Frontiers in the Treatment of Trauma

Transcription

1 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 1 Frontiers in the Treatment of Trauma Finding Meaningful Change After Trauma: The Unique Strengths of the Affect-Based Approach the Main Session with Diana Fosha, PhD and Ruth Buczynski, PhD National Institute for the Clinical Application of Behavioral Medicine

2 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 2 Frontiers in the Treatment of Trauma: Diana Fosha, PhD Finding Meaningful Change After Trauma: The Unique Strengths of the Affect-Based Approach Table of Contents (click to go to a page) The Power of Affect... 3 How Change Can Happen Rapidly... 5 The Core Categorical Emotions... 6 How to Manage the Patient s Feelings toward the Therapist... 7 Practical Strategies for Working with Affect... 8 Working with a Patient Using the AEDP Model... 9 Connecting to Aliveness Revisiting the Trauma for Deeper Healing... 17

3 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 3 Frontiers in the Treatment of Trauma: Diana Fosha, PhD Finding Meaningful Change After Trauma: The Unique Strengths of the Affect-Based Approach Dr. Buczynski: Hello everyone and welcome back. I am Dr. Ruth Buczynski, a licensed psychologist in the state of Connecticut and the President of the National Institute for the Clinical Application of Behavioral Medicine. I m so glad that you re here. My guest is Dr. Diana Fosha. She is a licensed psychologist in New York City and the author of two very important books on the topic of trauma; they are The Transforming Power of Affect and The Healing Power of Emotion, which she co-edited with Dan Siegel and Marion Solomon. So, Diana, welcome I m glad you re here. Dr. Fosha: Thank you! It s a pleasure. I look forward to our conversation. The Power of Affect Dr. Buczynski: Yes, me too. One focus you have as a practitioner is on the power of affect. Let s start there: why do you think that s so important? Dr. Fosha: I have taken to calling that the Willie Sutton Principle. Now, Willie Sutton was a famous bank robber, and when he went before the judge, the judge asked him, Willie, why did you rob a bank? and Willie said, Because that s where the money is. In essence, that s my answer to your question. There are two aspects of affect and emotion, that we re interested in and are ways of gaining access. Through the affect, we get to the body, the nervous system, and the limbic system and that is both where When emotions and affects can slow naturally, they are tremendous sources of energy and vitality. trauma affects people and causes the kind of difficulties that it does. But that is also where it heals. By being able to access the affect, we re gaining access at the level where the trauma is in the brain and body. So that is one aspect. When emotions and affects can slow naturally, they are tremendous

4 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 4 sources of energy and vitality. By working and that is part of the Willie Sutton idea with affect and emotion, and being able to restore it to a place of functionality and slowing naturally, patients gain tremendous access to energy, vitality, and resilience all that is good and part of the amazing resources that are wired into our brains and bodies. Dr. Buczynski: Before we get too deeply into this, give me a little historical perspective: how did you get here? What were your roots? Dr. Fosha: Yes, professionally and before I am a novel reader. From early childhood there was just something about people s stories and the deep things that went on between human beings. These are the processes, documented by brilliant novelists that always intuitively drew me in and interested me. Professionally, my initial training was in psychoanalytic, psychodynamic psychotherapy, and then my training in the classics, which was Latin and Greek. The process of change was experiential in the moment. The thread that led to working on the ideas that I ve developed always had to do with this theme of vitality themes of energy, immediacy, or authenticity. On one hand it would seem to be characteristic of the work of certain people in that field but not of others. On the other hand, there was effectiveness. What was always unsettling to me about that initial training was the relatively cavalier attitude toward results or effectiveness, or the time frame. That drew me, and as I started to explore, the path led to more affect-based experiential approaches where the transformational process was much more immediate much more immediately effective. It wasn t cumulative over a long, long period of time; there was something about the process of change which was experiential in the moment. That is what drew me to explore more and more, and eventually, it evolved into the work that is in those books and that we re talking about. The approach, the model, has a name, and it s called AEDP, which stands for accelerated experimental dynamic psychotherapy. This captures the developments that we re talking about. We re paying attention to the timeframe it s not

5 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 5 infinite and endless, but the approach is experiential, and includes the dynamics that are part of my professional history understanding how things relate or how they connect present and past. How Change Can Happen Rapidly Dr. Buczynski: Let s stay with that concept of not having it take forever. One of the important perspectives from your theory is that change can happen rapidly. That wouldn t be just your perspective there are other theories that would say that as well. Do you see any danger in trying to encourage change to happen rapidly? I ll bet some of your colleagues or former teachers might have. Dr. Fosha: I m sure they might and that s an excellent, excellent question. The idea of rapid change produces interest and excitement, but also a little bit of, Whoa let s be careful here. That is a perfect way to lead into what the applications (of AEDP) are or how this works. This is the big idea that we re starting to talk about the work is about very, very carefully tracking what is This is about very carefully tracking what is already there. already there. It is not so much about creating these huge explosions or creating situations that will be dramatic, as much as it is very closely tracking all of the indicators somatic indicators, affective indicators on how these transformational processes or moves toward healing are already there, and then we can very carefully work with that. This has applications, not just in psychotherapy, but for people who work with the body, whether bodyfocused psychotherapies or other physical therapies we re working with the body or the psyche s natural responses toward healing, and then supporting, enhancing, and building on that. We re not creating something that is not already there. On the other side of that, you re always tracking how the person is responding to what s going on; you can always pull back a little bit, slow it down, or intensify it. Dr. Buczynski: Now, we ll get into a little more about how that s done in a bit, but before we do, I want to

6 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 6 stay with the nitty-gritty of affect a little while longer. The Core Categorical Emotions Dr. Buczynski: You said that there are some core categorical emotions that you need to be concerned with. Can you talk about these and tell us why they re so important? Dr. Fosha: Yes. I m sure that we ll eventually get into other aspects of it, which are all the affects associated with transformation, but to stay with the categorical emotions these are the big emotions like fear, or anger, or grief, or joy on the positive side. It s not just the negative. This is a link into biology and into evolution. These emotions are The expression of emotions might be culture-bound, but the wiring in our brains and bodies is a universal. universals This is our animal heritage. The expression of these emotions might be culture-bound, but the wiring of these emotions in our brains and bodies is a universal. We re accessing something with deep, deep roots in evolution and biology. By working with emotion and I started to talk a little bit about that in response to your first question we access the precise places where trauma gets stuck or where emotional suffering creates blocks. In psychotherapy, we get access to what we want to work with. But the other very important aspect of these categorical emotions is that they have, what is called in emotion therapy, adaptive action tendencies. In other words, these emotions are wired into our brains and bodies for a very good reason by Mother Nature, evolution, or however you want to reference that. This means that when we have access to our emotions, we re able to act effectively in the world grief Categorical emotions have adaptive action tendencies. allows us to process loss, fear allows us to get away from danger, and anger allows us to stand up and take action against a trespass or a boundary violation. Freeing these emotions so that they can flow freely as they are supposed to is the process that leads to a person s resilience and their capacity to be effective in the world. It is not just being able to process something that didn t get finished or that is affected by too much suffering; you are able to release resilience

7 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 7 and resourcefulness in the individual, and that is huge. How to Manage the Patient s Feelings toward the Therapist Dr. Buczynski: Another powerful affect that comes up in therapies can be the patient s feelings of compassion and generosity toward the therapist. From your perspective, why is that important and how do we manage that? Dr. Fosha: Yes, empathy and compassion is what makes us human and allows us to have deep connections with one another. By welcoming a two-way relationship, the patient has such a profound experience of being valuable. Relationships are mutual; they take two people it takes two to tango. Empathy and compassion make us human and allow us to have deep connections. When the therapist welcomes relationship and can be impacted and affected by it not just maintaining neutrality, but really taking it in that gives the patient a profound experience of having something to give as a human being. That is part and parcel of the adaptive action tendencies and of completing sequences. For the emotional experience of compassion and empathy to feel complete, it has to be received. For the emotional experience of compassion and empathy to feel complete, it has to be received. You offer it, and if you don't receive it that becomes an interruption, which in the long run, can cause blocks and trauma. Again, we re allowing and welcoming people s resources, and that leads to a therapeutic relationship that is based on, We re in it together a collaboration. It is not that, I, the therapist, have all the wisdom and you, the patient, have all of the need and the problems. We re human beings in it together and you have a lot to offer to me, as I have, hopefully, to offer to you. Dr. Buczynski: What about patients where love and compassion is shut out of their range of expression or

8 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 8 shut out of how they think of a therapist or any practitioner? We don't have just therapists listening; we have all kinds of practitioners. Let s broaden it out a bit. Dr. Fosha: Yes. A way to think about that is through the very nature of early attachment trauma and the kinds of things that happen in families originally, where people s gifts their natural empathy and compassion is not only not quite received but maybe even criticized, rejected, shamed, humiliated Instead of being welcomed, people have been hurt or shamed or rejected. Also, experiences with professionals, in settings where it is a much more one up, one down approach, can contribute to that kind of shutting down that you re talking about, or a more conscious suppression where the patient thinks, That is not what I do here; that is not going to be welcome so I am not going to go there. In a much deeper way, this is where these kinds of blocks become unconscious and procedural instead of being welcomed, people have been hurt or shamed or rejected for that. Again, that is not just with therapists; that has to do with physicians in medical settings, or with other kinds of practitioners who work with people. Practical Strategies for Working with Affect Dr. Buczynski: Let s move more into the practical strategies from your perspective, of working with and using your approach. Before we start, we should say that to work with affect you need to identify it. How would you go about tracking affect? Is that something you do consciously or? Dr. Fosha: It is something that I do consciously and is a huge aspect of what the teaching and training in this This model involves articulating very important distinctions and helping people to track and identify them. model involves articulating very important distinctions and then helping people to track and identify them. We distinguish the categorical emotions the somatically based and wired-in that we want to work with. We distinguish those by how they look their phenomenology. We distinguish that from the emotionality that is not productive, that is more defensive or more aimed at

9 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 9 blocking and distancing than expressing. Then we have another whole set of categories for the affects that come forth in the context of healing; the healing itself is not just that danger evokes fear, or that loss evokes grief. It is also that we are wired it seems that when healing or change for the better is taking place, a whole series of very specific affective indicators are there as well. We have identified those and we work with people who want to learn about this way of working. We work with patients to identify them to know what they look like and something about their course. Working with a Patient Using the AEDP Model Dr. Buczynski: Walk me through what you re thinking about doing when you re working with a patient. Dr. Fosha: Let s take the initial contact when we re meeting for the first time. I don't know them, they don't know me, and most likely, they re coming in because their life is really not working there s some big trouble. Something is stuck or there s a lot of suffering things are not good. For the most part, people don't come into treatment because things are great! What goes with that is a sense of helplessness; what goes with that is a sense of shame; what goes with that is a sense of fear all this is what the person brings in. One of the first things that I do as we sit down and begin is to be on the lookout out for the evidence of healing, the evidence of resilience, the evidence of adaptation, the evidence of their empathy, the evidence of their being able to receive my empathy. From the get-go, I focus on the good stuff they already have. Patients don't need to go through many months of therapy to have some healing or to have some change it s there to begin with, and we re processing that reaction. Whether it s about our connection or it s about affect, or it s about resilience, I really just try to pay attention to that and bring it into the Patients don't need to go through many months of therapy to have some healing or change.

10 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 10 process, and then process the person s reaction, which is often a surprise. That is not what patients are expecting to hear, particularly when they re coming in and expecting to talk about their failures, or that their marriage is falling apart or Dr. Buczynski: Give me a snippet of what you might say as you re looking for evidence of healing, adaptation, or resilience and empathy and you find some of that evidence. Just give me a little snippet of what you might say. Dr. Fosha: Yes I m thinking of this man who came in. On the phone, he told me that the previous year had been just one of the darkest years of his life and it felt like the wheels sort of fell off he really felt out of control with feelings of depression and panic. From the beginning, he was very present. He was just present. He felt connected; he was relating to me and started to tell me about his experiences in a very honest way. It seemed very direct. So I commented on a couple of things: I commented on his courage and I commented on his being able to go right to these very difficult feelings with a stranger. I commented on his clarity. Within fifteen minutes of this initial session, I told him that he struck me as a very compassionate person My first series of interactions makes me see him as a more resourced person. that he had a tremendous amount of empathy and compassion. Then I asked him, What is it like for you to have me recognize your courage to have me say that to you? What s that like? I am doing that because here is this man, who is telling me that the wheels flew off, and he comes in with a sense of shame about not being able to be engaged. My first series of interactions with him are: Wow this is what I m seeing, and, Wow, what he s saying is very powerful. This makes me see him as a more resourced person. Here, we re not working on the shame, particularly if the person can take in or be affected by what is coming back as, Oh, I m not a total loser. I m not totally incompetent, ineffective, impotent, or helpless. But then there might be somebody else where it s important not to give these good or positive comments right away.

11 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 11 It has to be very precisely rooted in what is happening so that the person can say, Yes, I can see what you re saying. The patient needs to understand that the therapist is not just saying nice things for the sake of reassurance. The person s own sense of self starts to shift a little bit: Hmm, I do The patient needs to understand that the therapist is not just saying nice things for the sake of reassurance. have some value. I do have some qualities that I can get on the ground immediately. In a way, that increases the person s resilience and capacity so that when we go into the shame or the horrible event(s) that happened the trauma work that they can t do on their own and they re coming to therapy for we already have a relationship between us. Plus, the self-relationship is just that: I am not a total loser. I have some strengths here. Dr. Buczynski: So what s next? That makes sense; you re building some resilience; you re also creating a good connection, strengthening the connection that you have with a new person so they feel a sense of safety. But they also came because they have something going on that they need to deal with. What s next? Dr. Fosha: As we start, he s telling me about what was happening and there s a lot of difficult emotion out there these dark feelings of shame, fear, and pain. Always with collaboration, there is this sense of, Is it okay if we now go to this? I always ask for a specific example. I don't want us to talk in generalities; I want to drop down into something that feels alive not some theoretical narrative. Then we start to explore the emotions that are associated with that incident or with that interaction or that I m alternating between seeing how much the person is able to go into the difficulty and at the same time emphasizing the connection between us. moment when things felt really bleak and dark. Again, I m alternating between deepening and seeing how much the person is able to go into the difficulty and at the same time emphasizing the connection between us which means, You re not alone now. You may have felt alone when it didn t work, but we re in it together right now. This changes everything and deepens the capacity to tolerate the trauma.

12 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 12 We re always working in two places: the identifying and the process Identifying connection, strength, and resilience as it comes up, which heightens the person s capacity; and then starting to process the various We re always working in two places: identifying strength and starting to process. emotions associated with whatever is leading to the difficulties. The third piece of this, which happens so often, is that you identify what we call healing affects or transformational affects. I will give you a very specific example, because it is a case that I have written up, and I have tracked it very closely almost moment by moment. It is with this same gentleman. He is telling me about a great deal of pain, the breakup of a relationship, difficulties at work, and not having a job which is evoking a lot of empathy and compassion in me. But at some point, I shift the focus and I ask him, So what is this like for you to speak with me? He says, I see a lot of compassion in your face; I m getting a lot of compassion from you. Then I say, What is that like? We re now shifting to explore the reception of the empathy and compassion from me, so that we re in the context of a lot of darkness and failure and loss. As he is starting to focus in on what happens for him, as he really pays attention to what it feels like to receive compassion I have him track the sensation and do it in as much detail as he can. He starts to notice that there is a kind of warmth a little glow somewhere in his chest. I keep on by saying, So what is that like? Within, I would say, two minutes, we have gone from the darkness of the loss to all of a sudden a sense of warmth a glow and he says to me, It s very nice. It feels like sunlight. So, we re constantly bringing, as I said, not just the resilience but a positive affect we haven't really talked about the positive affect up until this moment but the positive affect just leads into well-being, resilience, and flourishing, all of which is good for the immune system. Let s step out of psychotherapy. There is all this mass of research that shows that kind of impact Barbara Fredrickson s research and others. The positive affect just leads into well-being, resilience, and flourishing, all of which is good for the immune system. When you generate these positive affects, they re fantastically powerful benefits for cardiac health and for

13 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 13 improved immune system. This is like a little microcosm. What I ve just given you as an example is probably no more than ten minutes in time maybe less. Now, we re not done with my example of working with this man we go right back into the experiences of loss or failure or what have you. But side by side with accessing that, we re accessing what starts to lift and to open. This brings into the system all these yummy neurotransmitters that lead to very positive results, particularly over a period of time. What I ve just given you as an example is probably no more than ten minutes in time maybe less. Dr. Buczynski: And it makes sense building strengths and connecting people with their resources. What is next after that? Dr. Fosha: Shifting out of the head in this particular way happens next. This is a man who is really shifting out of the head and trying to go into the body. We re working on two things in tandem one is to deepen experiences of the difficult emotions as much as he can tolerate, and the other is to work with dissociation, which was this man s defense. If the affect gets too much, dissociation comes online, which is why he was having problems. Dr. Buczynski: That dissociation happens a lot. Many people, whether they re therapists or other kinds of practitioners, see patients who have had trauma and then dissociate. How did that come up and what did you do with it? Dr. Fosha: Let's say that he s telling me about the loss, or some experience of loss, and then he says, I just forgot what I was talking about in real time. That s the feeling of, Oh, my god. It feels like it s getting erased. I can t even tell you what I was saying a second ago. If the affect gets too much, dissociation comes online. At that point, I said, Okay, so there is something very important for us to pay attention to why it felt dangerous for you to talk to me or some version of that to validate our stopping to do the exploration in the moment.

14 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 14 In other words, we re not trying to override the defense and go right back into what triggered it, but rather to say, Oh, you re not letting yourself go there for a very good reason. I don't know what that is because I don't know you. But let s see if we can understand together what the fear is about, and I m so glad you have the resources inside that protect you. Let s see if we can understand together what the fear is about, and I m so glad you have the resources inside that protect you. In his particular case, that meant so much to him. We started to explore what some of his fears were the fears associated with going into this material had to do with falling apart. He got some message, as he put it, from the inside: If you go there, you re going to die. Again, I validated that we d go slowly and the slower we go, the faster you go. By not pushing and by saying, Okay, we don't need to do anything that doesn t feel safe to you it s really important to feel safe you re building safety in your patient. In this particular case, what came up were some memories. Slowly, some memories came to the fore about an experience when he was two/three years old and the abandonment he experienced from his father. We were starting to really work with that emotion. Over the course of the session, he was able to do some grief work and also to acknowledge his anger at being abandoned by a major attachment figure in his life. It was this constant back and forth between, Let s try. Are you sure you want to? If you don't want to, you don't have to. Then, there was this, Stay with it. Let s see what s happening. Wow, you re doing an amazing job. What s that like for you to hear me say this? This is the process and we ended up, at the end of this initial session, with a tremendous amount of vitality, energy and excitement that he felt in his body in a very direct way. It was also very interesting that there was some anxiety all this was quite different from what he had felt for quite a while.

15 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 15 Connecting to Aliveness Dr. Buczynski: When we started, you were talking about the feeling of aliveness and how important that is. I happen to agree with you; I came from a Gestalt perspective back in the seventies and the eighties. Aliveness was very important, and I studied a lot of Wilhelm Reich. I can see how what you were doing did help connect him to his aliveness. Where did you go after that with him? Dr. Fosha: We went to many different places. But to stay with the As he is becoming aware and becoming both mindful and experientially aware of vitality, there is more vitality. aliveness for a moment, he came into the next session and certainly by session three he felt that he got bumped over a rut and that the energy and good feelings that he had had in the session actually stayed with him for the week between the sessions. We did another piece of work with some traumatic experience, however that came up, and the positive affects came again. All of a sudden, he s sitting up straight; he is opening his chest, his eyes are bright; he is leaning forward I mirror it, and not just comment on it. Affect emotion in general is contagious. It s not just that I m working with him on his own experience of vitality; as he is becoming aware and becoming both mindful and experientially aware of vitality, there is more vitality. As he is getting excited, I m getting excited; now you have this resonance going on and we re amplifying it. To reference Barbara Fredrickson s work, you have upward spirals associated with flourishing this is one that occurred spontaneously in the course of trauma work. There are two things going on: one is focusing on his experience of vitality and the other is our back-andforth. I m not sitting there with an Uh-huh Uh-huh neutral response. I m engaged; I m excited; I m feeling a There s a lot of fuel for the whole therapeutic process that gets released through resonant, dyadic, and amplifying interactions. lot of, Oh, my god this is so cool! As this back-and-forth is going on, it amplifies. Then, we see a very different kind of motivation instead of not going into these dark places that he had avoided so much, dissociated, and just had been too afraid to experience, there s now motivation for going there, and finding out that going there will be okay good things will come out of it.

16 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 16 Not only will he not die, but something is possible here. There s a lot of fuel for the whole therapeutic process that gets released through resonant, dyadic, and amplifying interactions. Because they re so alive, that can trigger the next level of trauma in a very organic way he s going to ride this wave for only so long before he hits something that s going to make him scared or afraid or that s going to be an association to the dark areas of his life In that way, it s an organic process. Dr. Buczynski: Can you back up or move to a meta-level and tell us theoretically where you re going to go with this person over time? Will it be ten sessions or how many will there be what is typical for you? Dr. Fosha: It really varies. It is accelerated, but it s not short term. It can take a year, sometimes longer, to really do the de-processing work. But your question was: Where does it go? What are we thinking about? Dr. Buczynski: Yes. What are you thinking about? Theoretically, what is your game plan or your blueprint for what you re going to be trying to do? Dr. Fosha: By going directly to the negative affects and also to the vitality of somebody who has been very suppressed and depressed each one of Each one of these interactions is going to lead to some aspect of unprocessed trauma. these interactions is going to lead to some aspect of unprocessed trauma or unresolved issues. If we can process those emotions, piece by piece, he s going to get his self back, so to speak, so that having a job or being effective in the world on his own behalf is really something that he can support. It s the sense that his emotional resources are not all going to containing fear and shame, or being too afraid that if he moves into the world, he s not going to be able to maintain whatever it is that is required, without getting humiliated or without having some really frightening experience that makes him then withdraw. Dr. Buczynski: I m hearing you say that as you work to resolve or just allow him to stay with some of his more powerful emotions and couple that with finding his resources and his strengths, he gets you didn t use the word unstuck but perhaps that s what happens. You said, He gets his self back. His emotional resources aren t all going just to coping with those feelings of Getting unstuck and getting the self back means that emotional responses can flow in real time. shame or fear or whatever. Dr. Fosha: Yes. You ve articulated it perfectly. Part of getting unstuck and getting the self back also means that emotional responses can flow in real time.

17 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 17 Life is hard life is really hard. If he does have a setback at work, or a critical boss, or he gets rejected by a girlfriend, that s life. Having emotions work helps us in the moment to deal with whatever gets thrown our way. These kinds of things evoke a lot of painful emotions in us, but he now has more capacity to experience those emotions in real time and be able to get over a rejection without going into the depths of depression for years on end. He can somehow, in real time, cope with the challenge, whatever it is... Having emotions and having them work helps us in the moment, in our lives, to deal with whatever good or bad that gets thrown our way. Revisiting the Trauma for Deeper Healing Dr. Buczynski: We don't have a lot of time left, but thinking about trauma, some people come to us because they ve had a recent traumatic event a rape, or a car accident. Some people are there for other reasons and they re recalling a traumatic event. From a theoretical perspective, are you going to revisit the trauma, or would you say, Well, that all depends on the patient? Dr. Fosha: The most rigorous answer is: It all depends. My inclination is to revisit the trauma particularly with traumatic experiences, whether in the recent past or in an early past I have done some treatments where that hasn t been a huge focus. I do have a bias: the more that you can work with these original, very energy-consuming traumas, the deeper the results and the deeper the healing. The more you can work with energy-consuming traumas, the deeper the healing. When done with all of these safeties in place it s not just going back into the trauma, which can be retraumatizing but it s going back into the trauma in a way that makes it very, very different. So fundamental to this is, You re not alone. No matter what else happens, this time around, whatever we re dealing with, you re not alone with it. That has a huge potential for reprocessing.

18 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 18 Dr. Buczynski: I can see where you come from an energy perspective where you re thinking about aliveness, and even here, where you talked about the energy-consuming traumas or experiences. That is an interesting way to put a medical perspective on it; a lot of what we do is to look for the energy and also the energy-consuming parts of a person s experiences. Dr. Fosha: Yes. That is very interesting and you have a lot of presentations by people who identify themselves as energy workers or energy healers. For me, doing this emotion attachment-based work has emerged organically. That seems to be what captures it it is descriptive, it feels right, and it is a force. Dr. Buczynski: That is the word the energy folks have adopted to think about what they do but really, what we were doing in the seventies and eighties with Fritz Perls, Wilhelm Reich, and Alexander Lowen was very energy-oriented. Everything was about aliveness and awareness. Very Buddhistically oriented in some ways. Very energy and present-oriented even though another whole school of thought has taken on the word energy. If you ve been around for a while and there are some advantages to having been around for a while you know that those are some interesting and good ideas that we have done for a long time. I am so sorry we have to stop here because I feel like we just scratched the surface of your work. I can see how powerful your approach is. I can imagine that people are very, very lucky to have you as a therapist. Dr. Fosha: Thank you. You have been a wonderful interviewer. It was a wonderful conversation. As we have said, it has gone by fast and we have just begun I want to thank you deeply for the engagement and the opportunity. Dr. Buczynski: Thanks a lot to you, too.

19 Finding Meaningful Change After Trauma: Unique Strengths of the Affect-Based Approach Diana Fosha, PhD - Main Session - pg. 19 About the speakers... Diana Fosha, PhD is the director of the AEDP Institute and the developer of AEDP, a healing-based, transformation-oriented model of psychotherapy. With a passionate interest in the phenomenology of transformational experience, Diana is on the cutting edge of transformational theory and practice. Changing how we think about change, she is opening up exciting possibilities for what can happen in psychotherapy. She is the editor, along with Dan Siegel and Marion Solomon, of The Healing Power of Emotion: Affective Neuroscience, Development, and Clinical Practice, which is part of Norton s Interpersonal Neurobiology Series. Ruth Buczynski, PhD has been combining her commitment to mind/body medicine with a savvy business model since As the founder and president of the National Institute for the Clinical Application of Behavioral Medicine, she s been a leader in bringing innovative training and professional development programs to thousands of health and mental health care practitioners throughout the world. Ruth has successfully sponsored distance-learning programs, teleseminars, and annual conferences for over 20 years. Now she s expanded into the cloud, where she s developed intelligent and thoughtfully researched webinars that continue to grow exponentially.