Attachment-in-Action: Movement-Inclusive AEDP as a Healing Catalyst
By Judy Silvan, LICSW
Abstract. AEDP with a body activation component can enhance state completion and regulation. This paper discusses and demonstrates with two case examples how movement of energy is used as an affective change process. Studied body movements are particularly useful and judiciously filtered into AEDP when other avenues of accessing, regulating, invigorating or integrating affect and energy are blocked. The therapist gently guides the patient through grounding or expressive body motions, attuned to the patient’s needs and introduced gradually. They are often done in tandem with the patient, while seated or standing. A solidly attached emotional container neutralizes the risk that movement of energy will incite shame or pathogenic withdrawal. Physical movements can (a) help “ground” the patient to prevent or reverse dysregulation, (b) soften defenses, and (c) deepen emerging affect.
Introduction
“Play is the exultation of the possible.” ― Martin Buber
Growing up in an extended family laden with first-generation, traditional psychoanalysts, my early career veered into partisan territories. I was fascinated by Self Psychology in graduate school, and once in the field discovered experiential models such as neurolinguistic programming, hypnotherapy and psychodrama. My psychodrama teacher Dr. Ildri Ginn, a gifted Norwegian psychologist, invented a merger of psychodrama, (a foundation of ‘parts work’ including dramatic action), with bioenergetics, a movement-based psychotherapy. She was instrumental in resurrecting a local bioenergetic training program in the late 1990’s. With a love for yoga with its grounding elements, and forever a fan of vigorous outdoor activity (cycling, swimming, walking, etc), I joined the training group with a sense of my body as ‘home’. I’d had little exposure to somatic or movement-based psychotherapy, yet felt inspired by my teacher, curious, and the bioenergetic training seemed like a path to follow with other colleagues who were innovative in their methods. Since studying Accelerated Experiential Psychodynamic Therapy (AEDP, Fosha, 2000), I’ve had a “click of recognition” (Fosha, 2009): Historically, what sings to me in any brand of psychotherapy, including my kinship with a movement-based model, is filtered into a deeply intuitive ‘attachment-in-practice’ lens. I was certified in bioenergetic analysis mid-career and gained a broad somatic and energetic clinical knowledge-base. I now theorize that carefully studied movement is at times a uniquely useful healing element in the context of the elegant, gentle, relational model provided by AEDP.
In my early years at family gatherings I professed employment of the body as a psychological healing entity to newly minted and older analysts, who barely listened with darting eyes. In retrospect, I see their awkward response was to the revolutionary notion, introduced by Wilhelm Reich in 1933 and now common knowledge, that the body could possibly be included in the concept or practice of psychological reparation (Reich,1933; Lowen, 1957; Van der Kolk,1994; Eckert, 2000; Fosha, 2000; Levine et al, 2010). Ildri Ginn’s modeling suggested melding of the body’s movement of energy as a natural expansion of experiential and psychodynamic modalities, and this was pivotal in my development as a psychotherapist.
AEDP has vast capacities as an integrative model, while maintaining its own phenomenology and integrity, and is another radical divergence from psychoanalysis. While AEDP is a talk-therapy, it has a somatic value-base (Fosha, 2000, pp. 24-25). When direct use of the body is sought by patients and taught with proper care, the AEDP model allows for seamlessly adding an energetic and movement facet as one of a banquet of springboards to regulation and transformation. Before formal AEDP training, I leaned into an intuited, uneducated, and thus unreliable version of AEDP. Processing and internalizing AEDP’s rigor and scope initially took all of my focus and concentration. I nearly abandoned hope of refining body movement into my new knowledge base. Yet the glimmers persisted, and this matrix started to manifest in my work with certain patients.
Current Practice Matrix: AEDP with a Movement Element
In the bioenergetics world, I never had a permissive office venue for loud vocal expression, nor felt comfortable using prolonged physical touch or pressure. Both are common elements of classical bioenergetics as gleaned from studying with Alexander Lowen and others. On the other hand, through an AEDP lens with patients who choose to work with body movement, our dyadic attunement may lead to a careful exploration of the body’s energy towards a determined “YES!” (stand-alone, or as a precursor or follow-up to a determined “NO!”). At times permission to tenderly, firmly hold my hand on someone’s back during heavy sobbing, or a move towards them to touch our hands or feet or sit beside them during a moment of intuitive sensing, provides the attunement and security that is needed. These body movements, voiced expressions, and/or touch, are ideally avenues to a ‘state change’ (Malan,1997; Fosha, 2005). For example, gently dropping the arm with a soft fist, or some controlled kicking, while standing or even lying on a couch, can enable stuck affect to surface, open body constrictions, or integrate errant energy. Leaning one’s neck and ribcage back over the soft top of a chair can open the throat and support the diaphragm for fuller respiration, offering a release of laughter, sobs or other trapped core affect. Tracking energy, like all moment-to-moment AEDP tracking (Russell & Fosha, 2008), is a roadmap toward recognizing, integrating, or releasing collapsed, constricted or over-charged energy, and a path to healing and transformation. (Reich,1933; Lowen,1958; Rapaport & Gill,1959; Levine,1997).
Distressed energy is carried around in one’s adult body, often from a childhood or more recent traumatic event, or from complex family trauma (Levine, 1997). In AEDP, our dyadic felt-sense of safety leads us to soften and integrate this hyper or under-charged energy. When a person’s history and narrative revolves around shame through profound loss and/or betrayal in seminal relationships or sexuality, energetic exercises for releasing the blocked or un-integrated emotions are titrated specifically towards quintessential healing phenomena. The healing is based on the AEDP protocols (Prenn, 2011) of creating emotional safety through the field of secure attachment (Ainsworth & Bell,1970). A careful invitation to add movement may offer a down-regulation or an up-regulation of energy if needed by the patient’s nervous system in a given moment of clinical work (Porges, 2010). In turn the patient may feel more fully ‘seen,’ or less dysregulated if proceeded by a sense of invasion. Being dyadically together and including the body in this way can deepen trust and sparks one’s ability to ‘experience’.
AEDP has taught me that the most powerful use of body and direct energy movement thrives with a slowed-down introduction, with many pauses and check-ins to metaprocess. Gradually, if a person needs an energetic boost or regulation, we begin relaxed expressive body movement while seated together, understood as part of ‘talking’. For example, dropping the fore arms onto the side of one’s legs on the chair on an out-breath, and slowly repeating this gravitational movement several times with a light, open fist can be integrated into the clinical moment to arrest shame, transform fear, or calm an incipient sense of overwhelm. Time and again the resultant embodiment promotes a gentle surfacing of categorical affect, or State 2 (Fosha, 2000). Removing the shoes, and slowly pressing sock-bearing feet on a wooden massage roller while talking creates an internal state of solidity and body focus. Almost everyone can tolerate sitting facing one another while engaging the body in these ways, perhaps also verbally communicating, and working to maintain eye contact. Eventually, after several weeks or even a year, a patient may seem open to standing together for active ‘grounding’, or for a studied expressive body-movement sequence (Lowen,1975).
Often, no movement (or even not speaking) at all is gleaned from dyadic attunement, and would not be considered or suggested with a particular patient. Strict adherence to an AEPD stance, as seen reflected in portions of the following transcripts, underlines that physical movement of energy can sometimes be a liability or cause dysregulation. AEDP repairs or revives whatever is dissociated or shut-down. So it is with all of AEDP: The dyadic connection and regulation, in particular, the therapists’ deft attunement to affective, expressive, aesthetic, somatic and energetic markers, uses an educated right-brain intuitive stance as a basis for emotional safety. The safety is registered as healing through left-brain phenomenological recognition and transformational skill sets. Any addition of movement needs to be discriminate, and based on intuited and explicitly permitted capacities of the patient in a given moment (Fosha, 2000; Fosha & Russell, 2008; Prenn, 2011; Pando-Mars, 2011, et. al). All of these concepts can also transfer to couple or to group therapy situations (Mars, 2009).
Some people seek out a movement-based psychotherapy based on prior understanding of somatic psychotherapy, or based on wanting to release their body’s holdings or to relieve feeling ungrounded. An athlete or a person driven to lose weight may perceive movement in psychotherapy as a ’short-cut’, from an addictive tendency to perfect their body shape. In the latter case, an experience of attachment without movement can be feared as an expenditure of autonomy from which to control weight or sexual self-image. Body-shame and traumatic experiences previously expressed through dieting, binging, exercise bulimia, sexual compulsion or sexual avoidance become free to surface. Healing is accessed through carefully attuned AEDP, if the addition of movement is gradual and titrated to the tolerance peak of the patient. Emotional healing commences when the internal body-concepts are safely exposed, and the “true-self” (Winnicott, 1960) is given an opportunity to emerge. In relationship with a True Other (Fosha, 2005), movement is then re-experienced as neither harmful nor defensive. The body’s energy becomes modified, and an ability to experience unburdened vitality and authentic affect (including joy) can emerge with the body’s natural pulsations (Reich, 1933) in a relational therapy context.
When people seek body-oriented psychotherapy from the get-go, the desire is sometimes retracted after a few sessions, and requested and reintroduced once trust is solid in the relationship. (This describes the therapy trajectory in the second case below). Motion-activated shame or dissociation is a crucial element for the therapist to scan and remain acutely attuned. The following transcripts both have portions where dyadic deconstruction of movement-induced ruptures occurs. The disruptions surface as an experience of “confusion” to the patient in both transcribed vignettes. The movements themselves, including dyadic repair around them, become central AEDP and energetic healing agents in unexpected ways.
In this matrix, the movements occur during a circumscribed portion of the session. We then sit down to energetically and verbally metaprocess. The movements lead to an Affective Change Phenomena or “deepening of rapport” (Malan,1997, p.20; Osimo, 2003, p.30), and can accelerate a healing event, through energy either coalescing, softening or releasing. For example, if introduced as a safe and soothing possibility during the beginning phase of a polyvagal shutdown, (Porges, 2009), the body-movements can reverse the energetic collapse and jump-start a revival as we see in case two. An individual can then return to a trusting, connected working state.
When the suggestion of a portrayal provokes an immobilization or shame state, a patient can also be offered carefully chosen physical activity. This might include grounding followed by a guided expressive release through the arms and/or legs. The tandem movement will likely decrease the sense of aloneness that often begets paralyzing anxiety or shame. Often no words are necessary for a few moments afterwards as both parties feel the energy shift in ourselves, as a dyad, and in the room. When verbal communication resumes in the portrayal (during or after the movement phase), it arises from a deeper state. Delight, relief or pride can surface as a “transformative action tendency” when the patient moves out from under the crush of withdrawal, rage or overwhelming sadness (Fosha, 2009).
Case One[1]
James is a 46 year old, African-American, gay married male. He came to me years ago for couples therapy with his (then) partner who was an active gambler and drug addict. In the past he remained in relationships in a caretaking role. In this second treatment, he has a vital, sexually positive, mutual partnership, and has nearly erased his tendency to lose himself in an “enabler” role. He is an underemployed standup comedian. We have a solid therapeutic connection, and while we have worked though most of what defeated his self-assurance in running a household, he yearns to move forward in his performance career. He inherited his parents’ house, and his new family lives there with him. Much to his pan-ultimate pleasure, he’s a few years into being a highly beloved stepfather to twin pre-teens, a girl and a boy, whom his husband of several years adopted in infancy.
By history, James experienced layered and complex trauma. He divides his childhood before and after his mother became ill (when both she and his father were over-attentive and “kept me on the shelf so I wouldn’t break”) James was much younger than his two stepsisters, and grew up as an only child. During his pre-teen years, his mother developed an allergy leading to sudden severe brain damage and was nonfunctional from when he was 13 until her death when he was 40. His dad was an oppressive taskmaster with an OCD-personality style. He enforced zero discussion of the mom’s condition in or out of the home, enlisting James as his partner as primary caretakers. James has recognized previously occluded feelings of anger at his father and horror at his past, which involved feeding his barely conscious bedridden mother, then extracting the waste from her body daily, for over two decades. His father’s hubristic pride (Tracy & Robins, 2004) kept the mother from receiving the professional nursing home care she needed.
Thus James was prevented from having a relatively healthy adolescence, and along with being gay his emotional development was thwarted and burdened (Tunnell, 2006, p.139). Of note, his mom died eight years ago, and finally James and his sisters were able to express love to their dad who lived for six more months. The father’s frail state allowed him to receive love from James during these months. James’ own capacity to feel finally emerged, and he could enter therapy in earnest several years after his father’s death. The excerpt begins with James referencing his underpaid job as a historical tour guide. He yearns to free up what holds him back from his authentic acting gifts; his desire is to star in a comic television series to support his new family. He frequently states that working for this company is akin to “prostitution.”
(Talking about his job 5 minutes into the session):
Pt: The inconsiderateness…
Th: Where do you feel that? [visceral/energetic experiential inquiry]
Pt: I feel it in my ass (fists clenched)…
Th: Yeah… (mirroring his movement)… Do you feel it in your fists? [an attempt for Dyadic Attunement which backfires……]
Pt: I just did…
Th: Yeah.. (coaxing affect): Don’t lose it if you can, stay with it, with me…okay? (lightly tapping chair arms with loose fists) [joining him with emergent affect]
Pt: (fists push forward) I start to feel a little lost…[confusion; red-signal affect]
Th: (gently) Do you want to stand up and feel your feet, feel your body?
When moment-to-moment tracking reveals red-signal affect, I suggest we stand and ground together to help him regulate the affect. My “AEDP Decision Tree” (Gleiser, 2008/2015) guides me to channel his anger into a portrayal by following his affect and energy as our roadmap. Through our attuned relationship, I suggest he discharge some of the affect through his fists, which he experiences as also held in his buttocks.
The following movement and ensuing conversation is a composite of the transcript. The movement lasted approximately seven minutes before we sit. His energy, initially very present, quickly dwindles and he is left feeling confused. We make the disruption explicit, using AEDP interventions to course-correct and allow him a healing experience (Gleiser, 2008/2015). My hypothesis is that his spontaneous movement, while not concluded as planned, allowed enough energetic release and integration to enhance the subsequent rupture-repair sequence.
Pt: (Both stand up, James takes off watch, begins walking in a circle, fists move up and down) Rrr…ahhh…
Th: Do you feel your legs?
I continue to suggest physical grounding to prevent moving too quickly into an anger portrayal; he has shut down in the past when we haven’t titrated movement gently enough.
Pt: Yeah…(swinging torso and hands around) [green-signal]
Th: Mmm… And let the feeling through…through your body…you know?
I’m feeling energized by his expression, thus we collude in skipping over a formal grounding sequence.
Pt: (anger quiets, backs off) I don’t know…I’m resisting and it’s not really what I’m feeling…[red-signal; his affect drains quickly from a few seconds ago]
Th: What is happening inside?
Pt: I’m not angry any more…Which part? [red-signal affect: confusion or dissociation arising]
Th: When we just did what we did—physically.
Pt: It feels good to move and all that…and I don’t mind doing it…but it doesn’t feel right…[yellow-signal; dares to be authentically vulnerable in State One]
The above sentence spoken by James indicates self-state recognition and trust; he is sharing a disruption with me. With AEDP as our paradigm, the apparent disruption is easily remedied. When he seems to be shutting down, we come back to the inhibiting event in a relational context, and we metaprocess the disruption (Fosha, 2000, p. 238).
Th: Ok…let’s stay with that part…the part when you were down on the chair. Do you remember? (Still both standing)
I return to the experiential moment when clear affect was present as categorical anger with an energetic charge. I offer repair by explicitly sharing with him what I saw, and next I will indicate that perhaps my behavior stops his flow. Our active AEDP stance, after the energetic disruption, continuously allows our safe attachment to wind in and out of interventions of moment-to-moment tracking, attunement, ruptures, dysregulation, repairs and ultimately core-state transformation (Prenn, 2011).
Pt: It was mostly when I did this (fists clenched)…
Th: (my fists clenched) When it first felt right… [Mirroring]
Pt: It was a moment of…
Th: Yeah…what’s it like to share that with me and for me to get it…that this isn’t right? [metaprocessing; In retrospect I wish I had not interrupted here as he seems to be moving into State Two. We manage to get back on track as follows…]
Pt: Well, I’m not saying it isn’t right…I’m just saying I’m not…
Th: That’s right that you’re telling me that… That you’re able to be with that and be with me at the same time…like remember? [rupture-repair; mirroring his bravery and making our attachment explicit]
Pt: Yes…
Th: That’s part of your central terror…of that little Jimmy…To say ‘No mom…this isn’t right…this is right’. [left-brain platform; refer to former AEDP-IR work we frequent with “Little Jimmy” (Gleiser & Lamagna, 2007). I offer more repair with James by explicitly championing him, versus faulting him when my instruction “doesn’t feel right” to him]
Pt: (both still standing) Sometimes I wonder what would have happened if I didn’t live in that same house…If I’d moved…maybe I just would’ve been freed up and never needed to come do this.. I don’t know…I don’t know…whatever… [state-change: emerging affect; James retreats to protect the vulnerability of deepening, when he ends his phrase with “whatever.”]
Th: Can you feel your feet right now? [dyadic tracking; I slow him down towards a more holistic grounding rather than the potential portrayal, which was not useful to him, apparently]
Pt: Yup…
Th: And breathe…
Pt: Not the way you’re describing it…[bravely, little Jimmie speaks up!]
Th: What way? [I sense receptivity arising]
Pt: I just feel like— I feel the rug…
Th: Yeah?
Pt: Between my toes cause I wanted to stretch them…[state-change, use of his tactile ‘channel of experience ‘ (Mars & Pando-Mars, 2012, 2013)]
Th: (softly) What does that feel like— all the stuff you just mentioned?
Pt: Really good…the rug is cool as I move my position…it feels very, very good…
Th: Yeah…can you peak at me and tell me about that? (pausing and waiting)… Yeah… [maintaining connection through eye contact]
When we acknowledge the rupture together, a state-change evolves, and he describes the pleasure of his feet and toes on the rug. The rupture and repair cycle includes re-initiating eye contact, and his comfort and safety strengthens. In the following segment, James deepens into core affect, then “tremulousness,” cascading into transformational core-states (Fosha & Russell, 2008).
Pt: Sure…yeah, no… [He says both “yes” and “no”, which implies disorganization. Yet he also trusts me enough to stay with the experience.]
Pt: (continues) It feels great…soft, cool, not exactly ticklish but almost ticklish…pleasant…soft, cool feeling.
Th: (smiling) MMMM.
Pt: And I still feel like I’m lost in this process but keep going cause I’m going along with it…[he initiates metaprocessing]
Confusion is beginning to overwhelm him, and he is seeking security from sharing that with me. I’m sensing another moment of dysregulation and suggest we sit down together as a means to re-regulate, to offer repair.
Th: How about if we sit back down and regroup? See what’s here between us right now…[explicit metaprocess; initiate down-regulation of energy]
Pt: I was gonna say ‘sitting down’ but I didn’t know…I don’t know that it’s the right thing…it’s just something else that we’re doing. [tracks his own anxiety]
Th: Well, do you know what happened that made you decide not to say, “let’s sit down…let’s sit back down”? [metaprocess for safety and dyadic-regulation]
Pt: Um…because I didn’t…I mean it isn’t like a huge life thing right now…I’m not understanding…not having a sense of…when we first got up…from this (fists clenched)…to this (pounding fists) and the noise in getting up…that’s when I didn’t connect as much anymore.
He is able to moment-to-moment track-backwards, so even through defensive confusion he’s also emotionally reaching towards me with trust. Next we see subtle state shifts as he moves up and down “the triangle of experience” (Malan, 1997).
Th: Like you were attuned to your connection and disconnection. And then what felt good with your feet on the rug. [left-brain platform]
Pt: No, that’s good (nodding, eyebrows raised)…that’s good and newish…[tremulous State Three (Fosha, 2009 p.188)]
Th: Newish…well, it’s newish for us, too. Cause I can be pretty stubborn, right? [naming the rupture again, then mini-repair in a playful way]
Pt: Like I said, I’m better and better at it…saying where I’m at. So…that was good too. [pride emerges; State Three]
Th: Yeah…
Pt: I’m still a little confused right now…but that’s still ok too. [tremulousness]
Th: Well let’s just make room for it, ok? Is that all right with you? (James nodding) Be with the confusion with me and breathe into the chair. [regulating and metaprocessing to help ground his energy]
Pt: I still don’t understand it, but that makes sense…[trust: Green Signal]
Th: Yeah…mmm…
Pt: Yeah (smiling). I get up in here a lot (finger circles around temple)…and totally forget about all this…(gesturing down toward his body) [recognition; shares somatic sensibilities; seems lighter]
Th: That’s very important… Right. Yeah…yeah…exactly…
Pt: I think that’s why I have a really high pain tolerance, or I never remember to pee…[Click of recognition: State Three]
Th: Right…yeah (nodding, smiling)
Pt: Which is good, but not good. [tremulousness] Even now…
Th: Even now…Yeah, what happens when you say that?
Pt: It’s sad. [core affect]
Th: Yeah…yeah…
Pt: Years ago, riding with Eric (ex-boyfriend) and we saw this guy in a parking lot…with a paper-bag… and I presume some sort of liquor…and he was just dancing in that parking lot…alone, homeless probably…but dancing…[emerging new narrative]
Th: Yeah…
Pt: And I remember thinking to myself…he’s gonna feel like shit tomorrow…but in that moment, he is absolutely happy (sadness rises, chin quivers). [emerging ‘truth-state’]
Th: Right…and that brings you to tears again.
Pt: Yeah…
Th: If we can make room…make room for all of it, ok?
Pt: (nodding) Yeah…and then whoever is in that ambulance…(pause as ambulance siren enters and leaves)
Th: Right…the “patient in the ambulance part of me”..the “drunken dancing part of me.”. Right?
Pt: (nodding) You’re saying: “I love all of those parts”?
Th: Yeah…yeah…mmm…what happens when we acknowledge that? [spiral; dyadic attunement with tracking]
Pt: It feels really good…it feels like a real God connection…it feels like a little touch of a moment (raises hand slightly, pointing upward with index finger) of the bigger thing. [core state; transformance in action]
Th: Yes…yeah…I feel it streaming through my body, J. (hands sweep from head to feet. And I especially feel it in my feet. [self-disclosure]
Pt: (head tilts forward) I feel my feet…I was feeling my feet the whole time there. [pride emerges; energetic integration]
Th: Yeah…I bet you were…cause you’re connected.
Pt: I haven’t focused on my feet, but I didn’t suddenly feel my feet. I just was feeling my feet this whole stretch. But before this I didn’t.
Th: While you’re feeling your feet, tell me about the God aspect…the drunk dancer…the patient in the ambulance…loving all those parts of you. [coaxing him to stay with core-state healing spiral]
Pt: Because it’s real…It’s truth…[core state; the moment of “being” himself]
Th: Yeah…truth…Wow…that touches me…(hands rise up, body leans back and then forward again, smiling). [emotional solidarity through self- disclosure (Fosha, 2000, p. 230-231)]
Pt: It’s a little giddy almost…I start to giggle a little here.
Th: Well, you love those renegade-parts of yourself…that’s what you came in saying today (smiling), you know? That there’s a peacefulness. (hand circles in front of torso) [left-brain consolidation]
Pt: Oh, yeah that is what I started saying is that I have the crazy parts, then I have these calm parts and I know it’s all part of the (hands make swirling gesture)…journey that I’m going through…being real…being me…being the real me. [core state James]
Skip ahead 3 minutes; James references Danny Thomas, sharing with me that he is one of his idols:
Th: What happens when you talk about channeling Danny Thomas here?
Pt: Oh…that… I could just start crying…[core affect; spirals deeper]
Th: What is it that he does for you?
Pt: It’s the fact that he took the time and the energy to help these kids…
Th: Yeah…yeah…that’s a big part of you…that’s that real core…you were saying the core of me wants to help…that’s core James.
Pt: That is me. And I don’t mean this in a martyr-istic way at all; what I need is to be able to help. [genuine pride versus his dad’s hubristic pride]
Th: Right…you need it…in your bones.
Pt: That’s my…Energy…[core state]
Th: That’s your energy…that’s life essence…..I know you, James…that’s why I feel like I won the lottery knowing you (lean forward, both laugh)…and working with you…[‘gluing the glimmers’[2], privileging our connection]
Pt: I don’t understand why this makes me wanna cry (tears; voice softer) [In this segment, James is moved by his emerging capacity to re-find feelings of love.]
Th: Stay with it…ok? Can we stay with the part that makes you cry?
Pt: (nodding) You should have been a lawyer. [playful connection; attunement-dance]
Th: I say that often! (both laugh)
Pt: Well yeah…thank you…that is correct…you are correct…
Th: Yeah…mmm…(exhale)…It’s so moving…it is so moving to me, James.
Pt: (nodding) Yeah…I miss it…I miss being loved (mouth squeezes as tears arise)…I miss being loved…[mourning of self; core affect]
Th: (gently coaxing) Yeah…stay there…(stay with him)
Pt: (tears) I felt love from my mom…felt love from Howard….With my dad, I only ever really got intellectual love.
Th: Tell me about how much you love your dad and miss your dad. [In this statement, I override his young self’s need for defense against being able to love his dad, which he calls “intellectual love.”]
Pt: I miss what we barely ever had…(sobs emerge)
Th: MMM, (pause) Right…you miss what you didn’t get to have…
Pt: At the end of his life…Dinged…just nicked…I mean we could see each other…or we could feel each other’s gravitational force…[State Three metaphor, core affect, yearning]
Th: Tell me what the force feels like…
Pt: That we were able to say I love you…to each other…back and forth…(more welling up with tears) [State Four: love. We continue with full cascade of core states for another 10 minutes until session is finished.]
Case Two
The second case excerpts a session after 10 months of working with a straight, white married female, age 44, who is the mother of a second-grade daughter. Laura came to therapy as an educated consumer; she is a practicing psychiatrist and currently training in AEDP. She has been in several non-AEDP psychotherapies in the past with little feeling of success.
Initially in our work, Laura asked for “body-therapy”, then completely abandoned movement by our third session. The week before this session, in relation to difficulty relaxing and being sexual unresponsive in her marriage, she asked that we re-introduce body movement to 1) regulate her anxiety to meet her deep desire to heal, and 2) to reconnect with a sexual self that she felt was robbed by her parents in puberty and adolescence. We had begun the movement the previous week and established an explicit need to repair the following rupture: A month earlier she insisted I see her husband for a session when he refused to see any other therapist. When I suggested he see someone else, she emailed the day of her session saying he was “coming in my place; I’m traveling for work and he wants to meet you.” I saw him that day, framed as a way for us to meet, gain trust to support Laura’s therapy, and to give him a well-matched referral for himself.
This transcript is the second of two repair sessions. In the first, she shared her need to withdraw in relation to me. Over the course of the full session we were able to uncover her truth: Some of her sexual withdrawal with her husband and current patterns of shame in relation to our work involved me meeting with her husband, John. There was dissociation and a memory lapse around “sharing” me with John, which had initially been set up as her own session.
This transcript begins as we stand four feet apart, me facing slightly to the side. I titrate our physical distance and orientation based on energetic and verbal dyadic-attunement (Siegel, 2007). Beginning with a grounding sequence can be useful as an antidote to shame or dissociation, both common states for Laura. Grounding together in this session also crystallizes our mutual, emergent understanding of an absence of energetic sensation in her gut down through her hips, pelvis, and legs, into her feet. She describes her legs as feeling “floaty” or “rubbery,” along with a muted sex drive. She is dropping her energy down through her pelvis and legs towards the ground that holds her (Lowen,1977). Together we bend forwards, relaxing our heads and necks, fingers and hands dangling, tailbone up towards the ceiling like ‘rag-doll’ in yoga.
Th: Would you be willing to put your heels out a little?
Pt: (readjusts position, looks down towards feet)…
Th: (pause) Imagine sending your energy down through your legs towards the floor…on the out-breath…bend your knees slightly (demonstrating) so you start to feel your legs on the in-breath as you straighten them…Synchronize your breathing with bending and straightening your knees. (gentle voice)
Pt: (breathing is rhythmic and slow; she looks down)
Th: Wiggle your toes a little…yeah…(pause) Can you feel your legs and feet?
Pt: Uh…yeah…they’re somewhat connected…yeah..I’m like halfway there…it’s still a little floaty but…(shoulders round forward, gazing down at feet)…. [ground to reduce “floatiness”]
Th: (gently) Do you like my directions? [metaprocess; enhance safety]
Pt: Yes…(slowly stands up to answer, arms float up from sides)
Th: (pause) Haaaa…hmmm (I demonstrate a “dive” position)…So put your knees forward and straighten your back behind you. Turn your head towards the hip that is on the same side as your head, and then very slowly the other way…so you’re wagging your tail and using your wide-open eyes to look behind you as you move. Synchronize your breathing with the wags…haaaa…(We slow our breathing down together; slow eye-movement used to loosen ocular blocks.) [dyadic-attunement in motion]
Th: How’s the floaty feeling? [Checking in, tracking]
Pt: It’s a little bit less floaty.
Th: (both of us stand upright now) Here, I want you to try one more thing, ok? (pause) And just…bend your knees and breathe out (I exhale, while my soft fist drops towards the floor from above my head). Very slowly alternate arms– letting their weight drop them down on the out-breath.
I choose this motion to encourage an experience of energetic discharge of the tension and anxiety in her head and upper body, to experience weight and soma in her legs and feet.
Pt: (repeats movements, exhales audibly while alternately each fist drops).
Th: Can you feel your feet each time? Follow with your eyes so they end up looking down to where your hand drops.
Pt: Ok…(deep exhale, arm slices down through air, movement repeated)
I non-verbally guide us to stand up and move back to our seats to meta-process and remain connected.
Pt: All right…(smiling, crosses and tucks legs on chair, clasps hands on lap)
Th: (gently) How’s it going, in terms of just our presence and contact? [energetic check-in and metaprocessing]
Pt: It’s going pretty…like better than average but…but still like, not fully comfortable…
Th: (check in after last session’s rupture/repair) So, last time what happened? I mean you wrote me that really sweet text after the session…
(I do not read it to her although I share it here to illustrate our process): “That was transformational! Judy, that was quite a session. I feel a bit internally reorganized like we moved some organs around in there, made some room for some new stuff.” [“newness;” tremulousness; gratitude]
Pt: I wrote to you? (head tilts) [dissociated memory lapse; red-signal]
Th: (laughs) It was something like…thanks for the great session…it was sort of a thank you…
Pt: Did I ask you anything in there?
Th: I don’t know…I’m just asking you because I like to bring it back between us. [making the implicit explicit]
I acknowledge her enthusiasm and outreach to me between sessions to help her to become present through our shared relational experience. I intuit our need to continue the repair we began last week.
Pt: (nodding) Yeah…
Th: Yeah…Is there anything from our experience last week that you can bring in? (pause) We did a lot of talking and finally got to trace back a lot…We used the word “repair” a few times…
Pt: Oh right (eyes wide, energy rises)…that’s right, ok…We were talking about our relationship [green signal]…I guess…maybe I’m doing too many things and I’m just not remembering each one very well…in my life right now…[begins to regulate]
Th: More what matters here is… How’s it going now between you and I?
Pt: (laughs, chin lowers) Yeah…it’s better than it was a week ago…Just basic trust stuff… So I thought more about it and found the email I wrote you saying John was coming instead of me. I’d completely forgotten that. [green signal]
Her dissociation is waning, her memory is now accurate and she trusts telling me so. She’s moving to a point of stability from which to deepen.
Th: I’m taking this in Laura. “Trust” is your word here and it’s, you know, of course, one of my favorite words too.. [playful self-disclosure]
Pt: And you said in an email recently— That it’s real…You were like, “It’s a real thing, Laura”…[deepens to State Two]
Th: Oh…(softly)
Pt: You were more normalizing. Yeah.. You said this ebbs and flows and it’s real and it’s worth our like…time and attention…(palms open and close). As opposed to just like…yeah, we have to like build our trust back up again…[State Two trust]
Th: (softly and gently) Right, right, right…[cooing her…Solidifying repair we began last week]
Pt: Like it’s a real thing…[recognition and safety]
Th: (gentle voice) As opposed to trust being an aside…It’s very central…I can feel it right now in the room… [self-disclosure]
Pt: I just remembered…I just know that last session it was uncomfortable in my body (hands raise up, elbows bent) [She initiates metaprocessing.]
Th: We did some kicking. In the semi-beginning…like that…(I point to the couch).
I’m referring to her being prone last week while kicking the couch; I immediately saw it dysregulated her. Thus I led her to sit, with us facing one another.
Th: Oh yeah…that’s right…it was kind of shameful to have you see me (head turns to side)
Th: Ohhhh….
Pt: In a…in a prone position…Like, in a more exposed way…it was yayeee (head jiggles, makes goofy noise)…[red signal]
Th: To see you lying down? So let’s not pass this by that quickly, okay. I wondered about that…I remember asking, “Where do you want me to sit?”…Is there anything about that part of last week’s session right now? [initiating more repair]
Based on her request last session to re-start movement in therapy as related to her lack of sexual energy, I had suggested she lie on the couch and slowly drop one leg at a time, kicking from her hips to activate and/or integrate her pelvic energy. Her response, which she again brings to my attention here, suggests that the movement was a dys-regulating rupture.
Pt: At some point in the process early on…we did the first really deep and vulnerable thing…Maybe it was when we were talking about being four years old or something…Since that point, I think, I am more embarrassed and shame-prone around you in our session because …I know that we could go to those places…
Th: Well this is really important. I remember at the time… you were saying, “This is a hot potato”…We established that—together, that it could re-surface in some form. I appreciate you sharing it….[making explicit our “we-ness” (Prenn, 2011)]
Pt: (eyes wide, nods) Cool..yeah…so like looking at you…looking at people is hard for me…just like looking at people in their faces is like …[green signal; deepens to State Two]
Th: Well once in awhile…I’ll remind you…”Can you peek?” And it opens up a whole new experience for you–the stuff that you don’t get to talk about in life…[platforming]
Pt: That’s true, it does…yeah…so like…so, I’m basically like…opening myself up to you…on a pretty regular basis…[State Two] And there’s kind of steady level of like…embarrassment and kind of shame hanging out. [Her shame transforms to an adaptive state.]
Th: Stay as present as you can…we’ll work with whatever happens… I know…You said last week, “I don’t know what to say when you ask ‘What’s it like?’” [more repair]
Pt: (laughs, head tosses back) [green signal; relaxing] Yeah, but I’m trying to do the right thing (fingertips lightly and quickly tapping)…I’m trying to be a good therapy-student. [playful State Two]
Th: Well you’re trying to do both, and you definitely get an A+ as a therapy-student in here… (gentle voice) And, you’re also being real, Laura. [affirming her strength]
Pt: (tosses head back and laughs) That’s good…(tilts head). (green signal!)
Th: And when you let yourself believe me for those moments…for those split…seconds…like little sparks…Could we stay with that for a second? [more affirming; slowing her down]
Pt: Yeah, there’s like light coming in but there’s a little thing in there and it doesn’t want to come out…it’s not gonna like run out and be exposed and do a little dance…it’s gonna stay in there and just kind of ….(voice trails off)
Both possibility and shame are present in her experience now. She is telling me she feels safe to explore this small, young part.
Th: Mmmm. I really don’t want to abandon your little thing, and you…
Pt: Yeah…but it’s not comfortable under there though so…it’s like an overarching wet blanket over the whole scene. [referring to last week’s metaphor of shame being like a “wet blanket”]
Th: And now?
Pt: (inhales) Um… Yeahhhmmm…I don’t know…now I’m just kind of more generally anxious (hands make swirling gestures above lap; remote look) or something. [red-signal withdrawal; incipient dissociation]
Th: So what if we stand up again…do a little more grounding right now…a little more energy stuff?
Laura describes the ‘shut-down’ as it is happening; she’s now dissociating with shame/embarrassment. I decide to quickly switch energetic tracks, leading her in a brief yet powerful movement sequence so we can remain on course and reverse the energetic collapse. She easily accepts my attuned invitation.
Pt: Ok. (fingers form prayer mudra in front of mouth)…
Th: (gently) Are you willing? (Laura nods as we both rise to standing.) Let’s try it… [asking permission/inviting]
Pt: Ok…(standing about three feet apart, facing in the same direction)
Th: Alright, feel your feet, and send the energy down…
The constancy of my voice and tandem activity soothes her. With an energetic discharge, my intention is to reverse her shame-based confusion and micro-paralysis. I guide her to stand and move into an embodied state. I model, and together we bend our knees with an audible exhale on each swift down-stroke, alternating arms with soft fists lifted behind our heads and falling fast towards the ground in front of our legs. Our energetic action lasts 45 seconds; I gesture us to sit and metaprocess the experience.
Th: (both seated now) Do you mind pressing your feet on the wooden massage roller to feel them as we keep talking?
I am guiding her to stay grounded by engaging her feet while seated, hoping a regulated energy state will solidify.
Pt: (noticeably brighter, more present and relaxed) It’s easier to look at you now…I feel like I’m a little bit more on equal footing…than like being down or like…powerless or something…When it’s hard to look at you…I am a little bit down and you’re like a little bit up (one hand high above head; vital, relaxed affect). [immediate regulation occurring]
A new relational reality is emerging (Fosha, 2009, pp. 3-4), which she marks by a state of “equality” and symmetry between us. The movement was pivotal in transforming her shame from paralyzing and maladaptive, into moments of vulnerable adaptive shame, which can now be unfolded for healing.
Th: (gentle soft voice) And….When we are on the same level, what is that experience like…if you just stay with it (mirror spherical hand motion)…if we can stay with it together for 20 seconds? [asking permission]
Pt: Yeah…And it’s kind of… (gazing upward, hands clasped) Also…where do we go from here…if we’re on the same footing then like there’s no more work to do. (tears well up) [tremulous state change; enters State Three, then backs up quickly fearing vulnerability, overwhelmed by a sense of loss]
Th: What a brilliant question…it’s so great that this is what’s coming up and then you’re sharing it…(exhales).. [affirmation]
Pt: (head bows forward briefly) OK…(tearfully)
Th: (soothingly) Yeah…don’t worry Laura, I am not gonna abandon you…[making the implicit explicit]
Pt: (slaps knees, smiles) That’s so good! [state change]
Th: Yeah..Is it touching when I say that?
Pt: It’s like “Really!?” or “Let’s play, I’m so excited”… rather than like (voice contained) ‘Oh…thank you Judy’…It’s like a little, little kid who’s running around. And there wouldn’t be like any “positions” that we have to deal with…[core state vitality; emergent click]
Th: (smiling) Yes, Let’s play! [joining her core experience of relief/joy]
Laura spontaneously moves into AEDP-IR parts work (Gleiser & Lamagna, 2007). Her 4-yr old part is transformed from the near mute, shame-ridden 4-yr old we’ve met prior to this. She moves down to invite a relational uplift between us. Her metaphor of being “little kids” together is unburdened by roles and positions in contrast to her shut down state before the interlude of swift movements. Now she is energetically and socially unconstrained.
Th: Like when you playfully braved helping me park this morning…right? [platforming and metaprocessing]
Pt: (chin rises, laughs) [recognition]
We metaprocess her shame about stepping out of role by spontaneously directing me in parallel parking right before we met: (“Maybe you wanted 3 more fucking minutes to yourself before you started working…”). She now feels accompanied versus separated, and tells me that each night when she’s finally able to let down, she chews on shame related to events during her day, such as taking the risk to help me park my car. We succeed at undoing her deep sense of aloneness (Fosha, 2000), leading to an emergence of core-state pride at her relational warmth and effectiveness.
Summary and Conclusions
In AEDP, the body unequivocally holds energy and trauma, somatic memories and accessible affect. These cases show the body’s capacity, in conjunction with rupture-repair and guided AEDP protocol, to inspire affective change processes and deepen into transformative experiences (Fosha, 2009). The movements are structured and led by me, and tend to be subtler and softer than classical bioenergetics. They allow palpable shifts in these two patients for deep healing states, as the energy safely unfolds. My careful guidance includes when to introduce and/or end movement, what movement to suggest, how to carefully attune to the patient before, during and after the movement phase, and when to sit down to metaprocess– with AEDP as the overarching healing paradigm. Neither case demonstrates classic bioenergetics and exemplifies my theory: Movement-inclusive AEDP is a means of using elements of body-oriented psychotherapy under the auspices of attachment-in-action. I purposely did not include cases where a strict Bioenergetic Analysis paradigm was maintained; I now use movement, energetic technique and theory only inside the parameters of AEDP.
The patient in the first vignette, James, is less comfortable working directly with his body. “Resistance” (his term) came up repeatedly in our prior treatment years ago, when he sought out bioenergetics. This time around, with a movement-inclusive AEDP paradigm, James is boiling over with dischargeable energy as the session begins. When I suggest he stand with clenched-fists and move towards an anger portrayal, he complies and our attempt to engage the anger is too avid. We remain loyal to moment-to-moment state tracking without judgment, and follow his energy and micro-state changes. He experiences an energetic core affect of sensory delight, exclaiming a state-change. Returning to sit together allows him a different sort of shared energy than the rigorous movement. We metaprocess the dysregulation, and he spirals into a “safety and repair” sequence. We are able to deepen into State Three, maintain it, and move into a cascade of transformational core state (Russell & Fosha, 2008). The movement sparked an energy shift with charge and discharge (Lowen,1957) reigned into both inter and intra-psychic AEDP healing phenomenon.
In the second vignette, we explore adaptive shame through rupture/repair, which began the prior week. Structured “grounding” to begin the session begets an intra-psychic, intra-body, and inter-personal connection, helping her avoid dissociation for most of the session. We work in deepened states and revisit the prior weeks’ experiences to continue repair of feelings of overexposure, while Laura manages to stay emotionally present and connected. We transform her shame into workable vulnerability, spontaneously leading to an intra-psychic AEDP-IR moment (Gleiser & Lamagna, 2007) with the “little thing’s” appearance. Despite this part’s strong pull to hide, she dares expose it to us, when suddenly an energetic collapse begins. I respond swiftly, by leading her in a second burst of movement chosen intuitively to jump-start regulation and bypass maladaptive shame. Her energetic self-state revives through tandem movement and metaprocessing, and successfully deactivates her shame. She experiences joy and playfulness, a healing core state. We share a felt experience of true play, and explicitly explore the trust and equality we’ve developed which organically surfaced. Despite her complex trauma history, sexual anxiety, and inhibiting energy blocks, through a course of steady dyadic-attunement including movement, we deepen into healing processes. Our work in this vignette leads to a transformance phenomenon, and she reports that she sustains this ‘true-self’ in her family and marital life. (Russell & Fosha, 2008; Winnicott,1960).
[1] Identifying information is disguised to protect confidentiality for both patients.
[2] “Gluing the glimmers” is a concept introduced by SueAnne Pilierio.
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