Introduction
By Diana Fosha
You are about to embark on the wonderful new work from Karen Pando-Mars on tailoring AEDP interventions to specific attachment styles. This is a momentous achievement in and of itself, as you will see. However, to my mind, it also ushers in a new phase in the development of AEDP. I say this because I want to put Karen Pando-Mars’ work on tailoring AEDP interventions to each attachment style in the context of what has come before it and the new era I think it is ushering in. This article, to which an entire issue of Transformance is dedicated, is the product of five years of work. In my view, the article by Karen Pando-Mars is groundbreaking not only in the content of her work, which is awesome, but that it also jumpstarts AEDP’s own theory and practice of how to work with psychopathology.
And, as such, I thought it important to place it in context.
We are in a phase of flourishing and expansion in AEDP. In recent years, we have had a significant addition to the theory of AEDP in Eileen Russell’s (2015) profound contribution to our understanding of resilience and its role in transformational work with our patients. Her book introduced several major constructs such as the yellow light signal affects, the transitional self, and the therapist as transformational other. Another major development is the application of AEDP to treating couples: David Mars’ systematic AEDP for Couples method (2011, 2015, 2016), and the work of Gil Tunnell (2006, 2012, 2015) and David Greenan (2015) in integrating AEDP with traditional systemic/structural couple therapy (Nichols & Minuchin, 1999).
AEDP is also expanding by leaps and bounds in its application to supervision in the soon-to-be released book on the topic, coauthored by Natasha Prenn and myself (Prenn & Fosha, in press). And finally, we now have the beginning of research publications documenting the efficacy of change mechanisms in AEDP (Iwakabe & Conceicao, 2016) and of AEDP training (Faerstein & Levenson, 2015), with these two studies being only the beginning. Stay tuned.
With Karen’s new work, the focus on categories of maladaptive patterns and how specifically to transform them becomes fair game for AEDP’s contribution and innovation in psychotherapy. Let me be specific about how Karen’s work opens and walks through a door that has been previously bypassed or, to use a different metaphor, takes and walks on the road not previously taken, actually actively eschewed, by AEDP, i.e., the focus on psychopathology. Let me articulate below the nature of the road privileged by AEDP, a road that had to be trailblazed, as it really didn’t quite exist prior to our establishing it. Because we trailblazed it, we have favored it and privileged it.
AEDP has made its contribution and theoretical mark by outlining a new path to transformational work to undo emotional suffering, with a special focus on healing attachment trauma. The path that AEDP trailblazed—captured in phrases like “healing from the get-go,” “leading with the corrective emotional experience,” “making the non-specific factors of treatment specific,” and “being a transformance detective”—is rooted in its central concept of transformance. Wired within us, we have the drive to heal, grow, learn, self-repair and resume impeded growth. This force exists within us as a capacity and a motivational drive, one which can become more tangible and reawakened under conditions of safety. We understand that healing is not just the result of healing trauma, but that healing exists side by side with trauma. However, for it to come to the fore, conditions of safety must prevail.
In AEDP, we understand transformance/healing and psychopathology/resistance to exist side by side. The nature of the affective/relational environment that exists in a given situation contributes powerfully to which one of them emerges, and the patient’s experience of either safety or stress/threat respectively brings one out. More to the point, no matter what history of trauma, chronicity of pathology, compromised functioning, what have you—no matter what—the capacity for health, healing, secure attachment, connection and emotional experience is there. It exists intact, side by side with the maladaptive patterns resulting from the unbearable suffering; and it is ready to manifest itself in conditions of safety and nurturance. This capacity, although usually camouflaged by pathology and engrained patterns of maladaptation, nevertheless makes itself felt through glimmers of positive affect, vitality and energy, what we refer to as in AEDP as the positive somatic affective markers or the vitality affects. These glimmers (which we track moment-to-moment at all times) are a way to access the transformance drive, i.e., healing, from the get-go, from the first moments of the first session and then throughout the entire treatment in each and every session.
As a consequence of its healing-from-the-get-go orientation, AEDP pioneered techniques for detecting transformance, melting or bypassing defenses, accessing emotional experience and working with it through dyadic affect regulation, processing emotions to completion or to an affective shift from positive to negative, metaprocessing transformational experiences and, of course, work with core state. From our healing orientation, AEDP also introduced to the world of psychotherapy an attachment-based stance that is affirmative and emotionally engaged, a stance that seeks to co-construct safety, as a positive, reparative relational bond is forged. This affirming and nurturing mindset, and the relational work that leads to the establishment of a therapeutic relationship characterized by secure attachment, allows the work to proceed under the aegis of transformance, and allows the therapist to form an alliance with the patient’s self-at-best, so that, together, they can work with the patient’s self-at-worst.
Thus, in the realm of attachment, contrary to patterns of insecure or disorganized attachment shaped by histories of trauma and attachment trauma, AEDP’s contribution to date has been to show the capacity to form secure attachments from the get-go, if only in glimmers and for moments, and to enlarge that capacity by making the implicit explicit, the explicit experiential, and the experiential relational. By working with receptive affective experiences of feeling seen, feeling felt, feeling cared for, feeling loved, we have again been pioneers in showing how to wire in such new corrective experiences through work aimed at increasing receptivity and growing the capacity to process and take in receptive affective experiences.
Most recently, my work on recognition and on transformation from the outside in (Fosha, 2009, 2013) has shown how serendipitous experiences of recognition, i.e., experiences marked by the click of recognition, have the capacity to access not only transformance glimmers, but at times, with incredibly rapid speed, to grant access to the full felt sense experience of the neurobiological core self. In other words, when these serendipitous clicks of recognition occur, it is possible to sometimes witness the patient’s dropping down from State 1 not only into affect and State 2 work, but also unexpectedly dropping down from State 1 to State 4 in one fell swoop, with experiences of core truth and “this is me.”
All of these transformance-based metatherapeutics are supported by the emergent science of neuroplasticity and the seamless integration of developmental research, especially developmental research into caregiver/infant moment-to-moment interaction, attachment theory and research, emotion theory, affective neuroscience, interpersonal neurobiology, the polyvagal theory of the autonomic nervous system, other trauma based treatments, and transformational studies.
Furthermore, our metatherapeutics have produced a rich methodology and technical armamentarium of AEDP-specific interventions we teach in our two-year-long sequence of AEDP Essential Skills courses and in supervision sessions. While AEDP therapists learn interventions on how to work with dysregulation, dissociation, and pathogenic affects, so as to transform them to access adaptive primary core affective states where the transformational work can take place and develop, the theory of how AEDP works with different types of psychopathology has not been a focus of innovation, and much less of theoretical work in AEDP.[1] It is the old road of psychopathology that AEDP has eschewed for so long, yet we now are ready to tackle it, confident that we can do so in our own distinctive AEDP way and make traveling on it a very different experience.
Until now, whenever I was asked the specific psychopathology question, i.e., “So what is the AEDP approach to working with avoidant attachment or eating disorders or …. (fill in the blank),” my rather proud answer would be, “There is no AEDP approach to working with (fill in the blank) per se.” Then I would elaborate that the AEDP path is always fundamentally the same, regardless of the psychopathology we encounter. Since all disorders are in the realm of psychopathology and self-at-worst functioning, the AEDP approach for working with them is to see how much they can be put to the side and how much glimmers of transformance, evidence of resilience, and manifestations of self-at-best can come to the fore. Once we do that, we can form a relationship with the patient’s self-at-best, and then with the accompaniment of self-at-best, we work with the stuff under the aegis of self-at-worst to transform it. Even in State 2 work, our focus has been toward the universals. We have emphasized interventions designed—as rapidly as possible and as effectively as possible—to access the adaptive neurobiologically wired-in pathways to healing represented by the emotions, sensations, self-states and coordinated relational experiences.
In essence, as Jerry Lamagna wrote (personal communication, October 23, 2016):
[It is important to not let] diagnosis or life history limit our view of our patients and what they are and are not capable of feeling, being, etc. It is a truly wise, open stance to being with another person. …… [as Buddhists also teach us], thankfully everything that is and can be is pre-baked into the therapeutic cake waiting for the right conditions to bring them forward. This is so simple that it is hiding in plain sight: Safety, connection, presence, receptivity. If those conditions can be activated in therapist and patient — the process largely takes care of itself.
Which takes us to what happens when those conditions cannot be activated, or cannot be sufficiently activated? What happens when the transformance path is blocked or so full of ruts and ditches as to not be travel-able?
Enter now the work of Karen Pando-Mars on tailoring AEDP interventions to the secure, insecure and disorganized attachment styles. It spearheads differentiated AEDP work within the realm of self-at-worst and the patterning that emerges as particular attachment-style states of mind, as a result of attachment trauma. It goes down the old road of psychopathology but does so in a distinctly AEDP way. You will discover its riches—theoretical, clinical and technical—for yourself in the pages to come. It shows us that indeed AEDP does have its own unique contribution to make, not only on how to bypass pathology and access adaptive wired in aspects of ourselves from the get-go and throughout, but also to how to work in the realm of psychopathology and the realm of self-at-worst in a differentiated and specifically AEDP fashion.
Karen’s work bears the hallmarks of quintessential AEDP: (a) a healing/health/resilience orientation, (b) an attachment-based therapeutic stance, and (c) an understanding of defenses and the maladaptive patterns they spring from. In her article, Karen elaborates on AEDP’s premise that the defenses and maladaptive behaviors are the patient’s best efforts at self-protection, given the difficult circumstances in which they arose. Finally, the other quintessential AEDP feature that characterizes Karen’s work is that it is informed by the seamless integration of attachment theory, interpersonal neurobiology, and research from other fields relevant to AEDP. These bodies of literature are reflected in the specificity of the three grids Karen introduces to organize and structure her work.
Gil Tunnell and I are very proud to have this work appear in Transformance: The AEDP Journal. Rather than dividing it in parts and publishing it serially it in two or three issues, we decided to preserve its integrity and offer it to you in a Special Edition.
I think you will find it illuminating and very useful. Laminated versions of the three grids will probably be a very useful accompaniment to AEDP therapists and other clinicians as well!
Personally, I look forward to future work that expands and develops AEDP’s healing-based orientation, and that elaborates on specific interventions that foster transformational work. I also look forward to further development of AEDP-specific approaches to different aspects of self-at-worst functioning (e.g., defense work, dealing with pathogenic affects) and different categories of psychopathology (e.g., addictions, eating disorders). In this way, we can enhance and expand the contribution that we can make to the field from the special vantage of our attachment-based, healing-oriented transformational methodology.
References
Faerstein, I., & Levenson, H. (2016). Validation of a fidelity scale for accelerated experiential dynamic psychotherapy. Journal of Psychotherapy Integration, 26(2), 172-185.
Fosha, D. (2009). 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. (2013). A heaven in a wild flower: Self, dissociation, and treatment in the context of the neurobiological core self. Psychoanalytic Inquiry, 33, 496-523.
Greenan, D. (2015). Resiliency-focused couple therapy. Transformance: The AEDP Journal, 5 (1).
Iwakabe, S., & Conceicao, N. (2016). Metatherapeutic processing as a change-based therapeutic immediacy task: Building an initial process model using a task-analytic research strategy. Journal of Psychotherapy Integration, 26 (3), 230-247.
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.
Mars, D. (2011). AEDP for couples: From stuckness and reactivity to the felt experience of love. Transformance: The AEDP Journal, 2 (1).
Mars, D. (2015). AEDP for couples: Transforming potential divorce into falling freshly in love in the thirtieth year of Marriage. Transformance: The AEDP Journal, 5 (1).
Mars, D. (2016). The community healing workshop: A final treatment phase of AEDP for couples. Transformance: The AEDP Journal, 6 (1).
Prenn, N., & Fosha, D. (in press). Essentials of AEDP supervision. Washington, DC: American Psychological Association.
Russell, E. (2015). Restoring resilience: Discovering your clients’ capacity for healing. New York: W. W. Norton.
Nichols, M. P., & Minuchin, S. (1999). Short-term structural family therapy with couples. In J. M. Donovan (Ed.), Short-term couple therapy (pp. 124-143). New York: Guilford Press.
Tunnell, G. (2006). An affirmational approach to treating gay male couples. Group, 30, 133-151.
Tunnell, G. (2012). Gay male couple therapy: An attachment model. In J. J. Bigner & J. L. Wetchler (Eds.), Handbook of LGBT-affirmative couple and family therapy. London: Routledge (pp. 25-42).
Tunnell, G. (2015). Facilitating transformance for couples: A comparison between structural family therapy and AEDP. Transformance: The AEDP Journal, 5 (1).
Notes
[1] The exception is the powerful contribution of Jerry Lamagna and Kari Gleiser in 2007, introducing attachment-informed intra-relational AEDP. While the intrarelational work, i.e., AEDP parts work, is an important aspect of AEDP State Two interventions, it is a fortiori relevant and even necessary to patients on the dissociative disorder spectrum.
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