Understanding AEDP (Accelerated Experiential Dynamic Psychotherapy)

© Tim Hartnett, MFT 2013

Note: Therapeutic Orientations The field of psychotherapy contains a vast array of therapeutic orientations, each with their own moniker and primary focus or wisdom about the human psyche. Different approaches, however, often share many similar concepts and techniques, even though they may use distinct jargon to describe their models. One can approach psychotherapy from many starting points, and still arrive at some common understandings of the basic nature of human emotional healing. Even rival schools of thought, in time, have tended to discover the value contained in constructs outside their own enclave of practitioners. The most exciting new orientations, moving the field forward, are now composite approaches that glean the most essential and effective strategies, from a variety of sources, to assist people in emotional pain. AEDP is one such approach. It builds upon the rich history of the field, as well as contributing some profound new understandings and effective strategies. AEDP is not the only approach, however, that employs many of the concepts and techniques described here. It is just the one the author is most familiar with. AEDP is a relatively new therapeutic orientation, originated by Diana Fosha. It combines the powerful contributions of both experiential-based and relational-based psychotherapies. AEDP also offers some unique contributions to the field, lifting the art and science of emotional healing to a new level of effectiveness and potential for facilitating transforma-tional experiences for both client and therapist.

Most people encountering AEDP first wonder what the term means. A brief explanation of the words in this acronym can provide an introduction to the key aspects that characterize this approach.

Accelerated
AEDP offers a way of working with people that can generate a natural and self-propelling spiral of healing experiences. Clients not only process their distressed feeling states to a sense of resolution. They also deepen their capacity to identify with their new experiences of emotional health and vitality. By focusing on newly acquired positive states and inner resources, clients build a platform for further growth. They become motivated not only by a desire to be free of pain, but increasingly by a desire to further experience the enlivening power of authentic expansion and personal growth.

Experiential
In AEDP, clients do not simply talk about or analyze their feelings. They exper-ience them. Humans have a natural emotional healing process that AEDP calls “transformance.” We are inherently motivated to connect with others, feel our emotions, and allow them to naturally transform. This process, easily observable in infants and children, is available to us throughout our lives. Unfortunately, most of our social environments do not support us in fully accessing our emotions. AEDP provides the safety and relational attunement that allows this natural healing process to operate freely.

Dynamic
In AEDP clients experience a dynamic interactional healing experience through an authentic relationship with their therapist. AEDP therapists are not blank slates or advice dispensers. They are living, feeling human beings who are willing to experience their own emotions as they interact with. They maintain a professionally structured relationship (they don’t become friends with clients outside of sessions), but they are willing to genuinely care and delight in their discovery of their clients, including their courage to face their feelings, and the unique personal resources they bring to their healing journey. By decreasing a clients’ sense of aloneness in their pain, their natural emotional healing process can be profoundly bolstered.

Psychotherapy
The new experiences clients have in AEDP generate a broadly transformational effect on their lives. Clients internalize the guidance of the therapist and are better able to identify and process their emotions in real time in their daily lives. Additionally, clients gain better access to the positive emotional states that emotional healing brings. Experiencing positive transformance allows clients to more clearly and rationally construct a positive narrative (personal story) about who they are and what is most meaningful to them. A better self-narrative helps clients make better, more satisfying choices. AEDP therapy also helps clients build the inner resources to feel more secure in their relationships with their loved ones, family, friends, and acquaintances; and most importantly, with themselves.

How Does AEDP View Human Nature?

Our Core State
To understand what an AEDP therapist does, it helps to know how AEDP views human beings, our emotions, and the difficulties we often experience. While people are capable of doing themselves and each other great harm, AEDP believes that we also have an inherent drive and capacity for healing and personal growth. AEDP believes that the “core state” of every person is an experience of calm and zestful contentment in the present moment. Our “transformance” drive is our motivation to heal the unprocessed emotional pain that lies between us and our ability to experience our core state. AEDP therapists see clients as people striving to grow, despite how afraid they may be of their unresolved emotions.

Attachment Styles: Our adult emotional lives are strongly affected by the dynamics of our early relationships with our caregivers. Children and caregivers normally form bonds (attachment) in which a child can regularly ground their emotional states in the attuned presence of a nurturing caregiver. Both the child’s drive to seek comfort and the caregiver’s drive to offer nurturance are innate human behaviors. When children feel secure in their bond they also experience a drive to explore the world beyond the caregiver. When a caregiver can support this exploration and remain available to the child if the child becomes upset, then the bond remains secure. Children do have some degree of resiliency, so parents do not have to be perfectly attentive for a child to feel a secure attachment. Caregivers can usually successfully repair a disrupted sense of connection. Different types of adult relationship styles can develop from the attachment experiences people have earlier in their lives. Someone who experienced a dependable, nurturing caregiver who supported his exploration and accepted his feelings would likely feel secure in the relationships he forms as an adult. Someone whose caregivers were inconsistent, unable to support his independence or respond well to his feelings, is likely to feel anxious and/or avoidant about closeness with others as an adult. Your attachment style will affect how you feel toward your therapist. A key goal of AEDP therapists is to provide consistent, well-attuned support for their clients. This offers the client an experience of secure attachment, which can help heal the effects of prior dysfunctional relationships. Whatever your attachment style, an AEDP therapist will attempt to support you in ways you have not felt supported before, helping you to feel more and more secure in the therapeutic relationship and in your relationships outside of therapy. Emotions

Our transformance drive is part of a natural emotional healing process within us all. In this healing process emotions arise, are experienced fully, and then naturally recede. When we sense danger for instance, we feel fear, and the emotion prepares our bodies to run. Muscles tighten and the heart rate, blood pressure and breathing rate all increase. If all goes well, in time, the emotion subsides and emotional balance returns.

Because humans are such a social species, our emotions are greatly influenced by our interactions with one another. Healthy connection with others can augment the natural release of emotions. Discordant connection with others, alternatively, can prolong or intensify states of emotional distress.

When we have strong emotions, we naturally seek help in regulating or “grounding” them by connecting with another person. A child, for instance, will seek the comforting presence of a caregiver when strong emotions are triggered. If the caregiver offers empathic attention, the child feels safe to allow her emotions to naturally discharge. If, on the other hand, the caregiver ignores or rejects the child’s feelings, the child may learn to suppress her feelings. To ensure they remain lovable, children often try to disown the emotions that are rejected by their caregivers.

Unfortunately, suppressing feelings interrupts the natural emotional healing process, leaving the unwanted feelings unresolved. These suppressed feelings do not actually go away. They are just temporarily buried. They may break into consciousness when triggered by environmental cues. Whenever something happens that is similar to the situation that originally generated the suppressed emotions, those feelings may arise unbidden. It can be very distressing when strong feelings from past situations flood into consciousness at inopportune times.

Over time, the amount of unresolved feelings can build to levels that seem too overwhelming to address. Unfortunately, keeping feelings repressed takes a serious toll. Suppressing feelings usually involves an increase in chronic muscle tension and a decrease in our awareness of our bodily sensations. We clamp down on our chest, stomach, and visceral organs. Our breathing becomes constricted. We have less energy and attention available.  Eventually, we may become depressed.

Because our emotions are often unwelcomed by others, and difficult to suppress, we may come to dread them. This dread, shame, or embarrassment about our emotions is a “meta-feeling” or a “feeling about a feeling.” The most troubling emotional pain people experience involves their meta-feelings, the agony they experience over having emotions they wish they did not. This pain is both cognitive (we berate ourselves for having unwanted feelings) and physical (our bodies suffer from chronic tension and constricted awareness).

It is important to distinguish between the pain of our meta-feelings and the experience of natural emotions. When we are openly and freely sad, afraid, or angry the experience of releasing emotion can be relieving, meaningful, energizing and enlivening. In contrast, the tremendous tension our bodies exert (by habit or by choice) in the effort to suppress feelings can be very painful. This overwhelming pain is what prevents most of us from opening ourselves to experience the feelings we have long supressed.

We all carry unresolved feelings. Intuitively, we may know that the way through these feelings is to allow them to be felt and released. But we often resist doing so. We may lack confidence that we can succeed in resolving the emotions, so we avoid feeling the pain involved in allowing emotions to surface. We fear that the effort may be unsuccessful. Our feelings may be stirred, the shame and bodily tension that habitually suppresses them may automatically heighten, and the feelings may be pushed back down without any satisfaction of release. No one enjoys that.

Thus, in order to engage our suppressed emotions, we need to feel safe. We need conditions that give us confidence that there is enough support for our feelings to allow them to successfully release. One potent source of this confidence is the presence of someone who can offer us their full attention, who welcomes our feelings and who is not overwhelmed by them. We sense the support we need when we believe our feelings will be understood and held with care. We feel safe when we can draw on someone else’s perspective that our feelings are not shameful, inappropriate, or burdensome, and that we will not be rejected for having them.

The calculation of safety may be conscious or unconscious. We might know we feel safe and therefore decide to let our feelings surface. Alternatively, our feelings may suddenly break to the surface, and only afterwards do we become aware of why it felt safe enough for them to arise.

Unfortunately, the presence of someone who can help us feel safe to feel our suppressed feelings is all too rare. Thus, AEDP notes that we often feel “alone in the face of our unbearable emotions.” AEDP therapists seek to ease the burden of this aloneness, while simultaneously reducing the amount of unresolved emotion. The two goals support each other. It is easier to resolve emotions when you feel connected to someone who cares. And as you release emotions, your capacity to trust that you are not alone increases. These mutually reinforcing goals accelerate growth as the client’s natural emotional healing process increasingly becomes more easily engaged. This is the focus and objective of AEDP.

How Does AEDP Help People?

The Goal of Therapy
The primary goal of AEDP is to help clients resolve their emotions by helping them feel less alone. The therapist provides authentic, caring attention, and guides her client to experience her feelings, fully engaging the natural human emotional healing process. Further, the AEDP therapist assists the client in reflecting on the resulting transformational experiences, enabling these new experiences to build confidence and motivation for continuing rounds of self-exploration and personal growth.

Establishing a Safe, Connected, Authentic Relationship
AEDP therapy is relationship based. Specifically, the relationship between the therapist and the client is the essential ingredient for emotional healing. This means that an AEDP therapist must be willing and able to be authentically present with her client. She must be able to track her own spontaneous feelings as she witnesses her client. And she must be willing to share her internal responses with her client. This authentic sharing allows both parties to discover when the therapist is well attuned to the client’s experience. Whenever there is a high degree of attunement, the client is likely to feel safer to experience her own feelings more fully.

Further, the AEDP therapist must have the capacity to welcome the client’s feelings at any level of emotional intensity. To do this, the therapist must have extensive experience dealing with the full range of her own emotional landscape. A client is not likely to feel safe exploring emotions that are overwhelming to the therapist. This capacity to make room for whatever feelings the client may have is developed through the therapist’s engagement in her own personal growth, before and throughout her career as a therapist.

AEDP therapists also increase a client’s sense of safety by affirming and appreciating the client’s strengths and personal resources. The therapist must be able to see a client’s uniqueness and recognize their gifts and their inherent goodness. The most authentic way to do this is for the therapist to express her own feelings about the way her connection to the client affects her. Since it is a natural human response to feel caring for someone who vulnerably presents himself in need of help, therapists usually experience genuine appreciation and caring for their clients. When they do not, it is usually an indication that some unresolved feelings in the therapist have been triggered. It is the therapist’s duty to address and transform these feelings through her own self-exploration outside of sessions with clients. Difficulty feeling caring or appreciation for a client is never an indication that the client does not deserve to be held with unconditional positive regard.

AEDP therapists establish an authentic therapeutic relationship by communicating versions of the following messages:

    • I am here with you.
    • I am noticing your strength, your awesomeness, your courage, your goodness.
    • I have room for your feelings. I welcome them.
    • I am affected by what I see in you. My feelings are moved when I witness yours.

 

Facilitating Access to Emotions
AEDP therapists guide clients to keep focused on their emotions. Because emotions have both somatic and cognitive components, AEDP therapists will often guide a client’s attention to their bodily sensations. People have often learned to avoid being aware of their bodies, particularly the subtle sensations associated with emotion. In AEDP, the focus on sensing one’s body in the present moment helps clients more fully experience their feelings, rather than talking about them or analyzing them.

One technique AEDP employs is asking clients to speak in present tense as much as possible. The immediacy of speaking in present tense helps make our feelings about whatever we are talking about more alive and accessible. If you are telling a story of something that happened to you, for instance, your feelings about it may be more present if you tell the story as if it is happening to you now. For instance, instead of recounting a dream in past tense the a client might say, “In my dream I am walking through the sky. I see my grandmother on a cloud and she is gestering to me. As she does this, I am feeling so sad that I don’t seem to be able to come to her…” When a client speaks in the present tense, they can report spontaneous emotions they are having as they speak, rather than reporting on feelings they once had, but now only remember.

AEDP therapists also deepen emotional experience by asking clients to rephrase any language that serves to distance themselves from their feelings. We often couch the expression of our feelings in ways that protect us from actually feeling them. For instance, a client might say, “You can’t trust people not to screw you over.” An AEDP therapist might then ask the client to express this more vulnerably and with more direct ownership of the feeling. And the client then say, “I guess I mean that I can’t trust people. I am afraid they will screw me over.” The new phrasing helps reduce the emotional distancing embedded the first, more abstract phrasing. By rephrasing the sentence, a client is more likely to directly experience the feelings he or she is talking about.

As clients begin to experience more intense emotions, AEDP therapists support them to stay connected to their emergent feelings. Often, as feelings arise, we automatically distract ourselves, in order to regain composure. An AEDP therapist helps clients become aware of when they have dodged experiencing an emerging emotion. The therapist will ask the client to slow their process down so that there is room for spontaneous feelings to be fully experienced. This focus on “staying with” a feeling applies to both pleasurable and undesirable feelings. Whatever experience a client tends to avoid offers a rich terrain for new self-exploration.

Additionally, an AEDP therapist assists clients to deepen into their emotional experience by helping them process their meta-feelings (their feelings about having feelings). Directly addressing the habitual shame or embarrassment people often have about their feelings can help people feel safer and more willing to allow their feelings to release. Shame about our emotions usually develops from situations in which we are rejected or humiliated for having feelings. Focusing on this type of shame can help a client realize that the presence of an attuned therapist renders any habitual suppression of feeling unnecessary. We never want to lose the ability to suppress our feelings when we choose, based on our circumstances. But it is useful to directly re-evaluate any beliefs we may have adopted that prevent us from freely experiecing our feelings when it is entirely safe to do so.

AEDP therapists facilitate clients accessing their emotions by communicating versions of the following messages:

    • I notice your voice tone changed a little there. Is there a feeling that goes with that?
    • What is happening in your body as you say that? What sensations do you notice?
    • Could you describe that as if it were happening now, so that any current feelings you might have about it could arise?
    • That feeling you just had… would you be willing to stay with that a little and see what happens if you focus on it?
    • I am thinking you might be describing your own feelings as well as making a larger point. Would you be willing to try starting that last sentence with “I feel…” and see what effect that has on you?
    • How do you feel about having these feelings or about letting them show? How do you think it affects me to see you feeling the way you do? Would you like me to tell you?

 

Supporting Self-Exploration with Internal and Relational Resources
The client in AEDP has a heroic role. He or she is engaged in the courageous task of attending to emotions that have previously been too difficult to face. They may have to brave the sense of being alone in the midst of overpowering emotion if they seek to reduce the suffering of this aloneness and overwhelm. To support them in this endeavor, AEDP bolsters both the client’s internal resources as well as the client’s receptivity to support from the therapist.

From the beginning of therapy an AEDP therapist notices and reflects the personal strengths he sees in his client. Drawing on his own spontaneous feelings of appreciation and awe, the therapist communicates his discoveries of the client’s courage, strengths, passions, honesty, resilience, and inherent goodness. Being held in this unconditional positive light lends confidence to clients to self-explore parts of themselves that have previously been shrouded in shame. The therapist need not fabricate any falsely positive perspective of the client. Simply and authentically noticing the clearly evident personal gifts of the client provides more than adequate support.

The AEDP therapist also assists the client in recognizing her own personal resources. When a client experiences a resourceful state or emotion, the therapist will ask her to deepen and explore that positive state. As she is encouraged to experience and identify with her own resourced emotional states, those states strengthen and provide support for her to explore more vulnerable feelings. AEDP therapists highly value time spent exploring clients’ positive feelings about themselves. This exploration helps clients both shift their self-identification to their more positive emotional states, and it empowers them to more confidently embrace the emotions that trouble them.

When a client does begin to explore suppressed parts of herself, the therapist facilitates the client to bring her own resourced states into the exploration. For instance, when one part of a client identifies herself as an intelligent and caring person, that part can reach out to a more vulnerable “inner child” part, who may feel alone and overwhelmed by the dynamics of life she experienced long ago. By helping a client simultaneously access both the strong and the vulnerable parts of herself, the therapist facilitates self-healing. The aloneness of one part is relieved by the resourceful presence of the other part.

The therapist’s own presence is, of course, an additional resource for reducing the client’s sense of aloneness. Often, however, a client will not fully receive the connectedness the therapist may have to offer. The client’s entrenched sense of being alone may prevent the client from acknowledging her connection with the therapist. AEDP therapists help clients become better able to receive support by calling attention to the present relationship between client and therapist. The client is asked to notice whether she senses the therapist’s attunement to her. She is asked to reflect on this awareness, and how it may differ from any past experiences of aloneness.

AEDP therapists support self-exploration by offering versions of the following guiding questions:

    • You smiled as you said that. Is there a part of you that enjoys yourself as you say that?
    • How do you feel when you reflect on the things you know you did well in your last relationship?
    • What part of yourself made sure you could survive through all that you have been through?
    • Would you be willing to bring that strong, confident part of you into connection with the part of you that feels so young and vulnerable?
    • What do you have that this more frightened part of yourself needs?
    • You understand that little boy in you so well. You know exactly what he feels and what he needs. Does he know how much you care about him?
    • Do you sense that I am here with you? Would you like to bring me with you when you go inside to face those big feelings?
    • I am so moved by how alone you must have felt at such a vulnerable time. Can you sense that I am feeling that with you?

AEDP Couples therapy can bring a partner in as an additional resource for ending the suffering of aloneness in the face of overwhelming feeling. Relationship partners can be witnesses for each other as they self-explore the vulnerable parts of themselves. The therapist can guide this process by helping the partners consciously take turns self-exploring, and then supporting the other’s exploration. As in individual therapy, the therapist will likely begin by focusing attention on the couple’s resourceful states in relation to each other. He may, for instance, ask the couple to focus on any sign one offers the other of caring or appreciation. Deepening each partner’s ability to receive the love of the other is therapeutic in itself. But it also serves to strengthen the relationship resources prior to exploring how the partners evoke negative feelings in each other.

Meta-Processing Transformational States
As clients open to more fully experiencing their emotions, those emotions spontaneously transform or release. Such is the nature of our natural emotional healing process. To further growth, an AEDP therapist takes a step often neglected in other types of therapy. This step is called “meta-processing.” In meta-processing, the client is asked to fully explore the feelings emerging from the experience of having transformed the original feelings. The question might be, “How does it feel now to have experienced your grief the way you just did?”

The feelings that emerge when a client experiences a transformance can be profound. A client may have a very positive sense of herself, an afterglow of relaxation and clarity, an experience of her core state. Or, she may have a trembling feeling because the newness of her emerging emotion is unfamiliar to her. She may feel proud of herself, or grateful toward her therapist. Alternatively, she may feel distraught, flooded with more unresolved emotion seeking transformation. All of these potential feeling are candidates for meta-processing.

Staying with the positive affects of transformance offers a particularly therapeutic benefit. As a client spends time deepening her awareness of the positive states that spring from successfully resolving a previously overwhelming feeling, she builds a foundation for further growth. Fully appreciating her positive feelings bolsters a client’s motivation to continue her self-exploration through processing more suppressed emotions.

Additionally, staying with the good feelings brought on by transformance helps the client begin to shift her identity from one dominated by the discomfort of unresolved emotion to an identity that takes into account the newly discovered sense of emotional well-being. In the positive, post-transformative state clients often experience a clarity of mind that allows them to think through issues that were previously confusing to them. They can rewrite the story they tell themselves about who they are and what their life is about. The resulting insights and re-evaluated beliefs can stay with them long after the temporary emotional state fades.

When an AEDP therapist asks clients to meta-process their experience, the questions may sound like this:

    • How do you feel about noticing what a big smile you have now?
    • What is it like for you to have just gone through such deep grief?
    • How do you feel about yourself now, having just gone through what you did?
    • If you were to just stay with this good feeling, how would that be for you?

Meta-Processing Relational Attunement
Because AEDP therapists are deeply engaged in countering a client’s sense of aloneness, they will often ask clients to meta-process their experiences of the therapeutic relationship. By focusing on how the therapist’s presence has facilitated her healing, a client is given a chance to deepen her awareness of the connection she experienced as she traversed her emotional wilderness. Noticing how she feels in the company of the therapist can deepen her understanding of what it means to experience a secure attachment (within the boundaries of a professional relationship). When a client fully explores how the therapist’s presence affected her, she may eventually become able to offer herself the same type of healing presence, even when she is alone. In this way, the therapeutic relationship helps clients learn to ground their emotions the way that secure attachment to a caregiver helps a child learn to regulate their own emotions as they grow.

When an AEDP therapist asks you to meta-process your experience of the therapeutic relationship, their questions may sound like this.

    • How is it for you to tell me these things about yourself?
    • When I say that I am moved by the feelings you describe, how does that affect you?
    • How is it for you to feel the gratefulness you just described?
    • When did you feel me with you, and when were you not sure?
    • If you look in my eyes now, what do you see? And how does that feel?
    • What are you taking in from knowing me, from how I am with you?

What’s it Like for the Therapist?
Practicing AEDP is both very demanding and very rewarding. A therapist’s ability to attune to their clients feelings is only strong when they are not distracted by unresolved feelings of their own. Therefore, AEDP therapists must be regularly exploring and transforming their own feelings. Only then can a therapist expect to be able to hold a safe space for clients to self-explore.

The rewards for the therapist, however, are equally great. In an authentic relationship, the therapist is genuinely involved in the transformance of the client. Thus, as the client changes state, the therapist’s feelings are also affected. When a client moves from confusion and blocked emotion to a state of release and acceptance, the therapist is also changed. After work, a therapist may be tired from all the focused attention they offered, but they will likely also feel happy and grateful. Through their connection with their clients they will have met their needs for closeness and trust. And by making a meaningful contribution to their clients’ lives, they meet their need to give to others. Providing nurturance is an innate response when people see others in need. When AEDP therapists successfully facilitate their client’s natural emotional healing process, this need to nurture is profoundly satisfied.

What’s it Like for the Client?
AEDP clients are often surprised at how much they enjoy their initial sessions. Being guided to notice one’s strengths and deepen one’s awareness of positive states can be very uplifting. Clients are often relieved to find that their therapist believes in their goodness and their own motivation for personal growth. Clients who expect their therapist to pathologize them or give them feedback on what is wrong with them will be pleasantly surprised that this is not a part of AEDP.

As a sense of safety develops, clients will likely experience the emergence of suppressed feelings. This can be painful and alarming. As they feel even more support, however, their feelings are likely to flow more freely. Clients may even begin to enjoy the depth and power that opening to raw emotion offers. They will likely also experience new, profoundly positive feelings as a result of transforming suppressed emotion.  Meta-processing these new feelings can be very enjoyable, and lead to new insights and mental clarity.

As a client’s relationship to the therapist develops, they will like experience changing levels of trust. Sometimes they will feel secure in their sense that their therapist truly cares. At other times (as when shameful emotions are emerging) clients may have doubts, and need fresh evidence that they really are safe to be themselves. The therapist may not always respond perfectly. They are fallible humans. But if a therapist is willing to address any lack of attunement their client experiences, they may together rebuild safety within the relationship. In the process, clients may experience the type of secure attachment that some children feel in relation to consistent, nurturing caregivers. Experiencing this in relationship to a therapist can help a client feel higher levels of security in their other relationships as well.

As a result of therapy, clients may notice changes in how they live their lives outside the therapy office. Their comfort with their own emotions will gradually increase. Their ability to be present with others will be enhanced as they absorb this skill from their interaction with their therapist. A client’s backlog of suppressed emotions will be reduced, freeing up their energy and attention for new initiatives in their lives. Midway through therapy, clients may dread approaching sessions, knowing that there is often pain involved in surfacing old feelings. Gradually, however, the positive results of transformance will provide increasing motivation for continuing to pursue personal growth, whether or not the client is still driven by the symptoms that brought them to therapy. This is the promise, and often the gratifying result of AEDP.