How To Be an AEDP Supervisee: Get Ready To Be Transformed Molly Morgan, LCSW Certified AEDP Therapist and Supervisor
How To Be an AEDP Supervisee:
Get Ready To Be Transformed
Molly Morgan, LCSW
Certified AEDP Therapist and Supervisor
AEDP supervision is different from traditional psychotherapy supervision. AEDP is a model of radical change; learning it will change you radically. As I remember my early experiences as an AEDP supervisee, fresh from the inaugural 2010 Essential Skills course, I don’t think I fully understood what I was getting in to. Like many of you when I watched faculty videos, something inside of me dropped and opened. There was a click of recognition (Fosha, 2000, 2009): Yes! This feels exactly right! This is how healing happens and how people change.
But what exactly is it? What are they doing? It looked like so little and so much at the same time. How do I learn to do that? Triangles and charts to decipher and digest, and so many feelings swirling inside too. How do I balance left-brain learning of the four-state, three-state transformations map, the phenomenology and languaging, and also cultivate right-brain skills of slowing down, moment-to-moment tracking, deepening and building capacity to be with deep affective material? How do I learn to feel into the patient/therapist relationship, and then be brave enough to make it explicit? And when I ask my patient “How are we doing?” am I not erroneously and uncomfortably calling attention to me, the therapist? Is that intrusive? Will my patient hate me for asking, “What’s that like?” several dozen times a session? What do I do when my patient says she feels absolutely nothing in her body, and then asks, with disdain or annoyance, why exactly do I want to know?
Like AEDP therapy, AEDP supervision is bottom up, experiential and transformational. Yes, the theory, state map, triangles and phenomenology are foundational. Rest assured that they will become clearer with time. Fundamentally, learning to be an AEDP therapist is learning more deeply about you. The best way to learn is to have an experience of AEDP as an AEDP supervisee. What happens inside you when you feel blocked or stuck with a patient? What happens for you when your patient is defensive and pushes you away, or is deep into State Two pain, anger or grief? How is it for you when your patient expresses gratitude or love for you? And when your supervisor affirms you, or offers a teaching point, how does that feel inside?
AEDP asks that we be our authentic selves in an authentic relationship, therapist/patient and supervisee/supervisor. Inevitably the places where we struggle while learning AEDP are linked to where we struggle in life. Likewise, AEDP supervision offers opportunities to uncover and transform your sticky spots—outdated beliefs, behaviors or ways of being that get in the way of you being fully you. As you learn to be an AEDP therapist your capacities to be with deep affective experiences—both yours and others’—will expand. Your relational capacities will deepen: Your awareness, tolerance, and experience of intimacy, closeness and distance, safety and attunement. As you experience and reflect on the changes within the safety of a secure supervisee/supervisor alliance, you are likely to have a fuller and more satisfying experience of yourself.
Now as I sit with my supervisees I appreciate the multiple levels of learning involved with becoming an AEDP therapist. There is an alchemy to the process that involves learning the skills, practicing and feeling into the practice, and then reflecting, preferably with a trusted and true other AEDP supervisor. There are waves of experiencing and reflecting, just like in AEDP therapy (Fosha, 2000).
AEDP encourages you to be you, to internalize and metabolize the theory and skills and then bring yourself fully to your practice. The learning process also will be somewhat unique to you. It begins with noticing, affirming and feeling into what is good and right, the things that you are doing well as an AEPD therapist. Then from a resourced, Self-at-Best state, and in the safety of secure attachment, catching the wave of excitement and inspiration to be curious and explore. What could I have said or done with this patient here, and how would that feel? Why didn’t I say or do that? Can I notice and stay with this feeling of sadness (anger, joy, shame, etc.) right now with my supervisor?
To help you navigate the learning process the following is a primer of sorts on how to be an AEDP supervisee. It includes some how-to tips, as well as food for thought regarding what kind of supervisee you want to be. I hope that it helps to demystify the process, and also whets your appetite and inspires you to dive in.
Slow Down, Notice, Stay
By now you know the foundational AEDP essential skills: Slow down, notice, stay with and track emerging somatic and affective experience. The same is true with AEDP supervision, as illustrated in the vignette below.
Supervisee: (anxious and speaking quickly) I don’t know how to deal with M’s (an adolescent patient) mother. She is so anxious. She calls me after every session and keeps me on the phone for a long time. She says she wants me to give M concrete skills and then she wants to know how long it’s going to take for him to get better. I don’t know what to say to her. What skills should I be teaching him? What should I tell her?
Supervisor: (speaking slowly) And if we slow down (pause) and notice (pause) what’s happening inside right now as you’re telling me?
Supervisee: She makes me so anxious. She wants a quick fix and I don’t know what to tell her.
Supervisor: And inside, you feel…?
Supervisee: (big sigh) My heart is beating fast, and I feel tight in my throat.
Supervisor: Notice that. (long pause)
Supervisee: Actually I think a part of me is terrified. I’m terrified she’ll think I’m not doing a good job and that she’ll be angry with me.
Supervisor: Uhmmm..Is it OK if we stay with that?
The supervisor privileges the supervisee’s experience in the moment, rather than attending first to the content and the question the supervisee presents. Together they slow down and pay attention to what is happening now, and thus the supervisee’s anxiety begins to evolve and transform:
Supervisor: What are you noticing now?
Supervisee: Actually, now I’m feeling pretty annoyed and pissed off.
Supervisor: Hmm. Notice that.
Supervisee: She’s so intrusive. I know it comes from her own anxiety but I just want to tell her to back off.
Supervisor: Yes. (said emphatically to help up-regulate emerging anger energy) Tell her! What would you say?
Encouraged by the supervisor, the supervisee launches into an anger portrayal toward her patient’s mother. Experiencing and embodying her anger with an affirming other mobilizes healthy assertion, adaptive action. As her wave of anger recedes, she asserts that she wants better boundaries with the patient’s mother and begins to strategize concrete plans, including limiting phone conversations and providing a referral for the mother to get her own treatment and support. Rather than being told what to do, the supervisee has accessed the answers inside herself. Her presenting anxiety is transformed, and a sort of clinical self-righting system has been activated. She knows how to move forward with her patient, and the supervision process allows her to discover it from within. As they metaprocess, the supervisee feels pride and mastery; Yes, that feels right. That’s the way to move forward. I can do that. That feels better. Her supervisor affirms and encourages, Yes, stay with that. How does that feel, to know that you know how to move forward? The supervisee begins to embody a felt sense of confidence and clinical competence.
Your clinical questions and concerns are important and warrant your supervisor’s direct attention. Similar to AEDP therapy, slowing down, noticing and affirming emerging experience facilitates access to innate knowing. As with our patients, the process of being guided inside to discover inherent strengths and resources builds self-efficacy and agency, a sense of “Yes, I can do this!” From that state, Self-at-Best, learning and growing flow with ease.
Let Go of Getting It Right
For many of us, learning AEDP involves unlearning clinical habits or old ways of being. Add to that that AEDP requires a willingness to be open and vulnerable with our patients, to be our fallible human selves. It’s a tall order. Can you let go of being an A+ student? Do you know that inevitably, no matter how experienced and adept, we all will get it wrong at times? In fact, mistakes offer powerful lessons if we can remain open.
I remember showing video in a group supervision of a patient who presented with unrelenting anger. Emotion, this is great, I had thought, and I had diligently attempted to deepen: “Where do you feel it in your body? Notice that. What’s it like to feel it with me, etc.” I kept going for several rounds, and we got nowhere, just unsatisfying loops around the patient’s stuck narrative. “What could I have done differently?” I asked my supervisor. She responded, “We don’t deepen defenses.” Aha, and of course! My patient’s anger was defensive and not core. I felt shame, and because it was a close and safe group, I miraculously was able to stay present, blush, and fess up to how stupid I felt. My shame was met with compassionate “uhmmms,” and then transformed into excitement. Aha! The unsatisfactory looping made perfect sense, and now I had a reference point inside—that frustrating, dead-end feeling—a marker to help me distinguish core affect from defense.
What is it like for you when your supervisor offers a teaching point? Notice whether your vision narrows and your system wants to shut down. Mine did, on several occasions as I was learning AEDP. Notice, and try not to judge yourself. Can you take a deep breath and perhaps let your supervisor know what you’re feeling? Or, if in a group supervision, how does it feel if your supervisor praises your colleagues work? Is there a part of you that keeps score? Can you also notice that part with compassion and kindness rather than self-judgment? It is human to compare ourselves to others. We just don’t want to get stuck there. Sometimes, simply naming it, and being met with compassion, is all it takes to get unstuck.
Inevitably we all have critical, self-deprecating parts that will get activated when we are vulnerable, risk and stretch to learn something new. Learning AEDP will provide opportunities to befriend, embrace and melt those harsh internal voices. How familiar are you with your own shame narratives? What activates them? And what do you do when they pop up? The trick is to be aware, notice, give them space, get to know them. And keep them in perspective. You are not alone; we all have our own unique versions of shame. Can you share yours with your supervisors and colleagues to undo your aloneness, and theirs? Can you acknowledge the courage it takes to stretch and learn AEDP? Can you trust that you are exactly where you are meant to be in your AEDP learning curve? And in the next moment you will be in a new and different place.
AEDP is fundamentally and theoretically grounded in being imperfectly human. No one can be perfectly attuned and responsive to another; relational disruption is inevitable. We know from the attachment literature that secure attachment is both earned and strengthened via reiterative cycles of attunement, rupture and repair (Beebe & Lachmann, 1994; Tronick, 1989). What matters is the attachment figure’s genuine and explicit leanings for repair, and his/her empathic responsiveness to the other’s needs in the moment (Lipton & Fosha, 2011; Russell, 2015).
When we are miss-attuned there is an opportunity to explicitly explore the rupture, to repair, to provide a corrective relational experience, and perhaps heal painful, historic relational dynamics (Ladany et al. 2012; Lipton & Fosha, 2011). Careful moment-to-moment tracking and routine metaprocessing (foundational AEDP skills) ensure that we always have a feedback mechanism to help us know what our patient is experiencing, and thus inform us how to move forward. In AEDP the unit of intervention is the intervention and its impact on the patient (Fosha, 2000). If, during metaprocessing, we discover that something is not landing well there is an opportunity to explore why. Our sincere, heart-felt inquiry and exploration into how we got it wrong is a powerful message to our patients: Your feelings and your experience really matter to me, even if I am the cause of your pain. It can be exactly what is needed: The longed-for corrective relational experience (Ladany et al., 2012).
What’s it like now, potential AEDP supervisee, to know that not getting it right can be just right therapeutically?
Focus on We
Like AEDP therapy, with AEDP supervision the relationship is the vehicle for transformation (Prenn & Fosha, 2017). That means that we feel into and talk openly about how we are doing together, in this moment now. Your supervisor aims to be a secure attachment figure: kind, wise, steady, brave, emotionally available and explicitly helping and generous with their AEDP knowledge. The supervisor is both creating a secure base from which to stretch and explore, and modeling the stance of an AEDP therapist (Prenn & Fosha, 2017).
Supervisor: How are we doing so far?
Supervisor: What feels good?
Supervisee: It’s good. I mean, you’re helping me.
Supervisor: What’s that like, to have me here to help you?
Supervisee: It’s good. (long pause)
Supervisor: And inside, the good feels…? [The supervisor persists.]
Supervisee: GOOD! [Her fourth “good” and she says it with emphasis. We have a good laugh together, dyadic resonance.]
Supervisor: What’s it like that I’m AEDP-ing you like this? (playfully)
Supervisee: It’s good. I’m thinking it’s good because this is what I need to do with this client. You’re modeling for me exactly what I need to do.
Supervisor: Say more?
Supervisee: I mean, you’re focusing on the positive, and it makes me feel like I’m doing ok. It feels like I could show you anything, it’s ok to be vulnerable.
Supervisor: Hmm..and that feels…?
Supervisee: I’m realizing that that’s what this client really needs. She needs affirming. And then you’re asking me about how we are doing and I don’t really know how safe she (the patient) feels with me. I think she does, but I haven’t asked her. I need to do more of that.
Supervisor: How does that feel, all of that?
Supervisee: Good. Now I can’t wait to see her again and to try some of this. I’m excited about that.
What is it like for you when your supervisor asks “how are we doing?”? Perhaps it helps you to stay present and grounded in the moment with your supervisor as you delve into your cases. What if it feels intrusive or uncomfortable? How will it feel to fess up that you feel criticized, ashamed, angry or annoyed? Maybe you can feel accompanied, comforted and not alone in your clinical explorations, concerns or difficult patients. Can you take in your supervisor’s deep listening, affirming and care for you and your patient? And then bring back to your treatment room, with your patient, that felt sense of being seen, understood and affirmed? How does that impact how you are with your patients and your work with them?
Several years back the wife of a patient in treatment with me abruptly committed suicide in a horrifying way, leaving him with three young children. Needless to say, my patient and I were devastated, and I cycled through a range of feelings: grief, self-doubt, anger, fear for my patient and his kids, worry about what to do for my patient, etc. I brought it all to my supervision group, the full gamut of what I was feeling, and I was met and held with compassion and comfort. The group did for me exactly what I needed to do for my patient. They welcomed and listened to all of me and my feelings with care and empathy. They showed me and gave me an experience of it; the doing was in the being with. In turn I could be with the full gamut of my patient’s experience. Supervisee/supervisor group, therapist/patient, our capacities to be together and to be with deep emotional material expanded, and through many months I held my patient as I was held by that group.
Risk Being Vulnerable
The feeling of safety, fostered by the bond with a trusted companion counteracts fear (alarm/anxiety), promotes exploration and risk-taking, and fosters a full affective experience(Fosha, 2000, p. 47, bold font added).
As a supervisee you want to feel safe, to have an experience of secure attachment, and then to know you are having an experience and to reflect on it. How will you know? Do you feel accepted, affirmed and at times delighted in? What messages, implicit and explicit are you getting from your supervisor? Are you hearing that you are just fine where you are on the AEDP learning curve? Are your questions and concerns met with warmth, care, appropriate gravitas, and explicit efforts to adequately address them? As you experience, internalize and metaprocess the experience of secure attachment in supervision, you will develop a reference point inside that will help guide you in creating secure attachment with your patients.
Fundamentally a supervisee/supervisor relationship is hierarchical. It’s a leader/follower, teacher/student framework with an inherent power differential; the supervisor is the authority, which leaves the learner more open to vulnerability. While overall attachment style leanings play into the supervisory relationship, often it’s your prior experiences in similar relationships that dictate the attachment dynamics that arise in supervisory relationships (Fraley, 2007; Wrape, Callahan, Rieck, & Watkins, 2017).
Given a student/teacher framework, what interpersonal dynamics might emerge for you? How do your beliefs about yourself and the other in a teacher/student context impact your emotions, regulation strategies and behaviors? Given your history, what are your expectations of yourself and the other (supervisor/teacher/leader)? Perhaps you learned that it is safer to fly under the radar and thus better to avoid sharing your most difficult clinical moments or most challenging patients to avoid embarrassment and shame. Or are your expectations such that you are often disappointed or let down by teachers/leaders/supervisors? Perhaps you have learned that authority figures are not to be challenged and it’s better to avoid conflict. We all have our own unique narratives based on our unique histories. The goal is to notice, to be aware, to be-friend without judging ourselves. Then perhaps get curious about behaving differently.
Exploring, seeking and playing are perhaps as crucial for our adaptation and survival as safety. Risk-taking, when met with support, affirmation, and genuine engagement, leads to new learning, which, in turn leads to positive vitalizing, mutually enlivening and expansive experiences (Prenn & Fosha, 2017, pp.21-22).
AEDP therapy and supervision privilege the positive (Fosha, 2000, 2004, 2009). We notice, affirm and expand what is good and going well, between supervisee/supervisor and therapist/patient. Tracking and affirming create safety and positive feelings of interest, pride, mastery and dyadic resonance, which inspire more risking and learning. When we feel good about ourselves we are open to learning, and in turn, learning helps us feel good about ourselves. Our confidence and competence expand, which in turn impact efficacy with our patients, and that feels good too.
Barbara Fredrickson (2009, 2013) and others from the field of positive psychology (Lyubomirsky, King, & Diener, 2005; Seligman, 2011) assert that experiencing and savoring positive emotions—interest, hope, pride, amusement, love, joy, serenity—feels good and does good things for you, including enhancing learning and creativity, strengthening interpersonal bonds and bolstering your immune system (Fredrickson, 2009; Frederickson & Branigan, 2005). Fredrickson’s research shows that positive emotions, or what she calls positivity, broadens your thought/action repertoire: Interest might inspire learning and deeper curiosity, joy the urge to play, and love the urge to connect with and appreciate others. Positivity literally expands our peripheral vision, opens us up to new ideas, and allows us to see and consider possibilities that we might otherwise be blind to. In turn, new ideas, learnings, interpersonal and intra-personal connections expand our intellectual, physical, intrapsychic and social resources. Fredrickson (2009, 2013) describes it as an ever-expanding upward spiral of vibrancy, health and flourishing.
Supervisor: How are you doing right now?
Supervisee: I’m ok. I’m kind of like, I don’t know. I’m constantly amazed by this model. I mean, it connects so deeply (tears).
Supervisor: And the feeling inside?
Supervisee: I feel good. I mean calm, uhm, relieved, peaceful.
Supervisee: I don’t feel any of that tension that I felt beforehand. And that is so not how my supervision has felt in the past. Is this normally how supervision goes for people in AEDP? [We laugh together; dyadic resonance.]
Supervisor: What feels different? [making the implicit explicit]
Supervisee: Uhnm…instead of feeling inadequate and overwhelmed, I feel like, calm and encouraged, and like confident. Which again, is the opposite of what I used to feel.
Supervisor: Wow, encouraged and confident. Can you really let yourself be with that, inside?
Supervisee: (laughing) Yes, that feels good. That feels really good.
Get Ready To Be Transformed
In the process of radical change, we become more ourselves than ever before, and recognize ourselves to be so (Fosha, 2005).
Ultimately, learning AEDP inspires what many of us have described as a homecoming. We come home to a deeper, fuller sense of our self, one that we knew was there all along. And we experience that self as just right, perfectly imperfect, exactly where we are meant to be right now. It feels good and right, which in turn inspires more connecting, learning, growing, risk taking. AEDP is a gift that keeps on giving. Are you ready to dive in?
I am including three appendices on more practical matters of videotaping, preparing for supervision, and creating a “growth” mindset.
Appendix I. How to Start Videotaping
Videotaping can be un-nerving at first, but you and your patients will get used to it very quickly. If you’re hesitant about asking patients to videotape (and most of us are at first), start with the patient you feel most comfortable with, or with a new patient. Act with confidence and clarity. If you are at all tentative, chances are your patient will feel uncertain too. With new patients I say over the phone, I videotape my patients, so they have a chance to think about it before our first session. At other times, I bring up videotaping in the first session. With patients you are already seeing, you could say something like: I am videotaping my patients now.
I then say: I watch the videos in between sessions and it informs how we work together. Sometimes I share the videos with my supervisor, and she supports me in learning new ways to support you. Confidentiality is important to me so I am very careful about not sharing potentially identifying information. You of course have the option to opt out of videotaping. If you’re ok with it I’ll need you to sign this release.
Once you have video, what’s it like to watch as you prepare for meeting with your supervisor? Can you cultivate a witness consciousness, a neutral-observer part that can observe and be curious without judging? Notice when your inner critic shows up. Can you allow some room for that part, and also not inhabit it? Notice that voice, and also notice that it is just a part of you, not all of you.
Appendix II. AEDP Supervision: How to Prepare and What to Expect
Plan to show 20 minutes or less of tape. Check in with yourself as to why you are choosing that patient and section of tape to present.
What kind of help do you want and need? Do you have specific clinical questions and concerns, or questions regarding AEDP theory or interventions?
How will you articulate and ask for the help you are seeking? What can you say if you are not sure what you need?
How secure is your alliance with this patient?
In the taped sections you are presenting, where is your patient on the triangle of experience?
How are you feeling about you patient? Close and connected? Distant and pushed away? How does that make you feel, and how does that impact your choice of interventions?
How do you want to feel about yourself during supervision?
How do you want to feel when you leave?
Appendix III. Cultivate a “Growth” Mindset
What you believe (perhaps unconsciously) about your abilities to learn, grow and change can impact how you learn AEDP. Carol Dweck (2008) and her colleagues studied hundreds of students and learners and concluded that how you perceive your abilities directly impacts your motivation, your ability to persist in the face of setbacks, and your overall achievement. People who maintained what Dweck calls a “growth” mindset believe that their intelligence and abilities can grow and be developed. People with a “fixed” mindset believe that they were born with certain traits and abilities and they are fixed and unchangeable. Not surprisingly a growth mindset leads to higher enthusiasm and resilience and overall achievement.
Watch for a fixed-mindset reaction when you face challenges in your learning. Do you feel overly anxious, or does a voice in your head warn you away? Do you feel incompetent or defeated? Remind yourself that the major factor in whether people achieve expertise is not some fixed prior ability, but purposeful engagement.
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