What is Accelerated Experiential Dynamic Psychotherapy (AEDP)?
Accelerated Experiential Dynamic Psychotherapy (AEDP) is a healing-oriented transformation-based model of change. Traditional psychotherapies and the medical model often have as their focus pathology, symptoms, abnormality, and diagnosis. They aim to understand the different forms of “mental illness” and their possible causes. However, perhaps less emphasis is placed on the process of psychological change or on finding effective ways of helping people tap in to this process.
Diana Fosha (the founder of AEDP) became particularly interested in this process of change and started to explore the micro-components that a client and therapist engage in to bring about change. AEDP places the process of transformation at the centre of its approach. Underlying the AEDP approach are the ideas that under the right conditions we are wired for healing, growth, and transformation.
We often talk about “resistance” which represents the conservative aspects of the psyche. It often refers to defences and struggles that try to withstand changes and challenges. There is a greater anxious, constricted, and avoidant component that we might have learnt in order to keep safe. In contrast, “transformance” is the force in the psyche that moves people towards healing and growth and expansion (Diana Fosha). Diana defined transformance as an over-arching motivational force, operating both in development and therapy, that strives towards maximally adaptive organization, coherence, vitality, authenticity, and connection, and that drives processes that, in the right environment, eventuate in healing and thriving” (Fosha, 2007). Clinician’s are often well equipped to detect psychopathology. Within AEDP we also develop a client’s capacity to detect “glimmers” of positive, corrective, and new experiences that are life and self-affirming.
Four State Model of Transformation
At the heart of AEDP is a “Four state model” that outlines the process of change. There are quite a few nuances to the process of moving through this sequence of transformational states. However, usually people arrive at therapy because they want to change something about state 1: which includes a person’s distress, defences, symptoms, inhibitory states including (anxiety, guilt, and shame), and other states of suffering. These states are often a person’s struggle to maintain or prevent negative maladaptive emotions from breaking to the surface. These maladaptive emotional experiences include toxic shame, unbearable aloneness, hopelessness, and worthlessness.
The aim of AEDP is to assist people to access deeper emotional experience and to tap in to State 2’s: adaptive core affective and emotional experience. This might involve processing a core emotion to completion, having a more connected experience to self, or a having a new and authentic relational experience. Following this often people experience relief, perhaps a sense of break-through, lightness, hope or energy. This is then followed by access to state 3 or what is known as transformational affects. This might include a sense of mastery, pride, healing, or mourning affects. By working through these states sometimes state 4 is attained. This is referred to as core state and has a sense of truth and wisdom to it. I will outline each of these states below in more detail. Although this might sound simple and linear we can often be very entrenched the defences of state 1.
The AEDP Model: Development of Distress, Suffering, and Defences:
When people first call to make an appointment they are often stuck in defences and states of distress. As part of AEDP we take a developmental perspective. We try to understand the shape of our internal experience as deriving from past learning and adaptations.
Developmentally the new-born child is a bundle of emotion and intense experience. Common experiences include distress, sadness, hot/cold, helplessness, anger and rage, vulnerability, fear, anxiety, and hunger. We essentially arrive with a particular temperament that is more often than not geared towards hyper-arousal. Often we can carry this state throughout our life.
If we are soothed, organised, and tended to then there are more chances for growth, development, and expansion of the self. However, often our internal needs and emotions are not met as outlined below.
- Failures of Dyadic Regulation and Repair
- Omission – (withdrawal, rejection, avoidance, denial, neglect) – so often clients might present without a clear picture of their actual trauma, often where there has been omission a client does not know what was missing – only in the context of a developing and corrective relational, intra-relational experience that they start to see what they missed out on.
- Commission – (criticism, humiliation, punishment, ridicule, intrusion, physical abuse, sexual abuse).
- These failures of dyadic regulation and repair require the nervous system to adapt in specific ways.
- Defensive exclusion of negative and unbearable emotional states. What a parent is unable to tolerate a child might learn to block from experience. Under specific conditions we might learn to constrict, conserve, defend, and protect. For example, a child might learn that it is not ok to show emotions. Issues come to the surface when these defences no longer function and emotional experiences can no longer be warded off. This is usually when therapy or some input might be needed.
- Overwhelming unbearable aloneness. Often we have to hide emotional states that aren’t recognised, acknowledged and worked through.
- Psychopathology: What we consider and diagnose as psychopathology often simply reflects a person’s best attempts to function and survive in a maladaptive environment.
- Common patterns of attachment – avoidant-dismissive – rejecting, cold, anxious-preoccupied inconsistently available, disorganized traumatizing.
- Avoidant – dealing but not feeling or relating, over-regulation of affect, flight, low activation of energy, sacrifice of relationships.
- Preoccupied – hyper-feeling, not dealing, under-regulation of affect, fight, high activation, expends energy, sacrifice of exploration.
- Disorganized – not feeling, not dealing, not relating, reeling, dysregulation, freeze, overwhelm, dissociation, somatization, self-sacrifice.
- Self at Worst or Compromised Self states that are fuelled by fear and insecurity
- Resistance: The complex of forces and factors that prevent a client from shifting or changing in some way.
Establishing Safety, Undoing Aloneness, & Facilitating Experience
Usually when we start therapy our mental landscape is dominated by defences, anxiety, and other inhibitory responses. These states block off meaningful access and contact with inner experience, emotion, and others. This is the conservative, fear driven, insecurely attached, self-at-worst component of the psyche.
These states might include defences (e.g. dissociation, denial, distancing, and intellectualization), emotions (anger to cover vulnerability, tearfulness/helplessness to cover anger), and behaviours (e.g. avoidance) aimed at blocking meaningful work. We might be metaphorically stuck and stagnant in a valley with no clear pathways out. If a person stays stuck in state 1 effective change is unlikely and therapy remains more conceptual than experiential.
A person essentially arrives at therapy wanting to get from place A to place B. The AEDP model of change acts as a terrain map rather than a strict manual. The first goal is usually to move from a guarded position to one that is more open to exploration of self and other. The body and mind often signal the types of states we are in and what is needed at that point. Effectively we are trying to soften and bypass defences, undo aloneness, show the person they are seen and cared for at a deep level, and quieten the nervous system.
Therapy takes a degree of emotional risk-taking to dive in to our inner world, we are at the edge of our emotional experience. We might not quite have labelled, verbalised, or made clear in our own minds these experiences. The body viscerally changes when we are ready to go a bit deeper. With each therapeutic step we see what happens and unfolds next.
AEDP recognises that people often have to let go of old strategies that were initially developed to protect themselves. Giving up familiar patterns and habits (even those which are no longer helpful or adaptive) can be scary. AEDP helps people to recognise, name, contain, follow, organise, titrate, and calm inner experience. With moment to moment tracking the AEDP therapist can help people to access affective experience and facilitate change. AEDP seeks to adopt an open therapeutic stance that is genuinely active and engaged, attachment focused (e.g. fosters safety, delight and qualities of secure attachment). Furthermore, we focus on what is know as dyadic affect regulation (regulating the nervous system).
AEDP: Engendering New & Corrective Experience
From a safer and less defended place, AEDP centres on engendering new and corrective emotional and relational experiences. Th idea is that by processing core experience (e.g. sadness, anger, fear, old memories and relationships etc) intrinsic, self-righting mechanisms, healthy action tendencies, and internal resources can be accessed and integrated. There can be a freeing from the past stuck states to allow for more optimal psychological functioning in the world. This therapeutic work can help with healthy reorganization of life. For example, processing blocked anger makes it available for protecting one’s emotional space, for asserting our needs, or increasing drive, vitality, and confidence.
This is the Self at Best state of the psyche that is fuelled by increased hope, secure attachment, and greater capacity to feel, deal, and relate more completely and authentically.
AEDP also explore relational affects. Often some people have never experienced deeply attuned relationships. Moments of resonance, recognition, affirmation, care and compassion can be terrifying (old attachment map) but also deeply healing when truly received (new attachment map) rather than being blocked. AEDP also closely explores a persons relationship with their own experience. Do people meet themselves with compassion and care or disdain and denial. Th therapeutic work centres on cultivating, expressing, & taking in feelings of open heartedness.
Defences have often operated to block off deep pain of shame, emptiness, aloneness, and demoralization. They stop people from being swallowed by the abyss of these feelings. AEDP aims to regulate, shift out of, and gradually differentiate from these old pathogenic attachment experiences. Here we create a new pathways out of these affects so that they don’t dominate our lives.
AEDP: Transformational Affects
Often following the breakthrough of new and corrective emotional experience there is a lot to process. What follows can often be a rich and transformational experience. These states are often know as transformational affects.
Mastery affects – occur when a client has a deep sense of pride, achievement, or mastery for just having just worked through something big or having overcome and survived some trauma or struggle.
Mourning – Developing a keener sense of past difficulties can also bring up mourning linked to losses incurred due to trauma, neglect or a chronic reliance on defences. This is not the sadness linked to specific events, or relationships that might be processed in state 2 work but rather a broader mourning of the self.
Positive fear (“tremulous affects”) – Positive fear occurs as the patient perceives themselves as moving towards ways of being that are new and different. Finding oneself crossing that threshold can evoke a powerful and interesting combination of excitement and anxiety.
Healing and gratitude affects – arise when a person has a deep sense of “feeling moved” for completing a deep emotional stage of work.
Vortex of Feeling Associated with Quantum Change. This can include a sense of shaking, vibrations, spirals, dramatic shifts in body state that occur with doing a powerful piece of work.
AEDP: Processing Core State: Towards Enlightenment.
I particularly, like the inclusion of this state as part of the model, as it encapsulates the types of states that our clients and ourselves are aiming for. Often if we deeply and completely process an experience we can tap in to core state. Markers for core state include a sense of ease, openness, wisdom, compassion, and clarity. Think wise sage or buddha type of state. Or Richard Schwartz the developer of IFS describes the 8 C’s including calm, clarity, confidence, centredness, curiosity, compassion, courage, and creativity.
Within these states a person often has a deep understanding and a sense of clarity. Furthermore, people often have a greater ability to construct a coherent and cohesive autobiographical narrative (a hallmark of secure attachment) and a clearer sense of self and other. When people talk from this place there can often be a profound sense of wisdom, truth, and insight.
AEDP, at its heart, is a transformation-based healing oriented psychotherapy. It is a model of therapy that seeks to foster safety, regulate distress, and undo aloneness. Furthermore, it aims to tap in to a person’s strivings to transform and grow emotionally and in life. By facilitating these conditions the client and therapist aim to process oftentimes difficult emotions, relationships, and experience. In doing this AEDP can help to facilitate a spiral of healing and transformational affects. The over-aching aim to achieve and integrate a truer, richer, deeper, and more secure platform for a person to operate from.