AEDP for Couples

From Stuckness and Reactivity to the Felt Experience of Love

By David Mars

This paper offers a highly condensed description of the theory and practice of Accelerated Experiential Dynamic Psychotherapy (AEDP) for Couples.  It describes and demonstrates a somatically focused orientation of tracking the intersubjective field phenomena of both members of the couple.  The paper further describes how AEDP for Couples brings explicit awareness to the felt experience of love between the couple members beginning in the first session in order to set a safe container for the transformative work to follow.  It describes and shows examples of working with “edges”, the paradoxical and initially non-conscious embodied reactions that are both “for” and against the very changes the couple members want and need to make in treatment. The paper shows the theory and practice of catalyzing in couples: a.) being more attuned, more self-reflective, loving and responsive to the needs of the other partner within sessions and at home, b.) cultivating new capacities of perceiving and receiving the other partner’s differing ways of experiencing and expressing not only “affect” per se, but also in a whole range of other “channels of experience” c.) providing a secure “harbor” of safety and support when the other partner is vulnerable and in core affect or a transient dissociation d.) creating sufficient safety in sessions to work through historical antecedents of trauma and deprivation in the company of and with the active support and often physical holding of the marital partner. AEDP for Couples stands on the firm foundations of Accelerated Experiential Dynamic Psychotherapy (Fosha, 2000, 2010).  In the practice of AEDP on a one-to-one basis, the therapist accompanies the patient somatically on a step-by-step journey through affective experiences that lead to transformational state-shifts of consciousness (Fosha, 2000, 2005; Lipton & Fosha, in press; Prenn, 2010; Russell & Fosha, 2008).  The undoing of aloneness through resonant accompaniment enables the patient to side-step historical blockages and move through previously overwhelming affects all the way through to completion.  The healing of traumatic experience within the context of a safe relationship fosters deep repair and quantum change by accessing and occupying alternate neural pathways.  From this healing comes new ways of being, feeling and dealing in daily living (Fosha, 2000, 2003, 2009a, 2009b).  The patient dyadically works through embodied states of historically “burned in” defensive patterns that lie at the very source of the patient’s patterns of dysregulation both internally and in relationship with others.  The patient can then access biologically driven adaptive action tendencies (Fosha, 2005) that provide corrective, creative and internally derived solutions that address the deep sources of dissociation and other forms of affective and relational disconnection.  By facing previously unbearable states, the patient develops an embodied sense of verifiable trust (Mars, 2010) and new capacities to be deeply connected with self and other.  The AEDP therapist brings into awareness an expansive set of self-evolving resources within the patient herself that become accessible even in life areas never discussed in treatment (Fosha, 2009a, 2009b).  Ultimately, the therapist becomes an internalized “true other” (Fosha, 2005) for the patient, who learns to freely access self-righting capacities in daily life.

The Clinical Practice of AEDP for Couples

The process described above for treating individuals with AEDP provides an optimal context through which couple members can cultivate the capacity to become a “true other” to each other (Mars, 2010).  The longing to come toward one’s life partner and to successfully provide safety and security when the other is vulnerable and shaken is a highly satisfying and biologically driven imperative of attachment (Ainsworth, 1978; Bowlby, 1969).  The treatment is an invitation for the relationship, first in session and then at home, to become the vehicle for a forward-moving evolutionary process that generates “earned security” (Roisman, Padrón, Sroufe, & Egeland, 2002) in both partners.  They each come to provide a secure base for the other that affirms the deep longing to love and be loved in attuned and flexible ways that allow the life-partner to be different, and yet to be “let in” and to at long-last feel deeply accepted and valued for the differences each partner brings.  As life-partners accomplish differentiation and mutual honoring in treatment, a cross-pollination takes place that generates natural, transformational forces by liberating the best, most loving and life affirming potentials of each partner’s lineage (Mars, 2009).  The key to AEDP for Couples is the biological drive of transformance (Fosha, 2009a, 2010, Yeung, 2010).  Transformance, most simply put, is the inverse of resistance.  In sessions and in the lived life of couples, transformance is the drive experienced and expressed as the deep longing to love and be loved.

In AEDP for Couples, safety must be established first between the therapist and each of the members of the couple.  When this safety then extends between the couple members in the intersubjective field that is cultivated within sessions, the transformative states AEDP fosters become available for the couple to hold, experience and share.  Couple members learn to witness (Adler, 2002) each other in an increasingly somatically attuned way.  This progressively growing embodied attunement creates the necessary safety to soften defenses and work through issues that predate their coming together in ways that bring justice and peace to even the most mundane of daily interactions.  When between couple sessions, for example, the husband washes the dishes with a spirit of loving empathy for his deeply fatigued wife, rather than showing the accustomed resistance or resentful compliance or guilty submission, a deep level change has occurred in the relationship.  This experience of being seen, remembered and responded to with the felt experience of love allows for such empathic attunement to become the new atmospheric condition of the home.  Moreover, when that attunement is also informed by the husband’s reflective awareness of his wife’s history of feeling like a “thing made to do things,” the home becomes infused with a quality of corrective healing through deep reception of the other. This construction of new meanings (Tronick, 2009) that transform the mundane and menial tasks of lived family life into expressions of love and surprise infuses each member of the couple with new transformance strivings and re-enlivened eros that then potentiates and moves the next session forward.

A Challenge for the Person of the Therapist

In treating a marital dyad in the AEDP for Couples format, the therapist must track moment-to-moment and right-brain-to-right-brain the somatic and affective experiences of two people at one time.  Furthermore, couple members almost always present contrasting attachment styles (Wallin, 2007) with accompanying differences in how each member experiences somatically in a relational context (Mars 2009).  The therapist must provide a “bridge” (Mars, 1988) between the two couple members in which he recognizes, reflects and appreciates each member’s ways of perceiving, receiving and expressing somatically. Through the therapist’s affirmation and “translation,” each partner’s experience becomes increasingly accessible to the other couple member.  Over time, the couple members learn how to decode the ways the other is accessing and then broadcasting his or her experience and then learns how to “bridge” to the other (Mars, 1988). This bridging capacity also transfers to the home life between sessions, allowing the couple to increasingly navigate their own way through otherwise “blind allies” of repeated misunderstandings to a new “growing edge” (Mars, 1988; Mindell, 1985) of mutual understanding, flexibility and compassion.

To do this bridging most effectively and naturally, the AEDP for Couples therapist must cultivate whole body “witness consciousness” (Adler, 2002) of perceiving, receiving and expressing in a wide range of “channels of experience” (Mars, 2010) at one time.  This cultivation of self assists the therapist to transcend the defensive exclusion and limitations of his or her own internal working model.  Then with these expanded capacities to perceive, receive and express somatically, he can provide the necessarily proficient and flexible conduit of  “broadband capacity” (Mars, 2010) to track the intersubjective field in sessions in ways that match-up with both of the members of the couple.  The therapist in the AEDP for Couples model then gently nudges couple members to go beyond the procedurally learned non-conscious “rules” of each of their internal working models to stretch to meet the other.  There are seven “channels of experience” through which the AEDP for Couples therapist accesses and tracks the intersubjective field within sessions.  Essentially the therapist tracks “bottom-up” perceiving, receiving and expressing via i. sensation, ii. emotion, iii. energetic awareness, iv. movement, v. auditory, vi. visual, and vii. imagery (Mars, 2009).

In the productive and necessary stretches couple members make in order to reach each other, they take themselves beyond their comfort level during sessions.  By choosing to be consciously resonant with ways that are foreign to their previous life experience with its roots in their respective families of origin, couple members are imbued with a range of embodied experiences that are novel and undefended against.  This then triggers core affects and other somatic experiences that “surprise the unconscious” (Main & Goldwyn, 1998).  When the more avoidant couple member experiences the pleasurable core affect of love/joy in the foreground of awareness, a paradoxical “edge” is often triggered, of mixed emotional and somatic reactivity: one side for and one side against the experience.  (Lamagna & Gleiser, 2007; Mindell, 1985)  The vulnerability of the possible loss of that suddenly intensely felt love can trigger anxiety that may show up as an “out of no-where” background anger or dissociation.  This paradoxical anxiety/anger/dissociation needs to be carefully tracked by the therapist and worked through in the session as it arises, and safely processed to completion, as an explicit and experiential unpacking of experience in the foreground of awareness.  Meanwhile the other partner learns to become a compassionate witness to his or her partner’s process of exploring that previously non-conscious edge.  The body-based sensations, tensions, energetic states, movement patterns that are uncovered in the exploration are often found to be linked to painful “lessons” of the past, when to dare to love was simply too dangerous or too unsupported.  The role of the therapy is to work through to completion the historical roots of that anxiety and anger with the marital partner present as a loving and attuned other rather than being the sole target of reflexive enactments.  The therapist serves a reliable, kind and capable stabilizing force who helps to structure a deeply reparative experience that directly transfers into the lived life of the couple and in so doing helps to expand the internal working model of both couple members to love and be loved, to deeply understand and to be understood.

The therapist must then do another round of metaprocessing and work through the mixed somatic and behavioral reactions that are elicited in the other partner who served as the witness during these successful, but often triggering “edge crossings” (Mars, 2010).  This often results in vitality affects and tremulous affects, which when metaprocessed can set the scene for Core State experiences of relaxed flow in which fresh connections are made into the “unthought known” (Bollas, 1987) with remarkable ease and pleasure.  As both couple members continue to expand beyond their internal working models, the therapist again must be sensitive to make room for all the dissenting voices of doubt, protest, rebound anxiety and all the somatic reactions that are stirred up that are “against” those changes being made, even if these changes have been invited for years.  Paradoxically, this is especially true when the new loving experiences and expressions feel “sensible,” right and good at the time of the session.  If the edges are detected by the therapist and processed to completion at the moment they appear as non-congruent somatic expressions as simple as shaking the head no, while smiling and enthusiastically saying yes, the new loving behaviors have a much greater chance to become resilient and stable at home.   Unexplored edges are the sleeping non-conscious triggers for saboteur enactments driven by the return of the couple’s original interlocking internal working models that brought them into treatment.  Fewer ruptures at home translate into verifiable trust being built that it is safe to love and safe to receive love non-defensively.

In summary, for each marital partner to cross-over to meet and satisfy the long-denied attachment level longings of the other to feel and be loved and loving, requires “rule violations” of both couple member’s internal working model.   These experimental “rule violations,” while they can potentially generate enactments of betrayal of tender and tenuous trust, are also the very source of the “expansion of the loving behavioral and emotional territory” (Mars, 2010) that the treatment seeks to instill. It is the longed-for-love of the partner that is typically the sole motivation sufficient to take such stretches beyond the familiar (and in fact familial) survival strategies.  The treatment is about acts of love.  In truth though, most couples are driven into treatment by acute attachment anxiety.  It is the movement from fear to love, from survival to thriving which is the expression of transformance:  the motivating drive to evolve that gives AEDP for Couples its biological thrust and power as a treatment modality. As these new ways of perceiving, receiving and expressing love have been repeatedly, safely and explicitly unpacked and metaprocessed within the safety of the sessions, the stretches of new behavior become progressively more resilient and take up a stable residence in the couple’s daily life.  It is a major theme of AEDP for Couples to create new shared territory upon which the couple incrementally and dyadically constructs a “new culture” and a “hybridized internal working model” (Mars, 2009) of relating to each other and to themselves.

In AEDP for Couples, the dyad is supported, catalyzed and scaffolded by the therapist so they can manifest a sufficient affective attunement with each other, so they can progress from defense to core affect.  With softened defenses, the couple celebrates successes accomplished between sessions, makes repairs for regressions and moves through the blocks that showed up.  As each wave of core affect is worked through to completion in sessions, adaptive action tendencies (Fosha, 2009a) come to the fore and organismically provide the emerging “next steps” in the couples treatment.  For example, the follow-on effects of completing a wave of the core affect of sadness is seeking comfort that meets that felt-need-of-the-moment with that life partner instead of with the therapist.  When anger is accessed and expressed clearly and productively with the marital partner, a much-needed setting of boundaries and an asserting in highly specific and adaptive ways takes place and is, with the help of the therapist, taken in by the partner.  When the core affect of fear rises up in one partner, the other partner is helped to be present and come forward to offer the well-timed, attuned protection that at last matches the deeply felt core longing for what had “always” been missing, both in the marriage and in the developmental life that preceded it.  As each session progresses and the natural expressions of each couple member’s affect are received as having meaning (Tronick, 2009) and value to be heard and responded to by the life partner and the therapist, confidence and resiliency builds within the couple.   During these waves of processing core affective experience, the couple can physically hold each other hand-in-hand, body-to-body in ways the therapist cannot.  The rightness of fit of the dyad is both confirmed and constructed through these deeply corrective and pleasurable experiences of close gazing, holding and expressing care and valuing.

AEDP for Couples is not a “manualized” therapy.  The work is to evoke the authentic and spontaneous loving and attuned co-creations of the marital dyad.  While all core affective experiences are important in the treatment, by far the most vital to the process in AEDP for Couples is the core affect of love/joy.  The embodied experience of love is different from the idea of love or the memory of love, and certainly from the promise to love (Mars, 2010).  The process of softening defenses and opening to the embodied experience of love for the other begins in the very first session in AEDP for Couples.  This experience of love and the biologically derived inner direction that emanates from it, provides the guiding light and internal compass of the transformative process of each session and increasingly in the couples lived-life between sessions.  Couples who are in the later stage of treatment describe middle-of-the-night interactions that had historically produced re-traumatizing arguments turning instead into surprising and deeply healing breakthrough experiences of finally getting through to each other and completing a process that had repeated itself as an unsuccessful turn-key enactment dozens of times before.

If the couple has children, the experience of the secure base they form in sessions comes to extend naturally to how their children feel them together.  It has been demonstrated in recent research by the Circle of Security group that when a mother’s sense of security and attuned support improves, her baby’s status moves quite rapidly toward a greater security of attachment.  (Marvin, Cooper, Hoffman & Powell, 2002).  Also, improved teamwork in parenting results in increased stabilization and affect- regulation in the couple’s offspring.  This then generates deep satisfaction and a primal confirmation of the couple’s rightness of fit with each other and of being on the right track and in the right relationship.

Introduction of the Case

The following clinical case example of an AEDP for Couples treatment session will demonstrate the challenges and the invitations to engaging a somatically attuned transformative process with two patients in couple’s treatment.  The husband in the couple that is the subject of this paper has a primarily avoidant attachment style with pockets of disorganized attachment with associated unresolved trauma.  While his internal working model typically defensively excludes expressing emotions other than frustration and anger with his wife, he shows frequent non-conscious expression of his experience through movement of his hands, arms, torso, and facial expressions.  These reflexive enactments of reactivity generally take the form of dismissal caused by his wife’s overt expression of emotion.  His wife’s expressions of intense emotion are for him blatant violations of the rules of his internal working model that then trigger non-conscious motoric neural pathways suggesting forbidding or scorning, but triggered by his own underlying shame, anxiety, longing, loss and fear.  When his wife demonstrates emotion in the form of tears or longing for him to comfort her, his body language, (Birdwhistle, 1972) runs along themes of hand and arm gestures of putting down, blocking and pushing away.  His reflexive expressions of his internal state of even overtly waving his wife away, rolling his eyes, leaning his torso away from her and then averting his eyes, obvious as they are to the observer, are in the background of his awareness, unavailable to him as consciously mediated acts.  His wife meanwhile is penetrated by these reactive transmissions of his internal state, which register in the foreground of her perception at a level of unbearably high intensity that she feels and then reacts to and expresses loudly and intensely.  Her husband does not perceive that he is actually inflaming the very reactivity in his wife that he then reflexively objects to, engaging in an escalation that can set them at odds with each other for days or weeks.  Though this process of escalation has happened many hundreds of times in their long years together, the mystery of how to regulate the interlocking, repetitive and out-of-control activation has eluded them both.

The source of the intense distress they suffer can be understood as an innocent problem of rule violations of the internal working model of each partner by the other.  His right brain has been formatted in the first three years of his life and in myriad subsequent experiences of circumstantial deprivation and trauma in such a way that he naturally defensively excludes conscious emotional expression and down-regulates his nervous system activation in the face of his wife’s attachment-seeking behavior.  She is ambivalently attached, often with an angry-resistant style of expression with pockets of disorganization and unresolved trauma.  She has an indwelling internalized rule set that drives her, through her rising anxiety to produce amygdala-driven signals including crying and noisy protest in reflexive attempts to bring her wished-for-care-giver closer to comfort her.  She feels rejected by him, which activates her internalized angst and rage about never having felt adequately loved and protected in her life, which then evokes her shame and self-loathing about imagining herself to be unlovable that goes back to her earliest days.  Sadly, her tearful, angry and intensely critical attacks violate the rules of his internal working model against such emotional expression.  On top of that, she then triggers his shame through her seeing him as failing as a capable husband.  His shame activates intense defensive reactivity, withdrawal, dissociation, and even collapse on his part, leaving her again and again alone, feeling helpless and abandoned.

Some of the complexity of the dynamic shown by the wife is that in her self-at-worst, there is a razor-sharpness to her expressions, which she asserts are because of his tormenting her by being insufficient as a husband and father to their children.  Her eye contact with him often in these cases has a quality of a penetrating, accusing atmosphere in his experience of her.  When she talks to him, especially if she is not looking at him, there are claw-like finger and hand gestures that are part of her defensively excluded perceptions of her movement patterns that keep him away or overtly on the offensive.  When these gestures are gently pointed out by me as the therapist in the sessions, she is often startled and a bit embarrassed at how pointed and provocative her aggression is, even though she, in the foreground of her awareness, is asking, even imploring him to come closer, to soften and to open up to her.

The wife in this example of a high conflict couple perceives with great bitterness, the lack of emotion in her husband and takes his “withholding” as his stubbornly repeated personal affront to her.  Her between-session complaints about his short-comings and lack of emotional competence seem to fall on his deaf ears.  In her experience, he does not learn and won’t let her in.  Unbeknownst to her though, despite her amplified capacity to perceive and express intense feelings with him, she possesses a reduced capacity enforced by her own defensive exclusion in receiving his love in a stable and welcoming way, when her husband finally does express it.  This is partly because she feels a background of chronic emotional deprivation and wounding in her relationship with him, but also because she does not perceive his way of expressing his caring as real, valid or reliable.   In fact there is a palpable element of punitive contempt in her reactions that keeps him at bay and can trigger him into rage, and shame and then trigger past-trauma-based dissociation.  Her husband with all of his very real incapacities can be also be considered to be the stand-in on the triangle of relationships (Menninger in Fosha, 2000) for unresolved trauma associated with the injuries and deprivation in her family of origin.  She on the other hand is a stand-in for his history of abuse and deprivation at the hands of his violent and severely alcoholic mother and depressed and chronically dissociated father.

Another challenge of the AEDP for Couples model and of couples therapy in general, is that if the above–described dynamic of escalation and non-conscious mutual triggering is allowed to run its destructive course, the rapidly rising spiral can drastically reduce the safety of the treatment, setting a tone of replicating rather than resolving the problems for which the couple came into treatment in the first place. The opportunity of the treatment process is for the therapist to move slowly and deliberately with full attention to the nuances of all seven channels of somatic experience tracked in the intersubjective field and then going with the couple to the edge of what triggers their dysregulation with them, and then helping them to get through it in a way that transforms the couples experience of themselves and evokes a new and expanded sense of mutual safety, understanding and support that had previously been chronically blocked for them. Ultimately, the goal is to co-create new ways to be in the marital relationship with each other in which there is an experience of loving and being loved that, at the end of processing waves of somatic experience to completion, feels good, is resilient and is affect regulating rather than affect dysregulating (Mars, 2009).

What you will witness in the session that follows is a turning point that we have been preparing for in a number of previous sessions.  The couple has expressly given their permission for this transcript to be used.  The identity and non-crucial identifying information about the patients has been altered or omitted. For the first thirty minutes of this session, before the transcript begins, Mary is still furious and threateningly cold and ready to leave the marriage.  The turning point for her, was my helping her to reassemble in an embodied way her very real gratitude about his increasing patience and loving attention in his new ways of being her and with their two young children.  At the point that we begin the transcript, she has re-connected with her feelings of her love for her husband and begins to offer him comfort and repair.  He, however, cannot receive her, and in fact, is in a state of collapse and dissociation, still triggered by the preceding days of her hot and then cold fury that accompanied her ridicule and rejection of him.  His wife, in this particular session, is going to be serving primarily as a supportive witness to his struggle to find a new way to get through this worst-case scenario of the collapse in the intimacy and trust they had been building in their marriage.  Her vital attachment-level role is to provide a presence that welcomes him, along with me, when he comes back from this particularly intense dissociation and collapse.  It is also of primal importance that she witness and receive the depth of his sincere struggle to find himself freshly and for her to somatically and consciously register that his previous acts were not willful attacks on her value as a human being, but were flare-ups of deeply buried remnants of his past abuse and deprivation that are open to be healed with her help as the true love of his life and the mother of their two beloved children.

Introduction to The Transcript:

As we begin, I invite John, the husband to connect with me, since connecting with his wife was still far too triggering for him.  Her loving him and her showing her love so overtly and tenderly so soon after her cold rejection of him was still too overwhelming to his nervous system.  He was triggered into dissociation because too many of the rules of his internal working model would need to be crossed for him to open to her directly.  As the warmth and kindness of her love was offered, circuit breakers were being tripped in his brain, shutting down his capacity to respond.  We could say here that she has become  the present manifestation of the object of love who is also the source of danger.  This activation of neural circuits from past trauma triggered a dorsal vagal reflex (Porges, 2009) in John descending into a state of sleepy torpor, decreased capacity to think and feel, all in a context of dissociation and a sense of sinking weakness.

Mary is sitting near John on the couch, her eyes softly seeking him, tracking him with concern.  Her eyes are bright and soft, her body relaxed and showing her feeling of support for him now with full attention and focus.  With her clearly available to receive him when he returns from this collapse, I can turn my full attention to John, to accompany him to move toward a ventral vagal relaxation response (Porges, 2009) of returning to present-moment consciousness in the atmosphere of her loving and ready reception of him.

Th: What are you experiencing in your body right now, John?

John:  Just…(tone flat, eyes sad, shaking his head)… getting it done…not so concerned with anything other than the task…what needs to be done…and (takes a breath) wishing and wanting things to be different but not moving in that direction…maybe because either fear or…umm…

Th: Hmmmmm…(nodding)

J: …concern that I don’t know how to be…in that direction…

Th: (nodding, matching muted emotional tone but adding a little warmth) Hmm hmm

J: …um, and maybe because I don’t have the… ‘cause I’m not strong enough to move in that direction…(nodding slowly)

Th: Wow. (nodding with John), (taking in the unvarnished and undefended truth of what he is saying, which is in such sharp contrast to his usual defensive dismissal of his own internal limitations, particularly in the area of  being strong)  What do you notice right now in your body? (I am tracking, accompanying John in a place that becomes infused with a great and gentle sadness and heaviness in my own embodied experience) (John pauses, appears to be in deep connection with me, eyes begin to soften and tear up, as he takes two deeper breaths into his chest)…Just stay with me here, and I’ll stay with you. Let’s feel this together…this descent into feeling…this feeling into…

J: I don’t know what I’m feeling…

Th: Yeah. Let’s make a lot of room for this.  There’s something about tears, (which are now glimmering in his eyes) something about your breathing slowing and deepening … and I can just tell you I just feel such a tremendous sadness that is just kind of …  (nods, sighs, makes a gesture of a big collapse with his body) … really …  (I leave long pauses between the invitation to feel into, leaving incomplete sentences open, trusting that John’s right brain will fill in the blanks with bodily experience, while his left brain slowly brings meaning or memory; these blanks are John’s to fill in from a place of populating, occupying, presencing himself in what has been a multi-generational “no-mans-land” in his lineage)

J: Yeah… It’s…(John takes a really big breath in and forcefully exhales) (I continue to nod and feel this with him)…sad and angry…

Th: Hmm…hmmm.

J: …frustrated and…um…

Th: Hmm hmm (nodding slowly)

J:  …but part of me is very hopeful…(I see this as an expression of transformance strivings appearing in John as he feels the rising up of the part of him that longs to evolve in his capacities and believes that he can. Consistent with the ethos of AEDP, I choose to go with the upwelling of “hopeful”, and not right now with the sadness and anger.  I choose to support John to go toward the light and safety with me)

Th:  (smiles) (warm and gentle tone) … hmmm.

J:   …wanting and knowing that things can change…

Th:   (nodding more rapidly)…yeah…

J: so…

Th: And in this place right now, what do you want to move in yourself?  What do you want to develop in yourself, John, from this place of feeling right now?  (I call out for an adaptive action tendency in John that might want to come forward into the “wanting and knowing that things can change” experience)

J: (Clearly) My ability to love…My capacity to support through love…

Th: (Nodding, impacted by John’s realness and authenticity) Wow!

J:…Mary and my kids, and myself.

Th: Wow….I can’t remember feeling this with you before. What are you feeling in here? (I gesture to his belly feeling in my own belly a remarkable surging of heat and energetic expansion) What’s happening here when you are saying this?

J: I still don’t know.

Th: Can I share with you what I’m experiencing?  It’s a kind of a core sense of something connecting in here. (John takes a deep breath) I’ve never felt this with you before…here.   Just focus in here for yourself and just notice what is the experience of having a belly, being in a belly with consciousness … When you say, “I want to learn to love, to support Mary, to support my kids, and to find that love…I want that…”

J: (Nodding, breathing deeply in his chest, expanding it dramatically) I’m not in my belly.   I’m in my chest.  (John occupies himself now in the embodied realm that fills, that moves, both visibly and in my own embodied experience, up and out.  John and I are connected, though having a different foreground experience of embodied selves in relationship to each other)

Th: O.K., tell me about that.  I’ll stay here, and you stay there.

J: Tight and it’s hot…and it’s… (takes a deep breath, exhales forcefully)…

Th: Hmm Hmm. O.K.

J: I guess kind of a pit in my belly.

Th: A pit in your belly? O.K.  And the pit in your belly, when you occupy that, and you put that together with the hot in your chest, what’s that like to sit with both?

J: Fire … like I want to go…do…(chuckles). I want to go get stuff done. (I register that John has before gotten to experiences of deep bodily connection in past sessions and then has “revved” himself out of the depth and into an avoidant surge of over-activation with tangential associations about doing chores and projects alone, essentially escaping into solitary activity first in fantasy and then in totally changing the direction of the session)

Th: O.K., and what if the stuff to get done…isn’t doing “stuff”, but it’s actually about love…and loving…(John breathes more deeply, nodding, his eyes tear up even more) finding yourself … to be with your wife … to be with your children … to be with Billy and with Buddy [his two children] in new ways that are about love and support…being with them. (John is nodding now, taking it in) … being with your self, being with them…what happens now?  What do you notice?

J: Sadness. (Deep breath, eyes filling with glimmering tears)

Th: And the sadness gets words and the words are … what’s the sadness?

J: (Crying) I’m sorry.  (Lowers his head towards his chest then looks at Mary)

Th: Hmm hmm.  Is this a time you can see Mary and let her see you?  There’s a great cry here.   Just really feel the dimension, the hugeness of this experience. Make a lot of room for yourself here, John….So look at me or look at Mary, but look at one of us, so you are really staying connected here with us…one or the other…or both…(I want to be sure that Mary’s long established rage about the “failed father/husband that she so recently “saw” in John”, does not “knock him out” of his core affect.  So I give him several options of who to connect to and let his instincts be his guide)

J: (John looks at David, takes a deep breath) I’m sorry…(Long pause)…I am. (John looks from David to Mary)

Th: And what are you sorry for?

J: I’m sorry, (looks down to his left)

Th: (Long pause) And what are you apologizing for?

J: That I can’t meet you the way that you want me to meet you…

Th: Right now? (I want John to register what is true right now and not be depending on his fixed invariant memory of himself)

J:  That I need to meet you … that I should meet you.

Th: Hmm Hmm. (John takes off his glasses, looks down, sighs, shakes his head in a defeated way, Mary looks off to her left, away from him)…What’s the part of you that is going like this right now (shaking his head) What’s that part of you saying?

J: That I’m…I’m lost…(frustrated, furious tone) I’m f—-ing lost!

Th: I hear you … There’s a lot, there’s a lot against you coming through this gateway that you are in right now …  let’s just acknowledge that.  There’s a lot in you against it …  against coming through right now.  (I notice a very evident vertical bi-lateral asymmetry rise out of John’ face.  His left eye is clear and bright, while his right eye is dull, receded into the eye socket, defocused and foggy.  The left side of his mouth has a shy, hopeful smile, while the right side droops down.  This distinct facial asymmetry is a somatic manifestation of an “edge” that needs to be unpacked and metaprocessed)  What’s happening on your left side?  Your left eye…sight through your left eye, what’s the statement you want to make?  (I want John to occupy the part of him that looks and feels clear and bright and let that part of him be seen and heard and felt)

J:  Clarity.

Th:  O.K.

J:  I see things very clearly …

Th: Good …

J: … and I don’t like it.

Th: (Nodding his head, tilts it to the right) Because what are you seeing?

J: (Shaking his head, faces his palms up, voice rising in angry protest) My inability to do what I need to do!

Th: O.K. (John sighs and closes his eyes) O.K.

J: (Looks down, voice louder, even more fierce, teeth exposed) F–k!

Th: (I want John to stay clear of dissociation brought on by shame.  We have been here more than once in prior sessions, when he has popped out of consciousness and not been able to retrieve his emergent self or to retrace his steps) Right now … seeing your blocks feels how, in your body?  This is speaking to your left side.  It feels how, to see your blocks?  This is not about “can’t.  (I feel great hope and a fierce confidence in John’s presence and I show it by holding what I hope for, believe in, in the act of him believing in himself in Mary’s still palpably loving company as she gazes at him, radiating kindness I can feel as warmth in my heart)

J:  It feels strong.  It feels good to know it.

Th:  It’s about blocks being in the way.  O.K. tell me the strength to know what your blocks are, to see what is in the way of the good man in you to come through…the loving man…the big man who really is a loving father, a loving husband, with lots of capacity to love even when its difficult, and still come through with love and support.  (I speak in the present tense about the aspects of John that are expressions in line with the adaptive action he spoke of earlier, and that he had been showing and living in the weeks previous to this session and that I am remembering, trusting in and believing in.  I hold a place for those very real aspects of John to come into his present experience and expression in a way that I feel and express intensely on his behalf)

J:  (Looking at David directly with intensity) It can be done.

Th:  O.K. and what part of you is saying that right now?

J:  The left side, and then the other side is saying “F—k, I don’t know where to begin.”

Th:  O.K. (nodding his head)

J:  I feel lost…

Th:  (Chuckling, encouraging tone) O.K. Let’s talk to the lost side of you for a minute.  Which side of you feels lost?

J:  My right … (slurring his words slightly)…my right side…When I look at you, the right side of my face says…it doesn’t say anything, it just feels…(shrugs his shoulders, shakes his head)…lost…and…
Th:  Well thank, thank goodness you are saying I feel lost and you are looking at me and connecting with me…and I wonder, how much do you trust me to walk through this with you?  (I feel a tremendous coherence and fierce loyalty with John, a powerful longing for him to come to himself in a new and true way.  My own adaptive action tendencies of being the good father to him are fully, almost overwhelmingly, engaged.  I have tears in my eyes)

J: Completely. (Nods his head)

Th: (Nodding, breathing in synch with John) What’s it like to let that in?

J: (Tears filling his eyes) Hard. Very…(starting to cry)…uhhh…

Th: Hmm. Hmmm. (John shakes his head, closes his eyes, takes a deep breath)…Hmm…Hmmm.

J:  I’m …

Th: Hmm…hmm…

J: …f—-ing…

Th: Hmm … hmm.

J: …conflicted

Th:  … I hear ya … not just conflicted, but f—-ing conflicted … (both nod their heads for a few seconds together)  (More edge work)

J:  No, not conflicted… just angry.

Th: Hmm. Hmm. (Nodding his head more empathetically, gesturing with his hands like he is beckoning John to come forward to him) and tell me about the anger. Tell me the anger.

J: I’m angry that I (voice spikes)…have to fucking do this!!

Th: I hear you. (Nodding)…and there’s sadness here too.   (I respond to the great ponderous sadness I feel in my body sitting, leaning forward toward John, and am also aware that John’s wife Mary is right there inches away from John, looking at him with what feels in my heart to be a great warm glow of love and deep resonant, moist kindness.  I want her to be able to stay present and I need and receive her help to keep the safety in the room to remain palpably warm and strong)

J: Yeah. (His breathing deepens)

Th: And how about shame?  Is there shame around here too?  (My whole body experience is of a bundled emotion in which in my imagery at the moment is of shame, sadness and rage that are wrapped around each other like a twisted vine linked to an immense history of unresolved shock, trauma and deprivation in John’s life from his raging and shaming alcoholic mother and disempowered, dissociated and helpless father, who was unable to protect John or himself)

J: Yeah.  A lot of it.

Th: Hmm Hmm. Hmm Hmm. It’s a lot. It’s a lot.  It’s a lot to have to engage all at once isn’t it. (John sighs deeply) Anger and shame and sadness…(I see John’s eyes are welling up, glimmering) What else? What else is here? On the feeling level with you right now?

J: Loss is here. (Looks down, cries softly)

Th: Can we go with the loss for a while?  Make some space for the loss to exist in you. (John continues to look down taking deep breaths) with a kindness…towards you…(John wipes the tears glimmering in his left eye)…go ahead say it…(John shakes his head, fighting back a swelling of feeling and tears and takes a few more deep breaths, looking down)…let me just check with you now…this might be a time just to glance at Mary and see where she’s at with you, and this is not…I’m not telling you to do it, it just might be a time to check in and see where she is with you in her feeling self…(Mary has had her head resting back on the cushions of the couch, observing John with a soft and gentle gaze as he’s been connecting with me…John sniffles and looks directly at Mary for a second, then looks down, winces intensely, draws in a huge breath and begins to cry.  Mary extends her left hand and gently places it on John’s right arm…John begins now to sob deeply, covering his eyes with his left hand, restraining his breath and his voice with tremendous exertion.)  Just let the sound happen John, you are safe in here.  This is a safe place (Mary caresses John’s arm) to let this out. (John thrusts his head back, still covering his eyes with his left hand) Let the sound happen…(John cries intensely, but still compressed)…You are doing great…Uhh Hunhh… Let yourself hear the sound inside you…(John releases his hand from his eyes and continues to hold back sobbing, taking deep breaths, with his eyes tightly squeezed shut)  (Here, Mary is the attachment figure to whom he comes for safety and is held and comforted by her in such raw now non-dissociated vulnerable, soft sadness.  I get to feel John for the first time ever in treatment in this degree of complete coherence with his feeling expression and spontaneity.  Far more importantly his life partner is seeing him, hearing him feeling him in his depth, his undefended realness. In these unfolding moments, he is becoming a real person to her, a true other, who is different from her, who is imperfect and acknowledging his lostness and his dedicated longing to love and be loved)

J:  Huhhhh!  (A loud explosive full voice sound)

Th:  Hmm Hmmm. Hmm. Hmmm. This is a very, very, very big…big experience… huge…(John covers his eyes and makes more noise on his exhales)…Hmm. Hmmm. This takes so much courage to face this, John….Notice the sounds that are in you, even if you don’t make them…let yourself hear them…notice any imagery that comes to you right now…any images…do you see anything in terms of images right now? (I want to invite other channels of experience that could be available to access more foreground awareness in John and to keep providing novel up-regulating challenges to keep him from dissociating again)

J:  (shakes his head, eyes still closed tightly) No…

Th:  Hm Hmm.  (Mary looks toward him close-in, her poignant face very close to his, intimate, soft, loving, beaming at John with what I read as an immensely compassionate expression of longing to comfort him.  Her eyes search for his, seeking him.) O.K.  When you gather yourself and you’re ready, just have another glance at Mary…just see how she’s regarding you now…(John shakes his head, eyes tightly shut, fighting back the tears.  He covers his eyes and his face with his left hand)  (I invite John to receive the exquisite welcoming offered by Mary and accompanied by me as an alternative to dissociation) Let all the feelings come.  I’m right here.  I’m right here with you…Can you feel me with you John? (John nods his head) How do you know I’m here with you?  How can you tell?  (In this place of so much saturation of new experience, I want John to actively occupy and integrate awareness of touchstones of multiple channels of sensory experience that contribute to a cross-validated verifiable trust, so he can continue to build forward momentum in his process of connecting with himself and his wife Mary.  She has her own attachment level trauma that could be evoked at any moment, even by the fact that John cannot yet even look at her for more than a few moments.  This very dynamic has been an unbearable provocation for her in multiple previous sessions; yet she stays stable, loving and emerges in each passing moment as John’s true other, as she transcends the rules of her own internal working model through love, to surpass her fixed invariant patterning.  I am still in the field, safely scaffolding so much new experience for both)

J: I can hear you.

Th: Hmm hmm…OK….Can you feel through my voice what I’m feeling with you?

J:  (Nods his head, cries more intensely) I’m so fucking sad…as shit…

Th:  (Tender, compassionate, loving tone) Yeah…I hear you.

J: And sorry….

Th: (Feeling deeply with him) Hmm Hmmm…Hmmm. Hmmm…Hmm Hmmm…Yeah.  (John moves his wet left hand from covering his face and eyes and places it over Mary’s hand) And feeling Mary’s hand, noticing what you feel when you touch her. (Mary puts her right hand over John’s left). What energy comes into your body?  (John sobs)  And notice if you have a place to put it…a place where it can go…(I am again urging John to choose to take in to his foreground awareness explicit experiences of safety and nurturance, this time from the sensory channel of touch) (John breathes deeply, eyes still closed, holding Mary’s hands.  Mary is looking at him very softly.  She still conveys herself as unanimously very present, spacious and available to him) What happens now?…O.K…Just keep on noticing every moment, what’s happening in your body? (John opens his eyes and readies himself to look at Mary, then glances at her and looks down right away) Again take a little glance at Mary, just see what you are seeing in her. (This is an invitation for John to take in selectively from the visual channel and to register explicitly the experience of her loving him, while he is in this entirely new place of peaceful, yet intense vulnerability.  I can see the warmth and feel the unanimous love and kindness in her eyes, which I have never seen in her to this degree before.  I am witnessing her, taking in her remarkably stable, nurturing and loving offerings to John and allying with her by urging John to take her offered love in) (John makes direct eye contact with Mary now, both of them smile shyly and gaze softly at one another.  John’s smile opens up wide, still shy) Letting in what you can let in…

J: (Still looking at Mary) Thank you. (His voice is so tender, clearly touched, taking her love in.  He again breaks eye contact with her and looks down and to the left)

Th:  Can you tell her what you are thanking her for?…Just take your time John.  (He keeps looking down for a while, taking deep breaths, then he intertwines the fingers of his left hand with the fingers of her right)

J: (Looking up at Mary tenderly, shyly, vulnerable) For being with me. (He looks down for a few breaths, then back at her. He smiles at her.  She smiles back, her face is flushed with deep resonance and loving warmth at being taken in so fully by John)

Th:  O.K. stay with the feeling.  And what’s in the smile?  And seeing Mary’s immediate response to you instantly…what happens here? What passed between you, John.  See if you can find the language for this…What do you let in?…(Long pause)

J:  Thank you for your strength.

Th:  How do you experience her strength right now? (John and Mary continue to gaze lovingly at one another) (Again I am scaffolding John and Mary staying in the moment, I keep selecting one embodied invitation to let in love at a time, guiding the process of their reunion.  I would not do this degree of structuring with another couple perhaps, but the amount of newness is so extreme and their dynamic can be so volatile and can so rapidly shift, I feel it to be vital to stay very involved and very active in structuring an experience … “a somatic spoon feeding” of the process)

J:  Through her eyes, and my heart…

Th:  Wow. Feeling her strength in your heart.  (This is again a new and poetic level of embodied awareness for John to access and speak)

J:  Thank you.  (He speaks to Mary with a resonating depth of feeling in his voice and a body expression of cherishing her that again is again totally new in my experience of them as a couple)

Th:  Will you tell her how you know about the strength from Mary that you are receiving through your eyes and in your heart?

J: Yeah. I feel it. I feel like you are filling me up right now. (He now tenderly holds her hands and her direct gaze unflinching at the same time)

Th: Wow… (Mary smiles and John immediately matches it, like fresh sunshine coming through parting clouds)  How is it coming through…how is it coming in? (John takes a deep breath and looks down, beginning to cry softly now) Hmm. Hmm Hmmm…(John makes eye contact again with Mary and breathes deeply) With every breath, just really notice what’s happening John.  It’s very important. (John looks down as his face winces and he starts to cry more intensely)  Very deep…let whatever needs to pour out, pour out to make some room in there.  (John begins to sob and leans towards Mary…and continues leaning more toward Mary) Let her move towards you as you move toward her John.  (John initiates an embrace with Mary who completely, emphatically wraps her arms around him.  Her embrace of him envelopes his head, which is now buried in her in her much smaller and yet totally form-fitting chest and right shoulder) Just let it pour out.  You don’t need to hold this alone anymore. (Mary holds John tightly as his whole body rocks and sobs with a torrent of tears)…Hmm Hmmm.  Very important…Notice for you too Mary, any sounds, any breath changes, really track your body…track your energy…just notice what is happening in your body…and John notice any imagery that is going through, any memory, any bodily experiences…the flexing of your jaw…feel it all …(John says something to Mary, but inaudible to me and the microphone) Hmm?  Can you say it again John?  And take your time (John begins to breathe more with long drawn out full-body breaths) Let yourself hear yourself say it again when you are ready.  (My intention here is for John to metaprocess his experience and to help him to integrate more of what he has taken in and expressed.  Above all I want to help John stay present in his body in a right brain focus, but making his experience explicit in his left brain as well: mentalizing.  John is way beyond the permission set of his internal working model, and is in a realm that is so new, so original and full of potentially “edginess” .  I want to be very attentive to accompany him and Mary and help him integrate and find a home for what is happening moment-to-moment as a way to integrate his experience and to construct an alternative to future reactive shut down, regression and collapse.)  Hmm. Hmmm.  A very big moment…(John begins to sob, Mary responds by holding him more tightly, bringing him into her with even the tips of her fingers, as if she is claiming him unanimously as “her own”)…Very important…Hmmm…hmm….(Mary gently caresses John’s hair as his still muffled crying intensifies) You don’t need to be silent about this, it’s really O.K. to be heard, now…It’s O.K. to be seen…It’s O.K. to be held…Just check and see if what I am saying is true.  (John nods) Umm hmmm…good…wonderful.  (Long pause….Mary continues to hold John who is breathing deeply, abdominally)  Just check in and see, John, if you actually feel safe to let in Mary’s love…Just check and see…(John groans, holds Mary’s waist and sobs heavily and then sighs)  Hmm Hmmm. What was that?  What change just happened there?  Just notice it.  Track it…. (John chuckles and mumbles something to Mary)  Hmm Hmmm.  Can you say it again, because I didn’t hear you.

J: (speaking loudly, as if from the bottom of a very deep well) We can do it!
Th: Yes, and earlier did you say, “I can do it?”  (John nods his head) and this time you say, “We can do it.”  Yeah. They are so different, you know. I really appreciate and get the quality of I can do it, and we can do it…anything you need to say to John, Mary?  And, John, are you open to hearing from Mary?  (he nods, tender and raw)

M: still holding John so tenderly, so close in to her) I just want you to know I love you. (she strokes his cheek, John sobs softly.  She looks at John and speaks softly)  And…I need to know that you appreciate what I…how much I love you, (John and Mary smile and chuckle together, both of their faces are relaxed.  There is a palpable sweetness between them.  I smile and laugh with them) I guess, you know.

 

Th: (laughing) So how does that feel? (John chuckles)…She needs to know from you that you appreciate how much she loves you…(John is smiling, shyly.  Mary is looking at him smiling also.  Then they shift into a resonating, connected and in-sync and loving whole body expression of holding each other body to body on the couch)

M:  I think you know how much I love you.

J:  Honest.

Th:  Honest?

J:  It feels honest, (looking at her with soft, bright, somehow young and sweet eyes) and real. (John takes a few deep breaths each with a shuddering exhale)

M:  That’s exactly it. (vulnerably) It’s like, when I’m sick and I’m feeling weak, I’m just…can you just give me a hug? (chuckles at the same time tearing up and looking at John)  All I want is just a hug. (smiling, beaming at him)

Th:  Hmm hmmm.

M: Knowing that you care enough to give me a hug and maybe ask me if I want chicken soup or something…

Th: Hmm hmm

M: It’s like very small…

Th: Hmm…mmm.

M: That’s what I need back. (she looks directly at John, John nods gently in response, taking in her love and basking in a sense of relaxed permeability to letting her in)  (For me as the AEDP for Couples therapist, this exchange marks the beginning of Mary taking the focus to begin to go beyond her procedurally learned minimalist stance of needing so little for herself.   I see her responses as representing an “edge” she has reached in her internal working model for us to explore in future sessions that will challenge her capacities to perceive, receive and express more fully what she needs to be more stably engaged in the relationship, not from her chronically under-nourished stance, but ultimately in an evolved and expanded internal working model with equal rights, which can then lend itself to an enduring relational justice and balance between she and John)

A Brief Summary

The session continues for another thirty minutes of processing more waves of core affect of John’s sadness, of love and comfort and the repair between the two.  Mary speaks more of what she needs in her life with John.  I continue to assist Mary and John to metaprocess through the seven channels of experience, so they can integrate their gains, and to affirm the realness of their extraordinary opening together, while they physically and psychically hold, reflect and treasure each other.  They go in and out of tremulous states, vitality affects and back to Core State (Fosha 2000) with each other, in relaxed states of open knowing and poetic expression of the simple truths that so often eluded them due to the defensive exclusion and blocks inherent in their interlocking internal working models.  In Core State, in the presence of love and safety held stably in the foreground of awareness, best self emerges freshly, effortlessly in each of them.  In this state for the first time, they each scaffold and support each other with virtually no involvement from me, except to bask in the deep enjoyment of witnessing them together so seamlessly and yet without the previously repetitive  merger or blurring of one into the other.

This session represents a series of radically new openings for both John and Mary. They have each become real to the other. The habitual defensive exclusion of their true experience of love for each other is, in my experience and in their behavior, simply gone.   Although Mary was not overtly the focus in the part of the session shown in this transcript, the fact she was able to give John such loving focus and track with him so tenderly established a safety and physical holding and intimate reception for him that I would have never been able to supply as his therapist.  She was able to witness him and then to love him through the storm of his dissociation and then his racking feelings and to hold him in a stable and loving way that he had never been able to let himself be held before. With her tender responses he was able to let in her forgiveness for his very real past failings of capacity to meet her and to experience and stably show his love for her.  His heartfelt apology and newfound ability to come back repeatedly from the unpacking the bundled emotions of sadness, anger, shame, collapse and dissociation in a context of such somatic and edgy intensity was a remarkable achievement for him and for them as a mutually transforming dyad.  This is particularly remarkable for John, given the lack of any historical precedent for this degree of vulnerable, prolonged expression of a full and powerful range of core affect, sensation, energetic discharge, particularly vocalized sound, all the while taking in the love and witnessing from Mary and from me.
An additional development following this session is that in subsequent couple sessions, Mary became available for the first time to deeply meet and work through her own contributing blocks to their previously stuck dynamic.  Intense suffering from her early attachment wounding was then opened to John’s comforting and stable reception.  Her transformative process was unpacked and for the first time held with witness consciousness by her husband, in ways that were truly groundbreaking and necessary in bringing about further stabilization in their marriage and in their children’s lives.

The session depicted above, beyond any other in their treatment process, proved to be the major change moment (Boston Change Group, Russell, work in progress) in John and Mary’s couple treatment, in their lived lives with each other and in their collaborative parenting of their children.  From this point forward, the volatility in their relationship dropped off dramatically. Their sense of attunement and connection in their sex life, in intimate communication and coping with significant financial stresses all improved dramatically and stably over the next three months, despite multiple and intense circumstantial challenges.  We tapered off treatment, as they both stated they had “the tools they needed for their lives” without needing to come in to see me.  At three-month follow up post-treatment they remained remarkably stable and intimate and working as a team to resolve problems as they emerged and to enjoy each other and their family life together.

References

Adler, J. (2002). Offering from the conscious body: The discipline of authentic movement. Vermont: Inner Traditions.

Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Lawrence Erlbaum.

Birdwhistle, R. L. (1972) Kinesics and context: Essays on body motion communication

Bollas, C. (1987). The shadow of the object, psychoanalysis of the unthought known. New York: Columbia University Press.

Bowlby, J. (1969). Attachment and loss. Vol. 1. Attachment. New York: Basic Books.

Fosha, D. (2000). The transforming power of affect: A model for accelerated change. New York: Basic Books.

Fosha, D. (2003). Dyadic regulation and experiential work with emotion and relatedness in trauma and disordered attachment. In M. F. Solomon & D. J. Siegel (Eds.). Healing trauma: Attachment, trauma, the brain and the mind, pp. 221-281. New York: Norton.

Fosha, D. (2005). Emotion, true self, true other, core state: toward a clinical theory of affective change process. Psychoanalytic Review, 92(4), 513-552.

Fosha D. (2009a). Emotion and recognition at work: Energy, vitality, pleasure, truth, desire & the emergent phenomenology of transformational experience. In D. Fosha, D. J. Siegel & M. F. Solomon (Eds.), The healing power of emotion: Affective neuroscience, development, clinical practice, pp. 172-203. New York: Norton.

Fosha, D. (2009b). Positive affects and the transformation of suffering into flourishing. W. C. Bushell, E. L. Olivo, & N. D. Theise (Eds.) Longevity, regeneration, and optimal health: Integrating Eastern and Western perspectives, pp. 252-261. New York: Annals of the New York Academy of Sciences.

Fosha, D. (2010). Wired for healing: 13 ways of looking at AEDP. Transformance: The AEDP Journal, 1(1). Retrieved from http://transformancejournal.com/?p=80.

Lamagna, J. & Gleiser, K. (2007) Building a secure internal attachment: An intra-relational approach to ego strengthening and emotional processing with chronically traumatized clients. Journal of Trauma and Dissociation 8 (1), 25-52.

Lipton, B. & Fosha, D. (in press). Attachment as a transformative process in AEDP: Operationalizing the intersection of attachment theory and affective neuroscience. Journal of Psychotherapy Integration.

Main, M., & Goldwyn, R. (1998). Adult Attachment Scoring and Classification System.  Unpublished manuscript, University of California, Berkeley.

Marvin, R., Cooper, G., Hoffman, K. & Powell, B. (2002). The Circle of Security™ Project: Attachment-based intervention with caregiver-pre-school child dyads.  Attachment & Human Development, Vol. 4, No 1, April 2002, 107-124.

Mars, D. (1988). Biofeedback assisted couples therapy, Workshop presented at the Biofeedback Society of California, Berkeley, California.

Mars, D. (1995).  Biofeedback: Communication within and without. Presentation to the Annual Conference at the Biofeedback Society of California, Los Angeles.

Mars, D (2009). AEDP for couples:  A new paradigm in couples treatment. Marin CAMFT Newsletter.

Mars, D. (2010). Core change through heart to heart connection: AEDP with individuals and couples, a workshop co-presented with Diana Fosha and Karen Pando-Mars, San Anselmo, California.

Mindell, A. (1985). Working with the dreaming body. London: Routledge, Kegan and Paul.

Porges, SW. (2009). Reciprocal influences between body and brain in the perception and expression of affect: A polyvagal perspective. In D Fosha, D Siegel, and M Solomon, eds. The healing power of emotion: affective neuroscience, development, and clinical practice. New York: Norton, 27-54.

Prenn, N. (2010) How to set transformance into action: the AEDP protocol, Transformance: The AEDP Journal, 1(1). Retrieved from http://transformancejournal.com/?p=52.

Roisman, G.I., Padrón, E., Sroufe, L.A., & Egeland, B. (2002). Earned-secure attachment status in retrospect and prospect. Child Development, 73(4), 1204-1219.

Russell, Eileen (in preparation) Restoring Resilience Transformative Therapy at Work: New York: W.W. Norton & Co.

Russell, E. & Fosha, D. (2008). Transformational affects and core state in AEDP: The emergence and consolidation of joy, hope, gratitude and confidence in the (solid goodness of the) self. Journal of Psychotherapy Integration. 18(2), 167-190.

Wallin, D. (2007) Attachment in psychotherapy.  New York: Guilford.

Yeung, D. (2010)  Transformance and the phenomenology of transformation:  Self-transcendence as an aspect of core state. Transformance: The AEDP Journal 1(1).Retrieved from http://transformancejournal.com/?p=92.

[pdf-lite]