Diana Fosha: The Transformational Therapist

Tami Simon: You’re listening to Insights at the Edge.. Today my guest is Diana Fosha. Diana is the developer of AEDP—Accelerated Experiential Dynamic Psychotherapy—a healing-based, transformation-oriented model of psychotherapy. She’s also the founder and director of the AEDP Institute. Based in New York City, Diana is on the faculty of the Departments of Psychiatry and Psychology at NYU and St. Luke’s/Roosevelt Medical Centers.

With Sounds True, Diana Fosha is one of the featured presenters in Sounds True’s free online training summit called Psychotherapy 2.0 that will be taking place September 7–13, with two free broadcasts each day. Presenters in the series include Bessel van der Kolk, Richard Schwartz, Steven Hayes, Jack Kornfield, and Diana Fosha, who will be leading an online training on how to be a transformational therapist.

In this episode of Insights at the Edge, Diana and I spoke about the three pillars of AEDP and its distinctive features as a psychotherapeutic approach. We also talked about a central motto of AEDP, “Stay with it, and stay with me,” and how the work of AEDP helps clients “undo aloneness.” Finally, we talked about the role of the transformational therapist in our world today. Here’s my conversation with Diana Fosha:

Diana, to begin with, I would love it if you would be willing to share with our listeners a bit about your background and also the origin story, if you will, of AEDP.

Diana Fosha: Sure. It would be my pleasure to do so. In terms of my background—professional background— it starts with a psychoanalytic story. My initial training was psychodynamic; my clinical psychology graduate program, my doctoral program, was a program in—was a very, very strong psychoanalytic orientation, which—even though I’ve gone away from that in my current work—I think it served as a very, very strong foundation. I think of it as my study in the classics that prepared me for everything ahead.

From the psychodynamic, psychoanalytic initial training, the journey went to short-term dynamic psychotherapy. In a way, the origin of AEDP starts there—in the attempt to simultaneously preserve something about the intensity of the transformational phenomena that I encountered in that work—specifically in the work of Davanloo, but with a very, very different ethos in terms of the nature of the therapeutic relationship that helped those phenomena. That’s [it] in a nutshell—maybe overly succinctly, but that’s the origin of it.

TS: Why did you feel a need to develop a new therapeutic approach? I mean, that’s a big, bold move to make.

DF: Yes. I think that I didn’t set out to develop a brand-new therapeutic approach. In a way, I set out—or it became very, very important to me—to fill in what I felt [were] the gaps that I was experiencing in the model that I was working with, or in the experiences that I was having. They were several-fold, if that word exists. I think the first is what I started to talk about—that there was a power, a transformational power, in the kind of phenomena that were yielded by the intensive short-term dynamic psychotherapeutic work, Davanloo’s work. There were very powerful and drew me to that training to begin with, and that seemed extraordinarily important. That has remained a value that I have maintained over the years.

But, in terms of that approach, the nature of the confrontational relationship between therapist and patient didn’t sit well with me and it didn’t sit well with many therapists and also many patients. So, it became important, A) to be able to see if it was possible to create a work that gave rise to the same kind of powerful phenomena, but in the context of a relationship that was much more about being with rather than doing combat. So, I think that was one thing that was profoundly important to me.

The second thing that was very, very important to me was to have a coherent explanation for the phenomena that I was observing and seeking to evoke. The theory that was in that tradition was wholly inadequate—completely inadequate—to the transformational experiences that actually the work was evoking.

So, those were two very, very important impetuses or impeti for the development of my work. Then, really what started to happen was that—out of trying to theoretically account or to have a framework that did justice to those phenomena and my immersion in a whole literature that had to do with change processes and the current language of the day, which wasn’t a language of the ’90s, when I was developing this, about positive neuroplasticity. Really, what started to develop was a whole model, and there was just something about writing and trying to put it together coherently—and then, based on what I was finding, being in my office with my patients, paying attention to those phenomena, seeking. The kind of dialectical process between the clinical work and the attempt to explain it led to this kind of spiraling process that kept unfolding and developing. Before long, I had something of a model that used a very different explanatory framework than either psychoanalytic, psychodynamic thinking or the short-term dynamic psychotherapy. In that was really the birth of AEDP.

TS: For someone who is first hearing about AEDP right now, and they’re trying to dial in: “OK, help me understand, what is this therapeutic approach, and how is it different from other approaches?” Can you give them a kind of nutshell picture, if you will?

DF: I’d love to try! I think it has—right off the bat, there’s three things that come to mind that I would want to identify. The first is a fundamentally healing orientation—meaning being very oriented to phenomena of healing and growth and transformation within the individual rather than being focused on the psychopathology, and very much using that orientation or that detection of health and resilience and healing—even if in glimmer form—to orient and focus one’s clinical activities. So, that’s the first thing that I would say.

The second has to do with the nature of the therapeutic relationship and the degree to which it is modeled on a healthy caregiver-child relationship that gives rise to secure attachment. The implications being that there is something about the stance of the therapist that seeks to inspire, co-create conditions for safety by being actively engaged, welcoming, affirming—in other words, that not only are we going way beyond the stance of neutrality, but actually the therapist’s affective involvement is very important. So we’re going beyond neutrality, but we’re also going beyond presence and empathy of so many approaches that are resonant with AEDP by being—there’s a level of engagement and use of the self of the therapist in the co-creation of the relationship, and working with a patient’s experience of the therapeutic relationship that I think is rather specific and distinct about AEDP.

The third—and I’ll try to be succinct here as we sort of launch into it to begin with. The third has to do with the centrality of what we call “meta-processing” and working with transformational experience. That has been just a profound aspect of the work that’s based on a discovery. The discovery had to do with the fact that if one works or if therapists work and focus on not just seeking to facilitate transformation, but on the experience of change for the better as an experience—of focusing on transformation experience experientially—that in and of itself evokes a transformational process. I don’t know if I’m clear about that, but it is one of the most distinctive aspects of AEDP, and I think one of the aspects that contributes enormously to the transformational power that we seek to engender on a pretty systematic basis.

TS: Diana, let’s go into each of these three points, because I think they need a little bit of unpacking to make sure that our listeners are fully tracking with you. So, the first point you made—that AEDP focuses right from the beginning on this power that we have for healing and growth and transformation, and doesn’t focus in the same way as maybe some other psychotherapeutic approaches on psychopathology. So, if someone comes to you, does that mean that you’re not trying to diagnose, “Well, this is the problem, blah blah blah blah blah,” but you’re focusing on something else instead? Signs of health? Help me understand.

DF: Yes. I think that you bring several things into it, but I think the seeking to discover resources in resilience and capacity is an incredibly important goal of the initial consultation. It’s also something that we pay attention to throughout the therapy. But rather than being hyper-focused on, “What is the diagnosis?” or getting the lay of the land with respect to the psychopathology—that’s of course important, and that’s going to emerge in the course of the interaction and the discussion. After all, that’s why the person is there. But, somehow the focus on finding those glimmers of health and connection and resilience—and then reflecting them back to the patient and working with them experientially—is one of the things that we privileged.

One of the gorgeous consequences of this focus is that we take the patient by surprise, so to speak—or the patient’s unconscious by surprise, so to speak. There’s something about somebody getting themselves ready to do what’s necessary to be in a psychotherapeutic encounter—when they decide to do that, and in a way, almost like girding their loins about being ready to expose to a stranger something that’s so vulnerable or shameful, or someplace that they’ve gotten stuck, or something that’s really not working—just being able to tolerate that in the greater service of helping to relieve their suffering.

Actually, what comes back to them is not “You have failed,”—a reflection of the failure or the disturbance or of how much difficulty they’re having. But, what comes back in these moments of focusing on the healing is, “I am so struck by your courage,” or, “I am so struck by your capacity to be open and honest and so direct with me.” There’s something about that sense of being seen that shifts something about the nature of the relationship, and then shifts something in the nature of the patient’s experience so that when we actually go to the muck, when we go to the symptoms, when we go to the psychopathology, it’s already through a different lens, with a different set of resources on board.

TS: I can imagine a difficult or cynical client—patient—who—you know, the therapist says something like, “God, I see this glimmer of courage in you,” and they’re just like, “You know, come on, you’re pulling some kind of thing on me—‘Let’s accentuate the positive here.’ I feel terrible! That’s why I came to see you.”

DF: Right. “You say this to all your patients,” or, “Is that your schtick?”

TS: Yes, exactly. “I read a little bit about AEDP before I came in, and now this is what you’re saying to me? Come on.”

DF: Right. Which is very important, because we make the intervention—or I would make such an intervention—in the hope of genuinely reflecting and mirroring and helping the person really take in something important about themselves. But, it’s actually a powerful intervention that’s powerful in evoking either a deepening or a bringing up of something like resistance, or bringing up of the senses, much as you’re saying.

So, if somebody were to respond—and people certainly either drop down or have some kind of experience of being seen or feeling understood. Or, it evokes some sense of threat or disbelief, and [they] come back with something like what you said. I think that, again, my response could vary, but one of [them] would be to say, “I’m glad you’re being direct with me; I’m glad you’re telling me what you’re thinking. But I’m wondering, what’s your experience of me as you’re sitting here with me? Tell me more.”

I might shift it to their experience—what’s their sense of me with respect to them? That might be one intervention that I would make. I would validate the defense; I would not try to argue with their perception, but I would try to unfold it from there.

TS: Now Diana, I’m curious, how did you come to this principle, if you will, that focusing on these—you called them “glimmers”—is so healing and important in the psychotherapeutic process? How did you come to that?

DF: I think in part it was empirical. I think one of the things that is important to mention here is that the work is videotaped and I videotape all my sessions. I teach from a videotape, I supervise from my supervisees’ videotape of their sessions. When I was developing this work, I really spent a lot of time looking and videotape-tracking what was happening moment by moment, and seeking to pay attention to what works, and do more of that—[as well as] what doesn’t seem to work, or at least in my hands, and do less of that.

There was this observation that sometimes picking up on these small glimmers had a power that was disproportionate to their seeming size to begin with. In a way, it was just noticing that there was something about shifting figure and ground that shifted something in the patient. Then I became interested in this phenomenon and started to do it more systematically. And the more I did it, the more it seemed to yield a very powerful, very interesting set of phenomena that seemed to move it in the right direction.

TS: This idea of identifying these glimmers of strength in someone—even someone who might be complaining or in a difficult situation—part of me wonders: have you just tried doing this not in the therapeutic context, but just with people in everyday life? What kind of results [do] you get?

DF: Yes. Actually, today I’m coming from teaching a course. That was like some of the reflections of the participants—that this is not just a model of a specific way or set of interventions of doing therapy; in a way, it’s an orientation towards life or towards engagement. I have to say that in a way, I think I have tried to imitate myself as a therapist in my life outside of therapy sessions.

TS: Yes.

DF: I think that it’s the process—and again, different things with different people. But, there’s something about leading with a validation or leading with appreciation, or in the context of desperate situations, that has—I’ll give you an example.

I have a very dear friend who is currently in a very, very, very difficult life situation—very burdened by the care of an elderly mother alone, recently divorced, [and an] endless number of things. This is a person who is relatively depressive, depressed by nature. There’s something about listening to what she’s dealing with day by day that evokes hopelessness in her—a sense of hopelessness and futility and exhaustion. There’s a way in which it also evokes that in me.

And yet, when I said something to her about what a devoted daughter she is—that I am in awe (which is also true) at her commitment to being able to do her best to provide a certain quality of life for her ailing mother—a mother who has not been very good to her, incidentally—there was just something about that affirmation that for the first time brought a lightening to my friend, one that I hadn’t observed for weeks and weeks and weeks. In turn, that made me feel a little bit lighter than quite so burdened.

It’s just one example—and this is somebody who can be quite cynical, so it wasn’t clear to me that she wasn’t going to respond in some way—like your hypothetical patient—just saying, “Oh yeah, right, and a lot of good it’s doing me!” But it didn’t. And in part it didn’t because what I said was truthful. She does have an extraordinary devotion and commitment. So once I said it, it was said with sincerity. It wasn’t just a line or an attempt to manipulate the situation in a better direction.

TS: Just one more question about this first feature of AEDP before we move on, which is: I know in your work you talk about becoming what you call “a transformance detective.” This is part of what an AEDP therapist can do, and this word “transformance,” which you use in contrast to the idea of resistance and finding all those places in resistance. So, how do you work as a detective? What are you looking for to find the glimmer—“OK, I see it?”

DF: I think there’s so much experiential work in AEDP too. There’s a way of being present, and a way of listening, and a way of tracking that really tracks the subtle fluctuations that are sort of moment to moment—that is not just listening for the grand narrative scenes or looking for clusters or symptoms, or even necessarily clusters of qualities of resilience and so on and so forth. But, it’s really tracking the interaction between patient and therapist, and tracking the patient’s experience—of my own experience—in this kind of subtle, moment-to-moment way in which we’re always responding to each other.

There’s something about tracking these fluctuations and having learned something about what defines the glimmers of transformance, which is that they’re associated—invariably associated—with a sense of vitality or a sense of energy; and they’re positive that in the sense that if you stop the action—let’s say for instance, when you asked me about being a transformance detective, you’re not seeing my face because we’re talking on the telephone, but I don’t know if you heard a smile in my voice. Whether you heard it or not, I had a smile when you said that.

TS: I heard it right now; I just heard the smile, the little laugh and smile. So I just heard it. OK.

DF: Right? Upon hearing something like that, if you mirror it back and say, “Oh, so we’re talking, but I hear this smile, or I see this smile. What’s that like? What does that feel like?” Then I would be able to say, “Well, it sort of feels good. There’s something exciting or slightly pleasurable in our conversation. Right? It feels right or good to me.”

So, it’s not just in this particular case because it evoked a smile, which is a decidedly and obviously positive experience. For instance, sometimes it can be just a deepening, or a relaxation, or a big exhale, or a settling into a feeling—which can even be a potentially or possibly painful feeling. But at the same time, it feels right.

So, there’s something about the subjective experience of the individual who’s experiencing these little glimmers—and sometimes they’re little and sometimes they’re bigger—that they’ll tell you, invariably, that it feels good, or it feels right, or it feels true. These markers, these somatic markers, manifest in a brightening of the eyes, or in a relaxation of the shoulders, or in a deepening of the breathing, or any number of things. If you actually draw the person’s attention to them, what they’ll tell you is some version of, “It feels good,” or, “It feels right,” or, “It feels true.”

That’s really what we’re bringing in—that’s what I’m seeking to detect when I’m being a transformance detective, as well as the bigger qualities like courage in somebody who’s much more aware of being terrified. Or devotion—an unusually inspiring devotion in my friend, who was mainly aware of the burdens on her. That’s a big quality; that’s not just a little glimmer. But, it’s also just being on the lookout for, what those experiences [are], big or small.

TS: Yes. You’re activating the person’s vitality, courage, heartful devotion—whatever the quality is that you’re picking up the little glimmer of. Then by seeing it and saying it back to them, it’s like the glimmer becomes more like a fire, or something, because of your activation. That makes sense to me. That makes sense to me.

DF: That’s right. I appreciate that. Right.

TS: OK. Moving on to the second point you made about the unique emphasis in AEDP, you talked about the nature of the therapeutic relationship, and that the therapist is very actively engaged, beyond presence and empathy. And you said something else that I thought was really interesting: “Like a parent with a child, in order to create secure attachment for the client.” And I thought, “Really? Do I really want my therapist to be like my pretend parent? Really? Is that what I want, or do I want to go and see a therapist who I know is an adult in their own process, going through their own thing just like me?” So, I’m curious about that.

DF: I appreciate the opportunity to clarify that because I didn’t necessarily mean to—but in some ways I do, and in some ways I don’t. So, let me clarify.

The first sense in which I meant that the stance of the AEDP therapist is very much inspired by learning what parents of securely attached children do—or what kind of relationship they engender—and learning something about those qualities. I didn’t necessarily mean acting parental, but the capacity to listen, the capacity to respond to difficult feelings with the capacity to hold it rather than trying to shut it down or not being able to accept it—an ability to engage the spontaneous expression of delight in the child. It’s not a parental relationship like, “I’m going to treat you like a child and I’m going to do the ten million things that parents need to do with little children.” But, what are—maybe the best way to say it—what are the effective qualities of the parent who co-engenders secure attachment? Let’s try to bring those in the context of a relationship between two adults.

The other piece that you said is—the other piece that I realize, that I will own, because I started to say, “Well, it’s not an asymmetrical relationship.” There are aspects of the therapist’s stance or of the therapeutic relationship which I think are deeply symmetric in that here are two adults engaged in a process; they have different roles, but we’re two adults.

But, there are aspects of the process where I think there is an asymmetry. There’s something about the therapist being able to take the lead and set a tone and help when the person in the therapy is at a loss, or stuck, or feeling helpless, or feeling in some way unable to do something just through their own resources.

The lending of a hand—and I don’t mean at all parent-ified or the opposite, infantilizing, the adult patient—but a quality of taking the lead and saying, “OK, we have respective roles here, and you’re coming to me to consult me because I have something to offer you. If we’re meeting outside of my office, you might very well—I may look to you to do [something]. But in this context, when you’re in need, I will take the lead and help us navigate this process and direct us here or there as long as that seems to be necessary.”

TS: What do you think are the keys—from your experience with AEDP and the AEDP approach—to creating this sense of safety, and vulnerability, and, “Yes, I really feel I can fully share with you who I am?”

DF: I think a big aspect of this has something to do with acceptance, which counters shame. Pretty much no matter what the patient puts forth, including something cynical or skeptical or challenging, like in the example that you gave. But whether it’s that or whether it’s a feeling of helplessness, or a sense of stuck-ness—whatever it is, that I as a therapist am going to meet it with acceptance and some fundamental sense that even though it may feel very bad or it may in fact be somewhat inadequate to the person’s life circumstances and their difficulties, that it really reflects some reflection of best efforts.

It’s almost like what you learn when you‘re doing improvisational theater—that no matter what your improvisational partner says, you never say “No, but,” you always say “Yes, and,” no matter how ridiculous. There’s something about this “Yes, and,” that’s also fundamental to the attitude of or the stance of the therapist. Over time, the patient starts to get the idea. Again, they’re going to be met with acceptance whatever it is that they’re putting forth. There’s something about that that has this effect of undoing shame and starting to help people to be vulnerable and take risks, because they know they’re not going to be put aside and not be humiliated or rejected for it.

TS: Diana, you know, in doing some research about AEDP, I came across this motto, if you will, that seems to be part of how you present the work. Here’s what it is: “Stay with it, and stay with me,” in terms of helping a client work through a difficult, painful situation. As we’re talking about the relationship of the AEDP therapist, I wanted to talk about this motto a little bit, because first of all, I loved it—I thought it was very beautiful. “Stay with it and stay with me.” So, explain both parts of it—the “staying with it,” and then particularly I’m very interested in the “staying with me,” and how you help people do that.

DF: Thank you. I think the “stay with it” is really the motto, or a saying, of so many experiential therapies that basically urge the person to stay with this experience, and that through staying with it and being open to what happens as it changes or as it unfolds, there’s something about the process that’s important and will help. So, it’s “stay with it”—people who do Gestalt say “stay with it,” and people who do EMDR, and people who do somatic experiencing—really countless—these are just some that I’ve named off the top of my head. But, “stay with it” is really the mantra or the motto of experiential therapies and, as such, it is AEDP’s as well.

The piece that I think is specific to AEDP is “stay with me.” That basically says that as you’re going into this potentially healing but nevertheless potentially also painful or difficult or scary, risk-taking, vulnerable-making—what-will-you—experience, you’re not alone. Stay with it, but really stay with me. Keep me right with you, we’re in it together. I’m by your side. I’m accompanying you. I am witnessing it. I’m willing to help. So, “stay with me” really says, “Don’t lose the awareness. As you’re keeping awareness on your process, don’t lose the awareness that we’re in this together, that you’re not in this alone.”

TS: I think part of the reason I was so moved by this motto is that through my own spiritual work—somatic meditation—I was trained a lot in staying with it. I think a lot of people who do deep spiritual practice on their own come to a place where you have to learn—if you’re going to be in a yoga posture for a long, extended period of time, you’re going to learn how to stay with physical sensations that are uncomfortable. That kind of thing.

But then this second part, “stay with me,” that’s the part—personally—that has been so difficult and terrifying for me in my life. I’m curious to know how, when somebody is like, “You know, I just can’t—I can’t really do that,” or, “I can do that for ten seconds, but I don’t think I can do that for very long. I can stay with it, but I can’t stay with you. That’s too threatening.” How does the AEDP therapist work with that person so that they can do both—they can really stay with the therapist?

DF: Right. So, there are two things: one is prior to answering what you raised. I will answer the other, which is that—as you said, and I so appreciated you sharing something about your own experience—that very often those journeys which we seek are also terrifying. There’s something potentially about accompaniment that sometimes or in some people actually lessens the terror. There’s something about it that just allows being able to really tolerate what comes in a somewhat better way. I know I’m not alone.

Now, you’re raising a very interesting alternative to that, which is in a way the opposite—somebody for whom staying—they may be able to stay with “it,” whatever the experience is. But, that’s intrapsychic—that’s internal to themselves. But, there’s something about “stay with me,” the relational aspect, that’s absolutely terrifying.

If they were to say that, “I can stay with it, but I can’t stay with you,” then I—again, I would just validate that, that that’s so important. “Tell me what’s important about not staying with me,” or, “Tell me what’s scary or off-putting. I so appreciate your being able to say that.”

Then it’s about opening into what’s terrifying. For some people who have been so alone, there’s something so profoundly moving or reassuring about having contact. For other people who have been relationally traumatized, they’ve become very, very used to their own autonomy and self-reliance, but are quite terrified of contact because it’s associated with whatever trauma they suffered. So then, if the response to “stay with me” is, “But I don’t want to,” or “I can’t,” I think my response would be to deeply validate and welcome that, and see to what degree [we can] explore together what [it is] about “stay with me” that makes it off-limits or undesirable or too scary or too terrifying.

TS: Now, you talked about this idea of our aloneness, and one of the other aspects in my research about AEDP that really moved me was the idea that an emphasis in the approach is to help people—and you use this phrase—“undo aloneness.” I’d love to know how you came to that as an important goal, if you will, of AEDP psychotherapy.

DF: Right. Really, in a couple of ways. One of the things that seemed so fascinating is that thinking something to oneself and saying the very same thing to another person who is there, open, receptive, and listening, are two completely different experiences. The words may be identical, the idea may be identical, the thought may be identical, but the experience is so different, and there’s a quality that’s so often—there’s a richness and a meaningfulness and a transformative quality, almost, that happens in connection. That’s almost the flip side of the coin to what you’ve asked me.

But, I think it became so clear in listening to people’s stories of what the circumstances [are] that are traumatizing to them and what the features or conditions [are] that cause suffering. So much of it had to do with the sense of unwanted aloneness—not aloneness in the sense of the solitude that one seeks in some proactive way, but a kind of aloneness and isolation that was unwilled and was unwanted. This is such a profound, profound experience that one hears in stories over and over and over and over.

The sense of undoing aloneness really came out of one of the most traumatizing aspects of what makes certain situations [into] traumatic situations. In part, it’s the horrendousness of the experience, whatever it is, but there’s also something about going through such a disturbing experience without a sense of support or a sense of connection.

So, for instance, one of the things that we know is that in combat, soldiers who have a close buddy have lower rates of developing PTSD. Now, both buddies are exposed to the same risk and horrifying conditions and life-and-death combat situations, but there’s something about having a buddy that is a protective factor against the development of PTSD. Conversely, feeling alone in those kinds of terrifying situations heightens the risk of developing or feeling traumatized.

TS: Your presentation, Diana, as part of Sounds True’s Psychotherapy 2.0 online training summit, is on how to be a transformational therapist. Really, you could say that’s what we’re talking about when we talk about undoing aloneness and looking for transformance in a client. I’m curious to know, as we’re talking about this idea of “staying with it and staying with me”—staying with the transformational therapist—what do you think is the role, if you will, of the transformational therapist in society as a whole? I say that because at Sounds True, we’ve spent three decades really putting forward so many different spiritual teachings, and I think part of my draw to Sounds True hosting this Psychotherapy 2.0 training summit is that there’s some part of our healing as people that seems like it has to happen in relationship. I’m curious what your thoughts are about that.

DF: This is such a profound question that I really appreciate, and I appreciate that large perspective. In a way, I think that my own personal trajectory has been towards deepening—in a way, heightening the magnification powers of the microscope, if you will, and looking at smaller and smaller and smaller moments of behavior. So, you’re asking me, in a way, about the opposite—to go in the opposite direction, which is to go from the specifics of the moment-to-moment to something larger and outside of therapy. I think this quality of—whether it be listening or relatedness or connection—I think [it] does have so much to contribute to the world or to the relationships outside of therapy. This is not to be in any way simplistic and ignore so many other aspects, but so much of war or ethnic conflicts or what-have-you is so based on aggressive reactions in the face of fear or in the face of vulnerability or a sense of loss. At the moment that we’re able to connect as human beings with one another and be able to listen and empathize—whether the unit is therapist/patient or the couple or the family or different ethnic groups—there’s something about the process of deepening and listening that the qualities of being human come forth.

There was something that happened—I don’t know the story in super-great detail, but I believe it took place in the ‘90s in the context of the Arab/Israeli crisis. There was a Norwegian person whose name I’m not remembering—this was an article in the New Yorker that detailed a process whereby this peacemaker, or this person who hoped to play this role, really set about in a Palestinian/Israeli negotiation by inviting both sides to somebody’s home in a beautiful place in nature somewhere in Norway. The first day, the rule was that one couldn’t discuss politics; negotiations only started on the second day. People ate together, and walked together, and learned about each other as wives and sisters and grandparents and daughters, and so on and so forth.

What they ended up achieving at the negotiation table, which they engaged in on the second and third day—and pardon me if I’m not getting the details right; this was an article 15 years ago that made a huge impression on me. But in a way, that captures sort of what I’m trying to say. There was just something about the two sides not meeting as opposing factions, but really first the common ground of being humans and parents and children and spouses and friends, and relating to one another that way, and eating and walking, and being in a foreign country and taking something in, that created a degree of connection and human care—like, “I care that you’re here and your grandson is in the hospital in your respective country.” When it then came to the complex negotiations, something different was able to happen and they were successful in negotiating the particular set of issues.

That, to me, is a very powerful metaphor of accompaniment and undoing aloneness, and the capacity to be accepting and inviting until this sense of connection or resonance or empathy really is in the process. Then, the activity is profoundly changed.

TS: I want to just briefly touch on the third distinctive feature of AEDP, which you mentioned—which you described as “meta-processing,” particularly around transformational experience. So, if you could briefly unpack a little bit what you mean by that.

DF: I’d be honored to. I want just to give you an example. Let’s say that we’re working in therapy with anxiety or fear, and somebody who’s feeling sort of afraid and somewhat withdrawn. Through a therapeutic process, we’re able to deal with the fear or whatever emotion is underneath. Then, they get to a place, or you do a piece of trauma-processing. Then you come out the other side, where the individual is feeling more assertive or more confident or able to stand up tall. Now, that in and of itself is a lovely therapeutic result. However, for us, it’s a lovely result for one phase of the process, but it’s an entry point for the next phase of the process, where we’re going to process together what’s therapeutic about therapy, so to speak. That’s the meta-therapeutic processing: what’s it like to have a therapeutic experience?

So, in my example here, what is it like to have experienced this transformation from withdrawal and isolation to a place of confidence in your own capacities? That becomes the entry point. Or, what is it like for the two of us to have done this work together? As you stayed with it and stayed with me, what’s that like?

By actually focusing now on the positive experience of change and the positive experience of transformation, a whole series of—there’s a cascade of new emotions, transformational emotions, which, when worked with somatically—what’s that like in your body, what’s your experience of it—as well as reflectively—so it’s a right-brain left-brain integrative process—leads to more and more and more of these transformational affects and bringing yet a second transformational process to bear into the work. I don’t know if I described it clearly enough.

TS: I think so; I think I understand what you’re saying. That once I identify this experience of newfound strength or newfound confidence or I’m sitting up taller or whatever, then it’s not just happening, but I reflect on it happening, and that I’m reflecting on it further anchors it in my reference bank, if you will, of a newly embedded capacity that I have.

DF: Exactly! You expressed it so much more cogently than I did.

TS: No, that’s OK! You explained it well enough for me to understand it.

OK Diane, I just have two final questions for you. One thing I’m curious about is: here you’ve been working within this framework of AEDP that you’ve developed now for what? Twenty years?

DF: Yes. Yes, I think just about.

TS: I’m curious to know: are there any major questions that you’re asking yourself about this approach to therapy?

DF: Hmm. Can you do one more round of elaboration?

TS: Yes. Are you like, “Hmm, this is the question I’m wrestling with about how AEDP approaches therapy. This question, or that question. This is what I wrestle with.”

DF: Right. There are two, but I think I will focus on the second because I think it’s more in the spirit of what you’re asking. I think that one is that it’s ever-unfolding—it is how to make it better and deeper or more comprehensive. So, that’s one aspect of it.
But, I think the other aspect of it is what happens in those situations when leaning into the transformance or into the connection or into the resilience—all these things that we’ve been talking about, which I think is in fact profoundly transformational for many, many people—but not for everybody. Are there corners of the human psyche—corners of darkness or corners of recalcitrance—that are not accessible to being pursued or being explored or being revealed in this way? I think it has something to do with—from this very positively healing-oriented place—really revealing some of the aspects of negative experience that are just not quite touched by the transformational work without being addressed on their own terms, if you will. I think that the darker the motivation—towards some of the darker motivations as motivations, and not just as responses to hurt.

TS: That’s a very honest question, and I appreciate it. It’s interesting in this conversation that we’ve been having here—you’re in Manhattan, and I think that we’ve heard nothing less than four ambulances in the course of this hour. I was just thinking about that, because of all the violence in our time—as you talk about the potential limitations of any therapeutic approach, that sort of underscores that for me.

DF: Right. Right. My window is open, so there’s something about the sounds of the city being the objective or relative to that. Yes.

TS: OK, Diana: one final question for you, and this is a personal one. This program is called Insights at the Edge, and one of the things I’m always curious about is to know what someone’s personal edge is—what they’re working on in their own life and their personal life as part of their growth and development. I’m curious if you’d be willing to share that with our listeners and with me.

DF: I would love to respond in the same spirit in which you’re asking the question. I think for me, I really do think the edge has something to do with approaching my personal life with the same kind of mindfulness and orientation—as the sirens go again—with the same mindfulness and the same orientation that I have described to you. I think that’s the challenge of—for me—of meeting my significant others, my closest relationships—the most complex ones—in a way of the same generosity and the same challenge towards acceptance, and transcending some of the temptation of being smaller rather than bigger. That’s an edge.

TS: Diana Fosha, you’ve been so straightforward and honest with me, and I really appreciate it. I really appreciate learning more about AEDP. Thank you so much.

DF: Tami, I in turn am so grateful. I feel that your research into AEDP and my work has gotten to its essence in a way that made me feel seen, which I think allowed me to be able to be open and speak so openly. I felt very understood and felt my work honored in how you received it. So, I wanted to thank you for that very much.

TS: Thank you. I’ve been speaking with Diana Fosha. She’s one of the featured presenters in Sounds True’s upcoming online training summit, Psychotherapy 2.0. She’ll be giving a presentation as part of that training summit on how to be a transformational therapist. The summit takes place online September 7–13, with two free broadcasts each day. Presenters in the series include Bessel van der Kolk, Richard Schwartz, Steven Hayes, Jack Kornfield—and the entire series is hosted by Diane Poole Heller, who is a leading trainer of psychotherapists in the fields of attachment and trauma work. I’m so pleased that Sounds True is putting on Psychotherapy 2.0, September 7–13. SoundsTrue.com is your place for more information.

Thank you everyone. Thank you for listening. SoundsTrue.com: Many voices, one journey.

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