Letters from the Editors: Gil Tunnell and Carrie Ruggieri
Introduction to Special Issue: Shigeru Iwakabe, PhD and Diana Fosha, PhD
16-Session AEDP: AEDP, Only More So: Diana Fosha
Together We Say Goodbye: Termination in 16-session AEDP: Richard L, Harrison, Ph.D.
Race Matters: Stephen McDonnell, LCSW
Dyadic Accompaniment for Healing Sexual Trauma in a 16 session Treatment: Judy Silvan, LCSW
“Unequivocal Affirmation” of True Self in 16-session AEDP with Gay Men: Gil Tunnell, PhD.
Time & Slowing, Attachment & Loss in 16-Session AEDP Therapy: Gail Woods, LCSW, LMFT
Letters from the Editors: Gil Tunnell and Carrie Ruggieri
Editor’s Letter by Gil Tunnell, PhD
This special issue of Transformance Journal on 16-session AEDP has two excellent introductions by Diana Fosha and Shigeru Iwakabe and needs no further introduction here. Instead, I use this space first to announce that Carrie Ruggieri, our Associate Editor, will now become Editor of Transformance Journal (I will become her Consulting Editor), and second, to reflect on my experiences as Editor for the last eight years.
Carrie has been co-editor for several years already and has contributed greatly to the Journal by designing a new masthead, her careful editing on previous issues, and interviewing authors on Transformance Talks. For this issue, she became a devoted hands-on editor by taking on more than her share of the workload. She has been a joy to work with, and I leave knowing the Journal is in very capable hands.
As several articles in this issue on 16-session AEDP discuss, successful termination in brief therapy includes both a celebration of accomplishments as well as saying Goodbye. In my eight years as Editor, eight issues were published from 2015 to 2023. That’s one issue per year. Although we anticipated publishing more frequently, in reality, it became very difficult coaxing AEDP therapists to submit manuscripts. Good therapists are not necessarily drawn to writing professionally once they complete their dissertations and theses! Although some manuscripts were voluntarily submitted, most had to be directly solicited by myself or other faculty.
I am proud we published special issue topics including, AEDP with couples, applying AEDP to special populations, strategies to help therapists “get unstuck,” tailoring AEDP interventions to different attachment styles, and providing an inside look at AEDP supervision from the perspectives of both trainee and supervisor. Most of the time the collaboration between author and editor went smoothly, with authors agreeing to clarify, expand or simplify, but not always!
In retrospect, I am most proud of the current issue on 16-session AEDP. Although the five articles here have different foci, several writers make the point that this abbreviated version of AEDP forces the therapist to distill the essentials of our model, rather quickly and perhaps with greater precision. The pressure of the time constraint for both therapist and patient is present from the get-go, and once the therapy takes root, many patients do not want it to end. Fosha’s introduction describes how the project had to “rediscover” Mann’s time-limited psychotherapy as termination became a real issue to be grappled with. I appreciate that the American Psychological Association granted permission for us to reprint large sections of Richard Harrison’s earlier excellent article on termination.
One last word: Just as this issue encourages our community of AEDP therapists to become AEDP researchers by taking on 16-session research patients, I encourage more AEDP therapists to become therapist-authors. Unlike most peer-reviewed journals, the informal nature of Transformance Journal utilizes extensive transcripts that vividly illustrate principal concepts of AEDP. Moreover, unlike peer-reviewed journals, authors are encouraged here to reflect on their personal and emotional experience as AEDP therapists, e.g., choice points, blind spots, struggles and handicaps, and reveal moments in sessions, now in retrospect, they might have managed differently.
After eight years as editor of Transformance Journal, I say Farewell and pass the baton to Carrie Ruggieri. Cue up the orchestra, Carrie!
Gil Tunnell, Ph.D.
Editor’s Letter by Carrie Ruggieri, LMHC
I am very excited and honored to follow Gil’s committed and diligent editorship. I am also very grateful for his mentorship and his trust in me by handing over this responsibility which he performed with great dedication and skill. One particular editorial task that Gil modeled for me was to be sure to truly understand the author’s intention and message. Through observing Gil’s editorial comments and conversations, as well as my own experience with Gil and earlier with Natasha Prenn, when she was editor prior to Gil, of feeling that click of recognition and true- otherness when being helped to formulate my thoughts more directly and clearly. I am amazed that AEDP-ness applies to editing as well as to therapy!
To all writers and potential writers I want to encourage you to send your ideas to me. We all have something very important to say and to share. If you have never written before, I am here to help you clarify and formulate the words and phrases that will best express your thoughts and experiences. It is astonishing to me, and also a victory, that I am writing an editor’s letter. From my early school years into college and graduate school I struggled with reading and writing. I remember the pure agony of having an insight, but not the vocabulary to express my thoughts; always asking, “what is the word for when…”. At the same time I was indeed a writer, from the age of 13 onward, writing in my private journals where I didn’t have to find the right words and learned to express myself, to myself. I feel great companionship with those who ache to master the precious and difficult gift of language. And, it was here, in this community, on the AEDP listserv that I was first acknowledged and seen and so kindly welcomed and responded to in the written format. It was by writing on the AEDP listserv that I began to experience some ease and mastery of what had been wrenching and frustrating.
This is all to say that deep and strong state 3 and state 4 (I re-wrote a narrative!) affects are and will be driving my enthusiasm and gratitude for the tasks ahead. It will be a joy to fulfill my part in lifting up voices, as mine has been so lovingly and skillfully lifted up within this community.
In addition to traditional scholarly and theoretical articles, I will be advertising for short form articles which will share a brief but highly compelling portion of a session that illustrates an AEDP intervention or conceptualization. I hope to receive many of these transcripts, through- out the year. Please stay tuned for more. I look forward to your beautiful AEDP work and ideas.
Carrie Ruggieri, LMHC
Introduction to Special Issue
Shigeru Iwakabe, PhD and Diana Fosha, PhD
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This special issue of Transformance Journal marks a flourishing state that AEDP (Fosha, 2022) and AEDP Practioner Research Program (PRN) research have achieved. The five articles are the result of the crystallization of research-practice integration. We believe this special issue will contribute not only to the development of AEDP research and practice but also to psychotherapy research more widely as a prime example of a mixed methods study that combines the rigour of outcome studies and the clinical depth and richness of case studies (Fishman et al., 2017). This introduction will present a brief overview of AEDP PRN Research.
16-Session AEDP: AEDP, Only More So
Diana Fosha, PhD
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In a present characterized by an excess of openings and dissolving boundaries, we are losing the capacity for closure, and this means that life is becoming a purely additive process. Because it rushes from one sensation to the next, even perception is now incapable of closure. … It occurs to me that we can only experience ‘opening’ if we have ‘closure.’ Our hearts can pump blood only if our chambers can both open and close. The silence between sounds is what creates rhythm. From: Byung-Chul Han, (2020): The Disappearance of Rituals Courtesy of Stephanie Woo Dearden in AEDP 9+1 class 2023
In 16-session AEDP,] EVERY moment counts and presents an opportunity to co- create safety, engage an AEDP change process, and metaprocess moments of change for the better, be they big or small. Richard Harrison Therapist, AEDP Research Project
“We let ourselves aim high, and more often than not we achieve, and even exceed, the goals set at the beginning. …. It has been astonishing to witness case after case of unexpected transformations–it blows my mind and my sense of what is possible has also been blown open. Having witnessed this, I bring more authentic trust to each case, regardless of involvement in the research.” Mary Androff Therapist, AEDP Research Project
Together We Say Goodbye: Termination in 16-session AEDP
Richard Harrison, PhD
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Abstract: This paper explores the termination process in 16-session AEDP. The fixed treatment length and predetermined endpoint are regarded as additive and enhancing of the change process. Strategies and interventions to address and process termination are delineated and demonstrated with verbatim clinical exchanges; and potential challenges faced during termination are addressed. Congruent with AEDP’s healing orientation, termination is reframed as completion and launching: Although treatment ends, the change process begun in therapy continues, as does the therapist’s care for the patient. AEDP interventions during termination include: (1) relational strategies to undo aloneness, co-engender safety, and foster connection; (2) affirmation of patient resilience and celebration of personal growth; (3) affirmative work with defenses against loss; (4) dyadic affect regulation of patient’s core affective experience (CAE); (5) experiential, bodily-rooted strategies to process and transform negative emotions; and 6) metatherapeutic processing of ensuing, vitalizing positive emotions and in- session experiences of change-for-the-better, to expand these and promote positive neuroplasticity and flourishing. Therapists aim: (a) to elicit and process emotions related to the completion of treatment; (b) to celebrate patients’ affective achievements; and (c) to convey trust and confidence in an ongoing transformational process, predicted to yield not only diminishment of symptoms and suffering, but also upward spirals of flourishing. In providing patients a new, positive attachment experience of togetherness as therapy ends, termination in 16-session AEDP offers a unique opportunity to disconfirm earlier attachment-based expectations, revise internal working models, and help patients grow in self-confidence as they face, accept, and thrive in the wake of loss.
Race Matters: Co-Creating Secure Attachment from the Get-Go and the Work of Identity Consolidation for a Black Patient with a White Therapist
Stephen McDonnell, LCSW
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Abstract. This article presents a case from the AEDP 16-session research project of a black patient /white therapist dyad. The author discusses the application of AEDP therapeutic principals to the processing of racial trauma with a white therapist; specifically, three imperatives: to co-create a secure attachment from the get-go, the necessity of affirmation and recognition processes to kindle core- self experiences, and the necessity to metaprocess its transformational promise in order to propel identity consolidation, in this case, black identity as man, father, partner and community member. Moreover, the author speculates that ongoing metaprocessing of the patient’s identity strivings, leading to core-self delight, may account for the patient’s relatively frequent immersion in core state.
Dyadic Accompaniment for Healing Sexual Trauma in a 16 session Treatment: Judy Silvan, LCSW
Judy Silvan, LCSW
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Abstract: The case of Priscilla is a contribution to the ongoing AEDP 16-session research project on treatment outcome and efficacy. The outcome measures in this case confirm the ongoing research findings that Accelerated Experiential Dynamic Psychotherapy (AEDP) is an effective treatment for post-traumatic stress disorder (PTSD), in both open-ended and in time-limited treatments. One aspect of the AEDP 16-session research is therapists’ requirement to rigorously adhere to AEDP methodology. Fidelity to AEDP with this patient who suffered complex PTSD symptoms demanded systematic and disciplined use of therapist attunement, inter-relational interventions, and dyadic regulation of the patient. This article demonstrates the AEDP healing process resulted in improved functioning in pre, post and in-treatment outcome measures in numerous areas of emotional well-being. Symptoms previously bemoaned as unbearable and associated with reported suicidal feelings are absent by session 16. Our coordinated termination is experienced as a success; deep unending pain transforms into joy and gratitude, with exuberance, as we progress further into the 16 sessions. The healing is ‘inter’ and intra-relational with a felt sense of transformation both within herself and with current family and community, beginning with the establishment of dyadic trust, and ending with a bi-lateral secure attachment for the dyad.
“Unequivocal Affirmation” of True Self in 16-session AEDP with Gay Men: Using Relational Metaprocessing to Increase Receptive Affective Capacity
Gil Tunnell, PhD.
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Abstract. Two case studies of gay men from the AEDP 16-session research project are described in which the therapist’s primary AEDP intervention was continually “privileging the True Self.” Privileging the True Self is crucial when working with queer-identified patients who often have constructed a “false self” as they attempt to “pass” and fit into a largely heterosexual world. In initial sessions with each patient, the therapist established a strong affirmational stance by highlighting his inherent strengths and maintained that stance throughout treatment. The primary mechanism of change was the therapist’s relational metaprocessing of that stance, activating the men’s receptive affective capacities to fully absorb his “unequivocal affirmation” of them, providing “an explicit ‘yes’ to the whole self of the client.” Rounds of relational metaprocessing produced the primary “core affective experience,” as contrasted to processing specific negative core affects such as anger or sadness in AEDP State 2. Primitive receptive affective capacity is innate: Human beings are born ready to emotionally attach to their caregivers. When the caregivers’ nurturance is not forthcoming, receptive capacity remains constricted, like a bud that does not bloom. While both treatments were first and foremost relational therapies, they differ in that the second patient had a much less developed receptive capacity when treatment began. Upon taking in the therapist’s affirmation, he began to experience in real life that other people also appreciate his specialness. That external validation led to his exuberantly expressing “joy,” a core affect he had rarely experienced in his life. The author discusses how “joy” may be an underrated positive affect in AEDP clinical work. Both patients made
Time & Slowing, Attachment & Loss in 16-Session AEDP Therapy
Gail Woods, LCSW, LMFT
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Abstract: This case study of maternal loss explores the impact of time in 16- session AEDP Research therapy—specifically setting the time frame (“clock- time”) from the beginning and going slowly with affective time (“existential time”). The essential themes explored are:1 how slowing down affective processing and the experience of time at key change moments facilitates secure attachment and deepens change2. how the set time-frame, in the context of AEDP affective processing, mobilizes transformance and 3. how built-in anticipated loss of the therapeutic relationship may make this time-limited attachment therapy particularly sensitive to issues of loss.