Diana Fosha on Accelerated Experiential-Dynamic Psychotherapy (AEDP)

Diana Fosha on Accelerated Experiential-Dynamic Psychotherapy (AEDP)

by Polly Ely
AEDP founder Diana Fosha discusses the journey that led her to create a new model of psychotherapy, the strong community support that ties the AEDP community together and how men have traditionally gotten a bum rap in couples therapy.


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“What You Think is Impossible, You're Actually Already Doing”

Polly Ely: Diana, welcome. As a devotee and student of Accelerated Experiential-Dynamic Psychotherapy (AEDP), I’m so happy to have this opportunity to interview you. Because AEDP is still pretty new to the world of psychotherapy, could you begin by explaining a bit about it?
Diana Fosha: Well, to begin with, unlike most models of psychotherapy that proceed from psychopathology—that start from what’s wrong and very reasonably want to go about fixing and healing it—one of the core characteristics of AEDP is that it assumes healing is already there to access from the first contact with the patient, including the most traumatized person that we encounter. It proceeds from the assumption of healing as a process and healing as a phenomenon—something to be entrained and engaged.

And we’re an experiential treatment, so whether we’re working with healing or attachment or emotion or what have you, we’re not so much interested in the narrative or people’s stories about it as much we’re interested in helping people drop down as much as we can into their experience and exploring the experience.
PE: In terms of “dropping down,” are there particular components or interventions that feel most relevant to AEDP that allow for that to occur?
DF: One of the things that’s characteristic of AEDP is to make the most of what’s there before trying to work with what’s not there or what’s maladaptive. So even when dropping down, if we see little glimmers of greater contact with the body, we would try to focus in on that little glimmer and enlarge it. I think more than anything else the stance is, “You’re already doing it so let’s just do more of it.”
PE: So you’re trying to amplify it, stretch it out, do more.
DF: Make you aware that what you think is impossible you’re actually already doing.

“I Don’t Have Any Feelings”

PE: So when you talk about greater contact with the body, how might you proceed with bringing something to life by making contact with the body in some way that traditional psychotherapists or eclectic psychotherapists might not feel as comfortable doing?
DF: Well, I’ll just say what we would do in AEDP and let other people judge whether it’s what they do or don’t do. For instance, the last person that I worked with was a man with a huge trauma history and a lot of disassociation. He walks in and he is telling me about some severe illness in a parent, and I ask him how he feels about it, and he says, “I don’t have any feelings.” So my question to him is, “What are you aware of?” And he becomes aware of a kind of subtle sensation in his chest—and that becomes our entry point. So we stay with that and I ask, “What does it feel like?”

“Well, it’s tense and it’s sort of a little dense.”

“Is it pleasant? Is it unpleasant?”

Over the course of a period of time, we really stay with what’s in his chest, which turns out to have all sorts of qualities of heaviness and pain—it’s a painful sensation. So before you know it, here I am with this incredibly intellectualized, supposedly in-his-head patient, talking completely in the language of sensation.
We’re no longer talking content. We’re no longer talking narrative. We’re speaking this kind of right-brain language.
We’re no longer talking content. We’re no longer talking narrative. We’re speaking this kind of right-brain language. He’s touching his chest with his hand as he’s palpating the spot where he’s experiencing this, and he’s starting to notice all these shifts and fluctuations, which are very much occurring in the moment. So within a few minutes, we had sort of “dropped down.”
PE: Dropped down and undone some belief about him not having any feelings?
DF: Right. Or that he’s all in his head or that he has an impossible time accessing his feelings.
PE: I see. So you’re developing capabilities and his belief in those capabilities, too.
DF: Over time, yes, absolutely
PE: So when I think about that—what’s happening in the body—how do we tie that to either the intellect or the story that they’re coming in with about whatever their perceived problem is? How might that be an inroad to the problem?
DF: Oh good question, because, of course, he’s not coming in because he has this subtle sensation in his chest; he’s coming in for a variety of issues and we’re just using it as an example. But really as we’re able to get more body-based and right-brained as a way of speaking about these kinds of phenomena, he and I are also having an interaction and we’re noticing what goes smoothly and flows and what’s difficult; what brings him closer and what makes him more distant?

And as we’re evoking what the pain is about or the sensation and what happens when I empathize, associations start to come up. “Did you ever have this kind of feeling? What comes to your mind about what this feeling may be telling you?” That becomes a way in, a much deeper way than telling the story or narrative. And eventually, the goal is to bring it all together—to bring it to a place where we can integrate experience with narrative, with understanding, with some sense of how his experience is linked to whatever issues he was having in his past.
PE: Sounds almost like you’re bypassing the thinking mind by calling on associations from that place in the chest that you’re talking about.
DF: I think that’s very much the case; or we’re trying to do that in the earlier part of the process, where we want to get experiential, construct something from the bottom up. In other words, not with preset preconceptions, beliefs, narrative coherence, but to let the story emerge from the kinds of experiences that are getting generated in the therapy. And then once we’ve worked with that, then we’re putting together basically a new narrative.

The Origins of AEDP

PE: What are the origins of AEDP? Did it spring forth from another model or did it come from your own curiosities about psychotherapy and what works?
DF: That’s an excellent question. I think the easiest way to answer that question is to tell you a little bit about my personal trajectory. My own training and development as a clinician was very psychoanalytic, psychodynamic and also developmental.
At the time I felt uncomfortable with the length of traditional psychoanalysis and its relatively cavalier attitude towards effectiveness and results.
At the time I felt uncomfortable with the length of traditional psychoanalysis and its relatively cavalier attitude towards effectiveness and results. So when I came across short-term dynamic psychotherapy in the work of David Malan and others, I was very excited because it seemed to be a way of working that preserved some of the depth. The analytic way of working, but at the same time, it was short-term, it was intensive. And the effectiveness of the treatment was one of the measures.

So I trained in a particular form of short-term dynamic psychotherapy developed by a clinician named Habib Davanloo, who developed a very intensive and very confrontational model of short-term dynamic psychotherapy. That was my early training and the first exposure I had to viscerally-based, deep feelings and emotions being systematically accessed in a relatively short period of time.

However, that way of working was confrontational; there’s a fair amount of stuff around aggression, which was not ideally suited to my personality or my way of understanding what’s needed in treatment. So from that point forth it became my personal goal to access the phenomena that I witnessed and learned in short-term dynamic psychotherapy and have things that are as visceral and as powerful and as transformative, but proceed from a place of being with the patient, rather than from a place of confrontation.

My other goal was to have a coherent theory for these amazing transformative phenomena. And I thought psychoanalysis, as marvelous as it is, didn’t have a good explanation of why the hell these phenomena were transformative in the moment.

You know, you start a session, you access this experiential phenomena, and 15 minutes later or half an hour later you’re in a, very different, transformed place. So it became important for me to try to have a theory that really reflected the phenomena of experiential psychotherapy. And over time AEDP, with both its theory and its practice, started to develop.

Resistance vs. Transformance

PE: You talk a lot of about transformation and for me, as a student, transformation is a word that was fairly new to me in the context of psychotherapy until I came upon AEDP. It just wasn’t a term that I ran across in my own training. I’m thinking about the word “transformance,” which is a term that you coined. It’s an important term and concept in the language of AEDP. Would you be willing to share a bit about its meaning?
DF: Well, it’s this idea of healing from the get-go—of healing not just being an outcome but a process that exists within each person that emerges in conditions of safety. That idea is not new to AEDP; it exists in spiritual traditions; it exists in humanistic therapies; it exists in some other existential therapies.
Whereas resistance is the conservative force in the psyche that causes us to resist changes or challenges, transformance is the force in the psyche that’s moving towards growth and expansion and transformation.
But still, our language tends to be very psychopathology-based, so that it seemed to me that a term was needed in our therapeutic lexicon to capture this notion of healing from within that we’re trying to tap. I coined the word “transformance” to capture that force and to have it be in counterpoint with resistance. So, whereas resistance is the conservative force in the psyche that causes us to resist changes or challenges, transformance is the force in the psyche that’s moving towards growth and expansion and transformation.
PE: I know for myself that one of the key elements of being an AEDP therapist is videotaping our work. What feels most important to you about that? It has some obvious teaching potential but I wonder if there’s more to it that you believe contributes to the process?
DF: I think it’s very much this emphasis on experience and phenomena and being able to witness firsthand the actual, live interaction. When a student comes to me for supervision, I’m not hearing his or her rendition of what happened. We’re having an experience together, witnessing what happened on video. It’s a huge help for the therapist because there’s no way that one can, in the moment, have access to the multiplicity of things that are happening in any given moment. So there’s this component of being able, after the fact, to look and look again and again and again, which is a beautiful way of learning about the richness that’s there.

Meta Processing

PE: Going back and looking at my work has been a huge place of growth for me as a therapist, and layers of new understanding emerge each time I watch a session. As I become more sophisticated in my understanding of what I’m doing, I’m able to notice more about the experience in the moment with my patients.

One area that is very key to AEDP that has been a struggle for me and where I’ve stretched a lot is around the idea of doing meta processing with the patient. Could you talk some about how you define meta processing and its value and why we, as therapists, may want to consider doing meta processing with our patients?
DF: Meta processing is huge and I think it’s one of the more important contributions that AEDP has made to the field of psychotherapy. I can explain it best by using a scenario. Let’s take somebody who comes in with depression and is feeling sort of sluggish or hopeless or whatever aspect of depression they have. And as a result of doing a piece of work—maybe it involves mourning—30 minutes later the depression lifts. They have a somewhat new perspective. They start to have a little bit of confidence in their own capacity to be effective in the world, right?
PE: Okay.
DF: So the depression lifts and the person starts to feel some efficacy. Well, at that point for us, what we want to do is process
PE: In that session.
DF: Right there in that session. What happened that allowed them to come in feeling lousy and now, half an hour later, they’re feeling more energized or more effective? So we then go through the experience.

The reason it’s called meta processing is that we’re processing the experience of what’s therapeutic about therapy. So—meta therapy. We might start to explore with the patient, “So you’re saying that you’re feeling better. And you have a sense that maybe you can be more effective. What’s that like? What does that feel like?” In the same way that we would explore what the sadness felt like or what grief feels like or what heaviness feels like. Now we’re beginning to explore what does energy feel like? What does vitality feel like? What’s it like that you and I, through talking together and doing this piece of work together, ended up here when we started back there? So that all these experiences that are quite implicit start to become more explicit, and then we’re doing another round of experiential exploration.
PE: So the next round is kind of concretizing what was learned in those first 40 minutes?
DF: Yeah. That’s a beautiful way of saying it. Concretizing, solidifying, increasing awareness, and consolidating it.
PE: And is that something that you expect your therapists to do every session?
DF: Well, we think about it in the following way: we have “Big-M” meta processing and “Small-M” meta processing. And “Big-M” meta processing is when you’ve had an experience like the one we’ve talked about—a very definite change for the better as a result of doing a piece of psychotherapeutic work. Whereas “Small M” meta processing is when there is a tiny little shift. The patient says something, you make a remark, and maybe tears come to their eyes because they feel understood. It’s not that you’ve worked for half an hour and you’ve done a whole process; it’s been one little exchange. “When I said that, it seemed to have moved you. What’s that like for you? What happened?” That’s a little meta processing. But it doesn’t have to be positive. It can be negative. Let’s say you say something and you see the patient sort of turn away or advert their eyes. So there’s been a very specific moment, a little change. We want to zero in on that and not have preconceived ideas about what it means. It doesn’t matter. The point is for the therapist to really get inside the patient’s experience, in a precise way.

So that’s how we use the meta processing and it’s probably accurate to say that rarely does an AEDP session go by without several instances of either “Small-M” or “Big-M” meta processing.

Existing in the Heart and Mind of Another

PE: I’ve been asked a few times if there’s any research that supports the accelerated outcomes of AEDP. How do you answer that question?
DF: That’s a very good question. There are about five research projects that are currently in the works on various aspects of AEDP—on outcome, meta processing, the nature of the changes that people experience as a result of AEDP training—but there are many, many components of AEDP that have been researched in the context of other experiential models. So while we have no research on meta processing or on dyadic affect regulation—because nobody else has done it—there’s infancy research that shows that mother/baby dyads where there’s effective affect regulation are the dyads that produce the most resilient babies. We have developmental research that shows that working with the feeling of existing in the heart and mind of another, which is a phrase we use that relates to attachment, is a huge aspects of resilience in the face of trauma.

There’s a lot of experiential research in the field of trauma that shows that processing previously unbearable emotions through to completion in a safe environment is one of the factors that leads patients to both stay in treatment and have better outcomes on some of the interpersonal measures. So many pieces of AEDP have quite strong empirical validation. The last piece comes from what AEDP shares with short-term dynamic psychotherapy, which shows that when you get past defenses and when patients and therapists are in close contact with core emotions, that contributes significantly to good outcomes. There’s a whole literature on that.
PE: You mentioned a few minutes ago how therapists report being impacted by working with this model. Can you say more about how their lives changed or their own personal processes changed?
DF: That’s a beautiful question. I would actually love to turn it back around and hear what your experience has been.
PE: Well, it has sort of paralleled my own deepening and ability to understand myself and where my defenses lie and where breakthroughs occur for me. It’s such a big question because, as I deepen in my understanding of AEDP, I see a natural transformation in who I am as a human being with other people; how I do in relationships with other people. How much vitality and life I feel within myself on a moment-to-moment basis and just how well I recover and how resilient I become. Without sounding like I’m proselytizing, I feel pretty transformed by it, to be perfectly honest.
DF: I appreciate your saying that. It’s a beautiful answer and people often speak of the parallel process in terms of their own transformation and deepening. I think that one of the other aspects is the gratitude that people experience at the generosity of the community. In the same way that we do therapy with affirmation and empathy and focusing on what people already do, the AEDP community is a very affirming, supportive community.

Especially for people who have had a lot of experience having to steel themselves against criticisms. You can certainly learn with a lot of harsh feedback, but I think the sense of learning through deepening, while being held and being in resonance with others; learning to pay attention to what gives you energy and vitality and what saps your energy and vitality and bringing that into the work—these are things that people are profoundly grateful for.

People have often said that they have a sense of coming home, which is very moving to me.
Way before they became professionals trained in fancy models and systems of interventions, there was just some intuitive sense of wanting to be with people and help them—some sense of hope and generativity that very often gets trained out of people in graduate school.
Way before they became professionals trained in fancy models and systems of interventions, there was just some intuitive sense of wanting to be with people and help them—some sense of hope and generativity that very often gets trained out of people in graduate school. People learn techniques and learn models and become very competent, but lose contact with some of that kind of naïve but very core sense of what it takes to heal in the presence of another. There’s something about AEDP that really draws on those innate processes by which we connect and heal and need to be with one another that lets people feel more alive.
PE: The word that comes to mind for me is “sustainable.”
DF: Yes, something about it allows you to sustain rather than burn out, and feel actually fed by it.

Men Get a Bum Rap

PE: I know recently you did some work around the differences between working with men and women and I’m wondering if there’s anything about that you’re excited about and would like to share.
DF: You know, I’ve really felt that men, to be perfectly honest, were getting sort of a bum rap in the world of emotion focused therapy. I have a colleague who sees couples and the typical set up was that the woman dragged their male partners in and they came because they didn’t want to lose the relationship. But they would always be revealed in the therapy as cut off from their emotions and not therefore able to use the couple’s therapy, so my colleague would send the men to me for individual therapy. These men would come in with their tails between their legs and feeling sort of sheepish or defensive or alienated. And when, in AEDP fashion, I’d look for the glimmer of what’s resilient or what’s healing or what’s transformance based and reflect back to them sensitivity or care or empathy, it was such a mind-blowing experience because they were so used to being told everything that they do wrong.

It was in that kind of informal way that I got interested in what happens to men in psychotherapy, especially in emotion- or relationally-based psychotherapy, because AEDP is so attachment- and emotion-based. So I actually went to do some neuroscience research and there’s a tremendous amount of the neuroscience research on sex difference and affect regulation.

And surprise, surprise, all the stuff that standup comics and guys in bars and girlfriends speaking to each other talk about—you know, everybody’s so-called stereotypes of the other gender—have some bearing in neuroscience.

PE: Which ones stand out to you?
DF: Well there are some real differences in how male and female brains process emotion. One of the main characteristics of male brains is that they’re actually more emotional—counter to stereotype—and have more right-brain activation than women, but that more visceral, raw sense of emotion is not as linked with language, so that modulation of emotion is much more problematic in men. Whereas connectivity in the brains of women is much more evenly distributed in the left and right brain, so that everything is much more connected for women. Under extreme emotional activation, language sort of goes off screen for men.
So it’s not that men don’t have feelings; they have tremendous, tremendous emotion, but the capacity to articulate is different.
So it’s not that men don’t have feelings; they have tremendous, tremendous emotion, but the capacity to articulate is different. And then there’s all this backlash in terms of shame and feeling inadequate for not being able to have an emotional conversation.
PE: That’s such an empathic way to be with men who are experiencing some trouble with expressing themselves.
DF: Yes, and I’ll tell you one other fascinating one, which has to do with face recognition. There’s an area in the brain that’s devoted to face recognition and women are superior to men in face recognition in all conditions, across the board. Under stress, women’s face recognition gets better and men’s face recognition gets worse. In stress-based literature they say that under stress, men’s sympathetic nervous system—the fight-flight response—is activated. For women, what’s activated under the same kind of threatening conditions is the limbic system and what’s been called the “tend and befriend.”

We women reach out, seek, and offer care. Reaching out to others means better face recognition, right? Presumably, evolutionarily speaking, the more you can recognize a face, you can recognize friend, foe, nurturer, etc. Whereas under stress, men sort of go inside, get strong, get into fight or flight, and are more isolated. It’s like the focus is on action and the face recognition drops off. So those are two things that seemed to me to bear very directly on our work, whether we’re working with individuals or couples.

PE: What are your suggestions for people who are interested in learning about or getting involved in AEDP?
DF: The first thing would be to visit the website, www.AEDPinstitute.com which is a focal point for the community and a way to just find out something about the model. We’ve got videos, presentations, downloadable articles, and trainings with different members of the faculty. You can also find out where trainings in various parts of the country are.
PE: Thank you so much for taking the time to discuss your work.
DF: Thank you.

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Diana Fosha Diana Fosha, PhD, is the the developer of AEDP, a healing-based, transformation-oriented model of psychotherapy, and director of the AEDP Institute. She is the author of The Transforming Power of Affect: A Model for Accelerated Change (Basic Books, 2000), and of numerous articles and chapters on transformational processes in experiential psychotherapy and trauma treatment. She is the editor, along with Dan Siegel and Marion Solomon, of The Healing Power of Emotion: Affective Neuroscience, Development, and Clinical Practice (Norton, 2009), part of Norton's Interpersonal Neurobiology Series.  She is on the faculty of the Department of Psychiatry and Psychology of both NYU and St. Luke's/Roosevelt Medical Centers in NYC. She lectures widely and has done workshops, telecourses, and intensive trainings nationally and internationally in Brazil, Denmark, Italy, and Hong Kong. She teaches, supervises, and is in private practice in her beloved New York City, where she also occasionally leads AEDP training groups.
Polly Ely Polly Elly's orientation is strongly rooted in AEDP, a somatically focused attachment based practice. A graduate of The Wright Institute, Polly is leaning towards becoming an AEDP Certified Practitioner and is enjoying a thriving practice in Corte Madera. Polly is extensively trained in experiential couples work helping partners to create a warmth-filled life together and a deeply felt, enduring experience of love. She is a certified parenting specialist with the county of Marin. In-home parent-child work (super nanny style) and 24-hour remote parent coaching are among her unique offerings. Her dual approach to teen treatment includes parents in a way that builds new closeness and lasting connection to their teens. When needed, Polly is able to work with a special focus on anxiety disorders, bringing both heart and a proven effective treatment to OCD, Panic Disorder and Trichotillomania. www.pollyely.com

CE credits: 1

Learning Objectives:

  • List the core characteristics of AEDP theory
  • Describe the origins and evolution of AEDP
  • Apply AEDP in clinical work with clients

Articles are not approved by Association of Social Work Boards (ASWB) for CE. See complete list of CE approvals here