Triangles of Emotional Pain: A Conceptual Model for AEDP1

By Neta Ofer and Hans Welling

Download the PDF here

Abstract: The authors present a theoretical integrative model of Triangles of Emotional Pain for the categorization and transformation of emotional pain in experiential psychotherapies. We propose two major conceptual innovations to existing views on emotional pain. The first is distinguishing three types of emotional pain that are not only different in origin but also require distinctly different interventions to undo their emotional learning. Our second conceptual innovation is distinguishing the originating experience of emotional pain from the problematic emotional learning that can result from these experiences. Integrating data from research literature and clinical work, the model distinguishes between three types of emotional pain differentiated by three different functional systems through which pain is registered and processed: core emotional pain, relational pain, and self-pain. The authors show how each type of emotional pain has a distinct developmental etiology and evolutionary function, and how each type requires a fundamentally different transformational process to be healed. Though patients experience all three types of pain in their life, usually one particular pain is dominant in a session. The model provides markers for identifying the active pain in the session, directing the therapist to one of three transformational paths. It thus provides a focus for the work but also leaves plenty of room for intuitive moment-to- moment tracking of emerging experience. The Triangles of Emotional Pain can thus be not only an important conceptual model for working within AEDP but also a useful tool for systematically selecting and integrating interventions and techniques from a variety of experiential models.

---

1 This extended version of our article, Pain Dynamics: An Integrative Roadmap for Navigating Through the Experiential Process, was originally published in Person-Centered & Experiential Psychotherapies (2022, Vol. 22, Issue 3, pp. 322–347). We thank the publisher for granting permission to reproduce portions of this article for publication in Transformance: The AEDP Journal. Substantial parts are identical to the previously published article, other parts were rewritten using AEDP’s triangle of experience

---

Hans Welling, Ph.D. is a psychologist, supervisor, and trainer, in Lisbon, Portugal. He is a certified
AEDP therapist. Address correspondence to: hanswelling@yahoo.com.
Netta Ofer, MA is an Educational Psychologist in private practice in Tel Aviv, Israel. She is a certified
AEDP therapist and supervisor. Address correspondence to: noferziv@gmail.com

Introduction

From its inception, AEDP has emphasized a bottom-up approach and moment-to- moment tracking as hallmarks of its clinical work (Fosha 2000, 2021; Prenn

& Fosha, 2016, Hanakawa, 2021). At the same time, AEDP is likely one of the most integrative platforms, drawing from a wide range of theoretical paradigms – including

psychodynamic theory, attachment theory and neuroscience – to understand psycho- emotional functioning and explain transformative change. AEDP has been careful to

maintain the balance between top-down conceptual and a bottom-up experiential approach, ensuring that conceptualization does not interfere with the relational presence and the experiential focus of moment-to-moment of tracking. While the key road maps for AEDP interventions – the 4-State model and the triangle of experience – guide the AEDP therapist in moment-to-moment tracking through State changes, it is undeniable that theoretical concepts adapted from infant research,

affective neuroscience, and psychodynamic theory, are present in our clinical decision- making, even when not explicitly referenced.

In this article, we add to AEDP’s repertoire of experiential focus by proposing a new

conceptual framework identifying 3 types of emotional pain – core emotional pain, self- pain and relational pain -, which can further help AEDP therapists with clinical

decision-making by delineating three transformational paths. It is a conceptualization that avoids “case conceptualization,” relying instead on identifying what type of pain is active and present in a specific moment or session, helping to clarify transformational processes in the realm of core emotion, relational work, and issues related to the self. We believe it informs and guides the therapist toward the new experiences that will be most transformative, while preserving the precious moment-to-moment emergent experience. We initially developed this model of the “Three Triangles of Pain” to choose between different setups for portrayals (e.g., self-event, self-self, self-other, etc.), but later we found it to be extremely useful for supervision in general. The feedback from supervisees was that it provided guidance for their clinical work, which they felt had been missing. In this article, we will argue that psychological pain can be divided into three distinct categories that differ in origin, evolutionary function, and complexity of learning and, therefore, require distinctly different psychotherapeutic interventions to undo their emotional learning. We have tried to create a new integrative framework that brings together theories on emotion (Greenberg, 1993; Panksepp, 2009; Timulak, 2015), attachment (Bowlby,

Ofer, N., Welling, H. Triangles of Emotional Pain

Transformance: The AEDP Journal Monograph Series Issue Two ©AEDP Institute 2025 3

1973; Ainsworth, 1991; Mikulincer et al., 2003), psychodynamics (Freud, 1900; Malan, 1979; Fosha, 2000), emotional development ( A. Freud, 1936; Trevarthen, 2005; Tronick, 2007;), trauma (van der Kolk, 2015; Fisher, 1999), learning, and memory (Watson, 1913; Skinner, 1938; Duday, 2004). Unfortunately, very few of these theories have solid scientific proof. As a result, the validity of the theories in our field is determined by the accuracy with which they describe and predict phenomena, which is a somewhat subjective notion. To test our understanding of these things, we will break these concepts down to their simplest units. Furthermore, we will try to stay as close as possible to the phenomena we want to describe and explain, using a step-by-step approach with many examples. In this method, we follow Richard Feynman’s reasoning, who argued that if one can’t explain something complex in simple terms, they don’t really understand it (Gleick, 1992). This is a very long article, as we will discuss the implications for many aspects of clinical work in AEDP. The reader might also want to consult a short 5-page version in Addendum A, which might be used both as an introduction before in-depth reading about the model, as well as a cheat sheet when starting to work with the model Part I Two Conceptual Innovations We are proposing two major conceptual innovations to existing views on emotional pain. 1. We propose that emotional pain can be divided into three distinct categories – core emotional pain, self-pain and relational pain. These categories of pain differ in origin, evolutionary function, and complexity of learning, and, therefore, require distinctly different psychotherapeutic interventions. Each of the three types of pain we introduce in this article has been described numerous times by different theorists and therapists and is also amply present in AEDP in fully integrated form. In that sense, we are not introducing anything new but rather suggesting an integrative framework that makes the implicit explicit! Distinguishing among these types of pain is necessary, as therapeutic change requires three distinct therapeutic processes for each type of pain. Identifying the patient’s active pain in the session can help with mapping the entire transformational path, such as: what kind of painful experience needs to be activated, what techniques and resources are most appropriate, what defenses and challenges to expect, and how to structure the work to promote finding new experiences at the right level. 2. Our second conceptual innovation applies of memory reconsolidation theory of change to our conceptualization of types of emotional pain, distinguishing the originating experience of emotional pain from the problematic emotional learning that can result from such experiences (Ecker, 2012; Welling, 2012). This allows us to define

Ofer, N., Welling, H. Triangles of Emotional Pain

Transformance: The AEDP Journal Monograph Series Issue Two ©AEDP Institute 2025 4

more precisely the core emotion, inhibitory affects and defenses in the triangle of experience. This distinction, which is often not made explicit, is essential because psychotherapy should be equipped to change the memory of emotional pain and to undo the defenses against such remembering. 1. Three Types of Emotional Pain2 Our conceptualization of emotional pain is distinct in several ways from existing models of emotional pain, which classify pain according to types of causal events or types of resulting emotions. For example, Timulak’s (2015) model classifies pain according to three classes of maladaptive emotions: fear/terror, loneliness/sadness, and shame. Other models classify pain according to events such as loss, entrapment, or violence (e.g., Levine, 1997; Herman, 1997). Though we will speak about (typical) events and emotions in each pain, these are not the foundation on which the categories are based. The essence of the model is that it conceptualizes three different functional systems through which pain is registered and processed. Therefore, in our model, various emotions like fear, sadness, and shame or various events like loss, loneliness, or abandonment can play a role in all three types of pain systems. From our clinical experience, we have found that there are three kinds of emotional pain that have fundamentally different characteristics and origins. Core emotional pain3 is the feeling of being overwhelmed or stuck as a result of unbearably intense emotion that occurs when the demands of the situation outweigh the resources of the individual (too much, too early, too alone), and the inherent adaptive action tendencies (e.g., fight, flight) are ineffective. When emotions (e.g., fear, anger, sadness) are too intense, the individual experiences fear of (emotional and/or physical) disintegration, and the emotions cannot be processed to completion. As there is no resolution, the process immobilizes halfway and gets painfully stuck in the body (Van der Kolk, 2015; Fisher,1999; Medley, B. 2021). Relational pain is the feeling of disconnection and inhibition that originates from experiencing ruptures in the attachment relationship with our caregivers. When the expression of emotional needs (e.g., presence, care, love) repeatedly leads to a negative response from the caregiver (e.g., neglect, rejection), this will lead to the fear of abandonment or disconnection (Ainsworth, 1991; Bowlby, 1973; Frederick, 2021). This results in additional pain from repressed expression and unfulfilled needs. Self-pain is the feeling of worthlessness and not belonging, which originates from repeated experiences of attacks on aspects of the self by important others or experiences of humiliation and exclusion by peers or society. When the expression of certain aspects of one’s individuality (e.g., traits, character) repeatedly leads to a negative reaction (e.g., 2 It may be warranted to distinguish a separate 4th category of spiritual pain around existential issues such as meaning and death, but this idea is still in development. 3 Some readers found “basic emotional pain” or “situational pain” a better designation.

Ofer, N., Welling, H. Triangles of Emotional Pain

Transformance: The AEDP Journal Monograph Series Issue Two ©AEDP Institute 2025 5

criticism, humiliation, discrimination) from members of the family, peer group, or society in general, this will lead to a fear of unworthiness and losing one’s role, place, or status in the social group/family. This results in additional pain from hiding one’s true nature and living in a false “improved” self (Kaufman, 1996; Piliero, 2021; Winnicott, 1965). The Evolutionary Function of Emotional Pain From an evolutionary perspective, these emotional categories of pain are plausible, as they are rooted in three distinct affective systems, each safeguarding a particular domain that is crucial to our survival. The first domain is the relationship of the individual with its natural environment. Categorical emotions (e.g., fear, anger, joy) ensure the needs and well-being of the individual in relation to the natural environment through their inherent action tendency, which motivates adaptive action. When there is intense emotional activation because our physical well-being is under threat, it results in a fear of disintegration or annihilation. This innate response corresponds to Panksepp’s fear system (Panksepp, 2009). The second domain is the attachment relationship with caregivers, which is especially important in early childhood, as children depend on caregivers to get their basic physical and emotional needs met. Later in life, a similar need for attachment arises toward significant others, such as one’s life partner. When there is disconnection or when our attachment relationship is under threat, it results in the fear of abandonment or separation. This innate response corresponds to Panksepp’s panic-grief system (Panksepp, 2009). The third domain is the relationship between the individual and their larger social group (e.g., peers, society). This becomes increasingly important as one grows older, as survival without the resources of the larger group is almost impossible. When we don’t have a place in the group or our place is threatened, this results in the fear of unworthiness and losing one’s role, place, or status in the social group. This innate response corresponds to the shame system (Sznycer et al., 2016). In reality, these three systems are not as separate as the above sections may suggest. The attachment system is a supplemental system that supports the survival needs of the categorical emotion system. A good attachment relationship can provide regulation when dealing with core emotional pain. Furthermore, events often cause more than one kind of pain. For instance, cases of extreme relational pain (e.g., abuse) can also cause core emotional pain and self-pain. In real-life events, these three systems never function independently but interact constantly, so that in any given moment, they are all participating in creating the emotional experience, pleasurable or painful. Three paradigms of psychotherapy corresponding to three types of emotional pain

Ofer, N., Welling, H. Triangles of Emotional Pain

Transformance: The AEDP Journal Monograph Series Issue Two ©AEDP Institute 2025 6

Adding validity to this categorization of emotional pain is the fact that they can be easily identified in many existing models of psychotherapy. In fact, it may be warranted to view them as three different paradigms because of their use of distinct theoretical metaphors, therapeutic focus, and methods (compare Kuhn, 1962). Core emotional pain is at the heart of the Paradigm of Trauma (e.g., Herman, 1997; Levine, 1997; van der Kolk, 2015). The notion of trauma centers around intense emotional events that are seen as too big to process by the organism and become stored in the body as traumatic memories. Certain circumstances can function as triggers that cause these memories to be relived in an overwhelming fashion, “hijacking” mental functions. Therapies center around retrieving, reprocessing, metabolizing, and liberating the body of such traumatic memories. This trauma paradigm has greatly influenced therapies such as EMDR (Shapiro, 2001), Somatic Experiencing (Levine, 1997), Internal Family Systems (Schwartz, 1995), AEDP (Fosha, 2000, 2021), Sensorimotor Psychotherapy (Ogden & Fisher, 2016), and others. Relational pain is at the heart of the Paradigm of Conflict (e.g., Freud, 1926; Bowlby, 1969; Safran, 2012). The central notions of this paradigm are the needs for protection, care, and love from attachment figures that can lead to ruptures in the connection with the caregiver. When these needs, wishes, and impulses are unacceptable or cause anxiety in the caregiver, they need to be repressed in order to safeguard the attachment relationship, causing an internal conflict. Psychological suffering is caused by repeating these modes of interaction and unexpressed emotion. Therapy centers around corrective experiences to change these internal dynamics and relational patterns. This paradigm of conflict has greatly influenced therapies such as Intensive Short Term Dynamic Psychotherapy (Davanloo, 1990), Emotion Focused Therapy (Greenberg, 1993), AEDP (Fosha, 2000, 2021), and Schema Therapy (Young et al., 2003), Relational Psychodynamic Therapies (Safran, 2012). Self-pain is at the heart of the Paradigm of Identity (e.g., Adler, 1927; Rogers, 1959; Kohut, 1971; Beck, 2011). The notion of identity centers around the tension and compromise between the expression of one’s inborn nature and characteristics of the self and what is valued in the social context in which one lives. Psychological suffering is caused by the negative self-concept, hiding aspects of the self, and the self-deception that is needed to maintain a valued role and meaning in the social environment. Therapy centers around changing the self-concept and finding a new adaptive narrative and meaning, which is more in accordance with one’s true nature and a valued role in the world. This paradigm of identity was influential for therapies such as Existential Therapies (Frankl, 1945), Narrative Therapies (Neimeyer & Mahoney, 1995; Bruner, 2004), EFT Couples Therapy (Goldman & Greenberg, 2013), Schema Therapy (Young et al., 2003), and AEDP (Fosha, 2013).

Ofer, N., Welling, H. Triangles of Emotional Pain

Transformance: The AEDP Journal Monograph Series Issue Two ©AEDP Institute 2025 7

These three paradigms exist in a totally integrated form in AEDP as is most evident in the triangle of experience (Fosha, 2000; Pando-Mars, 2021) that considers the full palette of human experience.

As will become clear in the discussion about the triangles of pain, our proposal for conceptualization implies dividing AEDPs triangle of experience, into 3 separate triangles: identifying specific core affective experiences, inhibitory affects and defenses, and, most importantly, transformational paths for each pain. But before we engage in this discussion we first will examine the nature of the emotional learning that can result from experiencing emotional pain. 2. Conceptualizing Learned Emotional Pain A second important aspect of our model is that we distinguish between experiencing emotional pain, which is not necessarily problematic, from the problematic emotional learning that can result from (repeated) experiences of emotional pain. The experience of emotional pain, under certain conditions, is stored in emotional or ‘implicit’ memory (Ecker 2012). It is not entirely understood under what conditions an event will be remembered as emotional learning, but it is certainly more likely to happen when emotions are more intense and/or occur repeatedly. When natural responses to pain are ineffective, emotional learning is naturally catalyzed (Tulving, 1983) by the inherent higher levels of pain. The learned emotional response triggered by similar circumstances involves reliving aspects of the emotional pain, inhibitory affects, and defenses, and is adaptive as it prevents further emotional pain.

Ofer, N., Welling, H. Triangles of Emotional Pain

Transformance: The AEDP Journal Monograph Series Issue Two ©AEDP Institute 2025 8

As we grow older, however, and circumstances change, emotional learning that once protected us from emotional pain can become the source of unnecessary suffering, e.g. redundant defenses and painful inhibitory and maladaptive affects. We continue to suffer from events that are long gone and are a part of our history but no longer relevant today. Re-living such pain can cause emotional suffering well into adulthood, even when there haven’t been negative outcomes for many years. When the explicit memory of the concrete events associated with emotional learning is inaccessible, strong emotional reactions4 like anger, fear, or hopelessness are often puzzling to the patient and are felt to be exaggerated or out of proportion. In other cases, the patient is so accustomed to them that they see them as an inherently inevitable part of life. Schematically, we can represent emotional learning as follows:

In the left triangle, we can see the situation where the natural sequence of the action tendency following the emotional pain from an unfavorable event is compromised: no resolution is found as adaptive attempts fail. When the intensity of the emotional pain and fear rises, an emotional memory will be formed, represented in the triangle on the right. At the bottom of the triangle of remembered pain, we find the implicit learning that resulted from the experience of emotional pain. The perception of implicit internal or external elements (e.g., sound, facial expression, wish) associated with the original painful event now triggers the memory of the emotional pain, causing the individual to

relive aspects of the original painful experience (e.g., the innate fear, the pain from non- resolution or repression). In the right top corner are the inhibitory affects (e.g., anxiety

or shame) that motivate the individual to distance themselves from this rising pain 4 Greenberg (1993) referred to these as “problematic” reactions.

Ofer, N., Welling, H. Triangles of Emotional Pain

Transformance: The AEDP Journal Monograph Series Issue Two ©AEDP Institute 2025 9

through defensive responses (left top corner) such as distancing themselves physically or diminishing inner awareness of the pain. The most important difference between felt pain and remembered pain is that with remembered pain, there is a system that feels anxiety about feeling this pain (inhibitory affect) and a system that defends against the pain (defenses). Thus, the reaction to remembered pain is much more complex, as it not only involves remembering all the aspects of the old pain but also a system that works against experiencing emotional pain again, creating additional, more complex suffering. Emotional pain in and of itself is not a problem; it is an important mechanism to motivate the individual to take corrective action and protect oneself from unfavorable circumstances. It is the repeated remembering of emotional pain, the inhibitory affects, and the defenses against reliving emotional pain that cause problematic suffering and bring people to psychotherapy. If emotional pain weren’t remembered, there might be no need for psychotherapy at all. The maladaptive self-generated emotional pain that results from emotional learning is at the heart of what we try to change in psychotherapy. As Panksepp states, “Reconsolidation of affective-cognitive memories needs to be the prime concern of psychotherapy” (Panksepp, 2009, p. 26). Transforming emotional pain Because in psychotherapy we want to change remembered emotional learning we need to use techniques that are appropriate for changing memories. Our conceptual model, based on learning, remembering, and transforming emotional pain, fits very well with memory reconsolidation theory, which has been proposed as a crucial underlying mechanism of change in psychotherapy (Welling, 2012; Lane et al., 2015). In memory reconsolidation, the triggering of painful memories can be unlearned by a sequence of (1) re-activation of painful emotional memories, followed by (2) finding a new contrasting experience, which is then (3) experienced repeatedly alongside the old experience (Ecker, 2012). This new neutral or positive emotional experience will change the emotional loading of the memory and thus undo the emotional learning when the memory is restored (reconsolidated) in an updated form. This will uncouple the association of certain events, emotions, needs, or traits with painful affects and may even associate them with new positive affective states. In psychotherapy, after the memory of emotional pain is re-activated, the new contrasting experience can be a real one, such as a real-life experience with an important other (Ecker et al., 2012), or in the session with the therapist (Fosha, 2000; Levenson et al., 2020), or an imaginary one, such as chair work (Greenberg et al., 1993), or portrayals (Fosha, 2000; Medley, 2021). As might be expected from the fact that each type of emotional pain originates from very different experiences, we found that each of the three types of emotional pain also requires different kinds of corrective experiences to effectively reconsolidate such

Ofer, N., Welling, H. Triangles of Emotional Pain

Transformance: The AEDP Journal Monograph Series Issue Two ©AEDP Institute 2025 10

memory. In cases of core emotional pain, the painful experience of unbearably intense emotion is transformed by a new experience of regulated emotion, which involves undoing aloneness and increasing resources, thereby allowing emotions and action tendencies to be processed to completion. For example, in cases of relational pain, the painful experience of unmet needs and disconnection is transformed by a new relational experience through relational safety and validation of needs, allowing for reconnection, regained expression, and reception of emotional needs. In cases of self-pain, the painful experience of exclusion and defectiveness is transformed by a new experience of self through undoing shame, compassion, and reassessment, allowing for integration of parts that were disowned as unworthy. The fact that each kind of pain transforms differently and therefore requires a different therapeutic approach is probably the most important clinical implication of this model, as it provides a map for clinical interventions and a guide for treatment selection from the different paradigms for each type of pain. With this basic understanding of pain, memory, and transformation in place, we will now discuss each of these three pains and their transformation in greater detail. Part II. Applications 1. Core emotional pain 1.1 Pain from Unbearably Intense Emotion: Fear of Disintegration The system of categorical emotions generates mental states that are crucial for the survival of the individual in response to the environment. Emotions provide very fast and clear perceptions of the meaning of events around us, signaling what is best for our development and survival. For example, feeling fear signals important information that something is dangerous, sadness that something is being lost, anger that something is blocking our goal or intruding on our space, and joy that something favorable is happening. At the same time, each categorical emotion has an associated action tendency that enables us to respond adaptively to changes in the environment. They motivate us toward adaptive actions such as fight, flight, withdrawal, or approach. There are around six basic emotions (Ekman, 1984) with universal body and facial expressions. Only two of them are experienced as pleasant: joy and surprise. These “positive” emotions motivate us to approach or be curious and energize us to explore and relate. The other four—fear, anger, sadness, and disgust—are experienced as unpleasant5 . These “negative” emotions motivate the individual toward withdrawal and distancing. Fear tells us to run away, anger helps us fight and defend what is ours or what we want,

5 The pleasantness or unpleasantness of an emotion is often referred to as the valence of the emotion (Russel, 1980)

Ofer, N., Welling, H. Triangles of Emotional Pain

Transformance: The AEDP Journal Monograph Series Issue Two ©AEDP Institute 2025 11

sadness makes us mourn and search for comfort, and disgust motivates us to expel what is bad or toxic for us. The activation of negative emotions is experienced as emotional pain. Just as in physical pain, emotional pain warns us that there is a survival threat, making us ready for adaptive action. However, adaptive action may not be possible or effective. In such situations, emotional intensity may rise to intolerable levels and become dysregulated. A typical example is the helpless protest to an irretrievable loss6 or the experience of terror when one is trapped and cannot run in response to fear. In such cases, there will be no relief in expression of emotion and its adaptive action. The intensity of emotion will quickly rise and become dysregulated. The younger we are, the less able we are to tolerate emotion by ourselves, and even relatively low levels of emotion may activate distress and fear. This is because the demands of the situation exceed the resources of the child. This is what is called “too much, too soon” (House, 2011). From the relational AEDP perspective, we want to add to this “too alone” (Fosha, 2000, 2013; Lamagna, 2021). Events such as being alone in a hospital, physical pain, watching one’s parents fight, experiencing physical violence and sexual abuse are events that can easily become “too much.” A major means for regulating these states of intense emotion and getting back into tolerable levels of distress, in both children and adults, is through the presence of significant others. As Fosha put it, “Without relational support intense affects can become toxic instead of promoting optimal functioning and well-being” (2000, p. 5). Emotions are felt and experienced as waves of feelings and sensations, starting low, intensifying, and then calming down again when the process comes to completion. This natural sequence is a basic psychophysical quality of emotion. Instinctively, the presence of others will enhance the sense of safety and will bring the anxiety down to tolerable levels. The parent holding the child physically and soothing them by talking calmly will usually quickly bring down the level of distress. For example, when a child

feels intense sadness over the loss of a favorite toy, emotion is released by crying (self- regulation), and she will calm down as she is consoled (other-regulation). The repeated

soothing from the parent is required to learn the capacity for self-soothing and a sense of safety in the world. The soothing or holding by others or oneself is what enables someone to experience the wave of emotion until it naturally calms down. Children are very dependent on their immediate perception and do not have the cognitive capacities for understanding the changes in the environment that adults have 6 The fact that grieving loss and separation of an attachment figure is a process of core emotional pain rather than a relational pain may be confusing at first, especially as separation and loss are the titles of the seminal books on attachment by Bowlby (Bowlby, 1973, 1980). The loss (e.g., death) of the attachment figure is not a failure or conflict that results from within the attachment relationship (only feeling anger at the parent for dying might come up as relational pain in the context of such an event). (Emotional) abandonment or rejection happen within the attachment relationship and therefore lead to relational pain.

Ofer, N., Welling, H. Triangles of Emotional Pain

Transformance: The AEDP Journal Monograph Series Issue Two ©AEDP Institute 2025 12

at their disposal. Only with maturation will the child gain the basic capacities to understand that a mother is near even though he can’t see her (object constancy), develop a notion of time, an ability to see ahead and imagine a good outcome, or understand why certain things are happening, thus changing the meaning of the threat or of their pain. More sophisticated resources include understanding the inner world of others and their reasons for action (mentalization) or finding a creative solution to deal with the situation. As the child grows, he becomes less vulnerable, but even adults can experience overwhelming emotional pain from extreme events like car accidents, violence, or situations of war. When events exceed the child’s capacity for coping, despite the parents’ best efforts to help and regulate, he is outside his “window of tolerance” (Siegel, 2012) and will experience a fear of disintegration7 (terror). This is a signal from the body that the amount of emotional activation has become dangerous for the system. Emotions can no longer be held in awareness, expression is interrupted, movements stop and are held in muscle tension. Now the emotion cannot be processed to completion (Fosha, 2005), and this leads to a very painful state of being stuck halfway in a process without resolution8 . In summary, core emotional pain is made up of the experience of unbearably intense emotion, fear of disintegration, feeling stuck in unresolved action/emotion, and dissociating from one’s experience. Especially high levels of core emotional pain and repeated events will be stored in implicit memory. 1.2 Learned core emotional pain The way events can lead to core emotional pain and how such pain is remembered is schematically represented in the following diagram.

7 Compare annihilation anxiety (Freud, 1926). 8 Napier (2019) refers to this as unmetabolized emotion gets stuck in the body.

Ofer, N., Welling, H. Triangles of Emotional Pain

Transformance: The AEDP Journal Monograph Series Issue Two ©AEDP Institute 2025 13

When emotional learning occurs, the circumstantial and situational elements present at the time of the painful event are connected in an idiosyncratic way to the painful memory. These elements may include, for instance, smells, objects, noises, an angry face, physical closeness, headaches, tight spaces, or playgrounds. A present-day encounter of such associated elements that were present during the original event can now trigger an emotional memory, causing the person to fall back into a state of painful affect 9 (e.g., terror, intense emotion). In extreme cases, they may result in a full flashback, where not only the emotional dimension is re-experienced but also the physical sensations (e.g., pain), perceptions (e.g., noises and images), and mental state (e.g., confusion, dissociation). In many cases, full reactivation may not occur, as anxiety motivates the person to distance oneself from triggering elements to avoid re-experiencing the emotional pain. As a result, we often only experience anxiety over triggering stimuli and not the underlying painful affect. Again, this is an automatic process, and in most cases, the individual is not aware of exactly which cues in the situation triggered the negative affect or anxiety. Anxiety is an inhibitory affect that signals we are approaching dangerous (painful) memories and triggers detaching defenses10. Such a defense may involve distancing 9 Janina Fisher (1999) refers to this as feeling flashbacks or intrusive affects that represent feeling memories. 10 The 3 categories of defenses we named detaching (in Core emotional pain), countering (in Relational pain), and displacing (in self-pain), are inspired by ISTDP’s categories of isolation of affect, repression and projection (Davanloo, 1990). In our attempt to use simpler language, we chose

Ofer, N., Welling, H. Triangles of Emotional Pain

Transformance: The AEDP Journal Monograph Series Issue Two ©AEDP Institute 2025 14

oneself from external stimuli for example by avoiding certain interactions or situations that may contain triggering elements. This avoidance may begin to spread to more areas of a person’s life. For example, a memory of dread from visiting a dying parent in the hospital can cause anxiety over elements such as illness or death, which in turn may lead to avoiding places and experiences that could cause a reactivation of the anxiety (e.g., hospitals, funerals, going to the doctor), eventually leading to extremely limiting symptoms. Mary, when she was six, visited her dying mother in the hospital, feeling the terrible pain of her loss. The learning from this pain makes her avoid remembering this terrible event and associated places and experiences that make her anxious (e.g., hospitals, going to the doctor). A person may also begin avoiding internal experiences, such as bodily sensations and emotional states, by detaching oneself (dissociation) from the awareness of unbearable emotional and physical experiences. It is also possible that the person ends up habitually detaching internally from all feelings, living in a state of numbness and disconnection from their inner experience. Patients can therefore experience their core emotional pain in very different ways: -A clear traumatic event that the patient can’t “put aside”: “Whenever I drive my car, I start imagining how every car coming toward me is going to crash into me, just like what happened in the accident in which my husband died. ” (reliving old pain in intrusive memories) -Pain that they are afraid to touch since, fearing it will never end or will make them feel too miserable: “Just thinking about this little girl I was, alone in the hospital, makes me feel so bad. There is no way I’m going to agree to go there, it will make me feel too miserable.” (experiencing anxiety in response to triggering stimuli) – Emotional numbness around an event that they understand must have had an emotional impact on them:

the more insightful terms of detaching, countering, and displacing defenses. These categories are similar but completely equivalent: for instance, we distinguish mild self-criticism as a defense in triangle two to counter unacceptable feelings, from a more severe self-attack in triangle three resulting from a self-concept of defectiveness. Defenses can be further divided into external and internal defenses. Internal defenses have an effect in the outside world e.g. avoidance, suppressing expression. Internal defenses diminish inner awareness e.g. repression or splitting. McCullough (1997) described three categories of defensive functions: avoiding affect, avoiding closeness and false/impaired self, that are congruent with the defensive function of our three categories.

Ofer, N., Welling, H. Triangles of Emotional Pain

Transformance: The AEDP Journal Monograph Series Issue Two ©AEDP Institute 2025 15

“I feel so bad that I just have no emotion around the death of my sister. Does this make sense? Am I a robot or what?” (suffering from defenses) In summary, the suffering caused by the memory of core emotional pain consists of reliving the old pain, feeling anxiety, and experiencing the consequences of defenses, such as the limiting of one’s activities by avoiding certain situations and being habitually disconnected from inner experiences. 1.3 Transforming core emotional pain Therapy addressing core emotional pain focuses on working with the bodily experience of painful, overwhelming emotional experiences from the past and present, undoing defenses such as dissociation, numbing, and avoidance in order to reach a new adaptive experience on a bodily-emotional level that can be reconsolidated into emotional memory. The transformation of pain in this paradigm is achieved by regulating the dysregulated emotional experience, allowing emotions to be processed to completion (Fosha, 2000) and changed into new adaptive emotions (Greenberg, 2010). Since the overwhelming experience arises when it is experienced as “too much, too early, and too alone,”