The Hidden Mechanism Behind Healing in Therapy: Memory Reconsolidation
Written by: Allyson Inez Ford, MA, LPCC | Founder of ED & OCD Therapy
What is the difference between therapy that is stagnant vs. therapy that moves forward?
I personally consider myself lucky to have experienced two life changing therapeutic relationships in my own life. First in my early 20s and then again when I turned 30. In between these two positive experiences, I had a string of mediocre and Not Great therapy experiences. If you’ve spent time in therapy- then you know how hard it is to find the right fit. Even if someone checks all the boxes of what you’re looking for, sometimes you get in the chair, do the work, but something is just missing. You don’t feel seen, you don’t have that “we just click” feeling. It can be really discouraging and it makes the process of opening up to a stranger about all your inner pain and secrets all the more daunting.
Since becoming a therapist and helping countless clients through unimagineable pain, I have found myself curious about the science behind what exactly moves therapy forward in a meaningful way. Of course, the therapeutic relationship is a huge factor. And theoretic approach matters too- but what is the mechanism of change that ties various approaches together? What happens in the brain and body when we experience a “big breakthrough” in therapy?
Memory Reconsolidation
In the last decade, neuroscience has boomed in the field of therapy. There have been pros and cons to this. One of the benefits has been that scientists have discovered the process that makes therapy breakthroughs happen. it It's called memory reconsolidation. And understanding it can make the arduous process of healing feel more hopeful.
Understanding Memory: Fixed or FlUid?
For most of the 20th century, neuroscientists believed that long-term memories, once formed, were permanent. Emotions could be regulated. Behaviors could be conditioned. But the underlying emotional memory, the visceral, embodied sense that the world works a certain way, was thought to be fixed. How daunting, right?
That assumption started being challenged in the late 1990s, when researchers discovered that activating and retrieving a memory makes it temporarily flexible. During a brief window after reactivation, the memory becomes malleable, open to being updated and revised before it is stored again. This process is called memory reconsolidation.
In plain terms: the brain can actually rewrite old learning with new information that disconfirms the original predicted emotion or behavior. And the implications for psychotherapy are quite profound.
Bruce Ecker, Robin Ticic and Laurel Hulley, in their landmark book Unlocking the Emotional Brain, synthesized this research into a clinical framework and proposed that this mechanism underlies the transformational change reported across many different therapeutic modalities. When I first learned about this, it felt like an ah-ha moment. Finally, a process was uncovered that explains why various approaches to therapy can work- and why so many different types of therapy often boil down to similar concepts (this is not to say that if you are dealing with something like an eating disorder, you don’t need a specialist- keep reading for more on that part).
The Three Steps Of memory Reconsolidation
Ecker and colleagues describe a consistent sequence that seems to be required for deeper emotional transformation. It generally unfolds in three steps.
First, reactivation.
The old emotional learning, the deep seated core belief, the somatic response, the protective pattern- must be brought into awareness and re-experienced. Not just talked about but actually felt. This is what opens the reconsolidation window.
Second, mismatch.
While the old learning is active, the client must have a vivid, felt experience that directly contradicts it. Not a cognitive reframe, rather a living, present-moment experience that the old belief is simply not true or no longer necessary.
Third, re-encoding.
The new learning is integrated. The old emotional memory is updated. Over subsequent sessions, or sometimes immediately, the old trigger no longer produces the old response. Not dampened. Genuinely different.
The overall and transformative insight is this: therapeutic modalities that look radically different on the surface may all be working toward this same three-step sequence. They just use different doors to get there.
How Memory Reconsolidation works in various therapuetic modalities
Exposure and Response Prevention (ERP)
ERP works by having clients deliberately confront feared stimuli while resisting compulsive responses. The fear memory is reactivated and then the catastrophe doesn't happen OR the feared consequence happens but the client is able to cope with it, disconfirming the belief that they wouldn’t be able to tolerate the distress. The brain encounters the trigger in a context where the predicted outcome fails to materialize and the original threat-learning is updated. In the OCD world, we call this inhibitory learning, but at it’s core it is also technically memory reconsolidation!
Internal Family Systems (IFS)
IFS works by befriending the inner critics, managers, and firefighters, and ultimately reaching the exiled parts that carry old pain and protective beliefs. The moment an exile is truly witnessed, unburdened and receives what it always needed from the Self, that is a prototypical mismatch experience. The exile's implicit belief, "I am alone," "I am too much," "I am bad," is reactivated through contact and then met with a radically different relational experience. The unburdening that IFS describes in its own language looks remarkably like reconsolidation in action.
Relational Psychodynamic Psychotherapy
Relational and psychodynamic approaches have long emphasized the therapeutic relationship itself as the vehicle of change. Through what has been called a "corrective emotional experience," clients encounter a relational reality that disconfirms their deepest relational expectations. The client who learned that vulnerability leads to abandonment experiences, within the therapeutic relationship, something different happens: their pain is validated and cared for, not rejected or minimized. Their need is met, not shamed. This is the mismatch, the relationship itself becomes the reconsolidation agent. This takes time, as secure attachment grows over time and can’t just be built over a couple of sessions. This approach is powerful especially for those who have attachment trauma.
Ketamine Assisted Psychotherapy (KAP)
Ketamine works on the brain's glutamate system in a way that rapidly increases neuroplasticity, making it one of the most pharmacologically direct routes into the memory reconsolidation window. During a dosing session, the brain's usual defensive mechanisms softens- oftentimes they are almost none existent! Rigid and “sticky thoughts” seem to quiet down in almost every client I have utilized KAP with. The altered state creates conditions where old emotional learning can be accessed with less distress than is typically possible in a standard therapy session. Painful beliefs about the body, the self, the world or traumatic memories can surface. But these memories are met with expanded perspective, compassion, distance from the critical voice or simply a felt sense of safety that has never been so accessible before. That is the mismatch. Integration sessions in the days that follow are the re-encoding phase, where what shifted during the dosing experience gets consolidated into new learning. The neuroplastic window stays open for roughly a week after a ketamine session, which is why intentional therapeutic work during that period is so important. It’s truly profound to witness how KAP can free up a person inside from decades of pain.
What This Means
This framework doesn't erase the meaningful differences between modalities. The relational depth of long term psychodynamic therapy is not the same as the exposure hierarchy of ERP and that matters depending on what you are seeking therapy for. Nonetheless, this realization offers something clarifying: a shared language for the mechanism of change within high quality therapy.
This is why skilled therapists across all traditions describe the same kinds of moments: when something in the room shifts, when a client's face changes, when a belief that has organized someone's entire life simply stops feeling true. That is memory reconsolidation. That is the brain doing exactly what it evolved to do, updating its model of the world when the evidence becomes undeniable.
The therapeutic task, whatever the modality, is to create the conditions to disconfirm the deeply held core wounds that our clients carry, and so often, develop protective mechanisms around (such as eating disorders or OCD).
Further reading: Bruce Ecker, Robin Ticic and Laurel Hulley, Unlocking the Emotional Brain (2012).
Reach out to Start Healing
Did this resonate with you?! Feel free to reach out for more information on our approach to therapy.
If you’re looking for an eating disorder, body image or OCD therapist in San Diego- we’d love to support you in your journey to healing.
We see clients in CA, WA, UT, TN, MD & FL. We have an in person office in San Diego, CA and see the rest of our clients virtually.
Please note: ketamine assisted therapy is available for CA residents only.
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