Transformance: The Couples Issue

Introduction to Transformance: The Couples Issue

By Benjamin Lipton

As we stand together at the horizon of the second decade of AEDP, the view in all directions is quite stunning.  Behind us, the many milestones of our model and our community fill the landscape from AEDP’s beginning to today.  Fueled by a commitment to emergence, rigor and authenticity, the development of AEDP theory and technique during its first decade has brought dynamic, new theoretical understanding and increasingly effective and nuanced clinical strategies to the field of individual psychotherapy.

Beginning first with the publication of Diana Fosha’s visionary book, The Transforming Power of Affect, some representative highlights of this renaissance include: the expansion from a 3- to 4-state model of emotion processing; the elaboration of affective change processes; the central roles of explicit recognition and meta-therapeutic processing in psychological transformation; the introduction of intra-relational AEDP; the application of the model to self-help healing strategies, and of course, the emergence of the seminal concept of transformance after which this journal is named.  In terms of organizational growth and development, we have witnessed the birth of the AEDP Institute; the emergence of first and second generation Institute faculty and supervisors; a comprehensive training program with an ever expanding cadre of certified AEDP therapists; and AEDP regional organizations emerging across the US as well as in Canada, Asia, South America, Europe and Israel.  Cumulatively, these developments attest to the unmitigated power of transformance when it finds the right environments in which to flourish.  So much has happened in such a short period of time.

Now, shifting our gaze to what lies ahead, AEDP appears poised for a next wave of innovative clinical, theoretical and community developments.  A key component of this new wave is the elaboration of work already begun by some of our Institute faculty and community members to expand their (and thus our collective) focus beyond the realm of individual psychotherapy into working with couples and groups.  This current issue of Transformance stands as a seminal contribution to that project as it brings together three synergistic, yet distinct, approaches to AEDP-informed couple work.  Each approach engages in creative ways with existing models of individual and couple therapy and uses them as springboards for new ways of thinking about how to help couples gain and sustain access to their best individual and relational selves.  Together, the authors of the three articles in this current issue offer both inspiration and instruction to us all for how to extend the theory and technique of AEDP into new areas of clinical practice.

As you read the articles that follow, you may recognize your own work in what the authors are describing.  This, after all, is a familiar hallmark of the resonance so many newcomers to AEDP have felt when they first are introduced to the model.  Many of us are incorporating many of the things that these three authors incorporate into their couple models of treatment, for example mindfulness, a systems focus, and recognition of the energetic presence of transformance in the world around us beyond the confines of the individual.  But these three authors are the first to make these implicit phenomena explicit in the literature of AEDP theory and practice.  And in so doing, they are helping our collective consciousness to know more deeply what we have known and also to learn creative new ways of how to apply this knowledge in powerfully effective strategies for healing and flourishing.

Two of the authors, Gil Tunnell and David Greenan, come to AEDP with deep clinical roots in Minuchin’s structural approach to couple and family therapy, a very different, but in important ways also complementary model to AEDP.  In his article on what he calls Couple AEDP, Tunnell carefully outlines the points of intersection and divergence between AEDP and Structural therapy.  Like AEDP, structural family therapy is an experiential model that asserts that in order for change to happen outside of the session, a couple must experience a new and different way of relating in the session.  Unlike AEDP, however, in the Structural approach, anxiety is actively cultivated and intentionally front and center in the process as a vehicle for change.  Highlighting a couple’s maladaptive relational patterns, heightening anxiety, and directly confronting defensive behaviors are key interventions in this model that asserts that the fundamental mechanism of change is unbalancing the system by challenging and confronting a couple’s behaviors head on (Nichols & Minuchin, 1999).

Never quite comfortable with the confrontational, anxiety-amplifying therapeutic stance of Minuchin’s model, Tunnell yearned for a kinder, gentler yet equally, if not more effective way of practicing psychotherapy.  In his search, he found his way first to explore AEDP with individuals and then to use this approach to develop innovative ways for joining up his prior systems knowledge with AEDP’s shift in focus to privileging affect, safety and positive experiences as the primary mechanisms of therapeutic change in work with couples.  Tunnell writes, “In brief, if therapists want conflictual couples to be gentler, kinder and softer with one another, should not the therapy itself be of that ilk?”   In offering his own answer to this question, Tunnell makes an important contribution to shepherding couple therapy into the current era of neurobiologically informed clinical practice that is grounded in attachment research and a contemporary approach to what facilitates change for the better.

Providing both a theoretical overview and a transcribed clinical example from his work with a couple, Tunnell introduces us to a flexible, integrative model of couple therapy that adapts techniques from structural therapy and infuses them with an emphasis on emotion processing, attachment, and meta-therapeutic processing that he learned as a student of AEDP.  Importantly, whereas the Structural model focuses specifically on behavioral interactions between partners, the Couple AEDP approach places affect and emotion processing center stage.  Tunnell elegantly applies the fundamental components of AEDP with individuals to his work with couples and in so doing he widens our theory and clinical focus from individual dynamics to also include the couple system.  While those of us who practice AEDP have long referenced its applicability to systems that extend outside of the minds of individuals and therapeutic dyads, I am not aware of any publications to date that have articulated the implications of this awareness.  Here’s just one exciting result of Tunnell’s project: the wired-in phenomenon of Transformance, so central to AEDP’s understanding of individual health and healing, is now also understood explicitly as a co-created, interpersonal phenomenon of the Couple-at-Best!  The implications for extending the concept of transformance into social systems are powerful and exciting.

Like Tunnell, David Greenan’s journey to AEDP, which he outlines in evocative detail at the start of his article on working with high conflict couples, included a long immersion in Minuchin’s approach to family therapy, ultimately as the Director of the Minuchin Center in New York City.  Long before he found his way to AEDP, Greenan writes that through his work with marginalized, extremely underprivileged populations, he developed a profound appreciation for the central role of resiliency as both a buffer to trauma and an ally for healing from it.  Central to Greenan’s theoretical understanding and clinical practice with couples is Minuchin’s assertion that pathology resides within an unsafe system, rather than just a particular individual.  However, Greenan found that Minuchin’s behavioral emphasis for facilitating systemic change did not seem to have traction with couples who had histories of trauma during formative years of development.  While in treatment, these couples would improve.  But when they left treatment, this group would struggle with a resurgence of volatile, destructive patterns of behavior in the context of intimate relationships.  Like Tunnell, Greenan went in search of an effective treatment approach for his most challenging couples that moved beyond a focus on behavior and recognized the role of attachment trauma and emotion regulation in creating intrapsychic as well as interpersonal safety.

Weaving together the primary strands of his professional and personal journey, Greenan developed a response to his perceived gap in effective couple therapy through a creative integration of 1) mindfulness practice, 2) Gottman’s (1976, 2004) couple communication exercises for skill building and conflict resolution, and 3) AEDP.   His article in this issue of Transformance offers us a detailed description of this three-phase model of what he calls Resiliency-Focused Coupled Therapy and provides two evocative case examples to bring it alive for the reader.

While AEDP provides an overarching theoretical container and informs a therapeutic stance for Greenan from the get-go, his initial phase of treatment steers clear of emotion processing and transforming past trauma and focuses first on using the technique of enactments from Structural Therapy to assess a couple’s strengths and interpersonal challenges.  With this information in hand, the second phase of treatment then shifts focus to the installation of intrapsychic and interpersonal resources through psychoeducation and in-session practice exercises.  From an AEDP perspective, here Greenan concretely privileges the necessary creation of a platform of safety both intrapsychically for each partner and also in the couple system before focusing on areas of stress and conflict.  Once this second phase of safety building gains traction in the here and now of therapy, Greenan employs metaprocessing to make the implicit explicit and solidify a couple’s awareness of a new, better, safer working model for self-regulation and couple interaction that they can carry with them into their lives outside of the consulting room.  Then, once requisite safety and newfound capacities for regulation are in place, in Phase Three the focus now shifts to deepening each partner’s awareness of and working through earlier traumas that have created obstacles to his or her relational safety and desired intimacy.  While this explicitly attachment-informed conceptualization using AEDP language is mine and not Greenan’s, I would suggest that Greenan works to transform the internal, implicit working model of the Couple at Worst/Most Compromised from the earned-secure, explicit platform of the Couple at Best.  In this third phase, the full repertoire of AEDP interventions for softening defenses, regulating anxiety and processing emotions through to completion are employed in the service of transforming trauma and unburdening a couple from no longer necessary hypervigilance and reactivity.  Helping a couple to then metaprocess what it was like for each of them to do this healing work together cements their explicit awareness of positive ways in which their relationship—and each partner’s sense of self–is growing and changing for the better.  From helplessness, isolation and overwhelm, a couple may emerge into hope, connection and confidence in their collaborative capacities.

As with Tunnell, Greenan breaks new ground in the AEDP literature by offering an integrative model of treatment informed by an explicit inclusion of mindfulness practice in the service of facilitating AEDP with couples.  While mindfulness may certainly be a part of the integrative repertoire of many AEDP therapists, and it clearly resonates with the concepts of affect regulation and self-reflective capacity that are fundamental to AEDP, Greenan is the first to write about mindfulness in working with couples, specifically, as a component of an AEDP-informed model of treatment.  As such, he joins Ron Frederick (2009), who has previously included the concept of mindfulness as a cornerstone of his adaptation of AEDP to a self-help modality, in explicitly linking AEDP to this prevailing psychological concept.

Greenan ends his article with an optimistic and provocative question: Does witnessing one’s partner in a core state and perhaps having an opportunity to mirror back this state have a transformative effect on the traumatic wounds of the observer-participant too?  This question provides a ready segue into the work of the third contributor to this issue of Transformance, David Mars, the developer of AEDP for Couples who has been training AEDP clinicians in this model since 2008.

In what by now has become the traditional format for contributions to this journal, Mars structures his article around extensive verbatim transcripts from his sessions, here the first and the eleventh sessions of treatment with a couple who came to him in a severely compromised and actively distancing state of disconnection.  Word for word, intervention-by-intervention phenomenological data accompanied by meta-analysis allow us a “fly on the wall” experience of this treatment as it unfolds as well as a precise way to track its moment-to-moment technique.

Mars begins at the very beginning and introduces new territory for those of us who may be entrained in more conservative approaches to psychotherapy.  As one example, he describes his “shoes-off policy” as an important part of the AEDP for Couples method in order to free a couple up to make an “attachment nest” out of his over-sized couch.  Techniques like this may challenge the clinical boundaries for some of us, but Mars’s confidence and passion implicitly invite us to suspend reactivity or pre-existing assumptions and join him in an innovative exploration of what heals and how the healing happens.

From the get-go, Mars orients the couple towards each other, rather than the therapist, and actively directs the process away from complaints and demands and toward the expression of desires for connection that are the inevitable impetus, whether conscious or not, of a couple seeking therapeutic help with their relationship.  He informs us that the heart of the matter in every AEDP for Couples session is the actual heart; the therapist organizes the theme of each session around helping couples to speak from their hearts—their embodied selves—about what each yearns to give to and receive from the other.

In keeping with AEDP’s commitment to facilitating a new and better experience from the get-go and in contrast to aspects of the Structural Model that informs both Greenan’s and Tunnell’s work, Mars’ approach is here-and-now focused in its search for glimmers of transformance that can be noticed and nurtured.  There is no time allotted at the outset of treatment for the therapist, on the one hand, to hear about positive memories that first attracted the couple to each other (cf. Tunnell) nor, on the other hand, to observe the couple in their more compromised, unimpeded state as way of understanding their system before intervening (cf. Greenan).  Rather, in keeping with AEDP for individuals, Mars focuses on uncovering and amplifying what is happening well right here and right now.  Along the way, Mars gently but firmly sets expectations for a couple to relate with respect, personal responsibility and compassion by tracking and making explicit any and all responses that might usually fly under the radar and subtly undermine a couple’s positive connection.  Given our wired-in, evolutionary predisposition to privilege negative experiences as a means of survival, Mars is on careful lookout for dangerous intrusions that might tip a couple into harmful interpersonal territory.  He writes: “A distinctive feature of AEDP for Couples is to take a ‘nip it in the bud’ position and to skillfully, gently and kindly confront and redirect laughing about what hurts and are passive aggressive put-downs, however subtle or overt.  There is no ‘blowing off steam period’ or acceptance that “this is the couple’s cultural norm.”  Mars makes clear that his vigilant approach to ensuring “justice within the relational dynamic” is essential to creating trust and love and that this is serious business for the very reason that it is so easy for us to default into more self-protective, subtly distancing modes of interaction.

Similar to the models that Tunnell and Greenan have developed, AEDP for Couples privileges the importance of creating safety in the dyad before moving explicitly into working to repair earlier trauma that now contributes to problems in the relationship.  Whereas Tunnell utilizes therapist affirmation and retelling of a couple’s early love story of attraction and Greenan’s focus is initially on explicitly teaching mindfulness and communication skills building, Mars takes an as-needed, relational approach toward affect regulation that emphasizes somatic awareness of internal triggers and, when necessary, actively directs dysregulated affect toward the therapist and a away from the partner in order to preserve the safety of the couple dyad.  He also introduces us to his construct of the Seven Channels of Experience, a methodology for recognizing and organizing somatosensory experience that can help both therapist and patient alike to track their internal processes and those of others.  Taken together, the techniques employed by these three different approaches to couple work provide an exciting and bountiful clinical menu for State 1 work with anxiety and defenses in the service of encouraging deeper connection to emotional and relational authenticity and unleashing transformance strivings.

While Tunnell and Greenan also emphasize the effectiveness of portrayals in couple work, Mars asserts that intra-relational portrayals of reunion, rescue and anger between the Self of one partner of the couple and his or her younger, traumatized part that take place with the other partner present as an active participant or supportive witness are at the very center of healing in AEDP for Couples.  By using portrayals and active witnessing to address trauma, adaptive strivings toward both behavioral actions and emotional receptivity come on line in powerful ways that lead to healing experiences of gratitude, relief, love and shared joy.

At this point, I’m going to limit my introductory comments so you can proceed to the exciting primary source material waiting for you in the pages that follow.  However, I would be remiss if I didn’t draw your attention to one more especially innovative feature of AEDP for Couples.  In a radical, provocative (in the best sense) move unlike any that I am aware of in other models of therapy, AEDP for Couples introduces a new level of healing and transformation in its approach to helping couples by extending the AEDP concept of metaprocessing beyond the therapeutic space and into the larger professional community.  Called a Community Healing workshop, this technique involves the gathering of a large group of therapists who are learning AEDP for Couples.  Together, they bear witness to pre-selected, videotaped moments of transformation from a couple’s treatment process–and here’s the provocative part: this takes place while that couple is present on stage at the event.  Wow! In a carefully structured, circumscribed format that emphasizes safety for the couple and personal responsibility from the therapist-participants, audience members are invited to share their embodied, bottom-up responses to what they are watching.  Mars reports that the couple who serve as the case example for his article described the Community Healing event to be the high point of their work in therapy.  He writes that the process results in a “remarkably stable integration through the couple’s metaprocessing of the outcomes of their treatment session by session with me and the audience.”  On the heels of this event and enduring through one year follow up, this couple who began their treatment in a hollow state of aloneness and distress now report feeling “light, connected, calm, peaceful and confident” both intrapsychically and in their relationship with each other.  Once partners in a constricted and hopeless dance of insecure attachment, they now see themselves on an adventure together with their marriage as a secure base from which to explore what lies ahead.

Circling back to Greenan’s question about the potential for witnessing to potentiate vicarious healing, Mars’ AEDP for Couples model clearly answers Greenan with a resounding “Yes!” and then, by introducing the Community Healing technique, extends that answer beyond the consulting room and into a much larger communal experience of intentional witnessing and healing for both couple and workshop participants.  In so doing, Mars opens the door to further exploration of the application of AEDP to groups both as healing forces for community and as containers for individual healing in a group context.  Perhaps this heralds the potential for yet another wave of growth and development in AEDP as we consider thinking creatively about how to extend AEDP-informed transformational processes beyond the privacy of dyadic and triadic events and into the world at large.  But that project is for another time and perhaps another issue of Transformance.  For now, I invite you to settle in, get comfortable, and prepare yourself for a rich immersion in three important, AEDP-informed approaches to working with couples.