Point of View

The Alphabet Soup

Diana Fosha on the Convergence in Today’s Therapies

Magazine Issue
September/October 2011
The Alphabet Soup

DBT, ACT, IFS, EMDR, SE . . . We seem to have entered The Acronymic Era of psychotherapy. In today’s profusion of therapeutic models, with all their own particularities, there also seems to be many common assumptions about change, consciousness, biology, and the therapeutic relationship. These days, the approaches that generate the most discussion, each in their own way, try to incorporate a core group of new ideas that have emerged in the field over the last decade—about mindfulness, the use of somatic resources, Positive Psychology, brain research, and the nonverbal dimension of the therapeutic relationship. As various modalities borrow effective techniques and concepts from one another, we seem to be forming a common therapeutic language, a postmodern dialect of healing.

Nowhere is this more apparent than in AEDP—Accelerated Experiential Dynamic Psychotherapy—a modality developed by Diana Fosha, a Romanian-born psychologist trained at Columbia, Cornell, and The City University of New York. Her most recent book, The Healing Power of Emotion (coedited with Daniel Siegel and Marion Solomon), was praised by Daniel Stern as “A masterful, panoramic view of emotion.” Fosha lectures around the world, writes, supervises, and maintains her private practice in New York City. In the following conversation, she offers her perspective on how Freud’s “talking cure” has both changed and remained the same during this latest stage of psychotherapy’s evolution.


RH: In AEDP, I notice hints of Positive Psychology, solution-focused therapy, ACT, mindfulness, Gestalt. . . .

FOSHA: Yeah, keep going . . . there are lots of other approaches you could mention.

RH: Why is there so much overlap among different therapy models today?

FOSHA: All of these models of psychotherapy use different lenses to look at the same fundamental neurobiology of human experience. So the convergence of methods that we’re seeing comes from looking at the world using a Gestalt lens, or a solution-focused lens, or an AEDP lens, and isn’t so surprising.

RH: How is the new “convergence of methods” or “procedural convergence” any different than good old-fashioned eclecticism?

FOSHA: Eclecticism is a little bit like stew—you bring a little from here and a little from there. What we’re seeing in psychotherapy today is more like a bunch of different chefs agreeing on the value of certain common natural ingredients and then going off to come up with dishes that are different in many ways, but also have many similarities.

RH: The question for many therapists confronted with all these different-sounding therapy models is distinguishing between what’s really new and what’s simply old wine in new bottles. How is AEDP new wine?

FOSHA: To my mind, one of the most original aspects of AEDP is what I’ve called “meta-therapeutic processing”—closely and explicitly exploring the patient’s actual experience of transformation, especially when some positive change occurs. At these moments in AEDP, the therapist and patient pause to process what’s happening together, rather than taking what just happened for granted and moving on to something else too quickly. We try to make the patient’s new experience the focus of mindful reflection. Metatherapeutic processing supports the integration of the new change experience into the person’s sense of self, and also underlies the development of resilience and flourishing.

RH: How does this help the client?

FOSHA: Let’s say a client’s depression lifts, or she resolves some piece of her trauma history, or her anxiety diminishes, or she feels understood in a new way. Usually, we proceed in therapy as if that’s a good thing, which it certainly is, but we now need to move on to focus on the next issue. In AEDP, rather than being an endpoint, that experience of change is treated as an entry point into the next round of processing.

The therapist might say, “So, what’s it like for you to feel strong and clear? What’s it like for you to have your depression lift? What’s it like for you to feel vitality in your body?” This kind of metatherapeutic processing explores what’s therapeutic about the patient’s therapeutic experience and is a way of applying mindfulness to the actual experience of change. “Dyadic mindfulness” refers to mindfulness of both patient and therapist applied to their co-constructed interaction, which can also support healthy intimacy and closeness in the patient’s other relationships.

RH: Can you describe AEDP’s concept of transformance?

FOSHA: People often come into therapy traumatized, depressed, nervous wrecks; their relationships are in shambles, and their work is falling apart. They’re usually starting off with us in a terrible place, and it’s easy to focus on pathology. But at the same time, if you look closely, there are always glimmers of health, strength, and resilience, which is what we focus on in AEDP. That’s the idea of transformance—inside every individual, there’s a force that strives for healing and growth and self-repair. That force manifests in the motivation toward vitality, authenticity, and genuine contact, even in the face of trauma. It should never be overlooked, as it’s a huge ally in fostering therapeutic change from the get-go and throughout the therapy process.

RH: Even in our pain, there’s something in us reaching out.

FOSHA: Yes. Too often, therapists tend to ignore patients’ striving for growth and healing. The people who ask us for help are listening to that drive. Otherwise, they wouldn’t pick up that phone to make the appointment with the belief that something can change.

RH: I’m intrigued by this quote from your book: “Assumptions about the fragility of patients are often rationalizations for ineffective technique.” Can you explain?

FOSHA: I was initially trained in a psychoanalytic model in which the nondirective stance ruled. There was so much concern about the patient’s fragility or about doing damage with a premature interpretation or intervention that treatment often became unnecessarily prolonged. I believe our patients are often much more resilient than we might think, and we shouldn’t proceed on untested assumptions about their fragility.

I teach that the main unit of intervention isn’t what the therapist says or does, but rather what the therapist says or does and the patient’s response to it. If the patient’s response indicates fragility, then we work with that, based on the evidence we’ve just obtained; if the patient’s response gives us a green light, we proceed. That’s why the moment-to-moment tracking of experience is such a crucial part of AEDP.

RH: Let’s say a man comes to therapy and says he’s felt numb since his divorce a year ago. What would be some initial thoughts from an AEDP perspective?

FOSHA: Again, no thoughts! I have a colleague who jokes that you don’t have to be very smart to do AEDP because you don’t have to know anything! It’s true. You don’t have to be clever. But, of course, it’s not that I don’t have any thoughts—I may have 10 million. It’s that my thoughts don’t matter, since there’s so much going on inside the patient at any given moment. The right brain, the limbic system, and the autonomic nervous system all have minds of their own, so to speak. My interest is in how my patient’s experience is organized, and my job is to create conditions that’ll allow that unique organization of experience to reveal itself.

RH: So what might you say to this numbed patient?

FOSHA: I’d ask him to tell me about a specific, concrete example of a moment from his divorce or something that sticks out in his mind, and then explore with him what it feels like to tell me about this experience, what he feels in his body, and what he notices. From there, we could see where this exploration of his internal experience takes us and what it may have to do with the divorce or his numbness. As an AEDP therapist, I’m always on a mission of discovery with the patient, and we’re both finding things out for the first time. That process of discovery is so much more interesting than any hypotheses I might have.

RH: Your description of therapy reminds me of Irv Yalom’s idea of the therapist as a fellow traveler.

FOSHA: In a way. My phrase is “undoing aloneness”—the notion that the dyadic regulation of emotion is fundamental to the experience of good therapy. As therapists, we need to play different roles at different phases of the process. Sometimes you’re there as a companion and, at other times, a facilitator—all are aspects of “undoing aloneness.”

So much of what gets called psychopathology is just being overwhelmed by big emotions and feeling terribly alone in the world. There’s something about being together with someone who’s going to share it with you and lend a helping hand that can change the situation in a profound way.

Ryan Howes

Ryan Howes, Ph.D., ABPP is a Pasadena, California-based psychologist, musician, and author of the “Mental Health Journal for Men.” Learn more at ryanhowes.net.