it. What else?
Alan: And my throat feels pressure, or kind of choked off.
And my neck feels sort of rigid. Yeah, a kind of tight,
pressured, stiff feeling in my throat and neck.
Therapist: OK, good. Very clear instructions. Anything else?
Alan: Well, let’s see. Kind of a knot in my stomach, a tense
feeling.
Therapist: A knot with a tense feeling—a feeling of—?
Alan: The knot is a kind of anxious feeling, yeah.
Therapist: OK: Thick fog or cotton in your head and shoulders;
throat feeling tight, and pressure, and rigid; and a
knot of anxiety in your stomach.
Alan: Yeah.
[The therapist recognizes this as a description o f a dissociative
state, a protective action by which a person does indeed close down
emotionally when there is a perceived danger of reopening an
extremely vulnerable, unhealed emotional wound. The therapist,
always looking for signs of the pro-symptom position and how to
evoke it, now knows that Alan’s pro-symptom position is a reality
based in an old wound that feels regularly threatened.]
Therapist: So how do you know when to go into this state?
Alan: You ask the weirdest questions.
Therapist: And you give such good answers to them! How do you
know when to go in to this state?
Kate: It’s whenever I want anything from him!
Alan: Oh, come on.
Kate: It’s true! All I have to do is want anything, like just to
have him tell me what h e’s feeling about something
important in our lives, and he shuts down. Why am I in
this relationship?
Therapist: [To Alan, who was about to respond to Kate] Let me
246 Depth-Oriented Brief Therapy

change my question: With whom do you go into this

state?
Kate: With me and with his mother.
Therapist: Kate, I need to hear from Alan about this.
Alan: She’s right about that.
Therapist: What happened with your m other that you’d have a
knot of anxiety in your stomach?
[The therapist intends to usher Alan into directly experiencing
the wound that he normally avoids experiencing by dissociating.
T he them es and m eanings within this wound will be the em o­
tional truth of the symptom of his closing down emotionally so
often. To be experiencing that emotional wound directly would
be to have direct access to it as a construction of reality, and to
have that access would make a transformation of the wound-con-
struction immediately possible.]
Alan: I don’t know. I mean, when I was little she drank a lot,
but I don’t know exactly what I’d have a knot of anxi­
ety over.
Therapist: Well, something would happen that was pretty scary for
you, to knot up like that. Could you let yourself feel
that knot right now?
Alan: Actually I sort of already am, because of how angry
Kate just got at me.
Therapist: Good, good. Just give that knot your whole attention.
[Alan lowers his eyes as he attends to the knot.] Yes.
Let yourself kind of get into the emotional atmos­
phere of it, that familiar climate of tension and fog
that you feel. [Pause] Good. And I wonder if that knot
will tell you something about what in the situation is
so scary. Because the knot knows everything this is
about. Maybe the knot can send you an image of a
scene, a scene that shows what it’s about.
Alan: [His eyes and attention jum ping up and away from
the knot] Well, yeah, when you said that a picture did
come up, and it—
Therapist: Could you stay down there with the knot as you tell
me what the picture is?
 Experiential Shift: Changing Reality 247

Alan: Oh, OK. Well, my mom would get drunk and like tell
me her problems.
Therapist: So stay in that picture—and tell me, how old are you?
[The client may be regarding his picture as “the past,” but the ther­
apist understands it to be a visual representation of a current con­
struction of m eaning that is currently involved in generating
symptoms.]
Alan: Starting at about seven and until I was about twelve.
So she’d get drunk at night and come into my room,
and sometimes it was really late, so she’d wake me up
and start talking to me about all kinds of stuff that she
was miserable about—really personal stuff.
Therapist: So there you are at seven or eight, waked up by her
late at night, and she’s drunk and talking to you like
that, and I’ll bet you get whiffs of her breath—
Alan: Yeah, it’s horrible.
Therapist: —and see if you can feel what’s scary to you in what’s
happening.
Alan: The whole thing.
Therapist: Yes, the whole thing is scary. I imagine it’s scary in a
bunch of different ways all at once. See if you can put
your finger on some of the ways it’s scary.
Alan: [Puts hand on his stomach] Well—umm—it’s like I’m
supposed to fix it for her. I’m supposed to know how
to do whatever will make her feel better [bursts into
tears], but I don’t know how. [Cries] And that’s what’s
scary, because if I can’t fix it she’ll stay miserable and
it’ll be my fault and she’ll blame me. [Cries harder]
[Alan is now accessing the em otional wound in his normally
unconscious pro-symptom position; he is in the experiential real­
ity of that wound.]
Therapist: Keep seeing that image of mom in the scene, and try
out saying these words to her: “I d o n ’t know how to
make you feel good.”
Alan: [Crying] I do n ’t know how to make you feel good—
and I’m really scared you’ll stop loving me.
248 Dkpth-Orikntkd BrikfTiikrapy

Therapist: Yes. There it is.

Alan: Yeah. God.
Therapist: Alan, would you look at Kate and say those same
words to her? Not about mom, but to Kate herself—
how you feel the same things with Kate herself.
Alan: Yeah, I do. When you want to talk to me it’s like, “Oh
shit! I’m not gonna be able to fix it, and you’re gonna
think I’m not worth being with.”
Therapist: So try out saying the same thing to Kate: “I d o n ’t know
how to make you feel good, and I’m really scared
you’ll stop loving me.”
Alan: [Through tears] I do n ’t know how to make you feel
good, and I’m really scared you’ll stop loving me.
[The therapist is having Alan do position work by overtly stating
to Kate the emotional truth of his symptom of dissociating.]
Kate: But I’m not trying to get you to make me feel good or
fix me.
Therapist: He can’t let that in yet. We’ll get to that in a minute.
The thing is, Kate, knowing that’s what he's assuming,
does it make new sense why he goes into fear and
tightens up and closes down?
[The therapist is now reinforcing the change wrought in Aerpart
of the ecology of meanings by what has been revealed of the emo­
tional truth of his behavior.]
Kate: Yes, it does, because all along I thought it means he
doesn’t really love me and doesn’t share my goals and
doesn’t want to be with me.
Therapist: When actually it means you’re so im portant to him
that the thought of losing your love actually panics
him. [To Alan] Am I right?
Alan: Yeah, that’s about it.
Therapist: Alan, there’s one more part we should do. Can you
stay with that feeling of, “I’m really scared you’ll stop
loving me if I can’t fix it and make you feel better”?
Alan: Yeah, OK.
Therapist: Good. Let yourself feel that in relation to Kate, and
look at her. And where in your body do you feel it?
 Experiential Shift: Changing R eality 249

Alan: Right here. [Indicates the knot in his stomach]

Therapist: OK. When Kate says what she’s going to say in a
moment, see if you can let what she’s saying flow right
into that place. It’s OK if it flows into your ears, too, as
long as it also flows right there, too. Willing to do
that?
Alan: Yeah.
Therapist: OK. Kate, if these words are true for you, would you
just say to Alan, “I love you even if you d o n ’t know
how to help me with my problem ”?
Kate: I do love you even if you don ’t know how to help me
with my problem.

[The therapist is attem pting to orchestrate a transform ation of

A lan’s em otional w ound thro u g h the tech n iq u e of construct
substitution. It has become clear that an integral com ponent of
his w ound is the unconscious presupposition he holds in the
emotional (not cognitive) representation, “My value to a female
is in my ability to relieve her em otional distress.” It is this pre­
supposition that constitutes his knowing to expect rejection and
abandonm ent when he does not see how to fix or relieve Kate’s
problems. The sentence Kate is now saying disconfirms Alan’s
old presupposition; she had already stated th a t she does not
share it. However, in o rd er for Kate’s sentence to be effectual
in dissolving his presupposition, it is necessary for Alan to be
positioned in the em otional reality of his presupposition as he
hears her xvords. With the old presupposition already accessed
experientially, the new construction of m eaning he is receiving
creates an experiential disconfirmation that both motivates him
to dissolve the old view and provides the alternative construc­
tion he needs in order to do so.]

Therapist: [To Alan] Can you let it in there?

Alan: I think so, yeah.
Therapist: [To Kate] Give him another dose of that.
Kate: Alan, I love you even if you d o n ’t know how to help
me with my problem.
Therapist: [To Alan] How’s it feel to let that in there?
Alan: It’s like a picture of a soapsuds commercial I used to
250 D epth-O riented B rief T herapy

see on TV when I was a kid, like a clean white cloud

coming in and washing away the grime.
Therapist: Can you actually feel it?
Alan: Well, kind of a fresh, lighter feeling down there.
Therapist: Do you believe it when she says, “I love you even if
you do n ’t know how to help me with my problem ”?
Alan: [Looks closely at her face] Yeah. I think I do.
Therapist: OK, good. O ur time’s up for today, and I want to give
you something that will help you keep these new
things we’ve done.

The therapist gave each of them an index card and recommended

they look at their card twice a day, morning and night. On Alan’s
card was written, “I truly believe that if I d on’t solve your problem,
you’ll think I’m worthless.” For Alan this was position work; it
would keep this position consciously accessed and dim inish or
eliminate its capacity to come over him autonomously. On Kate’s
card was written, “I love you even if you d o n ’t know how to help
me with my problem .” This sentence would keep her positioned
in the new way of making sense of Alan’s emotional withdrawals
rather than in the old way of construing them to mean he doesn’t
love her. These cards would maintain the new ecology of meanings
developed in the session.
The therapist suggested that the second session could focus, if
Kate wished, on her “tar” and the lingering effects of being
molested. That session, one week later, included the following work:

Kate: I do affirmations and meditations, but I can’t get rid

of this yucky feeling about myself. People who know
me will say really nice things about me, and secretly I
feel like I’ve got them totally fooled . . . I remember
Henry [the uncle who molested her] would always say
to me, “How do you expect me to behave, lookin’ like
you do?” He was always making comments about how
I dressed, how I was trying to get him excited, and I’d
get so mixed up. He found any excuse to talk about
sex. I’d never know when he’d be spying on me when
I’d come out of the shower, or if I’d wake up in the
middle of the night because h e’d be touching me.
 Experiential. Suin': Changing R eality 251
And it all felt like it must be my fault. And actually,
when anything feels bad between people I feel like it
must be my fault.
Therapist: So that whole experience with him was nightmarish in
itself, and in addition you feel it was your fault. And
this feeling that it’s you who makes bad things happen
has stayed with you.
Kate: Yeah. Right. T hat’s the tar, like the real me is this
really dark, bad influence. If things start to feel bad
with anybody for any reason, it’s like, “Uh-oh, it’s com­
ing out again.” I mean, it’s always in there, but now it’s
coming out.
[This imagery constitutes an important pro-symptom construct, a
fourth-order presupposition of the nature of her self as dark, bad,
contaminating. Since this presupposition is already in awareness,
it is available for transformation by introducing incompatible con­
structs for her to hold simultaneously. The therapist will now
attempt to guide her to create new, incompatible constructs.]
Therapist: Sounds like you got tarred.
Kate: I sure did.
Therapist: Now, there’s something that’s very important to know
about the ordeal of getting tarred. Should I tell you
what it is?
Kate: You better!
Therapist: It’s this: Getting tarred means you get tar on you
because somebody else puts it on you. It’s somebody else’s
tar.
Kate: [Pause] I never thought of that.
Therapist: I know, because I can hear that you’ve been assuming
that it’s your own darkness or dirtiness.
Kate: Right.
Therapist: But when you get tarred, it means somebody else puts
that tar on you. It still feels very yucky to have it on
you, but you can know that it’s not coming out of you.
Kate: Yeah.
Therapist: It’s not your own badness. T hat’s the important thing
about it. [Pause] How does it feel to see it this way?
Kate: Umm—it’s kind of a relief you know? I mean, I still
252 D epth-O rientf.d B rief T herapy

d o n ’t see how to get it off me, but it’s a relief to think

of it like—like foreign matter.
[Her sense of “relief’ indicates that she has taken in the therapist’s
offer of a new construal and is dissolving her previous presuppo­
sition that the tar is of her own being. This is a step in the right
direction. However, the fact that “I still d on’t see how to get it off
me” indicates that she has an unconscious position of needing the
tar to stay. In other words, the therapist assumes coherence: what­
ever is, is because some position of the client requires it to be. The
therapist will now do radical inquiry and position work to find and
bring her into experiential knowledge of that position.]
Therapist: Want to find out how to get it all off?
Kate: Is that possible?
Therapist: I think so. Want to find out?
Kate: Yes.
Therapist: OK. Do you ever picture Henry and his house?
Kate: More than I’d like to.
Therapist: Mm-hm. I know it was really horrible for you there, so
if it’s too uncomfortable to imagine being there, and
being fifteen, that’s really OK and we’ll find another
way to do this.
Kate: No, it’s OK. For years I couldn’t stop picturing exactly
that, so one more time won’t hurt.
Therapist: OK. Let the scene form, and it’s in any one of the
rooms in Henry’s house, and h e’s there, with all his
creepy energy, and you’re fifteen. [Pause] And let me
know when you’re in that scene.
Kate: OK, I’ve got it.
Therapist: Good. And I wonder if you can be in this scene in a
certain way that I’ll describe, a certain version of your­
self. See if you can be the version of yourself where
there is no tar on you at all. See what it’s like to be
there, fifteen, with Henry, knowing that you’re a clean
person, with no tar on you. And you notice that Henry
has with him a large bucket—yes, a big bucket, and
you can see that the bucket is full of tar. All the tar is
over there with Henry, and it’s clear that the tar is all
his.
 Expkrikntial Shift: Changing Reautv 253

[The therapist is pursuing radical inquiry through the technique

of viewing from a symptom-free position.]
Kate: [Eyes closed; face now looking strained] This is feel­
ing really uncomfortable. Really uncomfortable.
Therapist: OK, stay with it. See if you can put words on what’s
uncomfortable for you, in knowing that you 're clearly
and all the tar is Henry’s?
Kate: I, ah, feel scared, like I’m in danger, worse than
before somehow.
Therapist: In a new way. What is it about this situation that you
know to understand as a danger?
Kate: Ah, I feel really vulnerable, or helpless. God, I just
flashed on being locked in with Blue Beard. Yeah, I
feel totally like I’m with a really evil monster in his cas­
tle, and I’m helpless.

[She is now to some degree directly contacting the core emotional

wound created by the sexual abuse, a state of u tter h o rro r and
helplessness to prevent a predatory monster from violating her at
his whim. It is now clear that her second-order construal of herself
as the cause of this badness spared her a conscious experience of
this state of utter helplessness. The therapist next will follow her a
little bit ahead, in order to foster position work.]
Therapist: So let me see if I’m understanding. By having all the
tar over there with Henry, and none on you, which
makes it clear that none of this is your doing, then you
feel helpless and trapped with him, and you see him
as a dangerous monster who has all the power. And
that’s really scary.
Kate: Yes. Oooh, it’s creepy.
Therapist: OK. Now let the version of you change back to the
familiar one of feeling you're the tarry one who brings
the tar. Can you do that?
Kate: [Pause] Yes.
Therapist: And let that be the reality of the scene now. Now you
feel you 're dark and dirty, and it’s you that makes bad
things happen. [Pause] And see how the situation
feels now.
254 D epth-O riented B rief Therapy

Kate: Well, it’s interesting, because—I mean, I’m yucky, but

it’s familiar and it’s not nmras scary and dangerous-
feeling as the other.
[To further the position work, the therapist has done some cycling
between symptom-free and symptom-bearing positions, and as a
result, Kate is consciously realizing that viewing herself as the dark,
dirty cause of the molestation is a strategic protective action that
keeps her from experiencing the much worse horror of knowing
that she isn’t the cause at all, and that the abuse occurs because she
is with a monster over whom she has no control whatsoever. Having
now found the position in which having the tar on her is needed,
and since she understands the meaning of what was found, the ther­
apist will immediately continue position work by inviting her to make
an overt statement that will integrate the pro/anti synthesis.]
Therapist: So would you try out saying this sentence and seeing if
it feels true to you? Try out saying, “I’d rather believe
the tar is from me, because then Henry’s not a monster,
I’m not helpless, and being here is much less scary.”
Kate: I’d rather believe the tar is from me, because then
Henry’s not a monster, and, um—
Therapist: “And I’m not helpless, and being here is a lot less
scary.”
Kate: —and I’m not helpless, and being here is a lot less
scary. [Pause] Yeah, that’s right. Wow. [Cries]
Therapist: Could you say the whole thing now?
Kate: OK. I’d rather believe the tar is from me, because then
Henry's not a monster, and I'm not helpless, and being
here is a lot less scary.
Therapist: [Pause] Would you tell us what you’re feeling, Kate?
Kate: [Speaking through tears] I didn’t realize I was so terri­
fied in all that. I didn’t realize I was trapped with a
monster.
Therapist: You’re realizing it was even more of a nightmare than
you let yourself know?
Kate: Yes. [Cries]
Therapist: And are you realizing this because now you’re letting
yourself know that the tar was really his, all along, and
not yours?
 Experiential Shift: Changing R eality 255

Kate: Yes. [Cries] And it’s so sad, and it really hurts, to

see that I’ve felt so bad about myself for so many
years, [Cries] when really it was all him. That really
hurts. [Cries]
[The painful grief she is now experiencing confirms that she has
allowed the old strategic construal of herself to dissolve, reveal­
ing to her the decades of tragic cost in self-regard accompanying
how she protected herself from the horror of the situation.]
Therapist: Yes, it hurts to see that. Really hurts. [She nods] I
need to ask Alan something. How are you doing with
Kate hurting like this? Feeling a knot or fogging up?
Alan: No. It’s pretty obvious nobody’s expecting me to fix
anything. But I would like to hold you. [They hug]
Kate: I can see us out with friends sometime, and I’ll ask
you, “How’s your knot?” and you’ll say, “Fine. How’s
your tar?” [Both laugh]

The session ended a few minutes later. The therapist gave her a
card with the words of her p ro /a n ti synthesis, “I needed to pre­
tend being molested was my fault, even though this really cost me,
because otherwise it would have been too horrifying to know I was
with a monster.” She was to read this daily and at any time when
feelings of “tar” occurred (the position work technique of using
the symptom as a signal to take the pro-symptom position).
At the start of the third session, Kate reported, “Some people
at work pulled some really sneaky moves that felt really bad, and I
felt myself getting really anxious and guilty and feeling like it was
all because of me, but then I read the card and realized, no, it’s not
me, it’s what they're doing that’s rubbing off on me. It’s not me. It’s
not me!”
Most of the session was used to bring about a further transfor­
mation of the core wound from the molestation through the tech­
nique of reenactm ent: The therapist had Kate again imaginally
focus on the incident of the abuse and coached her through mak­
ing new, powerful, self-protective responses to her uncle based on
knowing that he was the bad one. In this replay she awoke from
sleep just before he was about to begin touching her and screamed
at him, “You’re a monster! You’re trying to molest me!” She then
256 D epth -O riented B rief T herapy

got up, threw a chair at him, and ran out of the house screaming
for the police. At that point she saw Alan (also visualizing the scene
and imaginally participating in it) who now helped her in her
moment of need by bringing her to a neighbor’s house to phone
the police, who came and locked Henry up in a “jail car” and took
him away. All of this was emotionally vivid for her. When it was
over and their eyes were again open, the therapist said to her, “So
this time you knew Henry was being very, very bad to you, and you
stopped him, and Alan helped you. How does it feel?” She said, “It
feels like I’m finally waking up from a very long, very bad dream.”
Therapy ended with three more couple sessions at three-week
intervals, sessions that were used mainly to help them adjust to the
new internal and interpersonal realities. This included writing and
sending a letter to her father and m other revealing what father’s
now deceased brother, Henry, had done to her. In the last session,
Kate said, “Everything has changed. I came in wanting Alan to
open up to me, but then / wound up opening up to him about my
dark secret. It feels like we’re a lot closer now, like we’re really
friends and I can trust him to really know me.” Alan said the fog
and the knot were gone and that “it’s so clear now that she loves
me w hether or not she’s upset about som ething. It’s becoming
hard to remember what my problem with that was.”

Sum m ary_________________________________________
Change in depth-oriented brief therapy means creating an expe­
riential shift in the client’s construction of reality, resolving the pre­
senting problem. The therapy client has two fundamental abilities
to change emotional-cognitive reality: the ability to control the illu­
mination of constructs and the ability to control the existence o f con­
structs. We have described techniques by which the therapist
guides, coaches, and induces the client to use these native abilities
to bring about experiential shifts in his or her initially unconscious,
pro-symptom position.
In position work the client illuminates the pro-symptom position,
experientially inhabits it, apprehends the co h eren t em otional
meaning or value of having the symptom, and creates a pro/anti
synthesis by asserting the emotional truth that the meaning or value
of having the symptom warrants the costs. The client discovers that
 Experiential Suin': Changing Realitv 257

he or she is the ingenious architect and purposeful implementor

of the symptom.
For many clients, resolution occurs at this point, either because
the client spontaneously dissolves the position that has been made
conscious, or because the symptom, refram ed to its em otional
truth, is no longer seen as a problem . For others, the therapist
guides the client through an additional stage of carrying out the
transformation of the pro-symptom position by creating new constructs
that dissolve the emotional wounds and presuppositions compris­
ing the pro-symptom reality.

Notes
P. 203, People wish to be settled . . R. W. Emerson (1990), “Circles,” in
R. D. Richardson, Jr. (Ed.), R alph Waldo Emerson: Selected Essays,
Lectures, and Poems (p. 199), New York: Bantam.
P. 204, We define psychotherapy . . . presenting problem: T h is definition of psy­
chotherapy is similar to others previously formulated. For example,
Montalvo has defined psychotherapy as an “interpersonal agree­
ment to abrogate the usual rules that structure reality, in order to
reshape reality” [B. Montalvo (1976), “Observations of Two Natural
Amnesias,” Family Process, 15, 333]. For us this approaches a suitable
definition, provided the “reality” twice mentioned is understood to
be specifically the “reality” inhabited by the client as an individual,
and the “rules” are understood to be the clien t’s conscious and
unconscious ways of making sense o f experience (of self, others,
events, and so on). Our definition emphasizes our view that in psy­
chotherapy it is always the client who transforms his or her own
experiential world so as to become symptom-free, using native con­
structivist abilities to do so, including the ability to arrange to inter­
act with a therapist who prompts the effective use o f those abilities.
PP. 206-207, 11As long as I attend . . . keep change from occurring”: N. Shuler
(1985). “Trying to Change as Denial,” California Association fo r Coun­
seling an d Development Journal, 6, 49-51.
P. 215, an apt phrase coined by psychotherapist Kenneth Rhea: K. Rhea (1993),
“Essential Considerations in the Practice o f Psychotherapy,” The
California Therapist, 5(5), 60-61.
P. 217, Traumatic Incident Reduction . . . developed by psychotherapists Frank
Gerbode an d Gerald French: F. Gerbode (1988), Beyond Psychology: An
Introduction to Metapsychology, Palo Alto, CA: IRM Press. Information
on TIR is available from the Institute for Research in Metapsychol­
ogy, 431 Burgess Drive, Menlo Park, CA 94025. The Psychosocial
258 Depth-Oriented Brief Therapy

Stress Research of Florida State University has conducted compar­

ative research on the effectiveness of TIR and several other tech­
niques for rapid resolution of post-traumatic stress syndrome, but
as o f this writing these results have not yet been finalized or pub­
lished. For information contact Psychosocial Stress Research Pro­
gram, 103 Sandels Building, Tallahassee, FL 32306-4097.
P. 235, “the real question . . . but not in every case. W. H. O ’Hanlon (1990),
“Debriefing Myself,” Family Therapy Networker, 74(2), 48.
P. 236, dissolving the old construction in fa vo r o f the neiu (accommodation in
Piagetian terms):]. Piaget (1971), The Construction of Reality in the Child,
New York: Ballantine (original work published in 1937); andj. Piaget
(1985), The Equilibration of Cognitive Structures: the Central Problem of
Intellectual Development, Chicago: University of Chicago Press.
P. 237, The technique of reenactment: See, for example, J. Moreno (1962),
Psychodrama (vol. 3), New York: Beacon House; N. Drew (1993),
“Reenactment Interviewing: A Methodology for Phenomenological
Research,” IMAGE: Journal of Nursing Scholarship, 25(4), 345-351; L.
D. Crump (1984), “Gestalt Therapy in the Treatment o f Vietnam
Veterans Experiencing PTSD Symptomatology,”Journal o f Contem­
porary Psychology, 74(1), 90-98.
P. 237, revising personal history: R. Bandler and J. Grinder (1982), Refram­
ing: Neuro-Linguistic Programming and the Transformation o f Meaning,
Moab, UT: Real People Press.
P. 238, inner child work: See, for example, J. Abrams (Ed.) (1990), Reclaim­
ing the Inner Child, Los Angeles: Tarcher.
P. 239, voice dialogue: H. Stone and S. Winkleman (1989), Embracing Our
Selves: The Voice Dialogue M anual, San Rafael, CA: New World Library.
 Conclusion
He looked at his own Soul with a Telescope.
What seemed all ir regular, he saw and shelved
to he beautiful Constellations; and he added
to the Consciousness hidden worlds within worlds.
Samuel Coleridge, Notebooks

In this book we have presented a comprehensive, nonpathologiz-

ing approach that reconciles the perennial opposites of “deep” and
“brief” in psychotherapy. It is an approach organized around the
understanding that unconscious emotional realities are immedi­
ately accessible and changeable.
This way of working challenges conventional, limiting assump­
tions about what is possible in psychotherapy. To do depth-
oriented brief therapy is to know that clients can be guided to
rapidly experience and express their unconscious, symptom-gen­
erating constructions of meaning; that these constructions are
transform ed by the individual not over time, bu t in m om ents
when they enter awareness and when alternative acceptable posi­
tions are created; that significant change is an immediate possi­
bility in every session, from the first session; that brief therapy can
produce change beyond symptom relief by generating the expe­
rience of intrinsic wellness and worth; and that the authenticity
and poignance of the work—for the therapist as well as for the
client—need not be sacrificed because the work is brief.
The conceptual framework and the therapeutic logic of depth-
oriented brief therapy is actually extremely simple: the client has
a pro-symptom emotional truth; do nothing but empathically find
it; usher the client into experiencing it; and then, if necessary,
assist the client to change it.
For some therapists, however, learning this approach means
learning a new way of thinking and a new style of interacting with

259
260 C o n c lu sio n

clients. This can at first feel very difficult, especially if an old, famil­
iar construction of therapy is being shed at the same time. But
once familiarity with depth-oriented brief therapy develops, its
great simplicity becomes apparent, and the advanced trainee won­
ders what made it seem difficult at first.
The therapeutic benefits of working with the emotional truth
of the symptom are numerous, as we have shown in these pages.
Some of the most salient are listed below.

Leverage: Recognizing and accepting the client’s pro-symptom posi­

tion gives the therapist an alliance with the functional region
of the client’s psyche that has the most power over the symp­
tom, maximizing therapeutic leverage for change and mini­
mizing or eliminating resistance.
Trust: The client’s experience of the therapist as interested in and
unafraid of the client’s most im portant emotional truths, and
able to understand and accept them sensitively, rapidly engen­
ders trust and accelerates the psychotherapeutic process.
Permanence: Living as though the sym ptom ’s em otional truth
w eren’t the case is what generates the symptom in the first
place. Resolving the problem at the level of the em otional
truth of the symptom has the greatest potential for eliminating
the symptom permanently and preventing emergence of alter­
nate symptoms.
Potent reframe: Repositioning the client within the emotional truth
of the problem is inherently a compelling reframe—a contex­
tual shift that constitutes a second- or higher-order transfor­
m ation of m eaning. This refram e is highly effective at
dispelling the problem because (1) it registers strongly as true
(a high degree of “fit” to the client’s psychology is achieved)
and (2) it automatically transforms the client’s construal of
being the victim of the symptom into a position of being the cre­
ator or implementor of the symptom.
Easy hypnosis: Themes from the client’s em otional truth are the
most evocative for hypnotic induction. These them es make
induction easy, because they are the very themes with which
the client’s unconscious mind is already strongly preoccupied,
 Conclusion 261

and the full force of that unconscious involvement immediately

absorbs the client’s attention.
Gain of meaning: Symptoms arise precisely because of wnawareness
of the m eaningful personal themes generating them . Con­
scious retrieval of these themes puts clients back into the expe-
rientially true stories of their lives, which brings new energy,
aliveness, and wholeness along with new engagem ent in per­
sonally meaningful issues and choices.
Realization of selfworth: Working at the level of the emotional truth
of the symptom achieves resolution and healing of a deeper
kind than is the cu rren t norm or aim in the brief therapy
field—a realization of core well-being and self-worth that
comes from finding that symptoms regarded as evidence of
defectiveness or craziness turn out to be full of sense and
coherent personal meaning.

O f course, in keeping with the constructivist paradigm on

which depth-oriented brief therapy is based, we cannot claim that
its description of symptoms, therapy, and change is objectively true.
We know only that for a therapist to view the client’s problem in
this way will in the end always seem and feel true to both client and
therapist and will make therapy remarkably time- and depth-effec­
tive. And we know that what seemed all irregular will come to be
known as marvelously coherent and saturated with deeply felt
meaning and intelligence.

P. 259, He looked at his own S o u l. . K. Coburn (Ed.) (1957), The Notebooks

of Samuel Taylor Coleridge, Princeton, NJ: Princeton University Press.
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 The Authors

B ruce E cker is a psychotherapist in private practice in Oakland,

California, and teaches brief therapy at John F. Kennedy Univer­
sity. He is active as a clinical staff trainer and consultant at numer­
ous therapy centers, provides training intensives for professionals
nationally, and is coauthor and coeditor of Spiritual Choices: The
Problem of Recognizing Authentic Paths to Inner Transformation (1987).
His work in psychotherapy follows a career of well over a decade
in physics research with numerous professional publications.
Laurel H ulley is in private practice in Oakland, California,
and, as director of clinical training for Pacific Seminars, develops
and designs professional trainings in depth-oriented brief therapy.
She has been engaged for over ten years in the issues and theory
of training therapists for effectiveness. Her clinical interests include
the treatm ent of schizoid constructions in brief therapy, which is
the topic of a book in progress.
The authors are the originators of depth-oriented brief therapy.
 Index
A scious constructs, 25, 173,177. See
Abuse, childhood: 4; and multiglobal
constructions, 232-235; and
restoration, 233-234; and retribu­
tion, 233-234; case example of, in
couples therapy, 240-256; con­
structs formed in, 232-235, 250.
See also Molested child; Sexual
abuse
Accessibility of unconscious con­
structs, xi, 2, 4, 90-91, 128-131,
161-163, 200, 259; case examples
of, 28-30, 60, 68-69, 72-74, 130-
131, 140-142, 163-173, 189, 206,
207, 211-214, 241-243, 244-248,
252-254; principle of, 4, 91, 128-
129; through serial accessing,
170-173. See also Position work,
techniques of; Radical inquiry,
techniques of
Accommodation, 117-118, 215, 236
Active imagination, 173-174. See also
Imaginal interactive techniques
Active intentionality, 21, 131-136,
170, 180, 200; and multiglobal
clients, 235; definition of, 131;
lapse in, 134. See also Stance,
therapist’s
Addictive-compulsive behaviors, 4, 17,
42; compulsive eating, 4, 17;
manic activity, 4, 17, 130-131;
workaholism, 4, 17, 63, 71-72, 78,
80,81,84, 90, 98
Agoraphobia: 4; case example of,
28-37, 95, 207; fear of fear in, 29
Alice, 52, 218
Altered state: in accessing uncon­
also State-specific knowings
Andolphi, Mario, ix
Anger. See Rage
Anthropologist’s view, 144-147, 155;
definition of, 145; example of,
145-146. See also Stance, thera­
pist’s
Antisocial attitude, 139
Anti-symptom position, 15-16, 38;
and need to make sense, 16, 31;
and symptom-negative context,
96-97; as ineffective focus of ther­
apy, 21-22, 26, 34, 206-207; case
examples of, 17, 36, 116, 241;
client’s reversion to, 219; defini­
tion of, 15-16; in position chart,
115; meaning of symptoms in,
15-16, 20; obstacle to integration
of pro-symptom position, 24; ther­
apist’s empathy for, 159-160 (see
also Empathy, therapist’s; Rela­
tionship, client-therapist); trans­
formation of, 18, 26, 27, 90, 203-
204, 220; victimization in, 15, 192,
193-194. See also Position
Anxiety, 4, 28, 233; case examples of,
29, 33, 34, 35; over loss of familiar
reality, 231-232, 236
Attention, 119; client’s, 133-134, 206,
261; guiding client’s, 30, 68, 129-
130, 141, 142, 161, 163, 172, 180,
185, 189, 198, 214, 215, 216, 246;
therapist’s, 143, 153-154, 158, 172;
to painful emotion, 134-135
Attention deficit disorder, 221-222
Autistic reverie, 53
271
272 Index
Autonomy, 27, 76; of imagery, 173,
174, 177, 239; of unconscious posi­
tions, 36, 98-99, 102, 105-106,
123, 195, 206, 239, 250; problems
of, 16-17, 18, 23, 25, 96, 166-167
B ing student, 17-18, 26-27, 103—
Bateson, Gregory, 7, 103; and ecology
of ideas, 103, 221; and hidden
epistemology, xi; and logical types
of change, xi, 90-91, 118
Beavin, J., 1In
Beginner’s mind, 147
Behaviorism, 106
Berger, P., 12n
Between-session tasks, 209, 217, 218—
220; accessing emotional truth,
77-78; experiential question, 71;
index card, 64, 70, 74-76, 78, 83,
177-178, 185, 250, 255; letter writ­
ing, 256; using symptom as signal,
33-34, 255. See also Position work,
between-session tasks of
Binge eating, 17, 135. See also Weight
problem
Blame, 17, 42, 58, 230
Blocks, therapist’s, 131-137; list of,
132-133
Bodywork, 109. See also Mind-body
communication technique
Bogdan,Jeffrey, lln , 118
Brain structure, 119-121
Branden, N., 201 n
Brief therapy: training for, ix-x. See
also Training: and therapeutic
focus of DOBT
C of, 8
Cambien,Jan, 105
Case examples: agoraphobic woman,
28-37, 207; always attacked hus­
band, 8-9, 14; always fighting
again couple, 22-24, 25, 96; cou­
ple abused as children, 240-256;
cutting shard of M
I’m ugly,” 42-63,
207, 239; depressed no matter
what, 63-90, 211; family with act­
ing-out child, 221-230; intellectu-
alizing man with fear of failure,
180-183; lawyer-sculptor conflict,
231-232; mother of molested
daughter, 184-185; procrastinat­
104; symbiotic attachment and
depression, 167-170, 172-173,
175-178, 211-214; teacher’s impo­
tent rage, 186-194, 208; under­
achieving man, 215-216; woman
who wants a baby, 163-166;
woman with weight problem,
166-167
Causality, 112
Change: and stability, dialectic of,
19; and therapist’s assumptions,
3, 34, 43-44, 129, 135-136; basis
of ability to, 204; beyond symp­
tom relief ( see Resolution of
problems: beyond symptom
relief); client as source of, 9, 13,
136-137; conditions for rapid in-
depth, 2, 3, 36, 206, 207 (see also
Effectiveness, therapeutic); dis­
orientation accompanying, 217,
231-232; lack of, through
attempts to stop symptom, 147-
149; methodology of (see Experi­
ential shift; Position work; Trans­
formation of constructs); of
pro-symptom position (see Pro­
symptom position: transforma­
tion of); terminology of, 118
Change, first-order, 118; case exam­
ples of, 9, 62, 89-90; definition
Change, fourth-order, x, 90-91, 118,
121; case examples of, 75, 88-90,
177-178; in confronting with emo­
tional truth, 217
Change, ontological. See Ontological
change
Change, orders of, x, 90-91; case
examples of, 31, 62-63; resistance

to higher, 117-118; greater scope
of higher, 117-118; in therapeu­
tic strategy, 8-9; ripple effect
through, 89-90, 217. See also
Change, first-order; Change, sec­
ond-order; etc.
Change, second-order, x, 118; case
examples of, 9, 63, 89-90; defini­
tion of, 8
Change, third-order, x, 62, 90-91,
118; case examples of, 62-63,
89-90; for low self-esteem, 68-70
(See also Low self-esteem)
Character disorder, 132, 236. See also
Multiglobal constructions: and
character disorder
Chart, position. See Position chart
Child abuse, danger of, 148
Child, acting-out, 121-130
Clarity seeking. See Radical inquiry
Client: as architect of symptom,
33-34, 58, 61-62, 68-69, 90, 99,
139, 256-257, 260; as creator-
preserver-dissolver of construc­
tions of reality, 5-6, 10, 30, 97,
113, 139, 183, 204, 208, 236-239,
249
Client-therapist relationship. See Rela­
tionship, client-therapist
Cognitive neuroscience, 5, 119-121
Cognitive science: 119; and modular­
ity, 118-120
Cognitive therapy, x, 106, 107,
146-147, 236-237
Coherence, xi, 47; as basis of client
resistance, 194-195; as basis of ser­
ial accessing, 171; as basis of short­
est path of inquiry, 139-140, 158-
159; historical background of, 139;
in structure determinism, 156n; of
self, 37, 121, 261; of symptom pro­
duction, 6, 19-20, 97, 137-140,
231, 252; principle of, 137-140. See
also Pro-symptom position: orga­
nization of constructs within; Rad­
ical inquiry, defining features of:
Index 273
assumption of coherence; Symp­
toms: coherent nature of
Collaboration, 6; creating, 3, 159—
161,219
Confronting parents, 175-176
Confronting with emotional truth,
82-83, 176, 216-217
Congruence of positions, 26-28; defi­
nition of, 26; example of, 27
Connection, emotional: preserving,
with abusive parents, 233-235
Conscious “I,” 102-107, 113; and cog­
nitive neuroscience, 120; and
dialectic among positions, 106;
as unnecessary for knowing, 102,
103- 108; definition of, 103-
105; displacement of, 102-103,
104- 105
Conscious position. See Anti-symptom
position
Construct, definition of, 6
Construct substitution, 75, 239, 249,
251-252; procedure of, 239-240,
249
Constructionism, social, x, 97
Constructions of reality, uncon­
scious: accessing (see Accessibility
of unconscious constructs: case
examples of); and client resis­
tance, 194-195; as basis of prob­
lems (see Emotional truth of the
symptom: as unconscious con­
structs; Pro-symptom position: as
emotionally governing position;
Symptoms: coherent nature of;
symptoms: present-time basis of);
depicting the past, 7, 199; exam­
ples of, 145-146; in position
chart, 116, 171-172; manifesting
as imagery, 174, 175-178; stem­
ming from trauma, 217; trans­
formation of (see Pro-symptom
position: transformation of; Trans­
formation of constructs). See also
Reality, experiential
Constructivism, 5-11; and the basis of
274 Indkx
c h a n g e , 7, 2 0 4 ; a n d th e u n c o n ­
s c i o u s , x , 3 , 5 - 6 ( see a ls o C o n ­
s t r u c t i o n s o f r e a lity , u n c o n s c i o u s ;
U n c o n s c i o u s k n o w i n g s ) ; a n d v a l­
u e s , 10; a s i n t e g r a tiv e o f t h e r a p e u ­
tic t e c h n i q u e s , 10; c r e a t i o n o f n e w
m e a n i n g in , 7 , 9 - 1 0 ; e p is t e m o l o g y
o f, 6, 7, 1 0 5 -1 0 8 , 1 4 6 -1 4 7 ; e s s e n ­
t ia l c o n c e p t s o f , 5 - 6 , 9 - 1 0 , 1 0 0 ,
2 0 4 - 2 0 5 ; h e r m e n e u t i c v ie w o f l a n ­
g u a g e in , 1 4 6 -1 4 7 ; n o “c o r r e c t ”
r e a lity in , 6 ; p la s tic ity o f r e a lity in ,
9 - 1 0 ; p o s tm o d e r n n a tu r e o f, 6 -7 ;
ra d ic a l, 9 7 , 1 5 5 n -1 5 6 n ; th e r a p e u ­
tic p o t e n t i a l o f , x ; t h e r a p e u t i c
s tr a te g y in , 8 - 9
C o n s tru c tiv is t th e ra p ie s : c o n c e p t o f
r e s is ta n c e in , 1 94; d if f e r e n c e s
am ong, 7
C o n s tru c ts : a n d c o n te x ts , 9 7 ; as
d e te c ta b le m e n ta l o b je c ts , 1 2 1 -
1 2 2 ; c o m p a tib ility o f, w ith in a p o s i­
t i o n , 1 1 7 - 1 1 8 (se e a lso C o n s t r u c t s ,
in c o m p a tib le ) ; c o n tr o l o f e x is ­
te n c e o f, 3 7 , 2 0 4 ; c o n tr o l o f illu ­
m in a tio n o f, 2 0 4 ; d e f in itio n o f
s u b o rd in a te , 117; d e fin itio n o f
s u p e r o r d in a te , 117; d is s o lu tio n o f
(see T r a n s f o r m a t i o n o f c o n s t r u c t s ) ;
e p i s t e m o l o g i c a l n a t u r e o f a ll, 6 , 7,
1 0 4 -1 0 8 , 2 0 4 ; im a g e ry , 1 0 8 , 2 5 1 ;
i n v e n t e d v e r s u s d is c o v e r e d , 2 2 , 3 3 ,
1 2 1 - 122; p r in c ip le o f d is s o lu tio n
o f, 3 7
C o n s t r u c t s , e m o t i o n . See e m o t i o n
c o n s tru c ts
C o n s tru c ts , firs t-o rd e r, 2 1 7 ; c a se
e x a m p le o f, 11 6 ; d e f in itio n o f,
1 2 2 - 123
C o n s tru c ts , f o u rth -o rd e r: c a se e x a m ­
p le s o f, 6 3 , 8 8 - 9 0 , 1 1 6 , 1 7 3 , 1 7 7 ,
2 5 1 ; d e f in itio n o f, 6 3 , 114, 122;
i m p l i c i t i n c o n f r o n t i n g w ith
e m o t i o n a l t r u t h , 2 1 7 ; in lo w s e l f ­
e s t e e m , 2 3 4 (s e e a ls o L o w s e l f ­
e s te e m ); o f a b u s e d c h ild , 2 3 4
C o n s tru c ts , h ie ra rc h y o f, 6 3 , 9 0 -9 1 ,
1 1 3 -1 1 8 ; c a se e x a m p le s o f th e , 6 1 ,
8 9 - 9 0 ; flo w o f c h a n g e in , 8 8 - 9 0 ; in
lo w s e l f - e s t e e m , 2 3 1 - 2 3 5 (s e e a ls o
L o w s e lf - e s te e m ) ; in p o s itio n c h a r t,
115; p a tte rn s tru c tu rin g th e , 1 2 2 -
1 2 3 . See a lso O r d e r s o f p o s i t i o n
C o n s tru c ts , in c o m p a tib le , 1 1 7 -1 1 8 ;
c o n ta c t b e tw e e n , 5 3 , 6 9 -7 0 , 2 3 6 -
2 3 9 , 2 5 1 - 2 5 2 ; s e p a r a t i o n o f, 3 7 . See
a ls o C o n s t r u c t s : c o m p a t i b i l i t y o f ,
w ith i n a p o s i t i o n
C o n s t r u c t s , k i n e s t h e t i c . S ee K i n e s ­
th e tic c o n s tru c ts
C o n s t r u c t s , l i n k a g e o f, 6 3 ; c a s e e x a m ­
p le s o f, 5 1 , 6 3 , 7 0 , 8 8 - 9 0 ; in s e r ia l
a c c e s s i n g , 1 7 0 - 1 7 3 (se e a ls o S e r ia l
a c c e s s in g )
C o n s tru c ts , s e c o n d -o rd e r, 2 1 7 ; c a se
e x a m p le s o f, 6 2 , 1 1 6 , 2 5 3 ; d e f in i­
t i o n o f, 6 2 , 1 1 4 ; in lo w s e lf - e s te e m ,
2 3 2 - 2 3 5 (se e a ls o L o w s e lf - e s te e m )
C o n s t r u c t s , s i x t h - o r d e r : d e f i n i t i o n o f,
1 2 2 -1 2 3
C o n s t r u c t s , s o m e s t h e t i c . S ee S o m e s -
th e tic c o n s tru c ts
C o n s t r u c t s , s t r a t e g i c . S ee S t r a t e g i c
c o n s tru c ts
C o n s tr u c ts , t h i r d - o r d e r , 1 2 1 , 2 1 7 , 2 3 9 ;
c a se e x a m p le s o f, 6 2 - 6 3 , 9 0 , 1 1 6 ,
1 7 9 ; d e f i n i t i o n o f , 6 2 , 1 1 4 ; in lo w
s e lf - e s te e m , 2 3 2 - 2 3 5 (se e a ls o L o w
s e l f - e s t e e m ) . S ee a ls o P u r p o s e ,
u n c o n s c io u s
C o n te x t: as in te r n a l c o n s tr u c tio n , 9 7
C o n tro l o f e x is te n c e o f c o n s tru c ts ,
c l i e n t ’s, 2 0 4 , 2 0 5 , 2 3 6 , 2 5 6
C o n tro l o f illu m in a tio n o f c o n s tru c ts ,
c l i e n t ’s, 2 0 4 , 2 0 5 , 2 5 6
C o r r e c tiv e e m o t i o n a l e x p e r i e n c e , 1 3 3
C o u n te rtra n s fe re n c e , 132, 155; a n d
e ffo rtfu ln e s s , 137; a n d p s e u d o ­
e m p a t h y , 1 4 6 . S ee a ls o R e l a t i o n ­
s h ip , c lie n t-th e ra p is t
C o u p le s th e ra p y : c a se e x a m p le s o f,
8 - 9 , 1 4 , 2 2 - 2 4 , 4 6 , 2 4 0 - 2 5 6 ; r a d i-

c a l in q u ir y in , 8 - 9 , 2 2 - 2 4 , 2 4 1 -
2 4 7 , 2 5 2 -2 5 3 ; tra n s fo rm a tio n o f
p ro -s y m p to m p o s itio n s in , 9,
2 3 - 2 5 , 2 4 0 - 2 5 6 . S ee a ls o C a s e
e x a m p l e s ; E c o lo g y o f m e a n i n g
C r e a tin g c o n n e c tio n s b e tw e e n p o s i­
tio n s , 2 3 8 - 2 3 9
C re a tio n -p re s e rv a tio n -d is s o lu tio n o f
r e a litie s : c l i e n t ’s c a p a c i t y fo r, 5 - 6 ,
10, 3 0 , 9 7 , 1 1 3 , 1 3 9 , 1 8 3 , 2 0 4 , 2 0 8 ,
2 3 6 -2 3 9 , 249
C y c lin g in a n d o u t o f s y m p t o m - f r e e
p o s itio n , 2 1 4 -2 1 5 , 2 5 3 -2 5 4
C r o n i n , V. E ., 1 2 n
D s y m p to m s re s o lv e d by, 4; u n if ie d
D e ll, P a u l, 1 3 9 , 1 9 4
D e l u s io n , 2 9 , 3 3 , 9 5 , 9 8 , 2 0 7
D e p e n d e n c y , 4 , 1 6 7 , 2 1 1 . See a ls o
A u to n o m y : p r o b l e m s in
D e p re s s io n , 4, 21 , 9 8 ; as p ro te c tiv e
a c tio n , 17, 1 1 0 ; c a s e e x a m p le o f,
6 3 -9 0 , 177, 2 1 1 -2 1 4 ; u n c o n s c io u s
th e m e s p ro d u c in g , 6 5 , 6 7 -6 8 , 7 2 -
74, 80, 8 9 -9 0 , 159, 173, 1 7 7 -1 7 8 ,
2 1 1 ,2 1 3 -2 1 4
D e p t h : p r e s e r v a t i o n o f, in b r i e f p r a c ­
tic e , i x - x , 1 - 4 , 4 1 , 2 5 9 - 2 6 0
D e p th - o r ie n te d b r ie f th e ra p y : c o n ­
s tru c tiv is t g r o u n d o f, 5 -1 1 ; c o n ­
t r a s t e d w ith o t h e r b r i e f t h e r a p i e s ,
x , 1 ,3 , 4 , 15, 1 8 - 1 9 , 3 3 , 3 5 , 3 7 - 3 8 ,
62, 7 7 -7 8 , 1 0 0 -1 0 2 , 106, 139,
1 4 6 -1 4 7 , 1 5 2 -1 5 3 , 185, 2 0 5 -2 0 6 ,
22 0 , 2 3 6 -2 3 7 ; d e fin in g su c c e ssfu l
o u t c o m e i n , 1 8 - 1 9 , 2 6 (s e e a ls o
O u t c o m e , s u c c e s s f u l) ; d i a l e c t i c o f
c h a n g e v e r s u s s t a b ility in , 1 9 ; d is ­
tin c tiv e f e a tu r e s o f, 3, 4 , 7 - 8 , 15,
17, 3 4 , 3 7 -3 8 , 1 0 5 -1 0 8 ; h e te r o ­
g e n e ity o f re a lity in , 15, 9 4 - 9 7 ,
9 8 -9 9 , 1 0 5 -1 0 8 , 175; h ig h e r-o rd e r
c h a n g e in , x , 6 2 - 6 3 , 6 8 - 7 0 , 8 9 - 9 1 ,
1 1 3 -1 1 8 , 1 2 1 -1 2 3 , 1 7 7 - 1 7 8 ,2 1 7 ,
2 3 2 -2 3 5 , 2 6 0 ; in te g ra tiv e n a tu r e
o f, x, 157, 1 7 3 -1 7 4 ; m e th o d o lo g y
INDKX 275
o f d is c o v e ry in , 2 0 - 2 2 , 1 2 7 -1 5 5 ;
m e th o d o lo g y o f e x p e r ie n tia l s h ift
in , 2 0 , 2 4 , 2 0 5 -2 5 7 ; n o n p a th o lo -
g iz in g n a t u r e o f , 6 , 4 3 , 5 8 , 9 9 - 1 0 0 ,
1 0 8 , 2 5 9 ; o r d e r s o f c h a n g e in
(see C h a n g e , o r d e r s o f ) ; o v e r a l l
m e t h o d o l o g y o f, 2 0 - 2 2 , 2 4 , 3 8 , 6 0 ,
25 9 ; p h e n o m e n o lo g ic a l n a tu re
o f, 3, 1 4 3 -1 4 4 , 2 3 9 ; re s o lu tio n
b e y o n d s y m p t o m r e l i e f in , 4 ,
3 5 -3 6 , 3 7 -3 8 , 59, 70, 81, 8 7 -8 8 ,
8 9 , 121, 1 3 0 -1 3 1 , 2 5 9 , 2 6 1 ; s c ie n ­
tific r e s e a r c h c o r r o b o r a t i n g , 1 1 8 -
122; tr a n s f e r e n c e in , 1 9 7 -1 9 8 ;
t r a n s p a r e n c y o f, 1 5 2 - 1 5 3 ; ty p e s o f
e p i s t e m o l o g y o f , 1 0 2 - 1 0 8 ; w ith
c o u p le s a n d fa m ilie s , 1 0 0 -1 0 2 ,
2 2 0 - 2 3 0 (se e a ls o C o u p l e s th e r a p y :
c a s e e x a m p l e s o f ; F a m ily t h e r a p y
in D O B T )
D ia g n o s tic la b e ls , 2 2 , 2 9 , 3 1 , 1 0 0 , 1 3 5 ,
1 4 3 , 1 5 3 ; e f f e c t o n c l i e n t ’s t r u s t ,
135
D i r e c t r e s o l u t i o n : c a s e e x a m p l e s o f,
8 -9 , 2 3 -2 5 , 27, 2 8 -3 7 , 4 2 -9 1 ,
1 6 7 -1 7 0 , 1 7 2 -1 7 3 , 1 7 5 -1 7 8 , 2 1 1 -
214, 2 2 1 -2 2 9 , 2 4 0 -2 5 6 ; d e fin i­
t i o n o f , 2 6 , 3 8 - 3 9 , 6 0 , 2 0 3 . S ee
a ls o R e s o l u t i o n o f p ro b le m s ;
R e v e rse re s o lu tio n
D i s e n t i d e m e n t : o f s e lf, 2 3 3
D is lo y a lty , 2 3 3
D is s o c ia tio n , 4, 14, 4 2 , 1 0 2 -1 0 3 ;
c a s e e x a m p l e o f, 2 4 5 - 2 4 6 ; s ig n s o f,
1 9 5 , 2 4 5 ; te c h n iq u e s o f u tiliz in g ,
1 9 5 -1 9 7
D i s s o l u t i o n o f c o n s t r u c t s . See C o n ­
s tr u c ts : d i s s o l u t i o n o f
D i s t a n t v ie w in g t e c h n i q u e s . See R e s is ­
t a n c e : d i s t a n t v ie w in g t e c h n i q u e s
D o u b l e b i n d in D O B T , 3 3 - 3 4
E
E c o lo g y o f m e a n i n g s , 1 0 1 - 1 0 2 , 2 2 1 ;
c a s e e x a m p le s o f, 2 2 1 -2 3 0 , 2 4 0 ,
276 Index
2 4 4 , 24 8 , 2 5 0 ; s u p e ro rd in a te fe a ­
t u r e o f f a m ily ’s, 2 3 0
E f f e c t i v e s e s s i o n : d e f i n i t i o n o f , in
D O B T , 21, 28, 32, 38
E ffe c tiv e n e s s , th e r a p e u tic , 1 -2 , 3;
a n d a n t h r o p o l o g i s t ’s v ie w , 1 4 5 -
1 4 7 ; a n d b e t w e e n - s e s s i o n ta s k s ,
2 1 8 ; a n d c h a n g e o f h ig h -o rd e r
c o n s tru c ts , 9 0 -9 1 ; a n d c lie n t m o ti­
v a tio n , 1 3 6 -1 3 7 ; a n d c o n s tru c ts
fro m c h ild h o o d a b u se , 2 3 2 -2 3 5 ;
a n d le n g th o f th e ra p y , 2 3 5 -2 3 6 ;
a n d s c h e d u lin g o f s e s s io n s , 1 3 6 ;
a n d s ta y in g o n p u r p o s e , 16 0 ; a n d
t h e r a p i s t ’s a s s u m p t i o n s , 3 , 3 4 ,
4 3 - 4 4 , 1 2 9 , 1 3 5 - 1 3 6 ( s e e a ls o
S t a n c e , t h e r a p i s t ’s ) ; b a s is o f , in
D O B T , ix , 2 1 , 1 2 9 ; f r o m w o r k i n g
w it h e m o t i o n a l a n d u n c o n s c i o u s
m e a n in g , 2 -4 , 1 8 -1 9 , 131, 134,
1 4 0 , 2 6 0 - 2 6 1 (s e e a ls o E m o t i o n a l
t r u t h o f t h e s y m p t o m ) ; i n f a m ily
t h e r a p y , 2 2 0 - 2 2 1 ; lo s s o f, b y a v o id ­
i n g e m o t i o n , 1 3 1 , 1 3 4 (s e e a ls o
E m o tio n : a n d th e r a p e u tic e ffe c ­
t i v e n e s s ) ; lo s s o f , b y f o c u s i n g o n
a n ti-s y m p to m p o s itio n , 2 0 6 -2 0 7 ;
lo s s o f, b y p r e m a t u r e e f f o r t to d is ­
p e l s y m p t o m s , 1 4 9 - 1 5 2 (s e e a ls o
F r e e d o m t o c l a r i f y ) ; lo s s o f ,
t h r o u g h “s t o p t h e s y m p t o m ” m e s ­
sag es, 34, 1 4 7 -1 4 9 ; m e th o d o lo g i­
c a l p r i o r i t i e s f o r , in D O B T , 2 0 - 2 2 ,
2 8 , 3 8 , 4 2 -4 3 , 2 0 0 ; o f im a g in a l
in te ra c tiv e te c h n iq u e s , 174; o f
p o s itio n w o rk , 70, 77; th e ra p is ts ’
b lo c k s to , 1 3 1 - 1 3 4
E f r a n .J . S ., l l n
E m o tio n : a n d th e r a p e u tic e ffe c tiv e ­
n ess, 2 -4 , 1 8 -1 9 , 131, 134, 140,
2 6 0 - 2 6 1 (se e a ls o E m o t i o n a l t r u t h
o f t h e s y m p t o m ) ; a t t e n d i n g to ,
1 3 4 - 1 3 5 , 1 4 1 - 1 4 2 ; d i s r e g a r d o f, in
c e rta in th e ra p ie s , 2 -3 , 4, 102, 134;
t h e r a p i s t ’s f e a r s o f , 1 3 2 , 1 3 3 - 1 3 4 .
See a lso M o d e s o f k n o w in g : e m o t i o n
E m o t i o n c o n s tr u c ts : a s k n o w in g s , 1 0 4 ,
1 0 7 -1 0 8
E m o tio n s c h e m e , 119
E m o t i o n th e o r y , 1 1 9
E m o tio n a l tr u th o f th e s y m p to m , 13,
21, 22, 31, 9 3 -1 2 3 , 127, 154, 170,
180, 186, 199, 203; accessed
th ro u g h th e b o d y , 1 9 8 -1 9 9 ; a n d
d e fin in g su c c e ssfu l o u tc o m e , 1 8 -
19; a n d i n n e r v o ic e s , 8 4 - 8 6 ; a n d
m u ltig lo b a l c o n s tru c tio n s , 2 3 2 ;
a n d r e s o lu tio n b e y o n d s y m p to m
r e l i e f , 3 7 - 3 8 , 8 9 (s e e a ls o R e s o l u ­
tio n o f p ro b le m s : b e y o n d sy m p ­
t o m r e l i e f ) ; a n d s y m p to m - p o s itiv e
c o n t e x t , 9 6 - 9 7 ; a s a lr e a d y e x is tin g ,
22, 33, 1 2 1 -1 2 2 ; as m essag e o f
s y m p to m , 148; a s r e q u ir in g e x p e -
r i e n t a l d is c o v e r y , 1 4 0 - 1 4 2 ; a s
s u p e r o r d i n a t e to t h e s y m p to m , 8 9 ;
as u n c o n s c io u s c o n s tru c ts , 3, 9 8 ,
2 4 6 - 2 4 7 ; b e n e f i t s o f w o r k i n g w ith
th e , 4 2 -4 3 , 140, 2 6 0 -2 6 1 ; case
e x a m p le s o f th e , 9, 14, 18, 2 6 -2 7 ,
30, 33, 45, 49, 58, 61, 7 4 -7 5 , 77,
130, 1 6 6 -1 6 7 , 170, 1 7 2 -1 7 3 , 177,
189, 2 0 7 -2 0 8 , 229, 232, 242, 246,
2 4 8 ; c l i e n t ’s d i f f i c u l t y e x p e r i e n c ­
in g , 2 3 1 - 2 3 2 ; d e f i n i t i o n o f , 9 8 ; in
r e p r e s e n ta tio n s o f th e p a s t, 199;
u s e d in d o u b l e b i n d , 3 3 - 3 4 ; v e r s u s
e m o tio n a lity , 9 8 . See a ls o P r o - s y m p ­
to m p o s itio n ; R e f r a m in g to th e
e m o tio n a l tr u th o f th e s y m p to m
E m o tio n a l w o u n d s , 5, 108, 161, 175,
195, 208, 211, 237, 257; as c o m p o ­
n e n t o f p r o - s y m p to m p o s i t i o n , 3 2 ,
4 2 ; a s s o c i a t i o n o f , w ith p r o t e c t i v e
a c tio n s , 17; c a se e x a m p le s o f, 17,
30, 32, 4 1 -9 1 , 95, 130, 185, 207,
2 1 1 -2 1 4 , 2 2 2 , 2 4 1 -2 4 9 , 2 5 2 -2 5 3 ;
c o n s tru c ts c o m p ris in g , 109, 2 3 4 ,
2 4 9 ; d i r e c t s y m p to m s o f , 4 2 ; e x p e -
r ie n tia lly a c c e s s e d b y c lie n t, 3 0 ,
7 2 -7 4 , 2 1 1 -2 1 4 , 2 4 1 -2 4 9 , 2 5 2 -
2 5 3 ; in c lu d e d v e rsu s e x c lu d e d ,

3 5 - 3 6 ; n o n lin g u is tic n a t u r e o f, 1 0 9 ,
2 3 7 , 2 4 9 ; tim e - e f f e c tiv e r e s o l u t i o n
o f, 4 1 - 9 1 ,1 3 5 - 1 3 6 ; tim e le s s n e s s o f,
4 1 ,2 0 8 (see a lso S y m p to m s : p r e s e n t-
ti m e b a s is o f ) . See a lso T r a u m a
E m p a th y , t h e r a p i s t ’s, x , 2 0 , 2 2 , 2 5 - 2 6 ,
38, 4 6 -4 7 , 96, 138, 139, 142, 146,
186, 206, 244; a n d a n th ro p o lo ­
g i s t ’s v ie w , 1 4 6 ; a n d e s t a b l i s h i n g
c o lla b o r a tio n , 1 5 9 -1 6 0 ; in s e r ia l
a c c e s s i n g , 1 7 1 . S ee a ls o R e l a t i o n ­
s h ip , c lie n t-th e ra p is t
E p i s t e m o l o g i c a l n a t u r e o f p s y c h o lo g ­
ic a l a c tiv ity , 6 , 1 0 3 - 1 0 8 , 2 0 4
E p is te m o lo g y , 1 1 3 ; a n d c o n s tr u c ­
tiv is m , 7 , 1 0 5 - 1 0 8 , 1 4 6 - 1 4 7 ; u n i ­
fie d , o f t h e p s y c h e , 9 4
E r ic k s o n , M ilto n , x i
E x p e rie n tia l d re a m w o rk , 174, 178
E x p e rie n tia l q u e s tio n in g , 1 6 1 -1 7 0 ,
183
E x p e rie n tia l q u e s tio n in g : e x a m p le s
o f, 1 6 2 -1 7 0 , 2 4 4 -2 4 6
E x p e r ie n tia l s h ift, 2 1 , 2 4 - 2 6 , 143,
173, 176, 193, 2 0 3 -2 5 7 ; a lte rn a ­
t i o n o f, a n d r a d ic a l in q u ir y , 8 7 , 8 9 ;
d e fin itio n o f, 2 0 -2 1 ; d is o r ie n ta ­
t i o n i n , 2 3 0 - 2 3 1 ; f o r lo w s e l f ­
e s te e m , 5 7 -5 8 , 6 8 -7 0 , 9 0 , 2 4 4 ,
2 5 0 - 2 5 6 (see a lso L o w s e l f - e s t e e m ) ;
p o s itio n w o rk ( im p o s itio n w o rk );
tr a n s f o r m a tio n o f p ro -s y m p to m
p o s i t i o n ( se e P r o - s y m p t o m p o s i ­
tio n : tr a n s f o r m a tio n o f; T ra n s fo r­
m a t i o n o f c o n s t r u c t s ) ; tw o s t a g e s
o f, 2 4 , 2 0 4 -2 0 5 , 2 5 6 -2 5 7
E x p e rie n tia l w o rk , 155, 198, 2 0 0 ;
a c c e s s in g u n c o n s c io u s c o n s tr u c ­
tio n s th r o u g h , 2 8 -3 0 , 6 0 , 6 8 -6 9 ,
7 2 -7 4 , 1 3 0 -1 3 1 , 1 4 0 -1 4 2 , 1 6 7 -
173, 189, 206, 207, 2 1 1 -2 1 4 ,
2 4 1 -2 4 3 , 2 4 4 -2 4 8 , 2 5 2 -2 5 4 ; e sse n ­
t ia l q u a l i t i e s a n d t e c h n i q u e o f ,
1 4 0 - 1 4 2 ; n e c e s s i t y o f , x i, 2 0 , 2 1 ,
3 1 ; t h e r a p i s t ’s p h r a s i n g i n , 1 4 2 ,
1 5 8 - 1 5 9 , 2 1 1 , 2 1 5 (s e e a ls o L a n ­
Index 277
g u a g e : t h e r a p i s t ’s u s e o f ) ; u n i v e r ­
s a l a p p l i c a b i l i t y o f, 1 4 4
F
F a i r b a i r n , W ., 6 7
F a m ilia r ity : lo s s o f , i n p o s i t i o n w o r k ,
2 3 1 -2 3 2 ; s u p e ro rd in a c y o f p re ­
s e rv in g , 2 3 1 -2 3 2 , 2 5 4
F a m ily s y s te m s t h e r a p y , x , 2 , 1 0 6 ; d is ­
re g a rd o f e m o tio n a n d th e u n c o n ­
s c io u s in , 2 - 3 , 4 , 1 0 2 ; f u n c tio n o f
t h e s y m p t o m in , 1 0 0 - 1 0 1
F a m ily t h e r a p y i n D O B T : c a s e e x a m ­
p l e o f, 2 2 2 - 2 3 0 ; c o n c e p t u a l i z a t i o n
o f, 1 0 0 -1 0 2 , 2 2 1 , 2 3 0 ; s u p e r o r d i­
n a t e c o n s t r u c t s in , 2 3 0
F e ix a s , G ., 1 2 n
F ir s t s e s s io n , 1 7 , 2 1 , 2 2 , 4 3 , 1 3 0 , 1 3 1 ,
2 5 9 ; c a se e x a m p le s o f, 1 7 -1 8 ,
2 9 - 3 7 , 4 2 - 6 3 , 6 4 - 6 5 , 1 4 2 ,1 6 6 - 1 6 7
F i r s t - o r d e r c h a n g e . See C h a n g e , firs t-
o rd e r
F is c h , R ., 1 2 n , 4 6 n
F it, p s y c h o lo g ic a l, 3 3 , 1 4 3 - 1 4 4 , 2 6 0
F o d o r , J . A ., 1 2 6 n
F o e r s te r , H . v o n , l l n
F o llo w in g c lie n t a little b it a h e a d ,
2 1 5 -2 1 6 , 2 4 3 -2 4 4 , 253
F o u r t h - o r d e r c h a n g e . See C h a n g e ,
fo u rth -o rd e r
F r e e d o m t o c la r if y , 1 4 7 - 1 5 4 , 1 5 5 ,
1 6 1 -1 6 2 , 200; a n d n o n p re o c c u p a ­
tio n w ith c h a n g e , 1 4 7 -1 4 9 ; a n d
p r e m a tu r e e ffo rts a t c h a n g e ,
1 4 7 -1 4 9 ; c a se e x a m p le o f, 1 4 9 -
1 5 2 . See a ls o S t a n c e , t h e r a p i s t ’s
F re n c h , G e ra ld , 2 1 7
F r e u d , S ., 6 6 , 1 0 0 , 1 3 9
F u g u e s ta te s , 1 0 3
F u n c t i o n o f t h e s y m p t o m : i n f a m ily
s y s te m s t h e o r y , 9 4 , 1 0 0 - 1 0 1 ; in
D O B T , 1 0 0 -1 0 1
G
G a z z a n ig a , M ic h a e l, 1 1 9 - 1 2 1
G e e r t z , C lif f o r d , 1 2 n
278 Index
G e rb o d e , F ra n k , 217
G e s t a l t t e c h n i q u e s , 1 7 3 , 1 9 8 , 2 3 9 . See
a ls o I m a g i n a l i n t e r a c t i v e t e c h ­
n iq u e s ; M in d -b o d y c o m m u n ic a ­
tio n te c h n iq u e
G la s e r s f e ld , E . v o n , 1 2 3 n
G o o s e in a b o t t l e , 5 , 10
G r e e n b e r g , L . S ., 1 2 4 n
G rie f: c a s e e x a m p le s o f, 1 3 0 - 1 3 1 , 1 8 5 ,
2 5 5 ; a n d re c o v e ry fro m a b u se ,
2 3 3 -2 3 5 , 255
G u i d a n o , V. F., 1 2 5 n
G u i d e d v i s u a l i z a t i o n , 1 7 4 . S ee a ls o
Im a g in a l in te ra c tiv e te c h n iq u e s ;
V is u a liz a tio n
H I n n e r d i a l o g u e , 1 0 8 , 19
H a le y ,J a y , l l n
H a n n a h , B a rb a ra , 2 0 In
H e ld , B a rb a ra , 1 2 n , 23
H e t e r o g e n e i t y o f e x p e r i e n t i a l re a lity ,
15, 9 4 -9 7 , 9 8 -9 9 , 102, 175; a n d
e p is te m o lo g y , 1 0 5 -1 0 8 ; s c ie n tific
c o r r o b o r a t i o n o f, 1 1 8 - 1 2 1
H i e r a r c h y o f c o n s t r u c t s . S ee C o n ­
s tr u c ts , h i e r a r c h y o f
H i n k l e , D . N ., 171
H is to ry , r e v is in g p e r s o n a l , 2 3 7 . See a lso
R e e n a c tm e n t
H is to r y ta k in g : c a s e e x a m p le s o f,
4 4 -4 6 , 49, 72, 8 2 -8 3 , 2 4 2 -2 4 3 ,
2 4 6 -2 4 7 ; c o n tr o lle d by th e ra p is t,
2 8 , 4 5 , 1 9 9 ; p u r p o s e o f, in D O B T ,
4 5 , 1 9 9 - 2 0 0 . See a lso P a s t
H o f f m a n , L y n n , 101
H o m e o s ta s is , 1 3 9
H o p e le s s n e s s , 6 5 , 8 0
H y p n o tic in d u c tio n , 2 6 0
I J u n g i a n t e c h n i q u e s , 1 7 3 . See a ls o
“ 1,” c o n s c io u s . See C o n s c i o u s “ I ”
Id e n tity : c h a n g e in , fro m p o s itio n
w o r k , 6 1 , 2 3 1 - 2 3 2 , 2 3 4 . See a ls o
C o n s tru c ts , f o u rth -o rd e r; O n to ­
lo g ic a l c h a n g e
I m a g e r y , 1 3 , 1 2 3 . See a ls o P r o - s y m p ­
to m p o s itio n : im a g e r y c o m p r i s i n g ;
V is u a liz a tio n
Im a g in a l in te ra c tiv e te c h n iq u e s ,
1 7 3 - 1 7 7 ; a t t e n d i n g to t h e r e s p o n s e
o f t h e im a g e , 1 7 3 , 1 7 5 - 1 7 7 ; a u t o n ­
o m y o f im a g e r y in , 1 7 4 ; c a s e e x a m ­
p le o f, 6 8 , 7 2 -7 3 , 7 5 , 7 6 , 8 2 -8 3 ,
130, 170, 173, 1 7 5 -1 7 7 , 191, 212,
216, 247, 252, 254, 2 5 5 -2 5 6 ; c o n ­
f r o n t i n g w ith e m o t i o n a l t r u t h in ,
7 2 -7 3 , 75, 8 2 -8 3 , 173, 176, 191,
2 1 6 , 2 5 5 -2 5 6 ; fo r c o n s c io u s -
u n c o n s c io u s c o m m u n ic a tio n , 174,
1 7 7 . See a lso V is u a liz a tio n
I n d e x c a r d . See B e tw e e n - s e s s io n ta s k s
I n n e r c h ild w o rk , 174, 2 3 8 , 2 3 9
I n s a n e : s y m p t o m v ie w e d a s , 2 8 , 2 9 ,
3 0 ,3 1 ,3 3 , 37
In te g ra tio n : o f u n c o n s c io u s c o n ­
s tru c ts , 2 5 , 5 3 , 6 9 , 173, 2 1 6 -2 1 7 ;
s t a b i l i t y o f , 2 1 8 . S ee a ls o P o s i t i o n
w o rk ; P o s itio n w o r k , t e c h n i q u e s o f
In te lle c tu a liz in g , 4 2 , 180, 195
I n t e n t i o n a l i t y , a c t i v e . S ee A c tiv e
in te n tio n a lity
I n t e n t i o n a l i t y , t h e r a p i s t ’s, 4 3 . See a ls o
A c tiv e i n t e n t i o n a l i t y
I n t e r p r e t a t i o n : a v o i d a n c e o f , in
D O B T , 20, 22, 31, 3 8 -3 9 , 58, 143,
144, 167, 174, 178, 188, 2 16, 230,
231
I n v itin g r e s is ta n c e , 1 8 3 , 1 8 5 - 1 9 4 ; c a s e
e x a m p l e o f, 1 8 6 - 1 9 4 . See a lso V ie w ­
in g f r o m a s y m p t o m - f r e e p o s i t i o n
j
J a c k s o n , D ., 1 I n
J u n g , C a r l, xi
Im a g in a l in te ra c tiv e te c h n iq u e s
K
K elly , G e o r g e , 7 , 1 2 n , 1 9 7
K in e s th e tic c o n s tr u c ts , 198; as n o n ­
v e rb a l p r e s u p p o s itio n s , 110; as

k n o w in g s , 1 0 4 , 1 0 7 -1 0 8 ; c a s e
e x a m p le s o f, 5 4 , 5 6 , 6 2 ; c o m p r is ­
in g u n re s o lv e d tra u m a , 2 3 7
K n o w in g : a n d c o n s c io u s “ I ,” 1 0 2 - 1 0 8 ;
a s n a t u r e o f a ll p s y c h o l o g i c a l
a c tiv ity , 1 0 3 - 1 0 8 ; p r e v e r b a l , 1 1 0 ;
u n c o n s c i o u s (s e e U n c o n s c i o u s
k n o w in g )
K n o w in g , m o d e s o f, 1 0 2 - 1 0 8 ; c o g n i ­
tiv e , 1 0 1 , 1 0 7 , 108; e m o t i o n a l , 1 0 1 ,
1 0 7 -1 0 8 ; k in e s th e tic , 1 0 7 -1 0 8 ;
p a rity o f a ffe c t a n d c o g n itio n as,
119; s o m e s th e tic , 1 0 7 -1 0 8
K r a u s e , I n g a - B r itt, 2 , 1 I n
L p ro je c tio n , 1 9 7 -1 9 8 ; as fo rm in g
L a d d e r i n g , 171
L a in g , R . D ., x i, 101
L a n g u a g e : c l i e n t ’s u s e o f , 1 4 5 - 1 4 7 ;
o v e re s tim a tio n o f ro le o f, 7 -8 ,
1 0 6 - 1 0 8 ; t h e r a p i s t ’s u s e o f , 5 8 , 9 3 ,
1 4 2 , 1 5 8 - 1 5 9 , 2 1 1 , 2 1 5 (s e e a ls o
E x p e r i e n t i a l w o r k : t h e r a p i s t ’s
p h r a s i n g i n ) ; s e c o n d a r y r o l e o f, in
e m o tio n a l w o u n d s, 109, 2 3 7 , 249
L e n g t h o f th e r a p y , 4 2 - 4 3 , 2 3 2 - 2 3 6
L e t t e r w r itin g , 2 1 7 , 2 5 6
L e v e r a g e , t h e r a p e u t i c , 2 6 0 . S ee a ls o
E f f e c tiv e n e s s , t h e r a p e u t i c
L in k a g e o f c o n s t r u c t s . ^ C o n s t r u c t s ,
lin k a g e o f; s e r ia l a c c e s s in g
L io tti, G ., 1 2 5 n
L ip c h ik , E ., I I n
L o g ic a l ty p e s o f c h a n g e . See B a te s o n ,
G re g o ry : a n d lo g ic a l ty p e s o f
ch an g e; O rd e rs o f ch a n g e
L o ss: c a s e e x a m p l e s o f, 1 3 0 , 2 3 1 - 2 3 2 ;
o f f a m ilia r r e a lity in p o s itio n w o rk ,
2 1 7 ,2 3 1 -2 3 2
L o s t c a u s e : c o n s t r u a l o f, a s p r o t e c t i v e
a c t i o n , 61
L ow s e ll-e s te e m , 4, 17, 4 5 -4 6 ; c a se
e x a m p le s o f, 4 2 -6 3 , 8 9 -9 0 , 1 8 3 -
184, 2 0 7 , 2 4 0 - 2 5 6 ; c o n s t r u c t s c o m ­
p ris in g , 6 1 , 6 7 -6 8 , 8 9 - 9 0 , 112,
2 3 2 -2 3 5 , 2 5 3 ; e x p e r ie n tia l s h ifts
Index 279
fo r d is p e llin g , 6 7 -6 9 , 9 0 , 2 5 4 -2 5 5 ;
u n c o n s c io u s p u rp o s e s m a in ta in ­
i n g , 2 3 2 - 2 5 3 (s e e a ls o S h r i n k i n g
p a r e n t e f f e c t)
L u c k m a n , T ., 1 2 n
L u k e n s , M . D ., 1 I n
L u k e n s , R .J ., 1 I n
L y d d o n , W illia m J., 5 , l l n , 1 2 n
M
M a h o n e y , M ic h a e l J . , 3 , 5 , 1 I n , 1 0 3
M a n ic a c tiv ity , 4 , 1 7 , 1 3 0 - 1 3 1
M a tu ra n a , H u m b e r to , 103, 1 5 7 n
M e a n in g , 22 , 142, 147, 2 0 5 ; a n d
o rd e rs o f p o s itio n , 123; a n d
e x p e r i e n t i a l r e a lity , 7 , 1 1 , 1 4 , 9 7 ;
fo rm e d d u rin g tra u m a , 7 -8 , 218;
t h e n e e d to c o n s t r u c t , 16; g a in o f,
2 6 1 ; id io s y n c ra tic n a tu r e o f,
1 4 4 - 1 4 7 ; in p r o - s y m p to m p o s itio n ,
2 4 , 3 1 , 3 8 , 1 2 9 -1 3 0 , 142; lin k e d
e l e m e n t s o f , in p r o - s y m p to m p o s i­
tio n , 1 7 0 -1 7 2 ; m o d u la r o rg a n iz a ­
tio n o f, 1 19; m u ltip le , 9 4 -9 7 ; n o t
b a s e d in l a n g u a g e , x , 7 - 8 , 1 0 6 -
108, 109, 2 3 7 , 2 4 9 ; o f d re a m s , 178;
o f s y m p t o m s (s e e A n t i - s y m p t o m
p o s itio n : m e a n i n g o f s y m p to m s in ;
E m o tio n a l tr u th o f th e s y m p to m ;
R e fra m in g to th e e m o tio n a l tr u th
o f th e s y m p to m ; P ro -s y m p to m
p o s itio n : m e a n in g o f s y m p to m s
i n ) ; p r e s u p p o s i t i o n s o f (s e e P r e ­
s u p p o s i t i o n s ) ; s o u r c e o f, in D O B T ,
13, 3 3 , 1 4 3 , 1 5 5 ; u n c o n s c i o u s c o n ­
s t r u c t i o n s o f, 5 , 16, 2 4 , 9 4 , 9 5 , 9 6 ,
1 4 5 - 1 4 6 , 2 2 1 . S ee a ls o E c o l o g y o f
m e a n in g s
M e m o ry , 14, 1 99, 2 1 8 ; a c c e s s in g
u n c o n s c io u s tra u m a tic , 2 1 7 -2 1 8 ;
e m o tio n a l, 110, 145; p e rc e p tu a l,
109, 110, 145; p r o te c tiv e a c tio n s
a g a in s t, in a b u s e , 1 3 4 -1 3 5 ; s o m a tic ,
42, 109, 110
M e n ta l R e s e a r c h I n s t i t u t e , 15, 1 4 8
280 Index
M e th o d o lo g y : a lte r n a tio n o f ra d ic a l
i n q u i r y a n d e x p e r i e n t i a l s h if t, 8 7 ,
9 0 ; a n d f a m ily th e r a p y , 1 0 2 ; o f d is ­
c o v e r y , 2 0 - 2 2 , 1 2 7 - 1 5 5 ( s e e a ls o
R a d ic a l in q u ir y ) ; o f e x p e r ie n tia l
s h ift, 2 0 , 2 4 , 2 0 3 -2 5 7 ; o v e ra ll,
2 0 -2 2 , 24, 38, 60, 259
M in d -b o d y c o m m u n ic a tio n te c h ­
n iq u e , 1 9 8 -1 9 9 ; c a se e x a m p le o f,
2 4 6 -2 4 7 ; p r o c e d u r e o f, 1 9 8 -1 9 9
M o d u la rity o f p s y c h o lo g ic a l p ro c e s s ,
1 1 9 -1 2 0
M o le s te d c h ild , 2 5 0
M o n ta lv o , B ., 2 5 7
M o re o f th e sa m e , 148, 2 06
M o tiv a tio n , c lie n t, 13 9 , 154; a n d
m u ltig lo b a l c o n s tru c tio n s , 2 3 4 ; as
d e f in in g s c o p e o f th e ra p y , 3 5 -3 6 ;
f o r c r e a t i n g t h e p r o - s y m p to m p o s i­
t io n , 2 0 8 ; n e c e s s ity o f, 1 3 6 - 1 3 7 (see
a lso P o w e r le s s n e s s , t h e r a p i s t ’s )
M u ltig lo b a l c o n s tr u c tio n s , 2 3 2 -2 3 6 ;
a n d c h a r a c te r d is o rd e r, 2 3 6 ; a n d
le n g th o f th e ra p y , 2 3 2 -2 3 6
M u ltip le p e rs o n a lity d is o rd e r, 1 03
M u s k d e e r , 13
N P a ra d o x ic a l in te r v e n tio n , 7 7
N a rra tiv e th e r a p ie s , x , 106; c o n c e p t
o f p o s i t i o n in , 1 5
N e im e y e r , R o b e r t A ., 5 , l l n , 1 4 6
N e is s e r , U ., 1 2 6 n
N e u ro -lin g u is tic p ro g r a m m in g , 167
N e u r o m u s c u la r re le a s e , 2 3 7 -2 3 8
O H is t o r y t a k i n g
O b j e c t r e l a t i o n s th e r a p y , x , 6 7
O b je c tiv is t p e r s p e c t i v e , 1 0 0 ,1 4 3 ; a n d
c a u s e o f s y m p to m s , 7 , 1 2 8 -1 2 9 ;
l i m i t s o f , 1 7 2 ; “c o r r e c t ” v ie w o f
r e a lity , 6
O b s e s s in g , 14, 17, 2 9 , 4 2 , 1 67, 211
O g d en , T hom as, 24
O ’H a n l o n , W illia m , 1 4 4 , 2 3 5
O n t o l o g i c a l c h a n g e : c a s e e x a m p l e o f,
3 7 ,1 7 3 , 177; a n d e m o tio n a l tr u th .
3 7 , 1 2 1 , 2 1 7 . S ee a ls o C h a n g e ,
f o u r th - o r d e r ; L o w s e lf-e s te e m :
c o n s t r u c t s c o m p r i s i n g ; S e lf - w o r th :
enhancem ent of
O n t o l o g y , 1 1 2 . See a ls o C o n s t r u c t s ,
f o u r th - o r d e r ; C o n s tr u c ts , fifth -
o rd e r; C o n s tru c ts , s ix th -o rd e r;
O n to lo g ic a l c h a n g e
O r d e r s o f c h a n g e . See C h a n g e , o r d e r s
of
O rd e rs o f p o s itio n , 1 1 4 -1 1 7 , 118,
1 7 0 - 1 7 1 ; c a s e e x a m p l e o f, 8 9 ; p a t ­
t e r n s t r u c t u r i n g t h e , 1 2 2 . See a ls o
C o n s tru c ts , h ie ra rc h y o f
O u tc o m e , s u c c e s s fu l: c h a n g e in
c l i e n t ’s c o n c e p t o f , 1 8 , 2 6 ; e t h i c s
o f d e f in in g , 19; in d ir e c t r e s o lu ­
t i o n , 2 6 ; in r e v e r s e r e s o l u t i o n , 2 6 ;
p r o c e s s o f d e f i n i n g , 1 8 - 1 9 . See a lso
R e s o lu tio n o f p ro b le m s : b e y o n d
s y m p to m r e lie f
O u t c o m e , v e r if ia b le , 1 8
O v e rt s ta te m e n t o f p o s itio n , 52 , 5 6 ,
2 1 0 -2 1 4 , 2 4 7 -2 4 8 , 2 5 4 -2 5 5
P
P a n i c a tta c k s , 4 . See a ls o A g o r a p h o b i a
P a ra lle l d is tr ib u te d p ro c e s s in g , 119
P a ra n o ia , 29
P a s t: r o l e o f t h e , i n D O B T , 1 2 8 - 1 2 9 ,
1 9 9 -2 0 0 ; a s e x is tin g in p r e s e n t
c o n s tru c ts , 4 , 7, 14, 4 1 , 4 4 -4 5 , 4 7 ,
4 9 , 8 5 -8 6 , 1 0 9 ,1 2 8 -1 2 9 ,1 9 9 -2 0 0 ,
2 0 8 , 2 1 0 , 2 1 3 - 2 1 4 , 2 4 7 . S ee a ls o
P e a r c e , W . B ., 1 2 n
P e rc e p tio n , 14; a n d p re s u p p o s itio n s ,
9
P e r is , F r itz , x i, 2 0 1 n
P e r s o n a l c o n s tr u c t p s y c h o lo g y , 1 9 8 .
See a ls o K e lly , G e o r g e
P h e n o m e n o lo g ic a l w o rk , 155, 1 6 1 -
162, 167, 2 0 0 , 2 3 9 ; c a se e x a m p le
o f, 1 6 7 -1 7 0 ; d e f in in g f e a tu r e s o f,
22

P ia g e t, J . , 1 2 6 n , 2 3 6
P la n s , u n c o n s c i o u s , 6 7 , 6 9 , 7 0 - 7 1 , 8 8 ,
164, 179, 185
P o litic a l o p p r e s s i o n , 8
P o s itio n : c o n c e p t o f, in v a r io u s t h e r a ­
p ie s , 1 4 -1 5 ; d e f in itio n o f, 1 3 -1 4 ;
e x a m p l e o f, 14. See a lso P o s itio n s
P o s itio n c h a r t , 1 1 4 - 1 1 7 , 1 2 1 - 1 2 2 , 171
P o s itio n w o r k , 2 5 , 1 9 3 , 2 0 5 - 2 3 2 , 2 3 6 ,
2 4 1 ; a n d c h a n g e in s e l f - c o n c e p t ,
2 3 1 -2 3 2 ; a n d c lie n t as c r e a to r o f
s y m p to m , 3 3 - 3 4 , 5 8 , 6 1 - 6 2 , 6 7 - 6 9 ,
9 0 , 9 9 , 2 5 6 - 2 5 7 , 2 6 0 ; a n d lo s s o f
f a m ilia r re a lity , 2 3 1 - 2 3 2 ; a n d p r o b ­
le m r e s o lu tio n , 18, 2 5 , 2 0 5 ; a n d
r e e n a c t m e n t , 2 3 7 - 2 3 8 ; a s a c c e s s to
p r o - s y m p to m c o n s t r u c t s , 2 0 6 , 2 0 7 ;
as a n e x p e r ie n tia l s h ift, 2 0 5 , 2 0 9 ,
2 5 6 ; as r e f r a m in g to e m o tio n a l
t r u t h o f t h e s y m p to m , 3 1 , 3 3 , 2 0 5 ;
b e t w e e n - s e s s i o n ta s k s o f (se e P o s i­
t i o n w o r k , b e t w e e n - s e s s i o n ta s k s
o f); c a se e x a m p le s o f, 3 0 -3 7 , 5 2 -
63, 56, 58, 61, 62, 6 8 -7 0 , 7 7 -7 8 ,
90 , 110, 185, 1 8 9 -1 9 0 , 1 9 2 -1 9 4 ,
2 0 7 -2 0 8 , 2 1 1 -2 1 4 , 2 1 5 -2 1 6 , 2 3 1 -
2 3 2 , 2 4 3 -2 4 4 , 2 5 0 , 252; c o n tra s te d
w ith r a d ic a l in q u ir y , 2 0 5 - 2 0 6 , 2 1 6 -
2 1 7 ; d e fin itio n o f, 24, 2 0 4 -2 0 5 ,
2 5 6 ; d if f i c u l t y o f , f o r c l i e n t , 2 3 1 -
2 3 2 ; f o r lo w s e lf - e s te e m , 5 2 , 5 3 - 5 4 ,
5 5 -5 8 , 61, 6 8 -7 0 , 90, 2 1 5 -2 1 6 ,
2 5 0 , 2 5 3 - 2 5 4 (s e e a ls o L o w s e l f ­
e s t e e m ) ; g o a l o f , 2 0 9 ; in c o u p l e
a n d f a m ily t h e r a p y , 2 5 , 2 2 0 - 2 3 0 ,
2 4 3 - 2 4 4 ; in f i r s t s e s s i o n , 3 0 - 3 7 ,
5 2 -6 3 ; p o te n c y o f, 2 0 6 ; p r in c ip le
o f , 2 0 7 ; p r o / a n t i s y n t h e s i s in , 2 5 ,
2 0 9 , 2 5 4 -2 5 5 ; re p e a tin g , 2 1 8 -2 1 9 ;
s t a y i n g in e m o t i o n a l t r u t h w ith
c l i e n t in , 1 3 3 - 1 3 4 , 2 0 7 ; t e c h n i q u e s
o f, 2 0 8 - 2 2 0 ( see a lso P o s itio n w o r k ,
b e t w e e n - s e s s i o n ta s k s o f ; P o s i t i o n
w o rk , te c h n iq u e s o f); tra n s itio n a l
p e r io d in , 2 1 8 -2 1 9 ; u s in g c lie n t-
t h e r a p i s t r e l a t i o n s h i p , 5 3 ; w ith
Index 281
c lie n t re s is ta n c e , 1 9 5 -1 9 7 , 2 1 7 ;
w ith p r o - s y m p to m p o s itio n f o r m e d
in t r a u m a , 2 1 7 - 2 1 8 . S ee a ls o
R e f r a m i n g to t h e e m o t i o n a l t r u t h
o f th e s y m p to m
P o s i t i o n w o r k , b e t w e e n - s e s s i o n ta s k s
o f, 2 0 9 , 2 1 7 , 2 1 8 -2 2 0 ; a c c e s s in g
e m o t i o n a l t r u t h , 7 7 - 7 8 ; d a ily
re v ie w , 2 1 9 ; i n d e x c a r d c a s e e x a m ­
p le s , 7 0 , 7 4 - 7 6 , 7 8 , 8 3 , 1 8 5 , 2 5 0 ,
2 5 5 ; in d e x c a rd p ro c e d u r e , 2 19;
u s in g s y m p to m as s ig n a l c a se
e x a m p le , 3 3 -3 4 , 2 5 5 ; u s in g sy m p ­
to m a s s ig n a l p r o c e d u r e , 2 1 9 - 2 2 0
P o s itio n w o rk , te c h n iq u e s o f, 2 0 9 ;
c o n f r o n t i n g w ith e m o t i o n a l t r u t h ,
8 2 - 8 3 , 2 1 6 - 2 1 7 ; c y c lin g in a n d o u t
o f s y m p to m -fre e p o s itio n , 2 1 4 -
2 1 5 , 2 5 3 - 2 5 4 ; f o llo w in g c l i e n t a lit­
tle b it a h e a d , 2 1 5 - 2 1 6 , 2 4 3 - 2 4 4 ,
2 5 3 ; o v e rt s ta te m e n t o f p o s itio n ,
52, 56, 2 1 0 -2 1 4 , 2 4 7 -2 4 8 , 2 5 4 -
2 5 5 ; tra u m a tic in c id e n t r e d u c tio n ,
2 1 7 - 2 1 8 ; tr ia l s e n t e n c e , 5 2 , 5 6 , 7 5 ,
231
P o s itio n s , 1 3 -2 0 ; c o m p o n e n ts o f,
1 0 8 - 1 1 3 ; c o n g r u e n c e o f (se e C o n ­
g r u e n c e o f p o s itio n s ); d ia le c tic
a m o n g , 106; o rg a n iz a tio n o f c o n ­
s t r u c t s w ith in , 41 (see a lso P o s itio n ;
P ro -s y m p to m p o s itio n : o r g a n iz a ­
ti o n o f c o n s t r u c t s w i t h i n )
P o s n e r , M . I., 1 2 6 n
P o s t-tra u m a tic s tre s s d is o rd e r,
2 1 7 -2 1 8
P o v e rty , 8
P o w e r l e s s n e s s , t h e r a p i s t ’s, 1 3 6 - 1 3 7 ,
1 5 4 . S ee a ls o M o t i v a t i o n , c l i e n t ;
S t a n c e , t h e r a p i s t ’s
P re d e te r m in e d e x p la n a to ry c o n te n t,
23
P r e s u p p o s itio n s , 1 3 , 1 4 , 1 0 9 , 1 1 0 - 1 1 3 ,
161, 195, 196, 201, 257; a n d
p e r c e p t i o n , 9 , 1 4 6 ; a r e a s o f k n o w l­
e d g e s t r u c t u r e d by, 1 1 2 -1 1 3 ;
as c o m p o n e n t o f p ro -s y m p to m
282 Index
p o s itio n , 32; c a se e x a m p le s o f, 14,
1 7 ,3 1 -3 2 , 9 6 , 111, 1 8 1 -1 8 3 , 2 4 9 ,
2 5 1 ; d e f i n i t i o n o f, 1 1 0 , 1 1 2 ; n o n ­
v e rb a l, 10 9 , 1 1 0 -1 1 1 , 2 4 9 ; o n to ­
lo g ic a l, 3 2 ; s tr a te g ic , 1 1 1 -1 1 2 ;
tra n s fo rm a tio n o f, 1 1 1 -1 1 2 ,
2 5 1 -2 5 2
P r i o r i t i e s , t h e r a p i s t ’s, 2 0 - 2 2 , 2 8 , 6 0 .
See a lso E f f e c tiv e s e s s io n
P r io r itie s , u n c o n s c i o u s , 2 5 - 2 6 , 6 7 - 6 8 ,
96
P r o / a n t i s y n th e s is , 2 5 , 2 0 8 , 2 1 5 , 2 1 6 ,
2 1 8 , 2 1 9 ; c a s e e x a m p l e s o f, 2 5 , 3 0 ,
58, 214, 2 1 5 -2 1 6 , 231, 244,
2 5 4 -2 5 5 ; d e f in itio n o f, 2 5 , 2 0 9 ,
2 5 6 -2 5 7
P r o b l e m s . See S y m p to m s
P r o c r a s tin a tio n : c a s e e x a m p le o f,
1 7 -1 8 , 6 4 ,1 0 3 -1 0 4
P ro je c tio n , 1 9 7 -1 9 8
P r o - s y m p to m p o s i t i o n , 1 6 - 2 0 , 2 2 , 2 9 ,
127, 144, 152, 159, 170, 171, 186,
1 9 0 , 1 9 8 , 2 0 4 , 2 1 5 ; a g e o f c l i e n t in ,
2 0 8 , 2 4 7 ; a n d b r a in m o d u la rity ,
1 1 8 -1 2 0 ; a n d c o n c e p t o f se c ­
o n d a r y g a in , 9 9 -1 0 0 ; a n d h is to ry
ta k in g , 199; a n d in n e r c h ild ,
2 3 8 -2 3 9 ; a n d s y m p to m -p o s itiv e
c o n te x t, 9 6 -9 7 ; as c e n tra l fo c u s o f
D O B T , 16, 21, 129, 200; as e m o ­
tio n a lly g o v e r n i n g p o s itio n , 1 9 , 3 6 ,
2 0 7 , 2 6 0 ; a s f o c u s o f b e tw e e n - s e s -
s io n ta s k s , 2 1 8 ; a s f o c u s o f f ir s t s e s ­
s io n , 2 7 ; a s in d if f e r e n t to p a in o f
s y m p to m , 19, 6 8 ; a s s e e k in g c o n ­
s c io u s a t t e n t i o n , 1 7 9 ; a s s o u r c e o f
c l i e n t r e s is ta n c e , 5 2 , 1 8 2 , 1 8 5 - 1 8 6 ,
188; as u n c o n s c io u s m o d e l o f re a l­
ity , 1 6 ; a u t o n o m y o f , 9 8 - 9 9 ; c a s e
e x a m p le s o f, 1 6 -1 7 , 1 7 -1 8 , 2 4 , 3 6 ,
49, 52, 5 6 -5 8 , 61, 64, 67, 116,
1 3 0 -1 3 1 , 165, 168, 185, 1 8 9 -1 9 0 ,
2 1 1 , 2 1 3 , 2 3 1 , 2 4 1 , 2 4 5 ; c l i e n t ’s
re a liz a tio n o f c re a tin g , 2 0 8 ; c o h e r ­
e n c e o f s y m p to m w ith in , 1 6 -2 0 ,
62 , 9 3 -9 4 , 9 7 , 121, 1 3 7 -1 4 0 , 252;
c o m p o n e n t s o f, 1 6 - 1 7 , 3 2 , 4 2 , 1 0 3 ,
1 0 8 - 1 1 3 ; d e f i n i t i o n o f, 1 6 , 9 8 , 9 9 ;
d iffic u lt a s p e c ts o f n e w a w a re n e s s
o f , 2 3 1 - 2 3 2 ; d is c o v e r y o f ( see R a d i­
cal in q u iry ); d is p la c e m e n t o f c o n ­
s c io u s p o s itio n by, 1 0 2 -1 0 3 ,
1 0 4 - 1 0 5 ; im a g e r y c o m p r is in g , 2 5 1 ;
in c o u p l e a n d f a m i l y t h e r a p y ,
2 2 0 - 2 3 0 , 2 4 0 - 2 4 1 , 2 4 2 ; in e c o lo g y
o f m e a n i n g s , 2 4 0 - 2 4 1 ; in lo w s e lf ­
e s te e m , 4 1 , 4 7 -4 9 , 5 2 -6 2 , 6 7 , 6 8 ,
6 9 , 9 0 , 2 4 4 , 2 5 0 - 2 5 1 , 2 5 4 (se e a ls o
L o w s e lf - e s te e m ) ; in p o s itio n
c h a r t, 115; in te g r a tio n o f, 2 4 , 25 ,
5 7 , 2 0 4 - 2 3 6 ( see a ls o P o s i t i o n
w o rk ); m e a n in g o f s y m p to m s in ,
16; m u ltip le , 8 7 -8 8 , 100; o r g a n i­
z a tio n o f c o n s tru c ts w ith in , 9 0 -9 1 ,
1 1 3 -1 1 8 ; p e rs o n ify in g o f, 99;
r e t u r n to u n c o n s c io u s n e s s o f,
2 1 8 -2 1 9 ; s c ie n tific c o r r o b o r a tio n
o f, 1 1 8 - 1 2 1 ; s h o r t e s t p a t h to f i n d ­
in g , 1 3 8 ,1 3 9 -1 4 0 , 152, 1 5 8 -1 5 9 ;
th e m a tic n a tu r e o f, 9 9 ; tim e le s s
r e a l i t y i n , 4 1 , 2 0 8 , 2 4 7 ( s e e a ls o
P a s t: a s e x i s t i n g i n p r e s e n t c o n ­
s tru c ts ); tra n s fo rm a tio n o f, 2 4 ,
3 2 -3 3 , 3 7 , 5 7 , 7 9 ,8 0 , 8 1 ,1 1 1 -1 1 2 ,
1 8 5 , 2 0 5 , 2 3 6 - 2 5 6 , 2 5 7 ( s e e a ls o
P r o - s y m p to m p o s i t i o n , t e c h n i q u e s
o f t r a n s f o r m a t i o n o f ) ; u b i q u i t y o f,
3 8 . See a ls o E m o t i o n a l t r u t h o f t h e
s y m p to m
P r o - s y m p to m p o s i t i o n , t e c h n i q u e s o f
tr a n s f o r m a tio n o f: c o n s tr u c t s u b ­
s titu tio n , 75, 2 3 9 , 2 4 9 , 2 5 1 -2 5 2 ;
c r e a tin g c o n n e c tio n s b e tw e e n
p o s itio n s , 2 3 8 -2 3 9 ; r e e n a c tm e n t,
2 3 7 -2 3 8 , 2 5 5 -2 5 6
P ro te c tiv e a c tio n s , 1 09, 161, 175;
a g a in s t m e m o ry o f a b u s e , 1 3 4 -
135; a n d re s is ta n c e , 1 86, 194; as
c o m p o n e n t o f p r o - s y m p t o m p o s i­
tio n , 14, 42; as p r e s e n tin g sy m p ­
t o m s , 1 7 , 4 2 ; a s s o c i a t i o n o f , w ith
e m o tio n a l w o u n d s, 17, 4 2 , 44,

4 7 -5 2 , 5 7 -5 8 , 59, 6 1 -6 3 , 6 7 -6 8 ,
72, 78, 1 6 6 -1 6 7 , 175, 177, 2 1 0 ,
2 4 5 -2 4 6 , 2 5 3 -2 5 4 ; c a se e x a m p le s
o f, 17, 18, 3 2 , 4 9 , 5 8 - 5 9 , 6 1 , 7 2 , 7 8 ,
88 , 1 0 9 -1 1 0 , 130, 168, 175, 2 2 2 ,
2 4 5 , 2 5 4 ; d e f i n i t i o n o f, 17, 1 0 9 ; in
lo w s e l f - e s t e e m , 4 9 , 2 3 2 - 2 3 5 (s e e
a lso L o w s e lf - e s te e m ) ; in r e p e t i t i o n
c o m p u ls io n , 66
P s y c h o d y n a m ic th e r a p y , x , 1, 3 4 , 1 3 4
P s y c h o g e n ic p a in , 5, 14, 1 4 3 -1 3 5 ;
c a s e e x a m p l e s o f, 4 2 - 6 3 , 1 0 7 - 1 0 8 ;
u tiliz in g , fo r r a d ic a l in q u iry ,
1 9 8 - 1 9 9 . S ee a ls o P s y c h o s o m a t i c
s y m p to m s
P s y c h o n e u r o l o g y . See C o g n i t i v e n e u ­
ro s c ie n c e
P s y c h o s o m a tic s y m p to m s : c a s e e x a m ­
p le s o f, 130; u tiliz in g , f o r r a d ic a l
i n q u i r y , 1 9 8 - 1 9 9 . S ee a ls o P s y ­
c h o g e n ic p a in
P s y c h o th e r a p y , d e f i n i t i o n o f, 2 0 4
P u rp o s e , u n c o n s c io u s , 121; c a se
e x a m p l e s o f, 2 8 , 3 3 , 4 7 , 6 1 , 6 2 - 6 3 ,
6 7 , 6 9 , 9 0 , 1 7 9 ; in lo w s e lf - e s te e m ,
2 3 2 - 2 3 5 (see a lso L o w s e lf - e s te e m ) .
See a ls o C o n s t r u c t s , t h i r d - o r d e r ;
S tr a t e g i c c o n s t r u c t s
Q e n c e , 1 3 7 - 1 4 0 , 1 5 5 , 2 5 2 (s e e a ls o
Q u e s t i o n s , e x p e r i e n t i a l . S ee R a d i c a l
i n q u i r y , t e c h n i q u e s o f: e x p e r i e n ­
tia l q u e s t i o n s
R 1 8 8 , 2 0 0 (s e e a ls o E x p e r i e n t i a l
R a d ic a l in q u iry , 2 0 , 2 1 , 2 2 - 2 4 , 2 9 ,
143, 1 5 7 -2 0 0 , 2 0 4 , 2 1 0 , 2 1 1 ,2 3 1 ,
2 4 1 ; a l t e r n a t i o n o f, a n d e x p e r i e n ­
tia l s h if t, 8 7 , 9 0 ; a s c la r ity s e e k i n g ,
3 2 , 1 4 - 4 6 (see a lso F r e e d o m to c la r ­
ify ); c a s e e x a m p l e s o f, 8 - 9 , 2 2 - 2 4 ,
2 8 -3 2 , 47, 49, 6 4 -6 6 , 68, 70, 130,
1 5 0 -1 5 2 , 1 6 2 -1 7 0 , 1 8 0 -1 9 4 , 2 4 1 -
2 4 2 , 2 4 1 - 2 4 7 , 2 5 2 - 2 5 3 ; c l i e n t ’s
e x p e r i e n c e o f, 1 3 6 , 2 0 5 - 2 0 6 ; c o n ­
t r a s t e d w ith p o s i t i o n w o r k , 2 0 5 -
Index 283
2 0 6 , 2 1 6 -2 1 7 ; c r e a tin g c o lla b o ra ­
t io n fo r, 1 5 9 - 1 6 1 ; d e f i n i t i o n o f, 2 0 ,
22; d ire c tio n a lity o f, 8 6 , 152,
1 5 3 -1 5 4 , 1 5 7 ; d is c o v e ry v e rs u s
in v e n tio n in , 2 2 , 3 3 , 1 2 1 -1 2 2 ;
e x a m p l e o f , in c o u p l e s t h e r a p y ,
2 2 - 2 4 , 2 4 1 - 2 4 7 , 2 5 2 - 2 5 3 ; f o r te s t­
i n g t h e r a p i s t ’s h y p o t h e s e s , 6 5 , 6 6 ;
g o a l o f, 9 3 - 9 4 , 1 2 7 , 2 0 0 , 2 0 5 - 2 0 6 ;
i n t o c l i e n t r e s is ta n c e , 5 2 , 1 8 5 - 1 9 6 ,
2 1 7 ; i n t o i n n e r v o ic e s , 8 4 - 8 6 ; i n t o
p r o - s y m p t o m p o s i t i o n f o r m e d in
t r a u m a , 2 1 7 - 2 1 8 ; s h o r t e s t p a t h o f,
1 3 8 , 1 3 9 - 1 4 0 , 1 5 2 , 1 5 8 - 1 5 9 ; s ig n s
o f c o m p le tio n o f, 3 3 , 154; th e ra ­
p i s t ’s b l o c k s t o , 1 3 3 - 1 3 4 ; t h e r a ­
p i s t ’s s t a n c e fo r, 1 2 7 -1 5 5 ;
t r u s t - b u i l d i n g e f f e c t o f , 1 3 6 ; w ith
h ig h ly v u l n e r a b l e c l i e n t , 1 6 0 - 1 6 1 ;
w ith s u r v iv o r s o f a b u s e , 1 3 4 - 1 3 5
R a d ic a l in q u iry , d e f in in g f e a tu r e s
o f: a c tiv e i n t e n t i o n a l i t y , 1 3 1 - 1 3 6 ,
1 5 4 , 1 7 0 , 1 8 0 , 2 0 0 (s e e a ls o A c tiv e
in te n tio n a lity ) ; a c c e s s ib le u n c o n ­
s c i o u s , 1 2 8 - 1 3 1 , 1 5 4 ( s e e a ls o
A c c e s s ib ility o f u n c o n s c i o u s c o n ­
s t r u c t s ) ; a n t h r o p o l o g i s t ’s v ie w ,
1 4 4 - 1 4 7 , 1 5 5 (see a lso A n t h r o p o l o ­
g i s t ’s v ie w ) ; a s s u m p t i o n o f c o h e r ­
C o h e r e n c e ) ; c e n tra l q u e s tio n a n d
th r e e v a ria n ts , 2 8 , 138, 1 3 9 -1 4 0 ,
1 5 8 -1 5 9 ; e x p e rie n tia l, 22, 23, 28,
3 8 -3 9 , 1 4 0 -1 4 4 , 155, 170, 174,
w o r k ) ; f r e e d o m to cla rify , 1 4 7 - 1 5 4 ,
1 5 5 , 1 6 1 - 1 6 2 , 2 0 0 ( s e e a ls o F r e e ­
d o m t o c l a r i f y ) ; li s t o f , 1 2 7 - 1 2 8 ;
n o n a g g re s s iv e , 135; n o n in te r p r e -
tiv e , 2 2 , 1 7 8 ; n o n p a t h o l o g i z i n g ,
22; p h e n o m e n o lo g ic a l, 22, 140,
1 4 2 - 1 4 4 , 1 5 5 , 1 7 1 , 1 7 4 , 2 0 0 (s e e
a ls o P h e n o m e n o l o g i c a l w o r k ) ;
p o w e rle s s n e s s o f th e r a p is t, 1 3 6 -
1 3 7 , 1 5 4 ( s e e a ls o M o t i v a t i o n ,
c lie n t)
284 Index
R a d i c a l in q u i r y , t e c h n i q u e s o f , 1 5 7 -
2 00; e x p e rie n tia l d re a m w o rk , 178;
e x p e rie n tia l q u e s tio n in g , 1 6 1 -1 7 0 ,
2 4 4 -2 4 6 ; fo c u se d e x a m in a tio n o f
p e r s o n a l h is to r y , 1 9 9 - 2 0 0 ; im a g i-
n a l in te ra c tiv e te c h n iq u e s , 1 7 3 —
1 7 7 (s e e a ls o I m a g i n a l i n t e r a c t i v e
te c h n iq u e s ) ; in v itin g re s is ta n c e ,
1 8 3 , 1 8 5 - 1 9 4 ; m in d - b o d y c o m m u ­
n ic a tio n , 1 9 8 -1 9 9 , 2 4 6 -2 4 7 ; s e n ­
te n c e c o m p le tio n , 6 4 -6 6 , 6 8 ,
1 7 9 - 1 8 6 , 1 9 6 , 2 4 2 (s e e a ls o S e n ­
te n c e c o m p le tio n ) ; s e ria l a c c e s s ­
in g , 1 7 0 -1 7 3 , 1 7 5 , 1 7 7 , 2 1 1 , 2 1 6
(see a lso S e r ia l a c c e s s in g ) ; s to r y f o r
h ig h ly v u l n e r a b l e c l i e n t , 1 6 0 - 1 6 1 ;
t r ia l s e n t e n c e , 1 3 0 , 1 9 6 - 1 9 7 , 2 1 0 ,
2 4 7 , 2 5 4 ; u tiliz in g c l i e n t r e s is ta n c e ,
1 9 5 - 1 9 7 (se e a ls o R e s i s t a n c e ) ; u t i ­
liz in g c l i e n t - t h e r a p i s t r e l a t i o n s h i p ,
1 9 7 - 1 9 8 (s e e a ls o T r a n s f e r e n c e ) ;
v ie w in g f r o m a s y m p to m - f r e e p o s i­
tio n , 2 9 -3 0 , 6 5 , 6 6 , 6 9 -7 0 , 112,
1 5 0 -1 5 2 , 1 8 3 -1 8 6 , 193, 214,
2 4 1 - 2 4 2 , 2 5 2 - 2 5 3 (see a lso V ie w in g
f r o m a s y m p to m - f r e e p o s i t i o n )
R a g e , 8, 4 2 , 2 3 8 ; c a se e x a m p le o f,
142, 1 8 6 -1 9 4 , 208; c rite ria fo r
b e in g a s y m p to m , 8
R a ic h le , M . E ., 1 2 6 n
R ape, 8
R e a lity , c o n s t r u c t i o n s o f . S ee C o n ­
s t r u c t i o n s o f r e a lity
R e a lity , e x p e r i e n t i a l : a n d u n c o n s c i o u s
c o n s tru c ts , 9, 14, 17, 9 7 ; c o n te x ­
t u a l o r g a n i z a t i o n o f , 9 4 - 9 7 ; d if f i­
c u ltie s a c c o m p a n y in g c h a n g e o f,
2 3 1 -2 3 2 ; h e te r o g e n e ity o f, 9 4 -9 7 ,
1 0 2 , 1 1 8 -1 2 1 ; in p ro - s y m p to m
p o s i t i o n , 1 7 , 2 0 8 ; in d iv id u a l a s c r e ­
a to r - p r e s e r v e r - d i s s o lv e r o f, 5 - 6 , 10,
30, 97, 113, 139, 183, 204, 208,
2 3 6 - 2 3 9 , 2 4 9 ; lim its o n f o r m in g ,
1 0 ; n a t u r e o f p a s t in ( s e e P a s t ) ;
p l a s t i c i t y o f , in c o n s t r u c t i v i s m ,
9 -1 0 ; p o r tio n o f, g o v e rn e d by
p ro -s y m p to m p o s itio n s , 2 3 2 -2 3 5 ;
r e c e iv e d f r o m c u l t u r e , 6 , 9 7 ; s t r u c ­
t u r e o f (s e e H i e r a r c h y o f c o n ­
s tru c ts ; p ro -s y m p to m p o s itio n :
o rg a n iz a tio n o f c o n s tru c ts w ith in )
. See a ls o C o n s t r u c t i o n s o f r e a lity ,
u n c o n s c io u s
R e e n a c t m e n t , 2 5 5 - 2 5 6 ; p r o c e d u r e o f,
2 3 7 -2 3 8
R e fra m in g : s o u r c e o f n e w m e a n in g
i n , 2 0 5 -2 0 6
R e fra m in g to th e e m o tio n a l tr u th o f
th e s y m p to m , 2 5 7 ; c a s e e x a m p le s
o f, 3 1 , 3 3 -3 4 , 4 9 , 1 8 9 -1 9 0 ; d e fi­
n itio n o f, 3 1 , 2 0 5 ; e ffe c tiv e n e s s
o f, 2 6 0 ; tra n s fo rm a tio n o f sy m p ­
t o m ’s m e a n i n g by , 4 9 ; v a l i d a t i o n
b y , 1 3 8 - 1 3 9 . See a ls o P o s i t i o n
w o rk
R e h e a rs a l: c a se e x a m p le o f, 7 6 ; o f
b e tw e e n - s e s s io n ta s k , 2 2 0
R e l a t i o n s h i p , c l i e n t - t h e r a p i s t , ix , 1;
a n d s h a r e d t r a n c e , 1 7 1 ; a n d w e l­
c o m in g re s is ta n c e , 1 9 4 -1 9 7 ;
b l a m e in , 2 3 0 ; c e n t r a l a g r e e m e n t
c o n s titu tin g , 20 4 ; c lie n t as a u th o r ­
ity o n e m o t i o n a l t r u t h , 1 4 3 - 1 4 4 ,
2 1 0 , 2 1 5 -2 1 6 ; e ffe c t o f p a th o lo -
g iz in g o n , 1 3 5 -1 3 6 ; n e g a tiv e ly
c o n n o tin g b e h a v io r, 2 3 0 ; q u a lity
o f, 2, 3, 2 0 , 2 1 , 2 2 , 3 2 -3 3 , 4 3 -4 4 ,
96, 129, 1 3 1 -1 3 3 , 1 4 1 -1 4 3 , 146,
1 5 9 -1 6 0 , 172, 2 1 7 ; ra p id tru s t
b u ild in g in , 1 3 1 , 1 3 5 -1 3 6 , 2 6 0 ;
t h e r a p i s t ’s i m a g e i n , 1 5 2 - 1 5 3 ;
t h e r a p i s t ’s r e l a x a t i o n , 4 4 , 1 5 2 , 1 5 3
(se e a lso S t a n c e , t h e r a p i s t ’s: n o n e f -
f o r tf u l q u a lity o f; P o w e rle s s n e s s ,
t h e r a p i s t ’s ) ; t h e r a p i s t ’s s e lf - d is c lo ­
s u r e , 4 6 , 4 7 ; t h e r a p i s t ’s s t a n c e in ,
6 - 7 (s e e a ls o S t a n c e , t h e r a p i s t ’s ) ;
u t i l i z a t i o n o f , 5 3 , 1 9 7 - 1 9 8 . See a lso
C o lla b o ra tio n , c re a tin g ; C o u n te r-
tr a n s f e r e n c e ; E m p a th y , t h e r a p i s t ’s;
I n t e r p r e t a t i o n : a v o id a n c e o f, in
D O B T ; T ra n sfe re n c e

R e p e titio n c o m p u ls io n , 5; c a se e x a m ­
p le s o f, 6 6 - 6 7 , 8 1 , 8 3 , 8 8 ,1 6 7 - 1 7 0 ,
1 7 1 -1 7 3 , 2 1 1 -2 1 4 ; c o n s tru c tio n
o f, 6 6 -6 7 , 8 9
R e s is ta n c e , 5 , 1 3 9 , 1 5 8 , 1 9 7 , 2 1 7 , 2 6 0 ;
a c c e s s in g p ro -s y m p to m p o s itio n
t h r o u g h its , 5 2 , 1 8 5 - 1 9 4 ; a n d
o rd e rs o f c h a n g e , 9, 1 1 7 -1 1 8 ; as
e x p re s s io n o f p ro -s y m p to m p o s i­
tio n , 1 8 5 -1 8 6 ; c a se e x a m p le s o f,
5 2 , 5 4 , 1 8 8 -1 8 9 ; c o n c e p tu a liz a tio n
o f, in D O B T , 1 9 4 -1 9 5 ; c r e a te d by
a n ti- s y m p to m fo c u s , 2 1 - 2 2 ; d i s t a n t
v ie w in g t e c h n i q u e s , 1 9 5 - 1 9 6 ; p o s i­
t i o n w o r k w ith , 1 9 6 - 1 9 7 ; u tiliz in g ,
1 9 5 -1 9 7
R e s o lu tio n o f p ro b le m s , 2 5 , 2 6 -2 8 ;
b e y o n d s y m p to m re lie f, 4 , 3 5 -3 6 ,
3 7 - 38, 59, 70, 81, 8 7 -8 8 , 89, 121,
1 3 0 -1 3 1 , 2 5 9 , 2 6 1 ; b y p o s itio n
w o r k , 1 8 , 2 5 , 2 0 5 ; p e r m a n e n c e o f,
2 6 0 ; tw o ty p e s o f, in D O B T , 2 6 , 2 7 ,
3 8 - 3 9 , 2 0 3 - 2 0 4 . S ee a ls o D i r e c t
r e s o lu tio n ; o u tc o m e , s u c c e s s fu l;
R ev e rse re s o lu tio n
R e v e rse r e s o lu tio n , 2 0 3 -2 0 4 ; d e fin i­
tio n o f, 2 6 , 3 8 -3 9 ; c a s e e x a m p le s
o f, 1 7 -1 8 , 2 6 -2 7 , 1 8 9 -1 9 4 , 2 3 1 -
2 3 2 . See a lso D i r e c t r e s o l u t i o n
R h e a , K e n n e th , 2 1 5
R ic e , L a u r a , 6 , 1 2 n
R ita lin , 2 2 2 , 2 2 9
S S lu z k i, C ., 1 2 n
S a f r a n ,J . D ., 1 2 4 n
S a tir, V ir g in ia , x i, 2 3 1
S c h e d u l i n g o f s e s s io n s , 1 3 6
S c h iz o id c o n s t r u c t i o n , 1 8 0
S c h w a rtz , R ic h a r d , 1 2 4 n , 1 3 5 -1 3 6 ,
155n
S c re e n c o g n itio n s , 4 2
S c re e n e m o tio n s , 42
S e c o n d - o r d e r c h a n g e . S ee C h a n g e ,
sec o n d -o rd e r
S e c o n d a ry g a in , 9 4 , 9 9 -1 0 0
S e lf , c o n s t r u c t i o n o f: c a s e e x a m p l e s
Index 285
o f , 9 0 , 1 3 0 - 1 3 1 , 1 7 7 - 1 7 8 . S ee a ls o
C o n s tru c ts , fo u r th - o r d e r
S e l f p s y c h o lo g y , x
S e lf, t h e r a p i s t ’s u s e o f , 1 5 2 - 1 5 4
S e lf-m u tila tio n , 1 3 4 -1 3 5
S e lf-w o rth : e n h a n c e m e n t o f, 4 , 3 5 , 3 7 ,
1 2 1 ,2 6 1
S e n te n c e c o m p le tio n , 1 7 9 -1 8 6 ; u se d
in d i s t a n t v ie w in g t e c h n i q u e , 1 9 6 ;
c a s e e x a m p le s o f, 6 4 -6 6 , 6 8 , IS O -
1 8 3 , 2 4 2 ; lo g ic o f, 6 4 - 6 5 ; p r o c e ­
d u r e o f, 1 7 9 -1 8 0
S e p a r a t i o n - i n d i v i d u a t i o n , 9 0 ; a n x ie ty
o v e r, 2 9 ; c a s e e x a m p le s o f, 3 5 , 7 7 ,
1 7 6 - 1 7 7 . See a ls o A u t o n o m y : p r o b ­
le m s o f
S e ria l a c c e s s in g , 1 7 0 -1 7 3 , 1 7 5 , 1 7 7 ,
2 1 1 , 2 1 6 ; c a se e x a m p le o f, 1 7 2 -
1 7 3 ; s ta te - s p e c if ic k n o w in g in , 1 7 2 ;
s h a r e d t r a n c e in , 1 7 1 . See a lso C o n ­
s t r u c t s , l i n k a g e o f; R a d ic a l in q u ir y ,
t e c h n i q u e s o f: s e r ia l a c c e s s in g
S e x u a l a b u se , c h ild h o o d : case e x a m ­
p le o f, 2 4 0 -2 5 6
S e x u a l p r o b l e m s , 4 ; c a s e e x a m p l e s o f,
4 7 -5 1
S h a m e , 4, 17, 20 6 , 2 22
S h a w , R o b e r t , x i, x ii, 1 2 8 , 2 0 0 n - 2 0 1 n
S h o r t e s t p a t h f o r r a d ic a l in q u ir y , 1 3 8 ,
1 3 9 -1 4 0 , 152, 1 5 8 -1 5 9
S h r i n k i n g p a r e n t e f f e c t, 6 9 - 7 0 , 1 8 4
S h u le r, N an cy , 2 0 7
S im k in , J a m e s , x i
S o l u t i o n - o r i e n t e d b r i e f t h e r a p y , 1;
m i r a c l e q u e s t i o n in , 1 8 5
S o m e s th e tic c o n s tru c ts , 14; as k n o w ­
in g s , 1 0 4 , 1 0 7 - 1 0 8 ; c a s e e x a m p l e s
o f, 2 4 5 - 2 4 6 , 2 4 8 - 2 4 9 ; c o m p r i s i n g
u n r e s o lv e d tr a u m a , 2 3 7 ; in e m o ­
tio n a l w o u n d s , 1 09, 2 4 5 -2 4 6
S p littin g , 104, 160
S ta n c e , t h e r a p i s t ’s, 6 - 7 , 4 3 ; a s b a s is o f
te c h n iq u e , 1 5 7 -1 5 8 , 2 0 0 ; c o n v ic ­
tio n in c l i e n t ’s c a p a c ity f o r c h a n g e ,
7, 4 3 -4 4 ; d e f in itio n o f, 1 2 7 ; f o r
286 Index
ra d ic a l in q u iry , 1 2 7 -1 5 5 ; n o n e f-
f o r tf u l q u a lity o f, 1 2 8 , 1 3 7 , 1 5 2 (see
a lso P o w e r le s s n e s s , t h e r a p i s t ’s ) . See
a ls o R a d ic a l i n q u ir y , d e f i n i n g f e a ­
tu re s o f
S ta te - s p e c if ic k n o w in g : c a s e e x a m ­
p l e s o f , 1 7 2 - 1 7 3 , 1 7 7 - 1 7 8 ; in
a c c e s s in g u n c o n s c i o u s c o n s t r u c t s ,
2 5 , 1 7 2 . See a lso A l t e r e d s ta te ; R a d ­
ic a l i n q u i r y , t e c h n i q u e s o f: s e r i a l
a c c e s s in g
S tra te g ic c o n s tru c ts , 5 6 , 6 2 , 6 3 , 66,
1 1 1 -1 1 2 ; c a se e x a m p le s o f, 6 1 ,
2 5 4 ; d e f i n i t i o n o f, 2 3 2 - 2 3 3 ; in lo w
s e lf - e s te e m , 2 3 2 , 2 3 4 - 2 3 5 (se e a lso
L o w s e lf - e s te e m )
S t r a t e g i c t h e r a p y , 1, 2 , 1 5 3 ; c o n c e p t
o f p o s itio n in , 15; d is r e g a r d o f
e m o t i o n a n d u n c o n s c i o u s in , 2 - 3 ,
4; p a r a d o x ic a l i n t e r v e n t i o n in , 2 2 0
S tr u c tu re d e te rm in is m , 1 5 6 n
S u ic id e , d a n g e r o f, 1 4 8
S u p e r o r d i n a t e c o n s t r u c t s . S ee C o n ­
s tr u c ts , s u p e r o r d i n a t e
S y m b io tic a tta c h m e n t, 4 , 2 9 , 17 2 ,
2 1 1 -2 1 4 ; c a se e x a m p le o f, 1 6 7 -
1 7 0 , 1 7 2 - 1 7 3 , 1 7 5 - 1 7 8 . S ee a ls o
A u to n o m y : p r o b l e m s o f
S y m p t o m , e m o t i o n a l t r u t h o f t h e . See
E m o t i o n a l t r u t h o f t h e s y m p to m
S y m p to m s u b s t i t u t i o n , 21
S y m p to m -n e g a tiv e c o n te x t: c a se
e x a m p l e s o f , 9 5 - 9 7 ; d e f i n i t i o n o f,
95
S y m p to m -p o s itiv e c o n te x t, 2 2 0 ; a n d
e m o tio n a l tr u th o f th e s y m p to m ,
9 6 -9 7 ; a n d h is to ry ta k in g , 199;
a n d s e c o n d a ry g a in , 100; c a se
e x a m p le s o f, 6 4 , 9 5 , 9 6 , 1 6 6 -1 6 7 ;
d e f i n i t i o n o f , 9 5 - 9 7 . S ee a ls o P r o ­
s y m p to m p o s itio n
S y m p to m s : a n d s to p -th e -s y m p to m
m e s s a g e s , 1 4 7 - 1 4 9 ; a s n e e d e d in
p ro -s y m p to m p o s itio n , 16, 4 7 , 9 0 ,
9 6 -9 7 , 1 2 9 -1 3 0 , 138, 1 3 9 -1 4 0 ,
2 0 9 , 2 4 0 -2 4 1 , 2 4 3 -2 4 4 ; as p o in t o f
a c c e ss to e m o tio n a l tr u th , 148,
1 5 7 , 1 9 4 ; a s s ig n a l to ta k e p ro -
s y m p to m p o s itio n , 3 3 -3 4 , 2 5 5 ; as
s o lu tio n s to u n c o n s c io u s p r o b ­
le m s , 2 4 , 3 0 , 6 2 , 6 7 - 6 8 , 9 6 , 1 3 8 ,
1 3 9 - 1 4 0 , 1 6 5 , 2 2 2 ; a s u n w a n t e d in
a n ti-s y m p to m p o s itio n , 1 5 -1 6 ,
9 6 - 9 7 , 132, 138, 2 0 9 ; c a u s e o f,
1 2 8 -1 2 9 ; c lie n t as c r e a to r o f, 16,
2 8 -3 2 , 58, 6 1 -6 2 , 6 8 -6 9 , 90,
2 5 6 -2 5 7 ; c o h e r e n t n a tu r e o f, 6, 9,
1 6 -2 0 , 62, 97 , 121, 1 3 7 -1 4 0 , 252;
d e c o n s tr u c tio n o f, 6 1 ; d e f in itio n
o f , 15; e m o t i o n a l s e n s e o f , 1 6 , 3 4 ,
3 5 , 3 7 , 6 1 , 2 4 4 (se e a lso S y m p to m s :
c o h e r e n t n a tu r e o f); fo rg o tte n , 37,
2 5 6 ; p r e s e n t - t i m e b a s is o f, 4 , 7 , 14,
4 2 -4 5 , 47, 49, 8 5 -8 6 , 109, 1 2 8 -
129, 173, 177, 1 9 9 -2 0 0 , 2 0 8 , 210,
2 1 3 - 2 1 4 , 2 4 7 ; r e s o l u t i o n o f (s e e
R e s o lu tio n o f p ro b le m s ); tra n s fo r­
m a tio n o f m e a n in g o f, 18, 2 6 ,
2 7 , 3 3 , 3 7 , 4 9 , 1 8 9 , 2 4 4 (s e e a ls o
R e fra m in g to th e e m o tio n a l tr u th
o f th e s y m p to m ) ; v a lu e o f, o v e r­
r id e s p a i n o f, 1 9 - 2 0 , 2 5 - 2 6 , 3 0 , 5 8 ,
68, 9 5 -9 7 , 138, 2 09, 2 1 5 -2 1 6 ,
2 1 9 -2 2 0 , 2 41, 2 4 3 -2 4 4 , 2 5 4 -2 5 5 .
See a ls o n a m e s o f sp e cific sy m p to m s
S y s te m ic t h e r a p y . See F a m ily s y s te m s
th e ra p y
T
T a rt, C h a rle s , 2 0 I n
T e c h n iq u e s , 2 2 ; as e x p re s s io n o f
s ta n c e , 1 5 7 -1 5 8 ; a n d th e r a p e u tic
s tr a te g y , 1 0 , 1 1 2 , 1 7 3 - 1 7 4 ; m is u s e
o f , 1 4 8 . S ee a ls o B e t w e e n - s e s s i o n
ta s k s ; P o s i t i o n w o r k , b e t w e e n - s e s ­
s i o n ta s k s o f ; P o s i t i o n w o r k , t e c h ­
n iq u e s o f; P ro -s y m p to m p o s itio n ,
te c h n iq u e s o f tr a n s f o r m a tio n o f;
R a d ic a l in q u ir y , t e c h n i q u e s o f; a n d
s p e c ific te c h n iq u e s , s u c h a s C o n ­
f r o n t i n g w it h e m o t i o n a l t r u t h ;
C o n s tru c t s u b s titu tio n ; C re a tin g

c o n n e c tio n s b e tw e e n p o s itio n s ;
C y c l i n g in a n d o u t o f s y m p t o m -
f r e e p o s i t i o n ; D i s t a n t v ie w in g ;
D o u b le b in d ; E x p e rie n tia l d re a m -
w o rk ; E x p e rie n tia l q u e s tio n in g ;
F o llo w in g c l i e n t a li t t l e b i t a h e a d ;
Im a g in a l in te ra c tiv e te c h n iq u e s ;
I n d e x c a r d ta sk s; I n n e r c h ild w o rk ;
I n v itin g r e s is ta n c e ; L e t t e r w r itin g ;
M in d - b o d y c o m m u n i c a t i o n ; O v e r t
s ta te m e n t o f p o s itio n ; R e e n a c t­
m e n t; R e h e a rs a l; R e s is ta n c e : u ti­
liz in g ; S e n t e n c e c o m p l e t i o n ; S e ria l
a c c e s s in g ; T r a u m a tic in c id e n t
r e d u c t i o n ; T ria l s e n t e n c e ; V ie w in g
fro m a s y m p to m -fre e p o s itio n ;
V is u a liz a tio n ; V o ic e t o n e
T e le o lo g y , 1 1 2
T h e r a p e u t i c e f f e c t i v e n e s s . See E f f e c ­
tiv e n e s s , t h e r a p e u t i c
T h e r a p is t: a n x ie ty fe lt by, 1 3 3 -1 3 4 ,
1 3 6 , 1 5 3 (se e a ls o E m o t i o n : t h e r a ­
p i s t ’s f e a r s o f c l i e n t ’s ) ; b l o c k s to
e f f e c tiv e n e s s o f, 1 3 1 - 1 3 7 ; e x i s t e n ­
tia l u n c e r t a i n t y o f, 1 5 2 - 1 5 3 ; r e l a x ­
a tio n o f, 152, 153
T h e r a p i s t - c l i e n t r e l a t i o n s h i p . See R e la ­
tio n s h ip , c lie n t-th e ra p is t
T h i r d - o r d e r c h a n g e . S ee C h a n g e ,
th ird -o rd e r
T r a in in g : a n d f r e e d o m to c la rify , 1 4 7 ,
1 4 8 -1 5 2 ; a n d th e ra p e u tic fo c u s o f
D O B T , 2 1 -2 2 , 2 5 9 -2 6 0 ; case
e x a m p le s o f, 1 4 8 -1 5 2 , 158; fo r
e x p e r i e n t i a l w o r k , 1 4 1 - 1 4 2 ; in
b r i e f t h e r a p y , i x - x ; in e m o t i o n a l
p ro c e ss, 134
T r a n c e , s h a r e d , 171
T r a n s f e r e n c e , 1 3 3 ; r o l e o f , in D O B T ,
6 0 , 1 9 7 - 1 9 8 . See a lso R e l a t i o n s h i p ,
c lie n t-th e ra p is t
T ra n s fo rm a tio n o f c o n s tru c ts , 2 4 ,
3 2 -3 3 , 3 7 , 5 7 , 79, 80 , 8 1 ,1 1 1 -1 1 2 ,
185, 205, 2 3 6 -2 5 6 , 257; case e x a m ­
p le s o f, 5 7 , 7 9 , 8 0 , 8 1 , 1 8 5 , 2 4 1 ,
249, 2 5 1 -2 5 2 , 2 5 5 -2 5 6 ; m e th o d o l­
Index 287
o g y o f, 2 3 6 ; p r i n c i p l e o f, 2 3 6 ; te c h ­
n i q u e s o f , 2 3 7 - 2 3 9 (s e e a ls o P r o ­
s y m p to m p o s itio n , te c h n iq u e s o f
tra n s f o r m a tio n o f)
T ra n sp a re n c y , 1 5 2 -1 5 3
T ra u m a , 4, 2 0 8 ; c o n s tru c ts c o m p ris ­
in g , 1 0 9 , 2 3 7 ; m o d e ls o f, 7 -8 ;
r e e n a c tm e n t te c h n iq u e fo r tra n s ­
fo rm in g , 2 3 7 -2 3 8
T ra u m a tic in c id e n t r e d u c tio n (T IR )
te c h n iq u e , 2 1 7 -2 1 8
T r e a tm e n t p la n s , 153
T ria l s e n te n c e te c h n iq u e , 1 3 0 , 2 1 0 ,
2 3 1 ; f o r w o r k i n g w ith c l i e n t r e s is ­
ta n c e , 1 9 6 -1 9 7
T r u s t . S ee R e l a t i o n s h i p , c l i e n t -
th e ra p is t
U
U n c o n s c i o u s : a c c e s s i b i l i t y o f (s e e
A c c e s s ib ility o f u n c o n s c i o u s c o n ­
s tr u c ts ) ; d e f in itio n o f, 3, 104; d is ­
r e g a r d o f , in v a r i o u s t h e r a p i e s , x ,
2 - 3 , 4 , 19; n o n p a t h o l o g i z i n g v ie w
o f , x i; p l a n s (s e e P l a n s , u n c o n ­
s c i o u s ) ; p u r p o s e (see P u r p o s e ,
u n c o n s c io u s )
U n c o n s c i o u s c o n s t r u c t s : a c c e s s ib ility
o f (see A c c e s s ib ility o f u n c o n s c i o u s
c o n s tr u c ts ) ; a n d p r o - s y m p to m p o s i­
tio n , 1 6 -1 9 ; a n d re s is ta n c e , 1 9 4 -
1 9 7 ; a n d s e r ia l a c c e s s in g , 1 7 0 - 1 7 3 ;
a u t o n o m y o f (s e e A u t o n o m y : o f
u n c o n s c io u s p o s itio n s ); d ir e c tin g
a t t e n t i o n to , 1 6 1 , 1 6 3 ; d is c o v e r y o f
(se e R a d ic a l i n q u i r y ) ; i m p o r t a n c e
o f, in d e f i n i n g s u c c e s s f u l o u t c o m e ,
1 8 - 1 9 ; t r a n s f o r m a t i o n o f (se e P r o ­
s y m p to m p o s itio n : t r a n s f o r m a t i o n
o f; T r a n s f o r m a t i o n o f c o n s t r u c t s )
U n c o n s c i o u s k n o w in g , 1 0 2 - 1 0 8 , 2 0 4 ,
2 0 5 ; b o d ily a n d b e h a v io r a l e x p r e s ­
s i o n o f , 1 0 6 , 1 0 7 - 1 0 8 ; in u n r e ­
s o l v e d t r a u m a , 2 3 7 ; n o t b a s e d in
la n g u a g e , x, 109, 2 3 7 ; s o p h is tic a ­
t io n o f, 1 0 5 - 1 0 6
288 Index
U n c o n s c i o u s p o s i t i o n . See P r o - s y m p ­
to m p o s itio n
U n c o n s c i o u s p r i o r i t i e s . See P r io r i t i e s ,
u n c o n s c io u s
U s in g s y m p to m a s s ig n a l to ta k e p r o ­
s y m p to m p o s itio n : c a se e x a m p le s
o f, 3 3 - 3 4 , 2 5 5
V V o ic e d i a l o g u e , 2 3 9
V a lu e s , 1 4 , 1 1 3 ; c l i e n t ’s, 2 3 1 ; in c o n ­
s tr u c tiv is m , 10 ; t h e r a p i s t ’s, 2 3 0
V a r e la , F r a n c is c o , 1 5 6 n
V e n t u r a , M ic h a e l, 1 0 5
V e rific a tio n o f c o n s tru c ts , e x p e r ie n ­
tia l, 1 4 3 - 1 4 4 , 1 9 0
V ic tim p o s i t i o n , 1 4 , 7 8 , 2 6 0 ; a n d n e u ­
r o m u s c u l a r r e le a s e , 2 3 8 ; a s p a r t o f
a n ti- s y m p to m p o s itio n , 15, 4 7 , 1 9 2 ;
c a s e e x a m p l e s o f, 4 7 , 5 8 , 1 9 2 , 1 9 4
V ie w in g f r o m a s y m p to m - f r e e p o s i­
tio n , 1 8 3 -1 8 6 , 193, 2 1 4 ; c a se
e x a m p le s o f, 8 -9 , 2 3 , 2 9 -3 0 , 6 5 ,
6 6 , 6 9 - 7 0 ,1 5 0 - 1 5 2 , 1 8 4 - 1 8 5 ,1 8 8 ,
2 4 1 - 2 4 2 , 2 5 2 - 2 5 3 ; f o r d is s o lv in g
p re s u p p o s itio n s , 112; p ro c e d u re
o f, 1 8 3 -1 8 4 ; s tra te g y o f, 2 9 - 3 0 ,
1 8 3 . See a lso I n v i t i n g r e s i s t a n c e
V io le n c e , d a n g e r o f, 148
V is u a liz a tio n , 1 7 3 -1 7 8 , 1 7 9 , 1 8 3 ,
196, 1 9 8 -1 9 9 , 239; a n d re e n a c t­
m e n t, 2 3 2 ; c a se e x a m p le s o f, 23,
2 9 -3 0 , 66, 68, 75, 8 2 -8 3 , 130,
1 7 5 -1 7 8 , 1 9 1 -1 9 2 , 2 5 2 -2 5 3 ,
2 5 5 - 2 5 6 . S ee a ls o I m a g i n a l i n t e r ­
a c tiv e t e c h n i q u e s
V o ic e t o n e , t h e r a p i s t ’s u s e o f, 3 4 ; c a s e
e x a m p l e s o f, 4 7
V o ic e s , i n n e r : f i n d i n g t h e e m o t i o n a l
t r u t h o f, 8 4 - 8 6
W
W a tz la w ic k , P., l l n , 1 2 n , 4 6 n
W e a k la n d , J ., 1 2 n , 4 6 n
W e i g h t p r o b l e m s , 2 7 , 1 6 6 - 1 6 7 . See
a ls o B in g e e a t i n g
W h ita k e r , C a r l, x i
W h i t e h e a d , A . N ., 1 1 8
W o r k a h o lis m , 4 , 1 7 , 6 3 , 7 1 - 7 2 , 7 8 , 8 0 ,
8 1 ,8 4 , 9 0 , 9 8
Z
Z a jo n c , R ., 1 2 4 n
In this groundb reaking b o o k , authors B ru ce E ck er and Laurel H ulley show
how to work d irectly and im m ed iately with the em otion al and u n con sciou s
m eanings that structure the very e x iste n c e o f th e p resen tin g p rob lem , m ak­
ing in-depth therapy so effectiv e as to be brief, D epth -O rien ted B rie f
Therapy rep resen ts a new stage in b rief therap y and offers clinicians new
h o p e o f m aintaining p rofession al satisfaction in th e tim e-effectiv e p ractice
dem anded by to d ay’s m an aged -care en viron m en t.

t4This is a brilliant, breakthrough b ook . E ck er and H ulley have created a

psychotherapy which is at o n ce analytic, phen om en ological, and exp erien tial,
based n ot only on this in tegration , but on r ecen t d evelop m en ts in cogn itive
scie n c e . This in n ovative co n tex t raises ea ch o f th ese field s to new lev els o f
effica cy and depth. A ccessib le, n on p ath ologizin g lan gu age, sop h isticated yet
profoundly sim ple theory, and pow erful th erap eu tic p ro cess com b in e to
m ake this w ork o f the highest sign ifican ce. I have rarely b een this
im p ressed .”

S tep h en M. Joh n son , P h .D ., author o f C haracter S tyles ,

,
The Sym biotic C h aracter H um anizing the N arcissistic S ty le ,
and C h aracterological Transformation

“A challenging, p recise, and ex citin g ap p roach to therap y that will delight

th ose therapists who celeb ra te and ch erish the co m p lex ity o f clien ts. E ck er
and H ulley com b in e a thoughtful atten tion to the u n co n scio u s with a co m ­
m itm ent to m aking every session cou n t. Gutsy, con vin cin g, and pow erful!”

^ D avid B . W aters, P li.D ., p rofessor o f fam ily p ra ctice and

psychiatry, U niversity o f V irginia, and author o f C om peten ce ,
,
Courage and Change

“This b o o k offers creative exam p les o f liow con stru ctivism can be applied
in clin ical p ra ctice. T h e authors show how an ex p erien tia l approach to felt
m ean ings can h elp clien ts ex p lo re alternative p erson al realities. This is r e c ­
o m m en d ed rea d in g.”

M ichael J. M ahoney, P h .D ., p ro fesso r o f psych ology, U niversity o f

N orth T exas, and author o f Human Change Processes

ISBN 978-0-7879-0152-3

PSY CH O LO G Y 9 780787 901523