NP0015 21st-Century Trauma Treatment

This blog focuses on discussion regarding the course NP0015 21st-Century Trauma Treatment: The State of the Art.

NP0015, Trauma, Session 6, Diana Fosha

Discover an attachment-based approach to healing trauma founded in affective neuroscience with Diana Fosha, the developer of Accelerated Experiential-Dynamic Psychotherapy (AEDP). Learn how to build a relationship with clients as a trusted “True Other” and enlist clients in a process of dyadic affect regulation that’ll allow the client’s latent resilience to develop.

Afterward, please let us know what you think. Do you have any questions for the presenter? What was most interesting or relevant to you? We encourage you to include your name and hometown with your comment, and to take a few minutes to read and response to other participants’ comments. As always, if you have any technical questions or issues, please feel free to email support@psychotherapynetworker.org.

03.13.2012   Posted In: NP0015 21st-Century Trauma Treatment   By Psychotherapy Networker
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  • Not available avatar Jim Kubalewski 03.14.2012 13:10
    I was very suprised at how emotionally moving this experience was for me. I had expected to be intellectually educated, but I was also emotionally moved and more aware of my own tendencies to stay at a safe distance. I would like to congratulate the interviewer, Rich Simon and Diana Fosha for a great educational exprience.
    • Not available avatar Diana Fosha 03.15.2012 00:06
      Dear Jim.

      Lovely feedback to receive -- reassuring that genuine engagement comes across and trumps cyber-flattening. If your experience of this interview was both intellectually stimulating and emotionally moving, then indeed Rich and I did good. Thank you also for sharing something of your own process.
  • 0 avatar Eileen Epstein 03.14.2012 13:13
    Kudos to Rich and Diana. Such a lively and enriching interview! Diana, you really brought the energy of AEDP to the screen. Allowing Rich to experience the process in vivo was quite creative and powerful. Thank you.
    • Not available avatar Diana Fosha 03.15.2012 00:01
      You're very welcome Eileen. The receptive affective experience of taking in the kudos is itself enlivening and full of delight.

  • 0 avatar Catherine Putkowski-O'Brien 03.14.2012 13:14
    this was wonderful, just in time with a recent session with a complex PTSD client and shared high 5 moment in session yesterday following an odd awkward moment I never experienced before with this client. I "followed" my instinct to "explore" the high 5 moment which relieved both our anxiety and allowed progress forward. thank you. I will actively look for these moments in the future with all clients. Catherine
    • Not available avatar Diana Fosha 03.14.2012 23:51
      Hey Catherine,

      Thanx for sharing your experience of rapidly putting into practice both seizing a moment of transformance, and also then metaprocessing it. Being on the lookout for these moments and "working them" yields important resources and also strengthens the attachment bond.
  • Not available avatar Richard Clampitt 03.14.2012 13:50
    Great interview! Can you expand on the difference between productive emotions that you want to make explicit and unproductive emotions that you don't. Please make the implicit explicit for me.
    • Not available avatar Diana Fosha 03.14.2012 23:45
      Dear Richard,

      I am so pleased by your response to the interview -- and very much appreciate your making the language of AEDP your own by asking me to "make the implicit explicit" with respect to the difference between productive (or adaptive) emotions and emotions which are not productive. Or another way of putting it, the difference between emotions that ARE transforming, and emotions that NEED transforming. Adaptive emotions are those that are (i) wired in and (ii) when processed to completion, unleash resources and resilience. With holding and support, they are also regulated. For instance, the core categorical emotion of anger, when processed through to completion gives the individual access to empowerment, strength, and assertive energy which can be put to use on behalf of the self for protection, assertion, etc. On the other hand, emotions that are not productive or what in AEDP are called pathogenic affects are usually dysregulated and rarely pure: they are usually mixed in with fear and/or shame. There is no completion and there is no accessing of resources: to the contrary, focusing on experiencing pathogenic affects is often re-traumatizing, and if anything depleting to the individual. I go into this in some detail in my 2003 paper which I provided for you guys. it is also a theme I discuss in other papers (2004, 2005), which can be downloaded free of charge on the AEDP website, at www.aedpinstitute.com

      Nevertheless, i hope this begins to answer your very important question

  • Not available avatar Eva Berlander 03.15.2012 08:29
    Thank you both Diana and Rich. I can see that must things that you do I also do with clients - my couples. Tracking, slowing down, focusing on the things that works, creating safety etc.. It was great for me to strengthen (Is that how you say in English?)and to hear that what I do - also works for a such an experiences therapist like you. Thanks! (Couple therapist in Sweden)
    • Not available avatar Diana Fosha 03.18.2012 13:12
      Hi Eva

      So great that cyber communication undoes geographic distance. thanks for your thoughts and also your sharing your own work with couples. indeed, focusing on resilience, and " on what works" and then deepening it experientially [and then, a la AEDP, also METAPROCESSING that] is a very powerful way to work.
  • Not available avatar Lynn Mikkelsen 03.17.2012 19:27
    Hell Diana and Rich --- a very heartfelt and touching interview. Could you say a little more about the woman who after feeling your care, realized her mother was not there for her? Does AEDP begin the process of healing by helping clients notice what real connection feels like and then with that support, they are able to grieve issues such as abuse or abandonment by a parent? Does AEDP address grief in a special way? Thank you.
    • Not available avatar Diana Fosha 03.18.2012 13:45
      Hey Lynn,

      Thanx! So glad to receive your response.
      You asked to hear a bit more about the woman who, after feeling my care, realized that she had not been mothered. Here goes: While this woman and I had made a very good connection from the beginning, she always fought it, dousing in suspicion my affirmative responses to her, as well as my appreciation of her: she was wary that they were "technique." That's why the "high 5" moment was so great -- it snuck under the radar (and in fact we had done a lot of previous work on this isssue). She got in touch--fighting it all the way because of the deep grief the awareness causes-- with how she had no mothering to speak of. No protection, no tenderness, no care.
      You then write: "Does AEDP begin the process of healing by helping clients notice what real connection feels like and then with that support, they are able to grieve issues such as abuse or abandonment by a parent?" The answer is yes.
      In AEDP, we help clients notice AND we also seek to help clients experience the real therapeutic connection (when it is there), so indeed we are connection detectives from the get-go: once we find it, or glimmers of it, we seek to make the implicit explicit and the explicit experiential. That's how we work: indeed first with the real connection in the here-and-now.
      We also do the same thing with clients' resilience, or in AEDP language, transformance. And then we become transformance detectives. also from the get-go: once we find it, or glimmers of it, we seek to make the implicit explicit and the explicit experiential. Both of these activities are deeply resourcing and help and strengthen for the work ahead, when we will indeed work with grieving issues of abandonment, neglect, and abuse.
      So that's one mechanism, a general one of the action of AEDP. Another one is the example I used with the woman, when doing the work on good solid experiences in the here-and-now triggers, by contrast, an awareness and an experience of how terrible and different things were back then
      You also ask about whether AEDP has any special ways of working with grief. In AEDP work, that's state 2 work and a lot of it involves portrayals, as we focus on helping clients process grief, and process it to completion.
      However, there is another aspect of AEDP work with grief, and that is quintessential AEDP: in the course of doing the trauma work, a transformational process arises, sometimes in response to work on the deep and solid therapeutic relationship now, sometimes in response to trauma- and grief processing. In AEDP, we call this transformational process "mourning the self." When we experientially work with this, and process the emotional pain associated with mourning the self, out of this work rises a deep self-compassion. And as shame, and self-loathing and low self-regard are such huge issues for trauma and traumatic loss survivors, the development of compassion for the self is a profound therapeutic accomplishment.

      Thank you so much for your questions and the opportunity to share more deeply and explore some other aspects of AEDP's approach to treating deep attachment issues as well as trauma

      • Not available avatar Trisha Rowe 03.18.2012 23:12
        Hi Diana,
        What a treat to watch this interview between you and Rich.

        I wanted to go a little deeper into the wonderful articulation of working with grief that you gave to Lynn and productive/unproductive affects addressed in Rob's questions. While in the process of mourning the self I have had clients drop into what feels like a very crucial examination of their own roles of perpetuating similar experiences and relationships as they initially had with abusive/abandoning caregivers. This inquiry into the construction of their relational patterns feels really important in the shift from an identification as a victim in more current relationships and being able to feel more empowered, as well as really seeing the costs of their defenses. For a client I have in mind it was pivotal in feeling more self-efficacy and undoing the pathogenic patterns of her relationships. However, it felt so delicate and feels like a client could easily slip into a vortex of shame, self-blame, and anger directed at the self. I feel and witnessed that there was something deeply transforming that was unlocked when she looked truthfully and openly at the ways she was abandoning herself. She could tolerate going there with my support. I have used the relationship and parts work to work with this and other clients and we were able to move to a transformation in their assertiveness and undoing patterns and relationships that were not serving them, but I was wondering if there are additional ways to work with this? Each time it feels so edgy and on the brink of that vortex and a tightrope walk between productive and unproductive affects. This issue feels so important to me in working with trauma and attachment challenged people.
        Thanks so much in advance!!!
        • Not available avatar Diana Fosha 03.19.2012 22:41
          Hey Trish,

          You raise a powerful issue -- i think being able to help patients examine their role in perpetuating traumatizing relationships is hugely important and indeed a delicate balance. So often, therapists tend to shy away from these areas, using empathy to avoid the difficulties intrinsic to the situation you describe.
          And indeed, when we do venture forth and really support patients' exploration of this crucial area, it is, as you wrote, "edgy and on the brink of the vortex and a tightrope between productive and unproductive affects." Doing the work slowly tracking moment and moment and with the deep and active support for the therapist is essential. However, a tightrope is a tightrope, and it is not always possible to stay on.
          This is when AEDP's understanding of the process of attunement, disruption/rupture, and repair is so important, accompanied by the understanding that, if repaired, disruptions/ruptures are huge opportunities. Because of this tightrope and how easy it can be to temporarily fall off, people tend to stay away from grappling with these issues.
          The additional way is always learning from the faLL: process and metaprocess the rupture and its repair, that it was repaired, validating just how difficult this terrain is for both members of the dyad. I would work collaboratively with the patient, on what we might do differently next time we are walking the tightrope. And in the process, the patient and therapist working together together, connected though their bond, keep strengthening that bond through going through this stuff together AND coming out the other side. in the process, resilience is enhanced and the patient is more resourced for next time. So is the therapist, equipped with this knowledge.



  • Not available avatar Leslie 03.19.2012 14:03
    Diana, Wonderful listening to you. You make sense. I am working with a gentleman right now with combat trauma and early childhood trauma. I was a bit frustrated in the beginning because he seemed reluctant to share and I questioned what I was doing wrong. Why would he trust me, a perfect stranger, to let down his walls and make himself vulnerable. He recently shared that his walls are thick and tall and what happens if he allows himself to be vulnerable and then therapy ends one day? What does he do with having exposed himself and then I am no longer there? What a profound learning I had in that session and listening to you today. The relationship is so important. I am challenging his earlier trauma and no wonder that is scary for him. You have given me the language to explain what I was feeling and experiencing. I am looking forward to our next session. Thank you. Leslie
    • Not available avatar Diana Fosha 03.19.2012 22:23
      Hi Leslie

      Thanx so much for writing -- if so inclined, do let us know how next session goes, for it sure sounds like the last one with this gentleman was so very powerful -- for both of you, actually
      Warm regards
  • 0 avatar Marybeth Greifendorf 03.19.2012 18:48
    Hi Diana,
    This session was so rich-- I would love to watch it again and again! So many great ideas... "surprise the unconcious, sneak underneath the clients' defenses, see how what they're trying to accomplish is already there, stay with me, make the implicit explicit, undoing aloneness"-- the list goes on and on! Given that the therapeutic relationship is so important in trauma work, your model makes so much sense. I would love to "see you in action," even in a simulated situation. Do you have any videos available? I feel that this would really help me to incorporate these concepts into my work with all of my clients.

    Thank you!

    • Not available avatar Diana Fosha 03.19.2012 22:21
      Hi Marybeth--
      Thank you for your comments -- I in turn feel seen and heard. To date, there is one video of my clinical work which is available to the public, issued by APA -- you can get it through the AEDP website at www.aedpinstitute.com, or from APA itself:
      Fosha, D. (2006). Accelerated Experiential Dynamic Psychotherapy with Diana Fosha Ph.D. Systems of Psychotherapy APA Video Series # 4310759. www.apa.org/videos/4310759.html
      I also teach from clinical videotapes of sessions with actual patients -- and i am doing a bunch of trainings June & July, and then again in the fall. Again, the place to check these out is at the AEDP website, www.aedpinstitute.com
      Btw, if you have trouble getting through any of these links, you can contact our AEDP administrator, Ginny Vaughn at v.vaughn020@gmail.com
      all best,

  • Not available avatar cameron 09.10.2013 14:17
    I had a therapist who completed level 2 of your workshops. I was confused from day one by her intense identification with me. It felt like she was feeling my pain (though it's her own pain, triggered by what I had said).
    I told her after 5 sessions, "It feels like you love me, but you just met me".
    She didn't have anything to say in response to that.
    She often used the words like 'us', 'together' until I asked her to stop.
    There was no 'us' yet, this was in the first few sessions. It felt artificial, deliberate and strange.
    I need a relationship to develop gradually. I was very confused.
    My therapist asked me, "So how is all this care and compassion resonating with you?" Are you kiddng me? If I needed evidence that all this 'care' had been turned on like a water hose from the first second of our meeting, and had little to do with me personally, this was it.
    I need natural caring that develops over time, so that it feels specific to me.
    I don't need techniques.
    I struggled for a year and a half with this therapist, who was obviously hurt, angry and frustrated that I was resisting her. I told her that it was very painful that it felt like she loved me (in the beginning of therapy-trust me-that feeling ended, what DID develop naturally over time was her dislike of me.) She said, "I'm sorry that the way I work gave you that impression." I can assure you, I'm sorrier than you are.

    My therapist eventually, and very manipulatively, pushed me out of therapy.
    I will never trust another stranger with my heart and soul again.

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