Case example

Nail biting

This basic example of coherence therapy illustrates how coherence can be found in even the most unlikely symptoms. It also shows how a habit that had persisted for years can fall away once its hidden coherence has been discovered.

Beth, a psychotherapist in London, contacted me wanting to learn about coherence therapy. In our first conversation, she asked if I believe that all symptoms are coherent. When I answered that I do, she immediately asked, "Even biting my nails?" She went on to explain that she had seen another therapist about trying to stop biting her nails a few years prior. She said that they tried a number of different things, and she was able to stop for a while but that she had constantly felt the urge to bite. Not long after stopping therapy, she was back to biting.

Because our time was almost up, I gave her four exercises to do on her own. The first two were sentence completions. I gave her the beginnings of sentences and asked her to say them and then let the sentence finish itself naturally, without trying to pre-think the ending. They were:
1. "If I never bite my nails again..."
2. "I NEED to bite my nails because..."

I asked her to do these when she was finished with the first two:
3. Imagine waking up in the morning and knowing that you will never bite your nails again. Pay attention to what feels uncomfortable about this.
4. Let yourself feel the urge to bite your nails, and allow that urge to be strong. Now ask the urge what its job is and listen for its response.

We spoke again one week later and she told me that she had a powerful experience doing the exercises. She was surprised and somewhat shocked to find that biting her nails was her way of coping when she felt a feeling that she described as an "emptiness" or a "void." She had never been aware of feeling that way, but in the process of those exercises, she discovered the hidden emotional truth of biting her nails. These are the results from her exercises:
1. If I never bite my nails again..."I'll be suspended in this void"
2. I NEED to bite my nails because..."the emptiness will be filled"
3. Not biting my nails and knowing I never will again..."gives me a queasy feeling in my stomach."
4. When I feel the urge to bite my nails and ask that urge what its job is ..."it is to soothe and keep me calm."

I told her just to stay in touch with everything she had discovered, to remember that biting her nails is her way of soothing herself when she feels that emptiness. I also told her not to try to stop biting, but instead just to be aware of what its about.

She mentioned that it was so powerful for her to go through the process herself, because it had seemed like such a simple concept. She also said that she was committed to becoming proficient at doing coherence therapy for her clients.

Another week later and she said that since she became aware of the "emptiness" feeling, she no longer feels the urge to bite her nails at all. In a follow up call a few months later, she still had no urge to bite and the emptiness came up only very rarely. She believed that just accepting that feeling instead of avoiding it through biting her nails allowed it to heal. She remarked how different this experience was compared to her first try at dealing with this in therapy. The most notable thing to her was that it never felt like a struggle. Instead she felt like she understood herself better.

This example shows how coherence therapy can work by helping someone discover the hidden emotional truth of her symptom, and how accepting that truth can lead to deep and lasting change.

This site is maintained by Tim Desmond, MFTI 51287 :: Supervised by Bruce Ecker, MFC 21355
copyright © 2007 Tim Desmond, MA. Last updated 31March2007.