Transformance Journal: Volume 11 Issue 1, The16-session AEDP Issue

Editor’s Letter by Gil Tunnell, PhD

This special issue of Transformance Journal on 16-session AEDP has two excellent introductions by Diana Fosha and Shigeru Iwakabe and needs no further introduction here. Instead, I use this space first to announce that Carrie Ruggieri, our Associate Editor, will now become Editor of Transformance Journal (I will become her Consulting Editor), and second, to reflect on my experiences as Editor for the last eight years.

Carrie has been co-editor for several years already and has contributed greatly to the Journal by designing a new masthead, her careful editing on previous issues, and interviewing authors on Transformance Talks. For this issue, she became a devoted hands-on editor by taking on more than her share of the workload. She has been a joy to work with, and I leave knowing the Journal is in very capable hands.

Shigeru Iwakabe, PhD and Diana Fosha, PhD

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This special issue of Transformance Journal marks a flourishing state that AEDP (Fosha, 2022) and AEDP Practioner Research Program (PRN) research have achieved. The five articles are the result of the crystallization of research-practice integration. We believe this special issue will contribute not only to the development of AEDP research and practice but also to psychotherapy research more widely as a prime example of a mixed methods study that combines the rigour of outcome studies and the clinical depth and richness of case studies (Fishman et al., 2017). This introduction will present a brief overview of AEDP PRN Research.

History and purpose of the AEDP Practioner-Research Network Study

AEDP Practitioner-Research Network Study was launched in 2016. In the era of evidence-based practice, it was an imperative that we demonstrate the effectiveness of AEDP in an empirically rigorous and systematic way. However, this was not our primary or solo goal. Our research project aims to build the research infrastructure within the AEDP Community and seamlessly integrate it into the practice of AEDP so that the research eventually becomes part of AEDP’s everyday practice. We also aim to develop research methods that can minutely describe the emergent change phenomena in AEDP so that we can identify more specifically principles of AEDP’s change process and therapists’ innovative and masterful moment-to-moment interventions that have not fully been articulated or delineated in the formal theory of AEDP (Fosha, 2000, 2021). We know through observing numerous hours of videorecorded sessions that AEDP can help patients have moments of unparalleled transformation. Such moments of profound transformation deserve not only to be appreciated by clinicians’ discerning eyes but to be examined fastidiously so that their underlying mechanisms are better understood and their principles teased out. Empirical research provides AEDP practitioners with firm objective support for their effectiveness, as well as communicates to the larger psychotherapy community the important contributions of AEDP.

Diana Fosha, PhD

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In a present characterized by an excess of openings and dissolving boundaries, we are losing the capacity for closure, and this means that life is becoming a purely additive process. Because it rushes from one sensation to the next, even perception is now incapable of closure. … It occurs to me that we can only experience ‘opening’ if we have ‘closure.’ Our hearts can pump blood only if our chambers can both open and close. The silence between sounds is what creates rhythm. From: Byung-Chul Han, (2020): The Disappearance of Rituals Courtesy of Stephanie Woo Dearden in AEDP 9+1 class 2023

In 16-session AEDP,] EVERY moment counts and presents an opportunity to co- create safety, engage an AEDP change process, and metaprocess moments of change for the better, be they big or small. Richard Harrison Therapist, AEDP Research Project

“We let ourselves aim high, and more often than not we achieve, and even exceed, the goals set at the beginning. …. It has been astonishing to witness case after case of unexpected transformations–it blows my mind and my sense of what is possible has also been blown open. Having witnessed this, I bring more authentic trust to each case, regardless of involvement in the research.” Mary Androff Therapist, AEDP Research Project

Introduction

The notion of finiteness in psychodynamic therapy came from necessity. In the 1940s, psychoanalysis was the dominant model in the US, and psychoanalytic therapy typically went on for many years. After WWII, demand for therapy rose exponentially: waiting lists at clinics and outpatient departments became unmanageable. It is in this context that Alexander & French (1946) developed the first model of time-limited or – short-term psychodynamic psychotherapy. Their aim was to preserve the depth of psychoanalytic treatment while curtailing its length. Incidentally, or not so incidentally, this is also the context in which the concept of the corrective emotional experience arose. Accepting the inevitability of repetition compulsion and of the reenactment of pathological patterns in the transference, Alexander & French’s innovation was to embrace the repetition compulsion yet actively work toward facilitating a different ending, i.e., the corrective emotional experience.1 Thus the shortened length of therapy.

Richard L, Harrison, Ph.D.

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Abstract: This paper explores the termination process in 16-session AEDP. The fixed treatment length and predetermined endpoint are regarded as additive and enhancing of the change process. Strategies and interventions to address and process termination are delineated and demonstrated with verbatim clinical exchanges; and potential challenges faced during termination are addressed. Congruent with AEDP’s healing orientation, termination is reframed as completion and launching: Although treatment ends, the change process begun in therapy continues, as does the therapist’s care for the patient. AEDP interventions during termination include: (1) relational strategies to undo aloneness, co-engender safety, and foster connection; (2) affirmation of patient resilience and celebration of personal growth; (3) affirmative work with defenses against loss; (4) dyadic affect regulation of patient’s core affective experience (CAE); (5) experiential, bodily-rooted strategies to process and transform negative emotions; and 6) metatherapeutic processing of ensuing, vitalizing positive emotions and in- session experiences of change-for-the-better, to expand these and promote positive neuroplasticity and flourishing. Therapists aim: (a) to elicit and process emotions related to the completion of treatment; (b) to celebrate patients’ affective achievements; and (c) to convey trust and confidence in an ongoing transformational process, predicted to yield not only diminishment of symptoms and suffering, but also upward spirals of flourishing. In providing patients a new, positive attachment experience of togetherness as therapy ends, termination in 16-session AEDP offers a unique opportunity to disconfirm earlier attachment-based expectations, revise internal working models, and help patients grow in self-confidence as they face, accept, and thrive in the wake of loss.

Stephen McDonnell, LCSW

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Abstract. This article presents a case from the AEDP 16-session research project of a black patient /white therapist dyad. The author discusses the application of AEDP therapeutic principals to the processing of racial trauma with a white therapist; specifically, three imperatives: to co-create a secure attachment from the get-go, the necessity of affirmation and recognition processes to kindle core- self experiences, and the necessity to metaprocess its transformational promise in order to propel identity consolidation, in this case, black identity as man, father, partner and community member. Moreover, the author speculates that ongoing metaprocessing of the patient’s identity strivings, leading to core-self delight, may account for the patient’s relatively frequent immersion in core state.

Theoretical introduction1

“I came in with the expectation that you’re good at what you do, and it doesn’t matter that you are white. It’s cool knowing that you didn’t ignore it, and act like it wasn’t there, like I’m not a white guy, I’m just a therapist, do you know what I’m saying? … You have to talk about the elephant in the room, or the elephant in the room stays an elephant in the room. It was good to make it part of normal conversation, instead of, we don’t talk about it, keep it over there in the corner. It made it more comfortable, less awkward, more realistic.” Edward

Judy Silvan, LCSW

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Abstract: The case of Priscilla is a contribution to the ongoing AEDP 16-session research project on treatment outcome and efficacy. The outcome measures in this case confirm the ongoing research findings that Accelerated Experiential Dynamic Psychotherapy (AEDP) is an effective treatment for post-traumatic stress disorder (PTSD), in both open-ended and in time-limited treatments. One aspect of the AEDP 16-session research is therapists’ requirement to rigorously adhere to AEDP methodology. Fidelity to AEDP with this patient who suffered complex PTSD symptoms demanded systematic and disciplined use of therapist attunement, inter-relational interventions, and dyadic regulation of the patient. This article demonstrates the AEDP healing process resulted in improved functioning in pre, post and in-treatment outcome measures in numerous areas of emotional well-being. Symptoms previously bemoaned as unbearable and associated with reported suicidal feelings are absent by session 16. Our coordinated termination is experienced as a success; deep unending pain transforms into joy and gratitude, with exuberance, as we progress further into the 16 sessions. The healing is ‘inter’ and intra-relational with a felt sense of transformation both within herself and with current family and community, beginning with the establishment of dyadic trust, and ending with a bi-lateral secure attachment for the dyad.

Gil Tunnell, PhD.

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Abstract. Two case studies of gay men from the AEDP 16-session research project are described in which the therapist’s primary AEDP intervention was continually “privileging the True Self.” Privileging the True Self is crucial when working with queer-identified patients who often have constructed a “false self” as they attempt to “pass” and fit into a largely heterosexual world. In initial sessions with each patient, the therapist established a strong affirmational stance by highlighting his inherent strengths and maintained that stance throughout treatment. The primary mechanism of change was the therapist’s relational metaprocessing of that stance, activating the men’s receptive affective capacities to fully absorb his “unequivocal affirmation” of them, providing “an explicit ‘yes’ to the whole self of the client.” Rounds of relational metaprocessing produced the primary “core affective experience,” as contrasted to processing specific negative core affects such as anger or sadness in AEDP State 2. Primitive receptive affective capacity is innate: Human beings are born ready to emotionally attach to their caregivers. When the caregivers’ nurturance is not forthcoming, receptive capacity remains constricted, like a bud that does not bloom. While both treatments were first and foremost relational therapies, they differ in that the second patient had a much less developed receptive capacity when treatment began. Upon taking in the therapist’s affirmation, he began to experience in real life that other people also appreciate his specialness. That external validation led to his exuberantly expressing “joy,” a core affect he had rarely experienced in his life. The author discusses how “joy” may be an underrated positive affect in AEDP clinical work. Both patients made

Gail Woods, LCSW, LMFT

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Abstract: This case study of maternal loss explores the impact of time in 16- session AEDP Research therapy—specifically setting the time frame (“clock- time”) from the beginning and going slowly with affective time (“existential time”). The essential themes explored are:¹ how slowing down affective processing and the experience of time at key change moments facilitates secure attachment and deepens change². how the set time-frame, in the context of AEDP affective processing, mobilizes transformance and ³. how built-in anticipated loss of the therapeutic relationship may make this time-limited attachment therapy particularly sensitive to issues of loss.

Introduction

“The slower you go, the faster you get there.”²

There are moments in AEDP therapy when we step beyond time. These are mutually transformative moments where we’re down deep and slow with our patients. Sometimes moments of silence speak more than words. The dance of shared gaze, gesture and feeling speaks volumes. Time expands and time slows.

This paper will first give a brief overview of some theoretical concepts related to the benefits of slow affective processing and of setting a specific time frame. The case study with verbatim transcripts which follows the overview, is offered as an illustration of how beginnings, middles and endings unfold in one 16-session process.