Accelerated Experiential Dynamic Psychotherapy Research Articles

An accelerated emergence of the self during the coronavirus (COVID-19) pandemic: a hermeneutic phenomenological analysis

ABSTRACT While research within positive psychology has demonstrated the potential for growth and flourishing when facing adversity, experiences of psychological growth during the coronavirus (COVID-19) pandemic have not yet been investigated. A hermeneutic phenomenological approach was used to explore the meaning and experience of personal growth and transformation during the COVID-19 first lockdown phase. Semi-structured interviews, with 49 adults between the ages of 20 and 58 occurred. Five themes emerged across participants: (1) pre-pandemic life as functionally complacent (2) the unexpected loss of coping strategies and familiar rhythms due to lockdown, (3) choice to engage with emotion and discomfort as a means to experience growth, (4) discovering and embracing an authentic sense of self, and (5) integration of the growth through sharing with others. Participants reported that participating in the interview itself was growth-enhancing. The findings of the study are discussed in light of existing AEDP (Accelerated Experiential Dynamic Psychotherapy) theory.

Maximizing Exposure's Benefit: Making it Possible, Bearable and Fruitful

Exposure is hypothesized to be a key active ingredient in several approaches to psychotherapy. Dr. Irada Yunusova (2023) explores this as a common element in both Accelerated Experiential Dynamic Psychotherapy (AEDP) and behavioral exposure therapy. The current commentary elaborates on other important factors that contribute to maximizing the effectiveness of interventions in both these models. These include titrating the level of challenge, memory consolidation, common factors, and neuroplasticity. Dr. Yunusova’s detailed case review is an example of assimilative integration, where one can see her incorporation of a model new to her (AEDP) into her home base of Behavior Therapy, as well as the factors noted above that enhance its effectiveness.

The Case of "Chris" through a Principle-Based and Alliance-Focused Lens

The case of Chris (Yunusova, 2023) details an 8-session Accelerated Experiential-Dynamic Psychotherapy (AEDP) treatment delivered in the context of a university clinic. Chris is a 30-year-old white male who had nearly completed a doctoral program at the time of treatment. He presented to treatment with the goals of addressing loneliness and depressive thought patterns in the context of the expectation that his emotions were overwhelming and noxious to others. The case illustrates the active role that avoidance and exposure can play in AEDP, with emphasis on affective exposure by way of AEDP’s efforts to increase the patient’s tolerance of their own emotions as well as those of others. The following discussion applies the integrative notion of principles of change in psychotherapy to the case of Chris, with an explicit focus on the therapeutic alliance and the emergence of alliance rupture markers in the development of the case.

An Exploration into New Approaches in the Treatment of Mental Health: Understanding and Possible Optimization in the Implementation of Accelerated Experiential Dynamic Psychotherapy (AEDP)

This paper aims to discuss the need for novel forms of therapy beyond traditional treatment programs. Accelerated Experiential Dynamic Psychotherapy, or AEDP, has increased acceptance and maintains a promising long-term outcome for patients compared to standard treatment protocols. This paper will review traditional mental health assessments and treatment types and their limitations. Then, traditional pre-and-post therapy success measures will be described along with their inherent limitations to assess treatment outcomes adequately. This will be the basis for considering AEDP as a promising, neuroscience-backed clinical field. The author will make a case for the pairing of AEDP with new psychotropic treatments recently and soon to be approved for use in the treatment of mental health. Finally, we will consider the use of applied neuroscientific tools for new forms of mental health assessments.

Enhancing working alliance through positive emotional experience: A cross-lag analysis

Although psychotherapy research has traditionally focused on decrease in distress, emotion research suggests the important role of positive emotional experience in healing and growing. Objective: The present study investigates the relationship between positive emotional experiences and working alliance. Method: We chose to investigate this relationship in accelerated experiential dynamic psychotherapy (AEDP), taking advantage of the modality’s focus on both negative and positive emotional experiences. Fifty-eight clients receiving 16-sessions individual AEDP reported on their post-session levels of working alliance and positive emotions (enlivenment affect, positive relational affect, and peacefulness). The alliance-emotion relationship for each emotional categories was tested with separate disaggregated cross-lagged panel models. Results: Across the three categories, higher positive emotions at the end of the previous session were associated with higher working alliance at the end of the next session. On the other hand, working alliance did not contribute to any of the positive emotions in the next time point. Furthermore, the three emotion categories showed different patterns of development. Conclusion: The findings suggest that fostering positive emotions may be a promising venue to enhance working alliance. Furthermore, differentiating specific positive emotions is likely important both for research and practice.

Mentalization—A Uniting Thread in the Treatment of Complex Posttraumatic Stress Disorder (CPTSD): Commentary on Phoebe Shepard’s Case Study of "Chloe"

Phoebe Shepard’s (2022) hybrid case study of "Chloe' describes a young woman struggling with a constellation of difficulties rooted in the relational trauma of her childhood. Shepard’s treatment approach with Chloe is anchored in Courtois and Ford’s (2013) Sequenced, Relationship-Based Approach to treating complex trauma. Within the structure provided by Courtois and Ford’s model, Shepard integrated techniques from a wide array of treatment perspectives including Cognitive Behavioral Therapy (CBT), Sensorimotor Psychotherapy (SP), and Accelerated Experiential Dynamic Psychotherapy (AEDP). Despite pulling from such seemingly disparate sources, Shepard presents a cohesive treatment anchored in a focus on the healing potential of the therapeutic relationship. In the approximately two years that she worked with Chloe, this emphasis on safety and connectedness yielded deeply meaningful and clinically significant change. In this commentary I hope to simultaneously honor the deeply reflective and compassionate approach taken by Shepard and to present a simplified guiding conceptualization of Chloe’s presentation and treatment—one rooted in "mentalization." Mentalization, sometimes summarized as "thinking about thinking," is the process of thinking about one’s self from the outside in and thinking about others from the inside out—considering the thoughts, feelings, and needs underlying our own and others’ behavior. I propose that many of Chloe’s difficulties can be viewed through a lens of mentalization lapses, and much of the beautiful and transformative work Shepard accomplished with this client may have been driven by improvements in Chloe’s capacity to mentalize. By simplifying what is an undoubtedly complicated clinical presentation—rich with history, multilayered interpersonal dynamics, transient self-states, and overlapping symptom profiles—I hope to present the perspective that treating complex trauma need not be quite so complex.

Termination in 16-session accelerated experiential dynamic psychotherapy (AEDP): Together in how we say goodbye.

This article explores key aspects of the termination process in a 16-session treatment protocol of accelerated experiential dynamic psychotherapy (AEDP). AEDP theory and its empirical support are described; interventions used throughout termination are 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 can continue, as does the therapist's care for the patient. AEDP interventions during termination include (a) relational strategies to foster connection and undo aloneness; (b) the highlighting of patient resilience and the celebration of growth; (c) affirmative work with defenses around loss; (d) coregulation of patient's emotional experience; (e) experiential, bodily-rooted affective strategies to process and transform negative emotions; and (f) thorough exploration and processing of ensuing, vitalizing positive emotions and in-session experiences of change-for-the-better (i.e., metatherapeutic processing), to expand these and promote enhanced well-being and flourishing. Therapists aim to (a) elicit and process emotions related to the completion of treatment; (b) celebrate patients' affective achievements; and (c) 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. AEDP suggests that in providing patients a new, positive attachment experience of togetherness as therapy ends, termination offers a unique opportunity to disconfirm patients' earlier attachment-based expectations, revise inner working models, and help patients grow in self-confidence as they face, accept, and thrive in the wake of loss. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The effectiveness of accelerated experiential dynamic psychotherapy (AEDP) in private practice settings: A transdiagnostic study conducted within the context of a practice-research network.

Accelerated experiential dynamic psychotherapy (AEDP) is an integrative model of psychotherapy that brings together relational and experiential work, with the aim of not only alleviating suffering but also bringing about flourishing. The present study took place within a developing AEDP practice research network and examined outcomes for 62 self-referred adults treated using a 16-session format of AEDP treatment. Participants completed self-report measures before and following treatment. Measures assessed a variety of psychological problems, subjective distress, as well as aspects of positive psychological functioning. Treatment occurred in naturalistic independent practice outpatient settings in the United States, Canada, Israel, Japan, and Sweden. Large effect sizes (d > 0.80) were obtained for clinical problems and subjective distress. The majority of patients evidenced clinically reliable change according to Jacobson, Roberts, Berns, and McGlinchey's (1999) criteria. Effectiveness was further examined by dividing the sample into a clinical group with pervasive and severe problems and a subclinical group with fewer problems and mild severity. Within the clinical group, total and global scores on all measures improved significantly following treatment. Effect sizes were d > 1.00 for all scales. The subclinical group also demonstrated significant improvements, with effect sizes ranging from d = 0.46 to d = 2.07. These results provide initial empirical support for the effectiveness of AEDP as a model of therapy that can effect meaningful and significant improvements across a range of psychological symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Metatherapeutic processing supports the emergence of flourishing in psychotherapy.

Psychotherapy has primarily focused on ameliorating symptoms and psychopathology. This is in contrast to positive psychology, which has focused on bringing about what Keyes (2002) has called "flourishing." Accelerated experiential dynamic psychotherapy (AEDP) seeks to bridge the two traditions by both relieving suffering through processing painful negative emotions to completion and then going on to foster flourishing, in session and beyond, through a technique called metatherapeutic processing. After a brief summary of the AEDP approach, the aim of this article is to elaborate specifically on metatherapeutic processing, where a focus on savoring and exploring the positive affects that accompany the change process itself can set into motion an upward spiral of positive affect that broadens and builds the treatment's effectiveness. We provide a how-to primer on metatherapeutic processing as well as annotated transcript material from three cases to illustrate the application of the technique. We describe how metatherapeutic processing can organically foster, from the bottom-up, positive feeling states labeled transformational affects, such as gratitude, love, hope, curiosity, and zest, freeing up these vital energies that were latent within the client. We go on to propose that although metatherapeutic processing was conceived of within the framework of AEDP, it is a technique that can be integrated into a wide variety of psychotherapies, to activate flourishing in session and beyond. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Becoming "Teletherapeutic": Harnessing Accelerated Experiential Dynamic Psychotherapy (AEDP) for Challenges of the Covid-19 Era.

The covid-19 pandemic raises substantial challenges for the practice of psychotherapy. The rapid changes in the personal experiences of both clients and therapists, and the required adaptations in the therapeutic setting, affect the therapeutic relationship and its process. We examine common challenges observed through supervision of therapists and peer group discussions, viewing them in light of reports of previous collective traumatic events. Consequently, we introduce major premises and techniques borrowed from Accelerated Experiential Dynamic Psychotherapy as they may apply to teletherapy. These interventions aim to maintain and strengthen the intimacy and safety of the therapeutic attachment relationship, essential for processing actual experiences of emotions and creating affective changes. We explicate the rationale and the clinical application of these relational and experiential interventions, and organize them through a comprehensive model. The model visually illustrates the matching of therapeutic interventions to the handling of the psychological upheavals triggered by the changes imposed by the pandemic, particularly the move to teletherapy. In addition to theoretical and practical suggestions, which could be adapted to various models of therapy, we present a brief clinical case demonstrating the application of the suggested therapeutic thinking and interventions.

Clinical recommendations for psychotherapists working during the coronavirus (COVID-19) pandemic through the lens of AEDP (Accelerated Experiential Dynamic Psychotherapy)

ABSTRACT The coronavirus (COVID-19) pandemic created an unprecedented physical and mental health crisis on an international scale. Clients and therapists alike navigated the fears and uncertainty surrounding the virus, often in an environment of social isolation. The following paper presents a brief overview of the unique stressors and psychosocial factors impacting therapeutic work in the time of the coronavirus pandemic, including fears of the virus and social transmission, relational stressors due to isolation, grieving in isolation, fear of death, financial challenges, and the transition to telehealth. In addition, this paper aims to provide specific interventions and helpful approaches for psychotherapists navigating the novel challenges and demands to their clinical work through an AEDP (Accelerated Experiential Dynamic Psychotherapy) perceptive. This includes finding an entry point for accessing the pain: undoing aloneness; moving through the pain: dyadic affect regulation; and paying close attention to vitality within suffering: searching for transformance. Recommendations for the health and care of the clinician are also discussed, such as attuning to self-needs, anticipating and detecting dysregulation, staying with the good, meaning-making, identifying and responding to burnout, and the importance of receiving personal therapy and clinical supervision.

Transforming emotional suffering into flourishing: metatherapeutic processing of positive affect as a trans-theoretical vehicle for change

ABSTRACTThis paper explores core adaptive emotions, both negative and positive, and investigates their respective roles in the transformation of emotional suffering into flourishing. We do so through the lens of Accelerated Experiential Dynamic Psychotherapy (AEDP), a mind/body, emotion-focused, healing-oriented model of psychotherapy that has articulated a four state phenomenology of the transformational process. Through such a transformational process, energy-consuming negative emotions are transformed into energy-enriching positive emotions, thus describing an arc that organically links the negative emotions of emotional suffering with the positive emotions of flourishing. AEDP achieves this through (i) amplifying the vitality affects that identify positive neuroplasticity through therapist transformance detection; (ii) experientially processing to completion the “gut-wrenching” emotions of trauma, and then, (iii) “turbocharging” the innate affects of healing to expand transformation through metatherapeutic processing, a technique for working with positive emotions to maximize their therapeutic impact. We conclude with thoughts on how metatherapeutic processing might be used by therapists of different orientations to systematically bring flourishing into psychotherapy sessions and on how AEDP’s descriptive phenomenology of affective states can function as a trans-theoretical vehicle of communication to further the exploration of the neurobiological mechanisms underlying change processes in psychotherapy.

A Bridge Over Troubled Water: Commentary on Paul Blimling’s Case of "James" Integrating Music Listening into AEDP

The integration of music listening into Accelerated Experiential Dynamic Psychotherapy (AEDP) is explored through discussion of Dr. Paul Blimling’s (2019) composite case study, "James." AEDP is a healing-oriented, non-pathologizing, experiential therapy model in which the therapist actively seeks to harness glimmers of resilience from the outset of treatment, and to co-engender safety within the therapy relationship in order to unleash the transforming power of attachment and emotion (Fosha, 2000, 2003, 2009, 2018). Blimling’s incorporation of music listening into the treatment of a highly defended, initially hostile patient helped bypass defenses, foster attachment within the therapy relationship, and access and co-regulate the patient’s affective experience. Key AEDP change mechanisms in the treatment included: undoing aloneness; affirmative work with defenses; dyadic affect regulation; emotion processing; and (to a lesser extent), metatherapeutic processing (metaprocessing for short). The latter is a unique and important contribution of AEDP to our field. Since the publication of Fosha’s The Transforming Power of Affect (2000), AEDP itself has evolved from an attachment- and emotion-focused model to also focus increasingly and explicitly on transformational experience as an agent of change. The experience of positive change itself is now seen as an equally important AEDP change mechanism, alongside attachment and emotion processing. Metatherapeutic processing of patients’ experiences of positive change, which involves a recursive alternation between exploration of new experience and reflection on that experience, frequently results in an expansive spiral of the transformational processes and affects identified by Fosha (2009, 2018). In addition to affirming Blimling’s choice of AEDP and his sensitive and skillful integration of music listening into the treatment, I envision how the transformational process described in the case study might have been further expanded, deepened, and consolidated, had the therapist more assiduously and experientially explored the patient’s experiences of positive change.

Facing the Music: Further Thoughts on Integrating Music into Psychotherapy

In this article, I respond to the insightful commentaries by Karen Riggs Skean (2019), by Richard Harrison (2019), and by Ben Adams (2019) on my hybrid case study of "James," a survivor of chronic relational trauma (Blimling, 2019). These commentaries have stimulated me to think further about the impact of music on my individual psychotherapy work, both with James and with subsequent clients, and specifically with regard to its impact on my approach to group psychotherapy work. In addition, these commentaries have raised particular issues that I respond to, including, (a) constructive criticism by Skean and Harrison regarding the potential further use of "metaprocessing" and the developments made in Accelerated Experiential Dynamic Psychotherapy (AEDP) since I completed the Case of James; (b) Skean’s perceptive point explaining how an individual therapist can take a personal passion—like music or literary writing or bicultural identity—and use it to enhance his or her enlivened presence in therapy with a client; and (c) Adams’ thesis that music and psychotherapy both have their origins in the shamanistic practices of our hunter-gatherer ancestors, suggesting that the combination of psychotherapy and music is a kind of return to our very roots.

The Effect of Integrating Music Listening With an Attachment- And Affective-Focused Short-Term Psychotherapy in an Individual With Relational Trauma: The Case of "James"

The purpose of this study is to explore the utility and feasibility of incorporating client-chosen music listening into a short-term dynamic therapy model in an individual with trauma. Specifically, Diana Fosha’s Accelerated Experiential Dynamic Psychotherapy (AEDP) was chosen due to its focus on emotional experience and attachment. Relevant literature regarding the current clinical applications of music is presented, along with research supporting music’s effects on relevant psychotherapeutic mechanisms such as affect, autobiographical memory, and attachment. These effects are illustrated through the use of the hybrid case example of "James," a composite psychotherapy client who struggles with symptoms stemming from relational trauma. In addition to being informed by clinical examples in relevant psychological literature, James' case is assembled from actual psychotherapy cases of the author. Demonstrating this client’s course of treatment provides an avenue for describing key clinical issues related to the utility of music within a more traditional short-term dynamic therapy model. By adopting a qualitative, disciplined inquiry approach, treatment is tailored to the client’s unique psychological struggles within the context of historical, contextual, and relational factors. Following a pragmatic case study research format (Fishman, 2005), case material is analyzed both qualitatively and quantitatively. Discussion explores how an integrative treatment approach, exemplified in the case of James, can effectively combine psychodynamic, relational, and musical elements in treating individuals with relational trauma and the resulting pathology. James’ case is designed to be a resource for therapists who seek to gain additional understanding of a new component in providing effective and meaningful treatment for individuals with relational trauma.

Integrating Client-Chosen Music in Relational Trauma Treatment: Pathways to the Heart

This commentary discusses the therapy of a hybridized client (Blimling, 2019) with a difficult relational trauma history in which client-chosen music was combined with a short-term treatment utilizing Accelerated Experiential Dynamic Psychotherapy (AEDP). This combination bypassed rigid defenses and allowed access to a level of affect not ordinarily available to the client, allowing significant symptomatic and relational shifts to occur. Primary goals of helping the client deal with a major loss, reduce his level of depression, and improve his interpersonal functioning were met. Implications for the use of integrative methods with short-term models and the importance of therapist flexibility are discussed.

In the Light: On Meta-Experience and Spiraling Effects in Psychotherapy—Commentary on Louis Sass’s Commentary on Diana Fosha’s Commentary on Nicole Vigoda Gonzalez’s Case of "Rosa"

In the previous issue of this journal, I commented (Fosha, 2018) on the psychotherapy case study of "Rosa," written by Nicole Vigoda Gonzalez (2018). To address Rosa’s relational trauma and major depression, Vigoda Gonzalez effectively put into clinical action the psychotherapy model I developed, called Accelerated Experiential Dynamic Psychotherapy (AEDP). In my commentary, I discussed how AEDP’s four-state transformational phenomenology can be used to guide the therapist’s choice of interventions. I also showed how the moment-to-moment tracking of the vitality affects accompanying affective experiences is crucial to (a) the processing of core emotions to a healing conclusion, and (b) the metatherapeutic processing (or metaprocessing for short) of this healing—two core concepts in AEDP. In the current issue of the journal, Louis Sass (2019), an internationally recognized expert on phenomenology and psychopathology, has commented on my commentary, endorsing the importance of a phenomenological perspective in psychotherapy. He also raised some concerns about the use and usefulness of metaprocessing for some types of clients, especially those with the distancing defenses of derealization and depersonalization. In this article I respond to Sass’s important and very thoughtful points.

In the Shadows: On Meta-Awareness and Spiraling Effects in Psychotherapy—Comment on Nicole Vigoda Gonzalez and Diana Fosha

I want to commend Nicole Vigoda Gonzalez (2018) for her sensitive, sophisticated, and successful treatment in the case of Rosa; and I want to commend Diana Fosha (2018) for the development of her phenomenologically sophisticated and effective Accelerated Experiential Dynamic Psychotherapy (AEDP) model, which Vigoda Gonzalez used. In this commentary I focus on a contrast between two different perspectives in Fosha’s model, and implications for the case of Rosa. This contrast includes: (a) AEDP’s focus on descriptive phenomenology, emphasizing the richness of each client’s moment-to-moment, subjective experience, versus (b) Fosha’s seemingly unqualified advocacy, in the Second Avatar version of AEDP, of the therapist explicitly encouraging meta-processing—that is, explicit self-awareness—as a final step of therapeutic healing. In my commentary I suggest that there seem to be certain limiting conditions for such advocacy. Specifically, I discuss how the clinical research literature argues that while meta-processing may be very helpful for some clients, for others—e.g., those employing the distancing defenses of derealization and depersonalization—meta-processing can be psychologically counterproductive. I conclude by re-emphasizing the importance of retaining a descriptive phenomenological perspective in AEDP.

The Case of “Rosa”: The Importance of Specificity in Our Quest to Integrate Cultural Competence in Practice

This commentary explores Nicole Vigoda Gonzalez’s (2018) treatment of “Rosa” with Accelerated Experiential Dynamic Psychotherapy (AEDP), an attachment-based, relational, and experiential approach effective for treating attachment trauma. I discuss how AEDP also welcomes culturally competent strategies. My focus is the importance of specificity in the inclusion of culturally competent strategies in psychotherapy practice. Specifically, I address the difference between a Caribbean versus an Hispanic identification. I also explore the impact of culture, including race/ethnicity and familial discrimination, in Rosa’s case. Finally, I explore the impact of the therapist’s disclosure, or lack thereof, of her own race/ethnicity in the context of AEDP interventions.

AEDP and Cultural Competence in Developmental Trauma Treatment

This commentary discusses the therapy of a complex trauma survivor combining Accelerated Experiential Dynamic Psychotherapy (AEDP) with culturally competent strategies, particularly the use of a shared second language of origin. This combination potentiated the transformation of early affectively and bodily held memories and facilitated a successful outcome. Implications for short-term models and the training of therapists are discussed.