What is Lucid Therapy?

Dear readers, I’m back from vacation and this is the run-up to the publication of my new book on August 20. During the two weeks that remain, I want to give a name to the guiding concept behind the book and the writings in this substack: Lucid Therapy.

Lucid Therapy is what I aspire to and how I try to practice. It means:

Helping people heal and grow, guided by an ever-deepening understanding of universal processes of psychological healing and growth, beyond modality or orientation.

This has always been an ideal for coaching, counseling, and psychotherapy, but until recently it hasn’t been possible because those universal processes were not understood. The best we could do was for each therapy to invent it’s own concepts and constructs that seemed to describe what was going on. Only recently has it become possible to make sense of why humans so often live in ways that are less than optimal and how the schemas that hold those patterns can change.

In this post, I want to describe what I think is a good representation (for now) of the minimum principles that guide my version of Lucid Therapy. I believe the clinical concepts are broadly accepted today and that the scientific principles are supported by enough evidence for adoption in clinical work and teaching.

Marvin Goldfried has called for principles on which we can all agree. Can we agree on the following minimal ideas? I’d like to hear from readers if they make sense to you or if these seem controversial or doubtful. Together they form the basis of what I would like to regard as the current state of Lucid Therapy.

These are general considerations on which many therapists agree, even though they may be expressed in different terms.

1. The tools of psychotherapy, as well as coaching and counseling, are words, nonverbal communication, and relationship. What we aim to accomplish with these is to change the way conscious and unconscious minds interpret and respond to the vast amount of data the senses bring in about the state of the self and the world.

2. Less than optimal coping and responsiveness are the primary targets of coaching, counseling, and psychotherapy, viewed as opportunities for growth and/or needs for healing. These patterns originate from survival-oriented problem solving, frozen in time, relatively resistant to change, and centered in subcortical schemas.

3. Resistance to change is universal and the reason professionals are often needed to support enduring change. It is presumed primarily to be due to the instinct to maintain response patterns predicted unconsciously and/or consciously to be required for survival. Overcoming this instinct results from a variable combination of intellectual clarity and trusting relationships.

The following science is evolving and is currently at the stage of proposed theory based on substantial evidence. It remains subject to eventual proof but is currently strong enough for adoption in clinical and training settings.

1. Three known change mechanisms with known requirements are responsible for the primary actions of coaching, counseling, and psychotherapy. These are new learning, to the point where improved patterns of response become available for automatic use, extinction, the temporary inhibition of maladaptive patterns of response, and memory reconsolidation, the only known pathway for enduring change applied to schemas and allowing enduring replacement of less-than-optimal coping and responsiveness with more satisfactory patterns.

2. Coaching, counseling, and psychotherapy aim to fulfill the following known requirements for memory reconsolidation as well as supporting extinction and new learning. These are first, neural activation of the old schemas, second, the approximately simultaneous delivery of disconfirming information to generate prediction error and rewrite old schemas, third, the availability of improved patterns of response through adaptation of existing patterns or learning of new ones, and fourth, the availability of one or more trusting relationships, supportive of change against internal resistance.

Your comments are important. Can we agree on these principles? In the coming weeks I would like to assemble a group to discuss these principles and how to make them available to a wider audience.

Jeffery Smith MD

The new book, How Psychotherapy Works: Navigating the Therapeutic Space with Confidence is available at a pre-publication discount from Routledge, the publisher.