Chloe is the 50-year-old daughter of well-known artists, both of whom were regularly featured in fashion magazines and lived a glamorous celebrity lifestyle. In her first session, she jokes about her true parents being a string of coat-check girls, bartenders, maître ds, and chauffeurs. “Once, my parents drank so much they left me in the back of a cab,” she says.
Chloe says she’s been in and out of therapy most of her life, mainly because she has difficulties managing her time and maintaining meaningful relationships. “I’ve always found it hard to do the everyday, ordinary things that other people have no problems with,” she says. “I try to go to the grocery store to buy healthy food, exercise, and go out to meet friends, but something always goes wrong: I buy the wrong foods, I say the wrong things. I just feel like I’m always swimming upstream. I’m 50. This shouldn’t be happening.”
Now, Chloe is living with an actor 10 years her junior. He moved in with her a few weeks after they met. “At first, he cooked for me and was really sweet, but now he’s out a lot at bars with the guys in his cast. I know he hates it when I cross-examine him. I worry that he’ll leave me, but I also don’t want to scare him away.”
Tracking Transformance
By Diana Fosha
As Chloe enters the room in a flurry of talking, I immediately attune to both her anxiety and her aliveness. Despite her scattered presentation, I’m struck by her capacity for metaphor (“swimming upstream”), her honesty and self-awareness, and most importantly, her courage in showing up for yet another therapeutic relationship despite repeated disappointments. This is transformance—the innate drive to heal—already at work.
In AEDP, a four-state model of the transformational process helps guide the therapist’s interventions. Although these states aren’t necessarily sequential, they serve as a “map” to orient therapists to their clients and where they are in the process. In State 1, the therapist privileges transformance while also seeking to undo aloneness, a term I use for the process of cocreating a safe, attuned relationship with a client that supports their healing and accompanies them on their journey. Because AEDP regards aloneness as the epicenter of emotional suffering, undoing aloneness precedes all other interventions. Clients feel accompanied as they take on the challenge of going to emotional places that were too scary and overwhelming to face alone.
In State 2, undoing aloneness allows embodied work with core emotions and relational experiences to unfold, with the therapist guiding the process toward a corrective emotional experience to heal trauma and emotional suffering. In States 3 and 4, the experience of the transformation that has just taken place is front and center: clients experience themselves in ways that are often new and surprising yet also true. Meta-therapeutic processing allows clients to integrate these positive shifts into their sense of self and thus gain access to clarity, calm, ease or compassion, as well as a sense of hope and wellbeing.
With Chloe, I keep this map in mind as we move through the process of our first session.
State 1: Privileging Transformance and Undoing Aloneness. “Chloe,” I start, “I’m struck by something. You say you’ve been ‘swimming upstream’ your whole life, that everyday things feel impossible—and yet here you are, 50 years old, having survived parents who were so lost in their celebrity world, they literally left you in a cab. That takes tremendous strength.”
I watch for her response, tracking it moment-to-moment, looking for those positive somatic-affective markers that will let me know she’s taking in my affirmation—perhaps a slight softening, a moment of surprise, a deeper breath. Or perhaps, some dismissive defenses arise. But even if the latter, I keep looking for the glimmers of transformance, or the innate drive to heal, and for even small signs of genuine emotion beneath her nonchalance about her neglect.
I continue, “What happens inside when I say that—that it takes strength to have survived what you survived?”
Chloe is a little surprised. “I . . . I never thought of it that way,” she responds. “I just thought I was a mess.
I lean in.
“Right there,” I say, “this sense of ‘I never thought of it that way’—what’s that like? Let’s pause for a moment. I see something shifting in your face.”
This is transformance detection in action. I’m not ignoring her pain but privileging the vitality and resilience that co-exist with it. When she mentions feeling like a “mess,” I don’t rush to fix or interpret or even explore. Instead, I stay with the emergence of this new healing-oriented perspective. There’ll be plenty of time ahead to explore the “mess” aspects of Chloe, but for now we have a precious here-and-now moment of opening.
As safety builds with our back-and-forth, some more glimmers of the resilience I’m affirming and reflecting back to her come online. I sense Chloe’s defended presentation giving way to underlying grief about the parents who were physically present but emotionally absent.
State 2: Undoing Aloneness and Experiential Work with Core Emotions. “Chloe, when you joke about coat-check girls and maître d’s being your true parents, underneath the humor, what’s there for the little girl who needed her actual parents to see her?” I ask.
If tears come, or anger, or even a deeper sadness, I stay with her. Chloe’s eyes fill with tears, which she tries to bat away. “Just let that come, Chloe,” I tell her. “You don’t have to be alone with this feeling anymore. I’m right here with you.”
This is undoing aloneness in real time. It’s not just a cognitive exercise; I’m offering my authentic emotional presence to help her be able to stay with and eventually experientially process with me what was too much for her to process alone as a child. I work with her grief. To do so, I use what in AEDP is called a portrayal: I ask her to imagine her feelings for little Chloe and what she’d wish to do if little Chloe, abandoned in a taxi, was here with her right now.
She speaks of wishing to hold and comfort little Chloe. I urge her to do so in imagination. As she does—and as we explore what adult Chloe is feeling holding little Chloe and what little Chloe is feeling, no longer alone in adult Chloe’s arms—there’s some relief within the portrayal: little Chloe can relax. We stay with Chloe’s growing compassion for little Chloe, and a bit for current day Chloe, too. Her breathing slows, and she looks different, perhaps lighter. She seems more relaxed, softer, more present.
After the wave of completed grief leads to the portrayal of inner care rather than abandonment, which in turn leads to Chloe looking lighter, more present and more relaxed, we then proceed to process Chloe’s experience of the change that has just occurred. In AEDP, we call this metatherapeutic processing, or metaprocessing for short: we systematically process the client’s experience of the therapeutic change that has just taken place as systematically as we processed the painful experiences of State 2. This ushers in State 3.
States 3 & 4: Metatherapeutic Processing and the Integration of Core State. “What are you aware of feeling right now, Chloe? Just check in with yourself,” I say. “Actually, lighter somehow,” Chloe says smiling and bit taken aback. “Like something I’ve been carrying just . . . lifted. At least for now.”
“Yes, I can see that too,” I say, smiling warmly. “What’s it like—this feeling of something lifting?”
“It’s nice. I feel more . . . here. More solid. But also weird or strange, like I don’t know what’s happening to me.”
“I get the weird or strange, because you’re not used to these feelings,” I tell her. “They’re so new. And you also said more solid. Can we be with that for a bit? What does ‘more solid’ feel like in your body?”
“Like I’m not floating away,” she says. “Like my feet are actually on the ground.”
“Wow, Chloe, that’s beautiful,” I say, moved. “Your feet on the ground. What’s it like to feel groundedness after all those years of swimming upstream?”
As we metaprocess Chloe’s emergent transformational experience, I watch for what else emerges—what comes is a sense of rightness, a deep example of the calm that announces the integration of State 4, or core state.
“It feels ,” Chloe says calmly, her expression still mildly quizzical, “like coming home to myself.”
“Coming home to yourself,” I echo. “Wow, that’s beautiful.” I let the silence hold this as we gaze at each other. “And what’s it like to share this moment of coming home with me?”
This relational metaprocessing helps her not only experience but know that transformation can happen in relationship. It’s a learning that good things can happen in connection, not only bad things. Now, in addition to the experience of feeling accompanied in her healing journey, Chloe can hear herself speaking of it, adding the representational to the experiential.
End of Session and Looking Forward
“You know what strikes me, Chloe?” I ask. “When you walked in today worried about your boyfriend leaving, about doing everything wrong, you were operating from that old template of the child whose parents were too busy being celebrities to really see her. But the woman I’m sitting with now [Chloe smiles widely at this], who just allowed herself to grieve, and to find the time to nurture her little inner child, and in the process, find her ground—she has choices about how to be in relationship.”
“I do feel different,” she says. “More . . . real somehow.”
By session’s end, we’ve moved from defended anxiety, with only little glimmers of transformance (State 1), through the grief work about emotional neglect and a corrective emotional experience of care and connection (State 2), into processing the transformational experience of feeling grounded and unburdened (State 3) toward a sense of authentic self (State 4).
Over the next few sessions, I’ll be on the look-out to see how this healing-oriented work manifests in Chloe’s increased capacity for self-assertion—perhaps setting clearer boundaries with her boyfriend, making choices from her own center rather than from fear of abandonment. Only after this foundation of self-worth and groundedness, buttressed by some corrective experiences and successes, is more established, would we turn to address the persistent day-to-day patterns that continue to plague her, such as the difficulties with time management, the self-sabotaging behaviors, and the relationship dynamics. But we’d now do so from a place of strength rather than a place of inadequacy and failure from repeated unsuccessful attempts at self-care.
The key throughout is tracking transformance, supporting her in experientially taking in my authentic presence so as to undo her aloneness, and helping her process painful emotions until corrective emotional experiences come aboard. And then, with change taking place in vivo, in the here-and-now, helping her metaprocess each moment of positive change to consolidate and amplify the emotional and relational healing already underway.
The Impacts of Addiction
My first impression of Chloe is that she lacks a strong sense of self. After hearing what brings her into therapy, and her description of her early childhood, I recognize that her previous therapy focused on current, present-day symptoms; it didn’t address underlying causes. At the same time, the fact that she keeps returning to therapy speaks to her motivation for change.
When she jokes about experiencing emotional abandonment as a child, I’m aware that humor is often a sign of resilience but can also hide pain. It’s often difficult for a child to see themselves as having been subject to traumatic stress when their basic needs for housing, food, and clothing were attended to, and when they didn’t experience blatant neglect or physical or sexual abuse. But emotional abandonment is a form of trauma—subtle, yet chronic.
Despite her ability to joke about being parented by non-caregivers like chauffeurs and coat check girls, my heart aches for this woman who grew up without a consistent, strong attachment to a caring adult. It’s likely that she internalized shame around beliefs around “lacking value,” “not being good enough,” or “there must be something wrong with me.”
It’s the job of parents to be available to their children, care for them, encourage and support them, and express their love. While Chloe’s parents may have felt love toward her, they were more preoccupied with their “celebrity” lifestyle than with parenting. Part of how I help Chloe reconnect with herself and her feelings is by inviting her to create a timeline of her childhood—a visual representation of emotionally impactful events. I ask her to note times in her life when she wanted her parents to be there for her and they were not. Chloe struggles with this, given that she’s quite disconnected from her emotional experiences. To support her, I ask her to visualize a young person who makes her smile when she sees or thinks of them. “Imagine this child having your same childhood experiences. How do you imagine that felt for her?” Finding compassion for another is often easier than finding it for oneself. Chloe’s ability to envision another child’s fear and loneliness helps her take a step in the direction of owning those feelings for herself.
Next, I ask her to note any feelings associated with the events she’s included as critical moments in her past when she felt forgotten or left behind. After that, I invite her to write down the ways she defended against experiencing those feelings. On her timeline where she noted being left in a cab, and the feelings of fear and loneliness that accompanied that experience, she writes down how she learned to minimize her feelings through humor and isolation.
Later, we can do additional timelines of Chloe’s other intimate relationships to see whether a pattern of relating emerges. We can also discuss who was available for her in healthy ways—family members, friends, coworkers, even if only for short periods. This process is about helping her recognize that she’s had healthy connections in addition to the ones that were lacking or unsatisfying. Remembering how healthy connection feels and identifying how these connections were similar to or different from her current relationship can bring additional clarity around what she wants and needs to feel loved and cared for.
As a clinician who specializes in addiction, I pay careful attention to the impact of substances and substance abuse on my clients’ lives. Chloe’s parents drank so much that they left her in the back of a cab in the middle of a bustling city when she was far too young to fend for herself. I notice that bartenders are included in her litany of others she experienced as “true parents.” In addition, her current partner drinks regularly to excess. All this encourages me to ask about her parents’ use of alcohol and drugs, and the way this impacted her. While Chloe doesn’t mention having any issue with substances, I make a point of asking her directly about her own substance use.
“I don’t drink or use drugs,” she says, her voice sounding surprisingly clear and strong. “I never have. I swore I’d never do what my parents did.”
And yet, having grown up in a world of glamorous couples, I suspect that Chloe may struggle with a less obvious form of addiction: always being in a romantic relationship. She tells me she was 13 when she had her first boyfriend and that she’s never not been involved with someone romantically. Yet despite always being in a relationship, not having a strong sense of herself has made it hard for her make healthy choices and relate to men in an emotionally intimate manner. As she shares about the struggles she’s facing now, I wonder whether it might be helpful to introduce Chloe to the love avoidance/addiction model.
Love addiction is a compulsive relationship cycle that appears to be intimate but is built on fantasy. In it, a partner wants the other person to be who they need them to be, but at the same time, they’re unable to communicate their feelings and needs directly or to share themselves vulnerably. As Chloe describes it, her most recent partner initially is kind and attends to her, then leaves her to be with his friends and drink. She doesn’t have a voice. “I worry that he’ll leave me. I don’t want to scare him away.” She’s frightened of being abandoned again. She’s still looking to be taken care of, to be told she has value.
Chloe isn’t just the pursuer in this romantic cycle, though. She has avoidant tendencies, too. She’s emotionally walled in and fearful of genuine intimacy. As long as she operates from a belief that she’s “not good enough,” she’ll try to avoid vulnerability out of fear that others will leave her, once they get to know her. She avoids being known by others to stave off rejection.
Once we’ve established a solid therapeutic alliance, I introduce inner-child and empty-chair processes into our work. This helps counter Chloe’s toxic beliefs about her own unworthiness, and shift some of the long-standing relationship dynamics that cause her pain. Working with her inner child is a way of helping her develop self-compassion. I’ve already introduced the concept of boundaries to support Chloe in beginning to distinguish between healthy, flexible boundaries and unhealthy rigid or nonexistent ones. We’ve started exploring how boundary distortion can contribute to situations that reactivate feelings of abandonment and contribute to her choices and behaviors in relationships, reinforcing a fragile sense of self. Since Chloe tells me she enjoys reading, I suggest she read a few books on boundaries and love addiction/love avoidance. She also finds journaling helpful, so I encourage her to focus on journaling daily about her feelings.
Chloe’s inability to attend to everyday tasks and follow through with desired interests could be due in part to emotional dysregulation. Having her engage in grounding and mindfulness practices in our therapy sessions provides her with a practical self-regulation tool. If I notice that her struggles with focus and organization continue over the course of treatment, I will provide her with a referral to formally assess for attention deficit disorder.
At the start of every session, I ask Chloe to acknowledge what she did or didn’t do since our last session that she’s found helpful. Beginning sessions with this question amplifies her motivation, but it also helps her develop the skill of self-validation. Gradually, she begins to feel less dependent on outward validation to feel good about herself and her “wins.”
Diana Fosha
Diana Fosha, PhD, is the developer of AEDP and editor of Undoing Aloneness & the Transformation of Suffering into Flourishing: AEDP 2.0. She is based in New York.
Claudia Black
Claudia Black, PhD, is a trauma and addictions specialist and author of numerous books, including “It Will Never Happen to Me.” She’s also the Clinical Architect of the Claudia Black Young Adult Center and Sr. fellow of The Meadows.
