DiCorcia, M., Iwakabe, S., Thoma, N. C., & Yamazaki, W. (2022). Transformational process scale: An initial validation and application to the first psychotherapy session. Journal of Psychotherapy Integration. Advance online publication. https://doi.org/10.1037/int0000296
This study demonstrated the reliability of the Transformational Process Scale, an observer-based measure of patient emotional processing during psychotherapy. This measure is based on the phenomenology of patient’s transformation in AEDP. One of the measure’s unique features is that it categorizes different classes of positive emotions. The TPS ratings can differentiate productive first sessions from less productive ones in both frequency and intensity of core affective phenomena and transformational affects. Patients experience a variety of positive emotions from the first session of psychotherapy, while in less productive sessions, the expression of secondary distress and defensive affects is more prevalent. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
Iwakabe, S., Edlin, J., Fosha, D., Thoma, N. C., Gretton, H., Joseph, A. J., & Nakamura, K. (2022). The long-term outcome of accelerated experiential dynamic psychotherapy: 6- and 12-month follow-up results. Psychotherapy, 59(3), 431–446. https://doi.org/10.1037/pst0000441
This study examined the long-term effectiveness of accelerated experiential dynamic psychotherapy (AEDP), a transdiagnostic treatment for psychological problems and positive psychological functioning in private practice settings. Scientists and practitioners partnered in the development of an AEDP PRN model. Findings: Findings supported a 6- and 12-month maintenance of therapeutic gains of AEDP for a range of presenting problems and symptoms. Meaning: Results support the clinical application of AEDP on varieties of psychological problems and functionings and ongoing research using a practice research network (PRN) model. Next Step: Future research will continue AEDP PRN initiatives and partnerships in private practice settings, and will investigate the mechanisms of change that contributed to the positive outcome. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
Notsu, H., Iwakabe, S., & Thoma, N. C. (2022). Enhancing working alliance through positive emotional experience: A cross-lag analysis. Psychotherapy research : journal of the Society for Psychotherapy Research, 1–14. Advance online publication. https://doi.org/10.1080/10503307.2022.2124893
The present study investigates the relationship between positive emotional experiences and working alliance. Method: We chose to investigate this relationship in accelerated experiential dynamic psychotherapy (AEDP), taking advantage of the modality’s focus on both negative and positive emotional experiences. Fifty-eight clients receiving 16-sessions individual AEDP reported on their post-session levels of working alliance and positive emotions (enlivenment affect, positive relational affect, and peacefulness). The alliance-emotion relationship for each emotional categories was tested with separate disaggregated cross-lagged panel models. Results: Across the three categories, higher positive emotions at the end of the previous session were associated with higher working alliance at the end of the next session. On the other hand, working alliance did not contribute to any of the positive emotions in the next time point. Furthermore, the three emotion categories showed different patterns of development. Conclusion: The findings suggest that fostering positive emotions may be a promising venue to enhance working alliance. Furthermore, differentiating specific positive emotions is likely important both for research and practice.
Iwakabe, S., Edlin, J., & Thoma, N. (2022). A phenomenological case study of accelerated experiential dynamic psychotherapy: The experience of change in the initial session from a client perspective. Journal of Psychotherapy Integration, 32(4), 363–376. https://doi.org/10.1037/int0000261
The present study examined a client’s subjective experience of initial sessions of AEDP psychotherapy . It revealed that in a relational environment of the therapist’s deep empathy, affirmation, and profound connection, the client experienced major changes in his emotional functioning. He noticed his bodily felt emotion, accessed emotional pain, and appreciated and enjoyed positive emotions that emerged from being with and working with the therapist. Although early sessions in other therapeutic modalities are often more oriented toward assessment, it may be important to realize that there is more that we can do to enrich and maximize the therapeutic benefit of these early sessions. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
Goto, A., Iwakabe, S., & Heim, N. (2022). Therapeutic courage in novice therapists in Japan: A qualitative study. Journal of Psychotherapy Integration, 32(3), 243–256. https://doi.org/10.1037/int0000260 https://www.researchgate.net/lab/Shigeru-Iwakabe-Lab
The concept of therapeutic courage is considered to be an essential therapist variable and is now at a stage of accumulating empirical support. The present study examined the subjective experience of therapeutic courage in Japanese novice therapists in order to gain insight into how culture and clinical experience contribute to the conceptualization and exercise of therapeutic courage. A total of 15 therapists with an average of 4.2 years of clinical experience were interviewed about therapy situations in which they were able or unable to exercise courage. The data was analyzed using grounded theory approach, which generated three main categories: living up to the professional role, keeping the balance, and tapping into an authentic voice. Japanese novice therapists were likely to be inhibited in their therapeutic courage due to feelings of incompetence, rigid views about presumed professional code of conduct and the fear of external evaluation. Taking action based on courage was a deliberated and well thought out decision. The role of therapeutic courage in the professional development of psychotherapists, as well as cultural influences, are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
Harrison, R. L. (2020). Termination in 16-session accelerated experiential dynamic psychotherapy (AEDP): Together in how we say goodbye. Psychotherapy, 57(4), 531–547. https://doi.org/10.1037/pst0000343
This article explores how AEDP therapists help patients achieve an integrative and generative end of therapy experience in a 16-session AEDP treatment protocol. Findings: Emotionally engaged AEDP therapists use interventions to process the complex, often painful feelings related to the completion of treatment, celebrate the patient’s affective achievements, and convey trust and confidence in the change process begun in therapy, which need not end with the completion of treatment. Meaning: The 16-session AEDP treatment offers patients a new experience of emotion in connection, through a shared ending, predicted to be facilitative of attachment security and enhanced confidence and self-efficacy. Next Steps: Future research will further elucidate how the termination process in 16-session AEDP restructures patients’ inner working models and yields ongoing change and upward spirals of flourishing that extend well beyond the end of the finite treatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Iwakabe, S., Edlin, E., Fosha, D., Gretton, H., Joseph, A. J., Nunnink, S., Nakamura, K. & Thoma, N., (2020). The effectiveness of accelerated experiential dynamic psychotherapy (AEDP) in private practice settings: A transdiagnostic study conducted within the context of a practice research network. Psychotherapy, 57 (4), 548-561. https://doi.org/10.1037/pst0000344
This study examines the effectiveness of accelerated experiential dynamic psychotherapy (AEDP), a transdiagnostic treatment for psychological problems and positive psychological functioning in independent practice settings. Clinical researchers and practitioners partnered in the development of an AEDP practice research network (PRN) model. Findings: Findings support the use of AEDP for a range of presenting problems and symptoms. Meaning: Results support the clinical application of AEDP across a variety of psychological problems and functionings and ongoing research using a PRN model. Next Steps: Future research will continue AEDP PRN initiatives and partnerships in independent practice settings and will investigate maintenance of therapeutic gains over a 6- and 12-month follow-up period. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Markin, R. D., McCarthy, K. S., Fuhrmann, A., Yeung, D., & Gleiser, K. A. (2018). The process of change in accelerated experiential dynamic psychotherapy (AEDP): A case study analysis. Journal of Psychotherapy Integration, 28(2), 213–232. https://doi.org/10.1037/int0000084
AEDP is a highly integrative treatment that incorporates elements of short-term psychodynamic and emotion-focused, process-experiential, psychotherapies, as well as attachment theory. The current study employed a mixed-methods multicase study design to describe how the process of change unfolds in a “successful” and an “unsuccessful” case of AEDP, as defined by reliable change (RC) on the Outcome Questionnaire-30.2 (OQ-30; Lambert, Vermeersch, Brown, & Burligame, 2004). Concurrently, several additional outcomes (affect experience and adult attachment), therapy relationship variables (working alliance [WA], real relationship [RR], and patient attachment to the therapist), and a qualitative description of the therapy process (Important Events Questionnaire [IEQ]; Cummings, Martin, Hallberg, & Slemon, 1992) were assessed at 3 time points during the course of therapy. Overall, the clinical observations in this study are consistent with AEDP’s theory of change, which predicts that symptom relief is accompanied by changes in affect and insecure attachment, and that these changes occur within a strong therapeutic relationship that is real, collaborative, and secure. Furthermore, qualitative analyses suggest that the advent of a corrective emotional experience (CEE) may have served as a catalyst for change in the “successful” therapy dyad. On the contrary, a reliable decline in agreement over the tasks of therapy and decreasing positive affect (PA) and negative affect (NA) may have hindered early change in the “unsuccessful” case. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Vigoda Gonzales, N. V. (2018). The merits of integrating accelerated experiential dynamic psychotherapy and cultural competence strategies in the treatment of relational trauma: The case of “Rosa.” Pragmatic Case Studies in Psychotherapy, 14(1), 1–57. doi:http://dx.doi.org/10.14713/pcsp.v14i1.2032
Abstract
In this article, I respond to commentaries by Karen Riggs Skean (2018) and Shigeru Iwakabe (2018) on my presentation of the case of “Rosa,” (Vigoda Gonzalez, 2018), a survivor of chronic relational trauma. In her insightful response, Riggs Skean (2018) elaborates on the interplay between language switching and the therapeutic frame, the suitability of Accelerated Experiential Dynamic Psychotherapy (AEDP; Fosha, 2000) for the treatment of trauma, and the short-term nature of the work with this particular client. Iwakabe (2018), an AEDP clinician and researcher, offers insights and reflections on the areas of language switching, emotional change process, and corrective emotional experiences, and poses evocative questions regarding the development of clinical skills relevant to affect-focused therapies. In the following response I consider these thoughtful commentaries and provide feedback with the hope to spur the dialogue regarding the flexible adaptation of treatment approaches to our clients’ psychological needs.
Faerstein, I. & Levenson, H (2016). Validation of a fidelity scale for accelerated-experiential dynamic psychotherapy.” Journal of Psychotherapy Integration, 26 (2), 172-185. http://psycnet.apa.org/doi/10.1037/int0000020
This study sought to investigate the psychometric properties of a self-report measure of therapist fidelity to AEDP. Subjects consisted of 2 samples: (a) 249 therapists (participants) who completed the measure before and after a 5-day AEDP training course, and (b) 13 AEDP trainers who completed the measure at a single point in time. The AEDP Fidelity Scale (AEDP-FS) consists of 22 items describing therapist behaviors considered essential to AEDP, each of which is rated separately for knowledge and competence. Results suggest that the AEDP-FS has promising indications of being a valid self-report measure of AEDP proficiency. Specifically, AEDP trainers reported significantly higher AEDP-FS scores than participants; participants with more AEDP experience reported significantly higher pretest scores than participants with less AEDP experience; and participants’ scores increased after training. In 2 multivariate statistical analyses (PCA and CFA), 3 factors emerged that are consistent with the scale’s theoretical base. Discriminant validity was suggested by 2 additional multivariate statistical analyses (principal component analysis [PCA] and confirmatory factor analysis [CFA]) that found a majority of AEDP-FS items load onto a different factor than items measuring general psychodynamic techniques. However, although the PCAs yielded relatively distinct factors, the CFAs failed to yield acceptable goodness of fit indices. Overall these findings indicate that with some further refinements the AEDP-FS may be a useful tool for describing essential AEDP interventions, investigating outcome in AEDP, and training AEDP therapists. (APA PsycInfo Database Record (c) 2017 APA, all rights reserved)
Iwakabe, S., & Conceicao, N. (2016). Metatherapeutic processing as a change-based therapeutic immediacy task: Building an initial process model using a task-analytic research strategy. Journal of Psychotherapy Integration, 26 (3), 230-247. https://doi.org/10.1037/int0000016
Abstract
The present study examined one particular class of therapeutic immediacy events called metatherapeutic processing in AEDP in which a piece of successful therapeutic work just completed is reviewed and processed by both therapist and client. A task-analytic research strategy was used to analyze 4 clear and exemplary instances of metatherapeutic processing in videotaped sessions conducted by the developer of the approach. A process model was generated in which the therapist’s interventions were represented at the level of change principles, and clients’ change processes were represented along both affective and reflective tracks. Therapist interventions followed 4 principles of change: affirmation, attunement, somatic and experiential focusing, and restructuring. The affective track in the client change processes had 4 components: relief, enlivenment, grief, and peacefulness, while the reflective track had 3 components: self-affirmation, becoming aware of self-limiting beliefs and behavior, and engaging in new emotional coping. Central to metatherapeutic processing events was the change process associated with tracking and processing the experience of positive emotions that organically emerged from successful work with painful emotional experiences. The implications of actively working with clients’ spontaneously emergent positive emotional experiences during metatherapeutic processing will be addressed in relation to therapeutic immediacy, the broaden-and-build theory of positive emotions, and psychotherapy training and practice. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Lilliengren, P., Johansson, R., Lindqvist, K., Mechler, J., & Andersson, G. (2016). Efficacy of Experiential Dynamic Therapy for Psychiatric Conditions: A Meta-Analysis of Randomized Controlled Trials. Psychotherapy, 53 (1), 90-104. Advance online publication. http://dx.doi.org/10.1037/pst0000024
Experiential dynamic therapy (EDT) is a subgroup of short-term psychodynamic psychotherapy (STPP) that emphasizes patients’ in-session affective processing. To evaluate the efficacy of EDT for psychiatric conditions, we conducted a meta-analysis of randomized controlled trials. Twenty-eight studies published between 1978 and 2014 were included, encompassing 1,782 adult patients with mood, anxiety, personality, or mixed disorders. Across targeted outcome domains, medium-size between-groups effects (Cohen’s ds ranging from 0.39 to 0.65) favored EDT over inactive controls at posttreatment and in symptom measures at follow-up. We found no differences between EDT and active treatments (e.g., medication, cognitive–behavioral therapy, manualized supportive therapy) at posttreatment, but EDT outperformed supportive therapy at follow-up (d = 0.75). In terms of within-group effect sizes, EDT was associated with large improvements in general psychiatric symptoms (d = 1.11), depression (d = 1.33), and anxiety (d = 1.09) and with small to moderate gains in the areas of interpersonal problems (d = 0.55) and global functioning (d = 0.86). Small but significant effects suggested continued improvement between posttreatment and follow-up. Heterogeneity in pre–post effects was explored in subgroup analyses, which indicated that EDT might be most effective in depressive disorders and that individual EDT had larger effects compared with group treatment. In addition, EDT performed better in higher quality studies. We conclude that EDT is a promising treatment for psychiatric conditions in adults. Further high-quality studies evaluating contemporary versions of EDT in specific psychiatric conditions are warranted. (APA PsycInfo Database Record (c) 2016 APA, all rights reserved)
Johansson, R., Bjorklund, M., Hornborg, C., Karlsson, S., Hesser, H., Ljótsson, B., Rousseau, A., Frederick, R. J., & Andersson G. (2013). Affect-focused psychodynamic treatment for depression and anxiety through the Internet: a randomized controlled trial. PeerJ 1:e102. http://dx.doi.org/10.7717/peerj.102
This study provides initial support for the efficacy of Internet-delivered psychodynamic therapy based on the affect-phobia model in the treatment of depression and anxiety disorders. The results support the conclusion that psychodynamic treatment approaches may be transferred to the guided self-help format and delivered via the Internet.
Johansson, R., Frederick, R. J., & Andersson, G. (2013). Using the internet to provide psychodynamic psychotherapy. Psychodynamic Psychiatry, 41(4), 513–540. https://doi.org/10.1521/pdps.2013.41.4.513
Abstract
Over the last 15 years, there has been a substantial increase in research and clinical implementations of Internet-delivered, cognitive behavioral therapy (ICBT). Several studies on ICBT have been in the format of guided self-help where a therapist guides the patient throughout the whole treatment. ICBT is typically in the form of self-help material (e.g., text or video) which is provided to a client over the Internet with additional therapist contact by e-mail. ICBT has been shown to be effective for various conditions and, in some studies, has shown to be as effective as face-to-face cognitive behavioral therapy for mild to moderate depression, anxiety disorders, and somatic problems. Recently, the field has expanded to include other orientations including psychodynamic psychotherapy. Currently, there are three randomized controlled trials that have tested the efficacy of psychodynamic psychotherapy delivered in this format. The latest published trial focused on an affect-focused, psychodynamic psychotherapy delivered to a sample of participants with mixed depression and anxiety disorders. This article aims to provide a deeper understanding of the process of providing psychodynamic psychotherapy via the Internet. We will give a detailed description of our latest manual and show how psychotherapeutic work is conducted utilizing this text. Furthermore, we provide examples of dialogue between therapist and client from the online environment. Similarities and differences between psychodynamic psychotherapy delivered over the Internet and in face-to-face formats are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Johansson, R., Hesser, H., Ljótsson, B., Frederick, R. J., & Andersson G. (2012). Transdiagnostic, affect-focused, psychodynamic, guided self-help for depression and anxiety through the Internet: Study protocol for a randomized controlled trial. BMJ Open. Dec 19;2(6). pii: e002167. doi: 10.1136/bmjopen-2012-002167. Print 2012. http://www.ncbi.nlm.nih.gov/pubmed/23257775
Pass, E. R. (2012). Combining expressive writing with an affect- and attachment-focused psychotherapeutic approach in the treatment of a single-incident trauma survivor: The case of “Grace.” Pragmatic Case Studies in Psychotherapy, 8 (2), 60-112. http://pcsp.libraries.rutgers.edu/
AEDP Research: Dissertations
Lee, A. (2015). Building a Process-Model for Metaprocessing: Exploration of a key change event in Accelerated Experiential Dynamic Psychotherapy (AEDP). Doctoral Dissertation. Wright Institute, Berkeley, CA.
Faerstein, I. (2014) “Validation of a Fidelity Scale for Accelerated-Experiential Dynamic Psychotherapy.” Doctoral Dissertation. Wright Institute, Berkeley, CA.
Schoettle, E. (2009). A qualitative study of the therapist’s experience practicing Accelerated Experiential Dynamic Psychotherapy(AEDP): An exploration of the dyadic process from the clinician’s perspective. Doctoral Dissertation. Wright Institute, Berkeley, CA.
Piliero, S. (2004). Patients reflect upon their affect-focused, experiential psychotherapy: A retrospective study. Doctoral Dissertation. Adelphi University, New York