AEDP: State of the Union

Transcription

1 AEDP: State of the Union A Presentation in Two Parts Part 1: What is AEDP? What we are, where we are, where we ve come from, and where we are going. Part 2: Beyond Safety, to Vitality and Truth The Neurobiological Core Self & Recognition in the AEDP treatment of Dissociation DIANA FOSHA, PH.D. October 18, 2013 For more on AEDP, visit us at

2 Diana Fosha, Ph.D. AEDP: State of the Union Page 2 The work that follows reflects the collaboration of the members of the AEDP Institute Faculty and community Diana Fosha, Director Anne Cooper Ron Frederick Kari Gleiser Jerry Lamagna Benjamin Lipton David Mars Jenna Osiason Karen Pando-Mars Natasha Prenn SueAnne Piliero Eileen Russell Steve Shapiro Barbara Suter Gil Tunnell Danny Yeung with thanks for significant contributions to: Ken Benau, Andrea Goldberg, Shigeru Iwakabe, Elizabeth Lehmann, Colette Linnihan, Heather MacDuffie, Miriam Marsolais, Carrie Ruggierri and all the wonderful members of the AEDP listserve and along with, to quote D. W. Winnicott, my patients, who paid to teach me

3 Diana Fosha, Ph.D. AEDP: State of the Union Page 3 Part 1: What is AEDP? What we are, where we are, where we ve come from, and where we are going. Some New AEDP references Hot off the press: Fosha, D. (2013). A heaven in a wild flower: Self, dissociation, and treatment in the context of the neurobiological core self. Psychoanalytic Inquiry, 33, Fosha, D. (2013). Speculations on emergence: Working the edge of transformational experience and neuroplasticity. International Neuropsychotherapy Magazine, 2013, 1 (1), also in The Neuropsychotherapist, Issue I, Fosha, D. (2013). Turbocharging the affects of healing and redressing the evolutionary tilt. In D. J. Siegel & Marion F. Solomon (Eds). Healing moments in psychotherapy. Chapter 8. New York: Norton. In press: Gleiser, K. (2013, in press). Seeing the invisible: the role of recognition in healing from neglect and deprivation. Transformance: The AEDP Journal, volume 3. Hill, R. & Dahlitz, M. (2013, in press). What s hot in neuroscience for psychotherapy. Transformance: The AEDP Journal, volume 3. Snyder, M. (2013, in press). Leaning into love: The radical shift. Transformance: The AEDP Journal, volume 3. Preview of coming attractions: Lamagna, J. (in preparation). Existing in one s own heart: Intra-relational experience and the harnessing of self-referential affective change processes in the treatment of complex trauma. [stay tuned!] Russell, E. (in preparation). Enhancing resilience: Transformative Therapy at Work. New York: Norton. [stay tuned!]

4 Diana Fosha, Ph.D. AEDP: State of the Union Page 4 AEDP 101 " The patient needs to have an experience, a new experience. And that experience should be to be good. From the first moment of the first contact, and throughout the treatment thereafter, the aim and method of AEDP is the provision and facilitation of such experiences" (Fosha, 2002). "The unit of intervention is not the therapist's comment, but the therapist's comment and the patient's response. What matters is the patient's experience of the intervention and her/his subsequent response... The only thing that matters is that the shifts in the patient's moment-to-moment experience be dynamically processed and empathically used to inform the therapist's next intervention" (Fosha, 2000, p. 214). Some AEDP Practice Guidelines be a transformance and transformation detective, on the lookout for glimmers of it promote patient safety, and therapist risk-taking undo the patient's aloneness in the face of overwhelming emotional experience notice, stay with, unpack make the implicit explicit, and make the explicit experiential. And thus turbocharge neuroplasticity entrain the self-at-best to work with self-at-worst nothing that feels bad is ever the last step: process to affective shift from negative to positive (always accompanied by positive affective/somatic markers) work to promote the patient's felt sense of existing in the heart and mind of the other, i.e., in your heart and mind

5 Diana Fosha, Ph.D. AEDP: State of the Union Page 5 WHAT WE PRIVILEGE, WHAT WE TRACK in AEDP glimmers of transformance: we are transformance detectives (and notice them side by side with manifestations of resistance) glimmers of resilience (and notice them side by side with manifestations of vulnerability and triggers) glimmers of transformation/healing/new & emergent/change for the better (and also notice everything that stands in their way) glimmers of (any of the constituents of) secure attachment and all the receptive affective experiences associated with giving and receiving attachment, care, empathy (and also notice everything that stands in their way) glimmers of positive affects associated with change for the better (and also notice everything that stands in their way) DYADIC MINDFULNESS: AEDP 301 Additions to Objects of Mindfulness and especially Dyadic Mindfulness, which in AEDP we call Metatherapeutic Processing: In AEDP, in addition to body, emotion, sensation, breath, we have some additional objects of mindful attention, especially dyadically mindful attention, which when experientially explored, constitutes its AEDP s GEMs, and the fundamental AEDP method of GEM-to-GEM tracking Transformance Receptive affective experiences, especially as the constituents of the secure attachment we are seeking to co-construct, dyadically explored Dyadic/relational experiences Experiences of transformation Fosha, 2011

6 Diana Fosha, Ph.D. AEDP: State of the Union Page 6 AFFECTIVE CHANGE PROCESSES, especially those privileged by AEDP (a non exhaustive list) The Experience and Expression of Categorical Emotions: processing emotion to transformation: the shift from negative to positive Shedding Defenses, Removing Blocks Explicit Experiential Work with Relational Experience the in vivo here-and-now experience of attachment right-brain-to-right-right communication (> 30 sec): gaze, contact, connection receptive affective experiences (attachment, care, empathy, recognition) positive intersubjective experiences: moments of meeting, contact, delight dyadic experiences of resonance; repair in the wake of a disruption of attunement and the re-establishment of a coordinated state Undoing Aloneness The shift from no to yes: flipping the switch 1. With digital circuitry when a switch changes from 'no' to 'yes', all circuits downstream have potential to change also. This is rapid electronically. But with feelings, it can be rapid or it can be a gradual cascade. Privileging Transformance Manifestations & New, Emergent Transformational Experiences, and amplifying positive experiences associated with change for the better The Empathic Reflection of the Self & the Experience of Recognition: recognition of experiences uniquely /idiosyncratically/ precisely salient to self; recognizing aspects of self experience: agency, will, desire, drive. [SRP (Panksepp s self-related processing)] Intra-Relational Work with Ego States: internal attachment work; processing the moment-to-moment experience of relatedness to self Somatic Focusing, Experiencing Metatherapeutic Processing of Transformational Experiences: : The affirmation of new, emergent, positive transformational experiences through alternating waves of experience and reflection on the experience 1 Courtesy of Heather MacDuffie, communication to AEDP Listserve, Fosha 2013

7 Diana Fosha, Ph.D. AEDP: State of the Union Page 7 WORK WITH THE RELATIONSHIP in AEDP Affective Change Processes Involving Relational Experience Explicit, Experiential Work with the Experience of Attachment: processing and working through, i.e., State 2 work, of attachment experience (adaptive and maladaptive aspects) Experiential Work with Receptive Experiences (empathy, attachment, care, recognition, transformation) Experiential Work with Moments of Positive Relational Experiences: moments of: meeting, soothing, seeing, understanding, helping, intersubjective contact, delight, repair, recognition The Experience of the Dyadic Coordination of Affective States: relational experiences of attunement, disruption and repair; and re-coordination Undoing Aloneness Intra-Relational Work with Ego States defense &/or processing work; internal attachment work; explicit focus on processing the moment to moment somatic/affective experience of relatedness to self Experiential Work with and the Affirmation of New, Emergent, Positive Relational Experiences: Metaprocessing Transformational Experiences Alternating waves of experience, with reflection on the experience, and the experience of the reflections leading to new emergent experience; then repeat the same process with new experience emerging from the transformational processing. There are many different aspects of transformational experience which are metaprocessed. Here I list some relational aspects of transformational experience and their metaprocessing (non-exhaustive list): what is it like to do this with me? what is it like to do this together? we ness exploration

8 Diana Fosha, Ph.D. AEDP: State of the Union Page 8 AEDP: Essentials in Emergence Transformation -- healing from the get go -- transformance based understanding of the phenomena of both change for the worse (psychopathology) and change for the better (transformation) -- articulation of multiple paths of transformation: affective change processes Undoing Aloneness -- centrality of aloneness in AEDP s conceptualization of the development of psychopathology AND centrality of undoing aloneness as a key element in AEDP s therapeutics -- attachment-based and intersubjectively engaged therapeutic stance: going being mirroring by being explicitly affirmative, validating, inviting, welcoming, explicitly emotionally engaged(empathic, delighted, concerned, willing to help) -- dyadic affect regulation Phenomenology of Transformational Experience Moment-to-moment tracking, phenomenologically guided & differential phenomenology to guide the work -- somatic affective markers of transformational experience and processes that feel right and are on track -- differential phenomenology of affects that need transforming vs. transforming affects Experiential work with experiences of emotion, self, attachment, relatedness and transformation -- articulation and definition of different aspects of relational experience (of both patient & therapist) -- expressive -- receptive -- dyadic -- experiential work with relational experience

9 Diana Fosha, Ph.D. AEDP: State of the Union Page 9 AEDP: Essentials in Emergence (cont d) -- articulation of many affective change processes and thus multiple paths for experiential transformational work -- different experiential techniques to gain rapid access to and process somatically based adaptive potentially transformative experience, the genuine, core affective experience characterizing the many affective change processes -- privileging the shift from negative to positive (from feeling bad to feeling good, from no to yes) that marks the transformation of previously overwhelming experience and the beginning of the active engagement of resilience and adaptive action tendencies previously also inaccessible Metatherapeutic Processing of New, Emergent, Positive Transformational Experiences -- key understanding: experientially processing transformational experience is transformational and unleashes a transformational process -- phenomenology of transformation -- different metatherapeutic processes with their characteristic transformational affects -- metatherapeutic processing: dialectical experiential and reflective techniques for working with transformational experience: -- metaprocessing: experiential & reflective techniques for working with in-the-moment change and the experience of change for the better, and with the positive affects that accompany change for the better, be it big or small -- emergence based understanding of transformational phenomena -- centrality of experiences guided by the sense of truth and the sense of things that feel right and true in the emergence of the experience of the essential self and the construction of an individual s coherent and cohesive autobiographical narrative

10 Diana Fosha, Ph.D. AEDP: State of the Union Page 10 AEDP: Hx The roots of AEDP and the crises that led to it a. psychoanalysis and the crisis of accountability and effectiveness b. STDP accountable and effective but crisis of aggressive stance and even more importantly its pathology oriented understanding of the phenomena of therapy, specifically understanding psychopathology as a reflection of the harsh superego s punishment of the self c. thus AEDP, reflecting its roots AND in response to the crises that gave rise to it -- accountable and effective -- affirmative validating stance of empathic, together with, engagement -- transformance-based, healing oriented understanding of the phenomena of both psychopathology and healing -- the crucial importance of positive affect in a transformational model the articulation of a phenomenology and a transformational theory... while its roots are psychodynamic (Davanloo, etc.), [AEDP s] heart is experiential and phenomenological (Ken Benau, AEDP listserve, July 2013) AEDP: In response to the crises that made it necessary articulated a. a theory and phenomenology of transformational experience; b. a theory and phenomenology rooting transformational experience in relational safety, i.e., attachment, resonance, recognition, intersubjectivity; and b. articulated its own specific path Neglected in other approaches, and building on and assuming the contributions of other approaches, these are the phenomena that AEDP privileged, leaned into and build its theory on: -- healing and transformance based phenomena -- attachment based stance, tive delight -- self-at-best manifestations -- the moment -- what s new, emergent & positive

11 Diana Fosha, Ph.D. AEDP: State of the Union Page 11 AEDP as transformational theory and AEDP as a specific model While AEDP s articulation of the phenomenology of the transformational process guides its own therapeutics, the phenomenology of the transformational process is not modelspecific Affective change processes Some phenomenological and experiential contributions -- transformance detection -- affective change processes -- dyadic affect regulation -- experiential work with attachment -- experiential work with the positive realm of relational experiencing -- experiential work with the receptive affective experiences -- positive affective somatic markers of transformational experience -- experiential processing to an affective shift -- an affective shift from negative to positive being an opportunity for metaprocessing -- metatherapeutic processing and the transformational spiral -- gaze up as marker of healing affects -- sense of truth as an affective market of core state -- the experience of recognition and the sense of things being right in the sense of self Reflecting its history and its own emergent transformational theory, AEDP Theory Biases -- healing and transformance based phenomena -- attachment based stance, sprinkled with intersubjective delight -- self-at-best manifestations -- the moment -- what s new, emergent & positive

12 Diana Fosha, Ph.D. AEDP: State of the Union Page 12 AEDP as a therapy (in contradistinction to as a transformational theory) need not the be-all and end-all However --and this is a big however-- AEDP does not claim that its path is the one and only path. Clinical phenomena and quandaries that AEDP thus defined doesn't apply to or address, e.g., defenses that don t melt, enactments, are a spur to a. engage the wisdom of all the other approaches that have something to say about it (and, from an AEDP perspective, be in dialectic conversation with them) b. developing and expanding AEDP theory and technique, e.g., Intra- Relational AEDP (AEDP I-R) Correcting for declared AEDP biases: The Other Side of the Dialectic. Entraining the Triangle of Comparisons -- self-a best AND self at worst, transformance AND resistance: there is self-at-best, but also the richness of phenomena are in the realm of self-at-worst -- there is the moment and not just the moment: and there history over time, the kaleidoscope of all the moments over time constituting the individual s history. the world in a grain of sand (Blake) but also the infinitude multitude of grains of sand, each different from the other (I am making an assumptions that grains of sand are like snowflakes) -- what s emergent and present, but not only what s emergent and present Areas of challenge to present day AEDP -- (in response to Andrea Goldberg and the discussion that ensued on the AEDP listserve:) transference/ countertransference phenomena, enactments -- especially, those experiences that evoke hatred and anger in the therapist (personal triggers, but also excluded truth) -- what to do when defenses don t melt, when self-at-best explorations meet walls, recalcitrance, and other self-atworst phenomena

13 Diana Fosha, Ph.D. AEDP: State of the Union Page 13 Part 2: BEYOND SAFETY, TO VITALITY AND TRUTH The Neurobiological Core Self & the Role of Recognition in the AEDP Treatment of Dissociation SOME RELEVANT AEDP REFERENCES to the topic at hand (references to developmental and neuroscience research at the end of the section) **Fosha, D. (2013). Speculations on emergence: Working the edge of transformational experience and neuroplasticity. International Neuropsychotherapy Magazine, 2013, 1 (1), also in The Neuropsychotherapist, Issue I, **Fosha, D. (2013). A heaven in a wild flower: Self, dissociation, and treatment in the context of the neurobiological core self. Psychoanalytic Inquiry, 33, **Gleiser, K. (2013, in press). Seeing the invisible: the role of recognition in healing from neglect and deprivation. Transformance: The AEDP Journal, volume 3.

14 Diana Fosha, Ph.D. AEDP: State of the Union Page 14 INTERPERSONAL NEUROBIOLOGY The Neurobiological Core SELF as Fundamental Integrator: Damasio, Panksepp The CNS in Emotion Regulation Ignoring the origins of things is always a risky matter (Edelman, 1992, p. 33) The core-self, i.e., the respective neural networks, provides primordial neural correlates that represent organisms as living creatures (Panksepp & Northoff, 2008; use of capitals in original). The True Self comes from the aliveness of the body tissues and the working of the body functions, including the heart s action and breathing. [It is] at he beginning, essentially not reactive to external stimuli, but primary (the True Self) collect[s] together the details of the experience of aliveness.. [and is] the summation of sensori-motor aliveness (Winnicott, 1960, p ). [The core self is] a dynamic collection of integrated neural processes, centered on the representation of the living body, that finds expression in a dynamic collection of integrated mental processes (Damasio, 2010, p. 9). the process, gradual or sudden, by which a self, hitherto divided becomes unified (William James, 1902, p. 171)

15 Diana Fosha, Ph.D. AEDP: State of the Union Page 15 INTERPERSONAL NEUROBIOLOGY The Neurobiological Core Self & Self-Related Processing (SPR) (cont d) The neurobiological SELF is constituted of the coordinated functioning of subcortical midline structures in conjunction with cortical midline structures (with the periaqueductal gray at the relay center, massive interconnections link upper brainstem regions to higher medial regions of the frontal and prefrontal cortices, and vice-versa) fundamental integrative function automatic, affective, and action-based coherence self-related processing (SRP) and the self-related valuation of stimuli seeking (motivation): drive (energy), direction, reward (dopamine) The Midline Structures of the NEUROBIOLOGICAL CORE SELF: Subcortical (Limbic) & Cortical: The coordinated functioning of subcortical midline structures in conjunction with cortical midline structures is what constitutes the neurobiological self periaqueductal gray superior colliculi brainstem region connect to medial regions of the prefrontal cortex medial regions of the frontal cortex The midline structures of the neurobiological core self have a bidirectional connection to and with insula anterior cingulate right hemisphere

16 Diana Fosha, Ph.D. AEDP: State of the Union Page 16 INTERPERSONAL NEUROBIOLOGY The Neurobiological Core Self & Self-Related Processing (SPR) (cont d) SOME QUALITIES OF THE NEUROBIOLOGICAL CORE SELF The self s activities are guided by self-related values, i.e., the values selectively accorded to environmental stimuli reflecting their salience to self and those values being both unique to the individual and emergent. coherence, organization drive, direction self-related values: the values selectively accorded to environmental stimuli reflecting their salience to self; and emergent sense of identity agency, initiative ownership of experience behavioral coherence unique to the individual viewing the world through the lens of self-related values felt sense of I guided by recognition processes The bidirectional coordination of subcortical and cortical midline structures that constitutes the neurobiological core SELF is manifested through the fundamentally integrated affective/cognitive processes that give rise to identity agency ownership of experience behavioral coherence TAGS OF THE NEUROBIOLOGICAL CORE SELF (see next page) the tag of coherence the tag of seeking the tag of recognition, and its marker: the click of recognition the tag of aliveness, vitality, energy Fosha, 2012, 2013

17 Diana Fosha, Ph.D. AEDP: State of the Union Page 17 INTERPERSONAL NEUROBIOLOGY The Neurobiological Core Self & Self-Related Processing (SPR) (cont d) The SEEKING SYSTEM in SRP (Panksepp, Northoff) The SEEKING system is the active explorer inside the brain (Panksepp, 2009, p. 9) This appetitive motivational system energizes the many engagements with the world as individuals seek goods from the environment as well as meaning from everyday occurrences of life. [It is] a system that energizes our intentions in actions. (Panksepp, 2009, p. 9) motivational system, reward system: dopamine mediated cued by the felt sense of recognition direction, drive fuel for life: neural energy, vitality pleasurable DOPAMINE, Fuel of the Seeking System Dopamine is the fuel of the self s seeking. Like oxytocin, dopamine flows in conditions of low stress and threat (MacDonald, 2012, personal communication). In facilitating environments, i.e., in transformance-based conditions, the seeking system of the neurobiological core self can come to the fore and epigenetically unfold. However, in affectively thwarting environments, where stress/threat are high, not regulated and thus cannot be rapidly metabolized (Schore, 2009), the combo of oxytocin and dopamine is supplanted by the neurotransmitters of stress management. 2 2 While dopamine and cortisol (the HPA axis) are inversely related, oxytocin and dopamine are congruent and positively correlated (MacDonald, 2012, personal communication). Fosha, 2012, 2013

18 Diana Fosha, Ph.D. AEDP: State of the Union Page 18 INTERPERSONAL NEUROBIOLOGY The Neurobiological Core Self & Self-Related Processing (SPR) (cont d) The Link with NEUROPLASTICITY (Doidge, Siegel) The qualities of pleasure and reward are essential features for processes that support neuroplasticity (Doidge, 2007; Siegel, 2010): pursuits that are rewarding and pleasurable become recursive appetitive processes, where more begets more and thus the brain changes (Fosha, 2009a, 2009b; Fredrickson, 2001,2009; Ghent, 2002). Vitality and energy are the affective/somatic markers of such processes. Manifestations of seeking, in conjunction with the self-related valuation of stimuli, are to be found in experiences of agency, initiative, enthusiasm, and drive (From Fosha, in press, p. 8 in manuscript) Manifesting neuroplasticity in clinical action transformance, positive affect, motivation/drive and energy are organically aligned (Fosha, 2010). Fosha, 2012, 2013

19 Diana Fosha, Ph.D. AEDP: State of the Union Page 19 APPLIED INTERPERSONAL NEUROBIOLOGY THE FELT CORE SELF: Positive 3 experiences of vitality, energy recognition meaning knowing, truth The felt core self. Deeply felt moments of personal truth, vitality, energy, agency, and coherence from a self-related perspective, spontaneously emerge at meaningful moments of existence; they are also a feature of core state, the state of calm and integration that is the culmination of the transformational process. Deeply pleasurable --again pleasurable not in the sense of happy, but in the sense of feeling deeply right and true-- at these moments, the individual has a sense that this is me. Metaprocessing the experience of such moments leads to further unfolding: both the felt sense of I and the this is me experience deepen, consolidate and becomes more textured. This is the felt core self: it is as close as we get to an instantiation of the neurobiological core self in actual experience. If the self that is evident at moments of self-at-best living is the diamond in the rough, the self that emerges in moments of core state experiencing, the felt core self, is a brilliant crystalline diamond, all facets sparkling, clean and sharp. Such moments allow us to directly witness, experience, and thus grasp the essence of core self though its phenomena and experiential manifestations. There is something in such moments that is orienting, organizing and transformational. A paradigm shift (Kuhn, 1970) takes place: there is a reorganization of self based on felt core self experiencing, which affects self in both feed-forward and feed-back mechanisms. There is a re-representation of everything in light of the new experience: it is this new self, so to speak, that will now define the lens through which self-related processing will proceed from this point forward, including how the past is viewed. 3 Where positive refers not necessarily to happy, but rather refers to experiences marked by a felt sense of feeling right, or true. Fosha, 2012, 2013

20 Diana Fosha, Ph.D. AEDP: State of the Union Page 20 ON RECOGNITION the Glimpse of the Core Recognition is the phenomenon through which we glimpse core self and truth prior to being in core state I see you. And I see and feel you, even before you see and feel yourself Recognition, via the self-related processing (see below) it evokes and is guided by, sometimes offers us a glimpse and sometimes more than a glimpse-- into experiences and fundamental understandings that we usually only have access to in core state: core self, truth, and the sense of knowing. The clouds part and there it all is. Recognition, i.e., re-cognition, is not a primarily left brain phenomenon, rather it is deeply integrative re-cognition probably involving one s own SRPs, as well as the pre-frontal cortex and the mirror neuron rich insula Guided by Truth & Recognition, SELF Comes to AEDP ( SELF Emerges from We )

21 Diana Fosha, Ph.D. AEDP: State of the Union Page 21 And so, we return to the beginning: there is dissociation, fragmentation, numbness and then there is the self and its tags and glimmers which one do we lean into, while keeping the other one in mind? IN CONCLUSION: We shall not cease from exploration And the end of all our exploring Will be to arrive where we started And know the place for the first time T. S. Eliot Little Gidding (No. 4 of Four Quartets )

22 Diana Fosha, Ph.D. AEDP: State of the Union Page 22 SOME REFERENCES for recent RESEARCH relevant to the NEUROBIOLOGICAL CORE SELF & DISSOCiATION Damasio, A. R. (2010). Self comes to mind: Constructing the conscious brain. New York: Pantheon Books. Doidge, N. (2007). The brain that changes itself: Stories of personal triumph from the frontiers of brain science. New York: Penguin Books. Dutra, L., Bianchi, B., Siegel, D. J., & Lyons-Ruth, K. (2009a). The relational context of dissociative phenomena. In P. F. Dell, & O'Neil, John (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond. (pp ). New York: Routledge. Dutra L., Bureau J-F., Holmes B., Lyubchik A., Lyons-Ruth K. (2009b). Quality of early care and childhood trauma: a prospective study of developmental pathways to dissociation. Journal of Nervous and Mental Disorders, 197, Fosha, D. (2013). A heaven in a wild flower: Self, dissociation, and treatment in the context of the neurobiological core self. Psychoanalytic Inquiry, 33, DOI: Lanius, R. A., Bluhm, R. L., Frewen, P. A. (2011) How understanding the neurobiology of complex post-traumatic stress disorder can inform clinical practice: a social cognitive and affective neuroscience approach. Acta Psychiatrica Scandinavica, Lanius, R. A., Vermetten, E., Loewenstein, R. J., Brand, B., Schmahl, C., Bremner, J. D., Spiegel, D. (2010) Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype. American Journal of Psychiatry, 167(6), Panksepp, J. (2009). Brain emotional systems and qualities of mental life: From animal models of affect to implications for therapeutics. In D. Fosha, D. J. Siegel & M. F. Solomon (Eds.), The healing power of emotion: Affective neuroscience, development, clinical practice. Chapter 1. New York: Norton. Panksepp, J & Northoff, G. (2008). The trans-species core SELF: The emergence of active cultural and neuro-ecological agents through self-related processing within subcortical-cortical midline networks. Winnicott, D. W. (1960/1965). Ego distortion in terms of true and false self. In The maturational processes and the facilitating environment (pp ). New York: International Universities Press.

23 Diana Fosha, Ph.D. AEDP: State of the Union Page 23 COMPREHENSIVE AEDP REFERENCES DVDs Fosha, D. (2006). Accelerated Experiential Dynamic Psychotherapy with Diana Fosha Ph.D. Systems of Psychotherapy APA Video Series # Fosha, D. (2013). Accelerated Experiential Dynamic Psychotherapy (AEDP) with a Male Client. with Diana Fosha Ph.D. Series II - Specific Treatments for Specific Populations APA Video Series BOOKS Fosha, D. (2000). The transforming power of affect: A model for accelerated change. New York: Basic Books. Fosha, D., Siegel, D. J., & Solomon, M. F. (Eds.), (2009). The healing power of emotion: Affective neuroscience, development & clinical practice. New York: Norton. Frederick, R. (2009). Living like you mean it: Use the wisdom and power of your emotions to get the life you really want. San Francisco, CA: Jossey-Bass. Russell, E. (in preparation). Enhancing resilience: Transformative Therapy at Work. New York: Norton. Yeung, D. & Cheung, C. (2008). The rainbow after: Psychological trauma and Accelerated Experiential Dynamic Psychotherapy. Hong Kong: Ming Fung Press. (in Chinese). BOOK CHAPTERS & JOURNAL ARTICLES Fosha, D. (2000). Meta-therapeutic processes and the affects of transformation: Affirmation and the healing affects. Journal of Psychotherapy Integration, 10, Fosha, D. (2001). The dyadic regulation of affect. Journal of Clinical Psychology/In Session, 57 (2),

24 Diana Fosha, Ph.D. AEDP: State of the Union Page 24 Fosha, D. (2001). Trauma reveals the roots of resilience. Special September 11th Issue. Constructivism in the Human Sciences, 6 (1 & 2), Fosha, D. (2001). Change: Emotion, body and relatedness. In A. Guerini, F. Osimo, & M. Bacciagaluppi (Eds.). Core Factors in Experiential Short-Term Dynamic Psychotherapy. Quaderni di Psichiatria Pratica, 17/18, Fosha, D. (2002). The activation of affective change processes in AEDP (Accelerated Experiential-Dynamic Psychotherapy). In J. J. Magnavita (Ed.). Comprehensive handbook of psychotherapy. Vol. 1: Psychodynamic and object relations psychotherapies, pp New York: John Wiley & Sons. Fosha, D. (2003). Dyadic regulation and experiential work with emotion and relatedness in trauma and disordered attachment. In M. F. Solomon & D. J. Siegel (Eds.). Healing trauma: Attachment, trauma, the brain and the mind, pp New York: Norton. Fosha, D. (2004). Nothing that feels bad is ever the last step: The role of positive emotions in experiential work with difficult emotional experiences. Special issue on Emotion, L. Greenberg (Ed.). Clinical Psychology and Psychotherapy, 11, Fosha, D. (2005). Emotion, true self, true other, core state: toward a clinical theory of affective change process. Psychoanalytic Review, 92 (4), Fosha, D. (2006). Quantum transformation in trauma and treatment: Traversing the crisis of healing change. Journal of Clinical Psychology/In Session, 62(5), Fosha, D. (2006/Winter). AEDP: Transformance in action. Connections & Reflections: The GAINS Quarterly, pp Fosha, D. (2007/Summer). "Good Spiraling:" The phenomenology of healing and the engendering of secure attachment in AEDP. Connections & Reflections: The GAINS Quarterly, pp Fosha, D. (2008). Recognition, vitality, passion. And love. Constructivism in the Human Sciences, 12, Fosha, D. (2008). Transformance, recognition of self by self, and effective action. In K. J. Schneider, (Ed.) Existential-integrative psychotherapy: Guideposts to the core of practice, pp New York: Routledge.

25 Diana Fosha, Ph.D. AEDP: State of the Union Page 25 Fosha D. (2009). Emotion and recognition at work: Energy, vitality, pleasure, truth, desire & the emergent phenomenology of transformational experience. In D. Fosha, D. J. Siegel & M. F. Solomon (Eds.), The healing power of emotion: Affective neuroscience, development, clinical practice (pp ). New York: Norton. Fosha, D. (2009). Healing attachment trauma with attachment ( and then some!). In M. Kerman (Ed.), Clinical pearls of wisdom: 21 leading therapists offer their key insights (pp ). New York: Norton. Fosha, D. (2009). Positive affects and the transformation of suffering into flourishing. W. C. Bushell, E. L. Olivo, & N. D. Theise (Eds.) Longevity, regeneration, and optimal health: Integrating Eastern and Western perspectives (pp ). New York: Annals of the New York Academy of Sciences. Fosha, D. (2010). Wired for healing: 13 ways of looking at AEDP. Transformance: The AEDP Journal, 1 (1). Fosha, D. (2013). Speculations on emergence: Working the edge of transformational experience and neuroplasticity. International Neuropsychotherapy Magazine, 2013, 1 (1), also in The Neuropsychotherapist, Issue I, Fosha, D. (2013). A heaven in a wild flower: Self, dissociation, and treatment in the context of the neurobiological core self. Psychoanalytic Inquiry, 33, DOI: Fosha, D. (2013). Turbocharging the affects of healing and redressing the evolutionary tilt. In D. J. Siegel & Marion F. Solomon (Eds). Healing moments in psychotherapy. Chapter 7. New York: Norton. Fosha, D., Paivio, S. C., Gleiser, K. & Ford, J. (2009). Experiential and emotion-focused therapy. In C. Courtois & J. D. Ford (Eds.), Complex Traumatic Stress Disorders: An Evidence-Based Clinician's Guide. Chapter 14, pp New York: Guilford Press. Fosha, D., & Slowiaczek, M. L. (1997). Techniques for accelerating dynamic psychotherapy. American Journal of Psychotherapy, 51,

26 Diana Fosha, Ph.D. AEDP: State of the Union Page 26 Fosha, D. & Yeung, D. (2006). AEDP exemplifies the seamless integration of emotional transformation and dyadic relatedness at work. In G. Stricker & J. Gold (Eds.), A casebook of integrative psychotherapy (pp ). Washington DC: APA Press. Gleiser, K. (2013, in press). Seeing the invisible: the role of recognition in healing from neglect and deprivation. Transformance: The AEDP Journal, volume 3. Gleiser, K., Ford, J. D., & Fosha, D. (2008). Exposure and experiential therapies for complex posttraumatic stress disorder. Psychotherapy: Theory, Research, Practice, Training, 45 (3), Greenan, D. (2010). Therapy with a gay male couple: An unlikely multisytemic integration. In Alan S. Gurman (Ed.), Clinical casebook of couple therapy. Chapter 5, pp New York: Guilford. Hanakawa, Y. (2011). Receiving loving gratitude: How a therapist s mindful embrace of a patient s gratitude facilitates transformance. Transformance: The AEDP Journal, 2 (1). Harmon, K. L. & Lambert, M. J. (2012). The case of Grace: A commentary. Commentary on Combining expressive writing with an affect- and attachmentfocused psychotherapeutic approach in the treatment of a single-incident trauma survivor: The case of "Grace." Pragmatic Case Studies in Psychotherapy, 8 (2), Harrison, R. L., & Westwood, M. J. (2009). Preventing vicarious traumatization of mental health therapists: Identifying protective practices. Psychotherapy: Theory, Research, Practice, Training, 46 (2), Hazlett, S. P. (2010). Attunement, disruption, and repair: The dance of self and other in emotionally focused couple therapy. In Alan S. Gurman (Ed.), Clinical casebook of couple therapy. Chapter 2, pp New York: Guilford. Hill, R. & Dahlitz, M. (2013, in press). What s hot in neuroscience for psychotherapy. Transformance: The AEDP Journal, volume 3. Hopper, E & Gleiser, K. (in preparation). Reaching across the abyss: Relational stance and relational strategies to heal from neglect and emotional abuse. In: E. Hopper, F.

27 Diana Fosha, Ph.D. AEDP: State of the Union Page 27 Grossman, J. Spinazzola, & Zucker, M.(Eds). A Yet Unnamed Book on Neglect and Emotional Abuse. Imming, J. (2011). The work of AEDP: Repair, growth & celebration. Transformance: The AEDP Journal, 2 (1). Johansson, R., Hesser, H., Ljótsson, B., Frederick, R. J., & Andersson G. (2013). Transdiagnostic, affect-focused, psychodynamic, guided self-help for depression and anxiety through the Internet: Study protocol for a randomized controlled trial. BMJ Open. Lamagna, J. (2011). Of the self, by the self, and for the self: An intra-relational perspective on intra-psychic attunement and psychological change. Journal of Psychotherapy Integration, 21 (3), Lamagna, J. (in preparation). Existing in one s own heart: Intra-relational experience and the harnessing of self-referential affective change processes in the treatment of complex trauma. Lipton, B. & Fosha, D. (2011). Attachment as a transformative process in AEDP: Operationalizing the intersection of attachment theory and affective neuroscience. Journal of Psychotherapy Integration, 21 (3), Mars, D. (2011). AEDP for Couples: From stuckness and reactivity to the felt experience of love. Transformance: The AEDP Journal, 1 (2). Messer, S. B. (2012). Assimilative and theoretical integration in the treatment of a trauma survivor. Commentary on Combining expressive writing with an affect- and attachment-focused psychotherapeutic approach in the treatment of a single-incident trauma survivor: The case of "Grace." Pragmatic Case Studies in Psychotherapy, 8 (2), Ossefort-Russell (2011). Individuals grieve: AEDP as an effective approach for grief as a personal process. Transformance: The AEDP Journal, 1 (2). Pando-Mars, K. (2011) Building attachment bonds in AEDP in the wake of neglect and abandonment: Through the lens and practice of AEDP, attachment and polyvagal theory. Transformance: The AEDP Journal, 1 (2).

28 Diana Fosha, Ph.D. AEDP: State of the Union Page 28 Pass, E. R. (2012). Combining expressive writing with an affect- and attachment-focused psychotherapeutic approach in the treatment of a single-incident trauma survivor: The case of "Grace." Pragmatic Case Studies in Psychotherapy, 8 (2), Prenn, N. (2009). I second that emotion! On self-disclosure and its metaprocessing. In A. Bloomgarden & R. B. Menutti, (Eds.), Psychotherapist revealed: Therapists speak about self-disclosure in psychotherapy. Chapter 6, pp New York: Routledge. Prenn, N. (2010). How to set transformance into action: The AEDP protocol. Transformance: The AEDP Journal, 1 (1). Prenn, N. (2011). Mind the gap: AEDP interventions translating attachment theory into clinical practice. Journal of Psychotherapy Integration, 21 (3), Piliero, S. (2004). Patients reflect upon their affect-focused, experiential psychotherapy: A retrospective study. Doctoral Dissertation. Adelphi University, New York. Ruggieri, C. (2011). Laura Hillenbrand: Author as True Other inspiring quantum resilience, Transformance: The AEDP Journal, 2 (1), Russell, E. & Fosha, D. (2008). Transformational affects and core state in AEDP: The emergence and consolidation of joy, hope, gratitude and confidence in the (solid goodness of the) self. Journal of Psychotherapy Integration. 18 (2), Schoettle, E. (2009). A qualitative study of the therapist's experience practicing Accelerated Experiential Dynamic Psychotherapy(AEDP): An exploration of the dyadic process from the clinician's perspective. Doctoral Dissertation. Wright Institute, Berkeley, CA. Snyder, M. (2013, in press). Leaning into love: The radical shift. Transformance: The AEDP Journal, volume 3. Tunnell, G. (2006). An affirmational approach to treating gay male couples. Group, 30 (2), Tunnell, G. (2006). Postscript 10 years after: The Oedipal Son revisited. In S. Minuchin, W-Y. Lee, & G. Simon (Eds.), Mastering family therapy: Journeys of growth and transformation (2 nd Ed). New York: John Wiley.

29 Diana Fosha, Ph.D. AEDP: State of the Union Page 29 Tunnell, G. (September 2010). AEDP for the common man: A review of Living Like You Mean It: Use the Wisdom and Power of your Emotions to Get the Life You Really Want (by Ronald J. Frederick, San Francisco: Jossey-Bass, 2009). Transformance: The AEDP Journal. Tunnell, G. (2011). An attachment perspective on the first interview. In C. Silverstein (Ed.), The Initial Psychotherapy Interview: A Gay Man Seeks Treatment. New York: Elsevier Insight Books. Recipient of 2011 Distinguished Book Award from American Psychological Association, Division 44. Tunnell, G. (2012). Gay male couple therapy: An attachment model. In J. J. Bigner & J. L. Wetchler (Eds.), Handbook of LGBT-affirmative couple and family Therapy. London: Routledge. Welling, H. (2012). Transformative emotional sequence: Towards a common principle of change. Journal of Psychotherapy Integration, 22 (2), Yeung, D. (2010). Transformance and the phenomenology of transformation: Selftranscendence as an aspect of core state. Transformance: The AEDP Journal, 1 (1).

30 THE TRANSFORMATIONAL PROCESS The 4 States and 3 State Transformations STATE 1: TRANSFORMANCE Glimmers of resilience, health, strength; manifestations of the drive to heal STATE 1: STRESS, DISTRESS, AND SYMPTOMS Defenses; dysregulated affects; inhibiting affects (e. g., anxiety, shame) FIRST STATE TRANSFORMATION Co-creating safety TRANSITIONAL AFFECTS HERALDING AFFECTS: Glimmers of core affective experience GREEN SIGNAL AFFECTS Announcing openness to experience, signaling safety, readiness to shift STATE 2: THE PROCESSING OF EMOTIONAL EXPERIENCE Categorical emotions; attachment experiences; coordinated relational experiences; receptive affective experiences; somatic drop-down states; intersubjective experiences of pleasure; authentic self states; embodied ego states and their associated emotions; core needs; attachment strivings. SECOND STATE TRANSFORMATION The emergence of resilience ADAPTIVE ACTION TENDENCIES POST-BREAKTHROUGH AFFECTS: Relief, hope, feeling stronger, lighter, etc STATE 3: THE METAPROCESSING OF TRANSFORMATIONAL EXPERIENCE THE TRANSFORMATIONAL AFFECTS The mastery affects (e.g., pride, joy); emotional pain associated with mourning-the-self; the tremulous affects associated with the experience of quantum change; the healing affects (e.g., gratitude, feeling moved) associated with the affirmation of the self; the realization affects (e.g., the yes! and wow affects; the click of recognition) associated with new understanding THIRD STATE TRANSFORMATION The co-engendering of secure attachment and the positive valuation of the self Energy, vitality, openness, aliveness STATE 4: CORE STATE AND THE TRUTH SENSE Openness; compassion and self-compassion; wisdom, generosity, kindness; clarity; calm, flow, ease; the sense of things feeling "right ; capacity to construct a coherent and cohesive autobiographical narrative Copyright 2012 Diana Fosha

31 THE SELF OTHER EMOTION TRIANGLE The Internal Working Model Enlarged to Include Emotion and its Regulation SELF-OTHER DYNAMIC INTERACTION SELF OTHER AFFECTIVE STATE associated with the gestalt of each Self-Other-Emotion configuration EMOTION Security of attachment is relationship-dependent. THE SELF-AT-WORST THE SELF-AT-BEST COMPROMISED SELF TRIGGERING OTHER EFFECTIVE SELF REALISTIC OTHER DEFENSE RED-SIGNAL AFFECTS SOFT DEFENSES GREEN- SIGNAL AFFECTS EMOTION (PATHOGENIC AFFECTS & UNBEARABLE STATES OF ALONENESS) EMOTION (CORE AFFECTIVE PHENOMENA)

32 THE TWO VERSIONS OF THE TRIANGLE OF EXPERIENCE 1a. SELF-AT-WORST FUNCTIONING PSYCHOPATHOLOGY EMOTIONALLY STIMULATING EVENT DEFENSES against emotional experience; against relational experience PROCEDURAL LEARNING INSECURE OR DISORGANIZED ATTACHMENT DYSREGULATED RED-SIGNAL AFFECTS: anxiety, unease, trace amounts of pathogenic affects Too much or too little access to emotional experience Does not lead to core affective experience EMOTIONAL EXPERIENCES PATHOGENIC AFFECTS UNBEARABLE STATES OF ALONENESS 1b. SELF-AT-BEST FUNCTIONING FLOURISHING SOFT DEFENSES Communication, delay, appropriateness GREEN-SIGNAL AFFECTS Hope, curiosity, willingness to trust, to take risks EMOTIONALLY STIMULATING EVENT PROCEDURALLEARNING SECUREATTACHMENT REGULATED EMOTIONAL EXPERIENCES Regulated access to emotional experience CORE AFFECTIVE PHENOMENA TRANSFORMATIONAL AFFECTS; ADAPTIVE ACTION TENDENCIES CORE STATE

33 THE TRIANGLE OF RELATIONAL COMPARISONS Its Interrelatedness With the Triangle of Experience and the Self-Other-Emotion Triangle Current Relationship + OR - Therapeutic Relationship SELF OTHER S O D SA Defense Signal Affect EMOTION EMOTION + OR - + OR - S O D SA E Past Relationships TRIANGLE OF RELATIONAL COMPARISONS C Current relationships T Therapeutic relationships P Past relationships SELF OTHER EMOTION TRIANGLE (Self-at-Worst or Self-at-Best) S Self O Other E Emotion TRIANGLE OF EXPERINCE D Defense SA Signal affects (Red or Green) E Emotion