Accelerated Experiential Dynamic Psychotherapy (AEDP) With a Male Client
For individuals in the U.S. & U.S. territories
Accelerated experiential dynamic psychotherapy (AEDP) is both a theory of transformational process and a model of psychotherapy with three fundamental elements
- emotion processing
Emphasizing the regulation and processing of relatedness and emotion, AEDP integrates psychodynamic and relational elements within an affect-centered experiential framework. This approach is effective with male clients because it avoids pathologizing problems, and instead affirms strengths and reflects positive qualities to offset commonly negative expectations of treatment.
In this phase-oriented treatment, Dr. Diana Fosha first focuses on building the relationship and establishing safety, simultaneously working with anxiety and attending to interferences with core emotion. She then helps the client to gain visceral access to experience, using moment-to-moment tracking of fluctuations in affect. Next, Dr. Fosha affirms and processes the experience of transformation by drawing attention to its positive and healing effects. Finally, the client is able to construct a coherent, cohesive narrative, with newfound personal truth and strengthened sense of self.
The function of a model is to tell us where to focus, and why; what to aim for in the clinical encounter; and then how to make it happen. In the AEDP model, AEDP metapsychology and metatherapeutics inform clinical work.
As a theory, AEDP seeks to explain the quantum transformational nature of deep somatically based emotional experiencing in the context of a relationship with a trusted, "true other." AEDP's metapsychology is an adaptation-based model informed by attachment theory, affective neuroscience, developmental mother-infant interaction studies, and, last but not least, emotion theory (à la Darwin, Tomkins, Damasio, Ekman & co.).
It emphasizes the quantum nature of change and specifically identifies positive affects as wired-in agents, markers, and sequelae of that quantum transformation. (There is an entire phenomenology of positive affects — e.g., relational [the "we"] affects, transformational affects, healing affects, core state — that has been developed within AEDP, and it is still unfolding as we keep exploring.)
In keeping with its (biological/evolutionary) adaptation-based metapsychology (attachment theory and emotion theory fit right in — it is how we are wired after all), AEDP understands psychopathology as reflecting the client's "best efforts" at adaptation in a maladaptive, skewed environment.
Thus, unlike, for instance, in a punitive-superego-based metapsychology where the self-destructive motivational vector has to be reversed, the vector of the client's motivational vector does not have to be changed: The adaptive intentions on behalf of the self that drive the client's attempts underlying even the most disturbed presentations have to be affirmed, all the while needing to process the need to change strategies that were once adaptive but are no longer, that were once "best efforts" given minimal resources (i.e., being a child, being helpless in a traumatic situation), whereas many more resources are available now.
As a theory of treatment, AEDP is healing oriented. Rather than being informed by an understanding of what creates psychopathology, AEDP's model of treatment is informed by an understanding emerging from transformational studies, a field devoted to elucidating the dynamics and phenomenology of healing, transformational processes that are at work naturally and/or in change-based systems.
So as to harness their healing power in treatment, AEDP seeks to learn from the naturalistic, healing, positive, transformational affective change processes that are at work in emotion, attachment, optimal mother–child interactions, and in the body's self-righting tendencies. Specifically reflected in its therapeutic stance, AEDP has sought to learn the lessons of good-enough (i.e., security-engendering) mothers and their good enough (i.e., securely attached, resilient) babies, thus being open to learning many lessons from good-enough Mother Nature.
The explosion of knowledge about how the brain processes and is organized by experiences of emotion and attachment roots AEDP's explorations in the developing field of affective neuroscience.
As a way of working with clients, AEDP features
- a therapeutic stance that is affirming, empathic, emotionally engaged, mutual (though not necessarily symmetrical), and affect-regulating
- therapeutic techniques — relational, experiential/affective, integrative — which rely on the moment-to-moment tracking of somatically based affective experience
This therapeutic stance, optimally suited for the dyadic affect regulation that is central to how AEDP works, aims to foster the emergence of a securely attached client–therapist relationship; the techniques aim to facilitate access to adaptive emotional responses.
The aim of the treatment is that the client should have an experience, a new experience, and that that experience be good.
Understanding psychopathology as the result of the individual's unwilled and unwanted aloneness in the face of overwhelming emotions, we seek to be there, together with the client. The client is not alone with painful, frightening emotions. Viscerally experiencing previously feared-to-be-unbearable emotions in the context of an emotionally-engaged relationship with a trusted other, and being able to process these to completion until their adaptive action tendencies are released, is the central agent of change in AEDP. Clients thus (re)gain access to their resources and resilience, previously locked away with the warded off experiences.
Finally, another central and original aspect of AEDP is the focus on the experience of transformation — particularly the experience of the transformation of the self within an emotionally-connected relationship with a true other — as a healing transformational process in its own right.
The typical AEDP client (or the client with whom a 45–60 minute single session of work is most likely to illustrate the quintessential aspects of AEDP at work) is someone whose problems and difficulties are the result of the overregulation, rather than the underregulation, of their emotional experience. Often, through a crisis (such as loss, job difficulties, relationship problems) and the desperation, helplessness and unhappiness that the crisis brings to the forefront, such people become aware of what they're missing or what is wrong in their lives and often such events and their consequences precipitate the person's decision to seek treatment.
The typical client is one who puts others before her/himself, whose self-care takes a back seat to taking care of others, whose functioning and responsibilities are at the expense of their inner life and personal well-being. Typical AEDP clients can be hyperresponsible, and have the identity of being "a trooper," or a "caregiver."
Typical scenarios that bring these clients to treatment are
- impending crisis
- threat of loss (due to illness, death or the deterioration of a relationship)
- relationship difficulties
- professional stuckness or dissatisfaction
- a deep sense of there being something missing in their lives
- a sense of malaise, futility, meaninglessness, or being ill at ease
- a global sense of there being something wrong without being able to exactly identify what or why
- knowing about one's problems and problematic patterns, even knowing something about their source, but still being unable to change
A history of trauma should not rule a client out, but is often a significant aspect of these clients' earlier history. Clients with disorders of the self are ideal.
Diana Fosha, PhD, the developer of accelerated experiential dynamic psychotherapy (AEDP) and Director of the AEDP Institute, is the author of The Transforming Power of Affect: A Model for Accelerated Change (2000), and of articles on experiential process in dynamic psychotherapy. She also contributed to Healing Trauma: Attachment, Mind, Body and Brain, edited by Marion Solomon and Daniel Siegel (2003).
Her current work in transformational studies has focused on integrating recent developments in affective neuroscience and developmentally-based understandings of the dyadic regulation of affect into clinical work with clients.
She is Director of Training for the International Experiential Dynamic Therapy Association, serves on the editorial boards of The Journal of Psychotherapy Integration and Constructivism in the Human Sciences, and has done workshops and trainings throughout North America, Europe, and Brazil.
Dr. Fosha teaches, supervises, and is in private practice in New York City.
- Fosha, D. (2000). The transforming power of affect: A model of accelerated change. New York, NY: Basic Books.
- Fosha, D. (2000). Meta-therapeutic processes and the affects of transformation: Affirmation and the healing affects. Journal of Psychotherapy Integration, 10, 71–97.
- Fosha, D. (2001). The dyadic regulation of affect. Journal of Clinical Psychology/In Session, 57(2), 227–242.
- Fosha, D. (2002). The activation of affective change processes in AEDP (Accelerated Experiential-Dynamic Psychotherapy). In J. J. Magnavita (Ed.), Comprehensive Handbook of Psychotherapy. Vol. 1: Psychodynamic and Object Relations Psychotherapies (pp. 309–344). New York, NY: John Wiley & Sons.
- Fosha, D. (2003). Dyadic regulation and experiential work with emotion and relatedness in trauma and disordered attachment. In M. F. Solomon & D. J. Siegel (Eds.), Healing trauma: Attachment, trauma, the brain and the mind, pp. 221–281. New York, NY: Norton.
- Fosha, D. (2004). Brief integrative psychotherapy comes of age: Reflections. Journal of Psychotherapy Integration, 14, 66–92.
- Fosha, D. (2004). "Nothing that feels bad is ever the last step:" The role of positive emotions in experiential work with difficult emotional experiences. Special issue on Emotion, L. Greenberg (Ed.). Clinical Psychology and Psychotherapy, 11, 30–43.
- Fosha, D. (in press). Emotion, true self, true other, core state: Toward a clinical theory of affective change process. Psychoanalytic Review.
- Fosha, D., & Yeung, D. (in press). AEDP exemplifies the seamless integration of emotional transformation and dyadic relatedness at work. In G. Stricker & J. Gold (Eds.), A Casebook of Integrative Psychotherapy. Washington, DC: American Psychological Association.
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