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 www.aedpinstitute.com 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”

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, 496- 2013. Fosha, D. (2013). Speculations on emergence: Working the edge of transformational experience and neuroplasticity. International Neuropsychotherapy Magazine, 2013, 1 (1), 120-121. also in The Neuropsychotherapist, Issue I, www.theneuropsychotherapist.com. 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!] 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

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 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 switch1. 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, e-mail communication to AEDP Listserve, 2012.

© Fosha 2013 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

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 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

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 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 model- specific

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

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-at- worst phenomena

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), 120-121. also in The Neuropsychotherapist, Issue I, www.theneuropsychotherapist.com.

**Fosha, D. (2013). A heaven in a wild flower: Self, dissociation, and treatment in the context of the neurobiological core self. Psychoanalytic Inquiry, 33, 496- 2013.

**Gleiser, K. (2013, in press). Seeing the invisible: the role of recognition in healing from neglect and deprivation. Transformance: The AEDP Journal, volume 3. www.transformancejournal.com 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. 148-9).

“[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)

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

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; unique to the individual and emergent  sense of identity  agency, initiative  ownership of experience  behavioral coherence  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 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 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 Diana Fosha, Ph.D. AEDP: State of the Union Page 19

APPLIED INTERPERSONAL NEUROBIOLOGY

THE FELT CORE SELF: Positive3 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 re- organization 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 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”)

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”) 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. 83-92). 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, 383–390.

Fosha, D. (2013). A heaven in a wild flower: Self, dissociation, and treatment in the context of the neurobiological core self. Psychoanalytic Inquiry, 33, 496-2013. DOI: 10.108007351690.2013.815067

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, 1– 18.

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), 640– 647.

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. 140-152). New York: International Universities Press.

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 # 4310759. www.apa.org/videos/4310759.html 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 http://www.apa.org/pubs/videos/4310906.aspx

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, 71- 97. Fosha, D. (2001). The dyadic regulation of affect. Journal of Clinical Psychology/In Session, 57 (2), 227-242. 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), 7-15. 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, 105-116. 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. 309-344. 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. 221-281. 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, 30-43. Fosha, D. (2005). Emotion, true self, true other, core state: toward a clinical theory of affective change process. Psychoanalytic Review, 92 (4), 513-552. Fosha, D. (2006). Quantum transformation in trauma and treatment: Traversing the crisis of healing change. Journal of Clinical Psychology/In Session, 62(5), 569-583. Fosha, D. (2006/Winter). AEDP: Transformance in action. Connections & Reflections: The GAINS Quarterly, pp. 3-7. Fosha, D. (2007/Summer). "Good Spiraling:" The phenomenology of healing and the engendering of secure attachment in AEDP. Connections & Reflections: The GAINS Quarterly, pp. 3- 13. Fosha, D. (2008). Recognition, vitality, passion. And love. Constructivism in the Human Sciences, 12 , 57-77. 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. 290-320. New York: Routledge. 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. 172-203). 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. 43-56). 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. 252-261). 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). www.transformancejournal.com Fosha, D. (2013). Speculations on emergence: Working the edge of transformational experience and neuroplasticity. International Neuropsychotherapy Magazine, 2013, 1 (1), 120-121. also in The Neuropsychotherapist, Issue I, www.theneuropsychotherapist.com. Fosha, D. (2013). A heaven in a wild flower: Self, dissociation, and treatment in the context of the neurobiological core self. Psychoanalytic Inquiry, 33, 496-2013. DOI: 10.108007351690.2013.815067 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. 286-311. New York: Guilford Press. Fosha, D., & Slowiaczek, M. L. (1997). Techniques for accelerating dynamic psychotherapy. American Journal of Psychotherapy, 51, 229—251. 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. 165-184). 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. www.transformancejournal.com Gleiser, K., Ford, J. D., & Fosha, D. (2008). Exposure and experiential therapies for complex posttraumatic stress disorder. Psychotherapy: Theory, Research, Practice, Training, 45 (3), 340-360. 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. 90-111. 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). www.transformancejournal.com Harmon, K. L. & Lambert, M. J. (2012). The case of “Grace:” A commentary. 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), 123- 138. http://pcsp.libraries.rutgers.edu Harrison, R. L., & Westwood, M. J. (2009). Preventing vicarious traumatization of mental health therapists: Identifying protective practices. Psychotherapy: Theory, Research, Practice, Training, 46 (2), 203-219. 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. 21-43. New York: Guilford. Hill, R. & Dahlitz, M. (2013, in press). What’s hot in neuroscience for psychotherapy. Transformance: The AEDP Journal, volume 3. www.transformancejournal.com 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. 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). www.transformancejournal.com 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), 280-307. 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), 253-279. Mars, D. (2011). AEDP for Couples: From stuckness and reactivity to the felt experience of love. Transformance: The AEDP Journal, 1 (2). www.transformancejournal.com 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), 113-117. http://pcsp.libraries.rutgers.edu Ossefort-Russell (2011). Individuals grieve: AEDP as an effective approach for grief as a personal process. Transformance: The AEDP Journal, 1 (2). www.transformancejournal.com 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). www.transformancejournal.com

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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), 60-112. http://pcsp.libraries.rutgers.edu 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. 85-99. New York: Routledge. Prenn, N. (2010). How to set transformance into action: The AEDP protocol. Transformance: The AEDP Journal, 1 (1). www.transformancejournal.com Prenn, N. (2011). Mind the gap: AEDP interventions translating attachment theory into clinical practice. Journal of Psychotherapy Integration, 21 (3), 308-329. 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), www.transformancejournal.com 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), 167-190. 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. www.transformancejournal.com Tunnell, G. (2006). An affirmational approach to treating gay male couples. Group, 30 (2), 133-151. 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 (2nd Ed). New York: John Wiley.

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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), 109-136. Yeung, D. (2010). Transformance and the phenomenology of transformation: Self- transcendence as an aspect of core state. Transformance: The AEDP Journal, 1 (1). www.transformancejournal.com

Copyright © 2012 Diana Fosha Diana 2012 © Copyright 20120806 associated emotions; core needs; attachmentneeds; strivings. core emotions; associated their and states ego embodied states; self authentic pleasure; of experiences The mastery affects (e.g., pride, joy); emotional pain associated with associated pain emotional joy); affects pride, (e.g., mastery The drive to heal to drive the of manifestations strength; health, resilience, of Glimmers STATE TRANSFORMANCE 1: construct a coherent and cohesive autobiographical narrativeautobiographical cohesive and coherent a construct to capacity feeling"right“; things of flow,sense calm, the ease; clarity; kindness; generosity, wisdom, self-compassion; and compassion Openness; STATEMETAPROCESSING THE OF 3: TRANSFORMATIONALEXPERIENCE affectivesomatic experiences;“drop-down” intersubjective states; receptive experiences;attachmentrelational emotions; coordinated experiences;Categorical affects; the “click” of recognition) associated with new understanding newaffects; with associated the recognition) “click” of affectsthe and realization “yes!” “wow” the (e.g., self; the affirmationof the with affectsfeelinggratitude,moved)healing associated change; quantum the (e.g., of experience affectsthe tremulous with the associated mourning-the-self; The co-engendering of secure of co-engendering The H RNFRAINLPROCESS TRANSFORMATIONAL THE attachment and the positiveattachmentthe and STATE 2: THE PROCESSING OF EMOTIONALSTATEEXPERIENCE OF PROCESSING THE 2: The 4 States and 3 State 3 and States 4 The Transformations valuation of the self the of valuation TRANSFORMATION TRANSFORMATION TRANSFORMATION Co-creating safety Co-creating STATE 4: CORE STATE CORE STATE AND 4: THE SENSE TRUTH The emergence The SECOND STATESECOND THIRD STATETHIRD THE TRANSFORMATIONALAFFECTS FIRSTSTATE of resilience of openness, aliveness openness, vitality, Energy, signaling safety,shiftsignaling to readiness experience, to openness Announcing SIGNAL GREEN AFFECTS affectivecore of experienceGlimmers HERALDING AFFECTS: TRANSITIONAL AFFECTS ihe,etc lighter, Relief,feelingstronger,hope, POST-BREAKTHROUGH AFFECTS: ADAPTIVE ACTION TENDENCIES shame) anxiety,affects inhibiting g., (e. Defenses;affects;dysregulated SYMPTOMSAND DISTRESS, STRESS, STATE1:

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 EMOTION gestalt of each Self-Other-Emotion configuration

Security of attachment is relationship-dependent.

THE SELF-AT-WORST THE SELF-AT-BEST

COMPROMISED TRIGGERING EFFECTIVE REALISTIC SELF OTHER SELF OTHER

GREEN- DEFENSE RED-SIGNAL SOFT AFFECTS SIGNAL DEFENSES AFFECTS 7 1 4 0 3

1 EMOTION EMOTION 0 2 (PATHOGENIC AFFECTS (CORE AFFECTIVE & UNBEARABLE STATES PHENOMENA) OF ALONENESS)

THE TWO VERSIONS OF THE TRIANGLE OF EXPERIENCE

1a. SELF-AT-WORST FUNCTIONING—PSYCHOPATHOLOGY

DEFENSES RED-SIGNAL AFFECTS: against emotional anxiety, unease, trace experience; against amounts of pathogenic relational experience affects ENT ING CHM ARN TTA L LE ED A URA NIZ CED RGA PRO DISO E OR CUR Too much or too little INSE EMOTIONALLY access to emotional STIMULATING experience D EVENT YSR EGU EM LAT OTI ED ONA L EX PER IEN CES Does not lead to PATHOGENIC core affective experience AFFECTS

UNBEARABLE STATES OF ALONENESS

1b. SELF-AT-BEST FUNCTIONING—FLOURISHING

SOFT DEFENSES GREEN-SIGNAL AFFECTS Communication, delay, Hope, curiosity, willingness appropriateness to trust, to take risks

G RNIN L LEA URA CED NT PRO HME TTAC RE A Regulated access to SECU EMOTIONALLY emotional experience STIMULATING R EGU EVENT LAT EM ED OTI ONA L EX PER IEN CES CORE AFFECTIVE PHENOMENA

TRANSFORMATIONAL AFFECTS; ADAPTIVE ACTION TENDENCIES 7 1 4 0 3 1 0 2 CORE STATE THE TRIANGLE OF RELATIONAL COMPARISONS Its Interrelatedness With the Triangle of Experience and the Self-Other-Emotion Triangle

Current Therapeutic + OR - Relationship Relationship

SELF OTHER SO

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 20050619