Lecture 8 accelerated experiential dynamic psychotherapy (adep)

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Lecture 8 of 10 on Complex trauma.
Focus is on person centred / emotion processing models

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Lecture 8 accelerated experiential dynamic psychotherapy (adep)

  1. 1. Lecture 8: Accelerated experiential dynamic psychotherapy (AEDP) Complex Casework Kevin Standish 1
  2. 2. Learning Outcomes This lecture is based on: Fosha, D.; Paivio, S.; Gleiser, K.; & Ford, J. (2009) Experiential and Emotion Focused Therapy found in Courtis, C. & Ford, J. Treating Complex Traumatic Stress Disorders . London. Guildford Press. 2
  3. 3. Learning Outcomes 1. Rationale for experiential approach to the treatment of complex trauma 2. Accelerated experiential dynamic psychotherapy (ADEP) 3
  4. 4. Rationale for experiential approach to the treatment of complex trauma 1. Living a life of vitality, resilience and human connectedness in the face of adversity requires ready access to emotional experience. 2. access to basic emotions is necessary to be able to harness adaptive responses, as well as relying on others to help bolster these coping resources 3. experiential psychotherapies are designed to systematically assist people in enhancing the ability to access emotions and the psychosocial resources linked to emotions 4
  5. 5. Rationale for experiential approach to the treatment of complex trauma 1. Trauma fundamentally is a threat to self integrity 2. Coping following trauma is characterised by a preoccupation with avoiding danger at all costs and is dedicated to avoiding trauma cues 3. This is achieved through the avoidance of people, places activities as well as thoughts and emotions 4. Also through isolation from others and detachment from emotions 5. When this traumatically based shift in responses and emotional engagement occurs repeatedly during key periods of development, survivors suffer from recurrent fear and lasting emotional disconnection from self and others 6. Therapy for complex trauma involves assisting clients to recover the core capacities for experiencing emotions and relatedness 5
  6. 6. Rationale for experiential approach to the treatment of complex trauma 1. Although other therapies have recognised the need for emotional processing through understanding what happened eg:CBT 2. or the resolution of emotional conflicts underlying the trauma, e.g. psychodynamic therapy 3. Accelerated experiential – dynamic psychotherapy (AEDP) and emotion focused therapy for trauma (EFTT) offer a template for understanding and achieving renewed emotional experience in the wake of psychological trauma. 4. Both approaches conceptualise emotion and somatically felt subjective experience as a primary path to both biopsychosocial development and healing from psychological trauma 6
  7. 7. Rationale for experiential approach to the treatment of complex trauma 1. Drawing on client centred, existential and Gestalt traditions, as well as CBT, short-term psychodynamic and relational analytic traditions, these approaches enhance the client’s abilities to access and explore emotional experience within an affirming, empathy based therapeutic relationship. 2. Adaptive processing of intense emotions in the context of a safe relationship is a foundation for enlarging the trauma survivors perspective from the preoccupation with danger and avoidance of feeling to a fuller experiencing of oneself as alive and relationships that have fundamental worth and meaning 7
  8. 8. Accelerated experiential dynamic psychotherapy (AEDP) 1. AEDP assumes that trauma survivors of possess core bioaffective resources they can be activated therapeutically right from the start of treatment 2. They view psychological healing not only as the eventual outcome of an effective therapy but also the potential that therapist seek to activate from the beginning of therapy 3. It is based on a metatherapeuticparadigm that includes relational, experiential and integrative techniques within a framework informed by the following: attachment research, emotion theory affective neuroscience transformational studies 8
  9. 9. Accelerated experiential dynamic psychotherapy (AEDP) It directly addresses emotional dysregulation and social isolation the two cardinal features of complex trauma by 1. The dyadic affect regulation of intense emotions in the context of an attachment based therapeutic relationship as the cornerstone of its experiential work 2. Its primary aim is having the client not to be alone with the intense emotional experience when it is relived 9
  10. 10. Accelerated experiential dynamic psychotherapy (AEDP) 10 https://www.youtube.com/watch?v=HasX4sW3mRw 23 minutes
  11. 11. AEDP Core Model 11
  12. 12. Relational interventions in AEDP 1. The aim of the therapeutic relationship is to be a secure base from which to undertake experiential explorations of the deep painful emotional experiences 2. The secure base is built through Rogerian principles as well as the moment – to – moment tracking of the client’s receptive affective experiences 3. The therapist remains attuned to and respectful of the client’s need for protection 12
  13. 13. Relational interventions in AEDP 1. The therapist manages the clients fears about intimacy, while holding the believe that they can achieve a level of connection it feels good to the client as well as being healing 2. Inevitable raptures in the working alliance promptly acknowledged and repaired with the goal of strengthening faith in the resilience of the imperfect but real and honest relationship 3. The following of the key hallmark of the relational stance: 1. Affective engagement: explicit empathy and affirmation 2. Emotional transparency: willingness to see and to be deeply seen 3. An explicit willingness to help: active engagement by the therapist in supporting the client in a 13
  14. 14. Experiential Emotion Processing 1. Only once the bedrock of relational connection and validation of the clients resources and resilience are established (phase 1) can be painful experiential processing of the trauma related emotions and memories be dealt with 2. The aim is to co-create a new positively experienced relationship in the here and now of therapy as a foundation for forming new attachment and emotional templates in the client’s life outside of therapy 3. Experiential processing of emotions is important, particularly the trauma related fracture, through experiential interventions geared toward dyadically down regulating overwhelming negative affects while focusing and deepening adaptive core emotional experiences are in the new positive experiences such as fear, grief and joy 14
  15. 15. Experiential Emotion Processing 1. The dyadic regulation of affect occurs via a moment to moment effective communication involving gaze, tone of voice, rhythm, touch and other non-verbal processes that promote attuned and coordinated states in the client and therapist: deep relational connection similar to parent and child. 2. The therapist track emotional experiences via moment to moment and dynamic assessment carefully differentiating between: 1. Secondary, defensive or pathogenic affects which require regulation and transformation 2. Distinguishing from adaptive emotions and core affective experiences which hold healing and transformation when regulated to completion Emotion processing interventions invite clients into the realm of effective experiencing through somatic focusing, explicit relational joining, effective mirroring and deepening portrayals15
  16. 16. AEDP metatherapeutic processing 1. AEDP offers a useful model of emotional transformation that identifies the stages of processing emotional experiences to completion. This is the first state of transformation. 2. The second state transformation is effected through metatherapeutic processing which involves focusing on and exploring the transformation itself 3. The process involves helping the client to alternate experiential work, in which emotions are experienced, with reflective observation and meaning making about the experience of emotional processing itself. (phase 2 trauma processing) 4. This metatherapeutic processing allows for a cascade of transformation and breakthroughs particularly in relation to affect 5. The transformational affects the hallmarks of second state transformation and markers of the entry into the final stage of therapeutic processing: core step and the capacity to develop 16
  17. 17. AEDP Institute 17 http://www.aedpinstitute.org/about-aedp/
  18. 18. Healing Power of Emotion: Affective Neuroscience, Development and Clinical Practice Editor : Diana Fosha, Editor : Marion F. Solomon, Editor : Daniel J. Siegel (2009) at Karnac books £26.00 18
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  20. 20. Chap 2: Experiential Therapy with Trauma Survivors 20 Available on Ebsco
  21. 21. Chapter 7 Experiential dynamic psychotherapies in the treatment of psycho-physical trauma 21
  22. 22. Core readings 1. Courtois & Ford (2009) chapter 14. Experiential and Emotion- Focused Therapy, Diana Fosha, Sandra Paivio, Kari Gleiser, and Julian D. Ford 2. The Activation of Affective Change Processes in Accelerated Experiential-Dynamic Psychotherapy by Diana Fosha on NL 3. Fosha (2004) Nothing that feels bad is ever the last step:’ The Role of Positive Emotions in Experiential Work with Difficult Emotional experiences 22
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