The Transforming Power Of Affect: A Model For Accelerated Change, by Diana Fosha. New York: Basic Books, 2000.

Reviewed by Jon Frederickson

Accelerated Experiential Dynamic Psychotherapy (AEDP) is a model of treatment which holds that what heals is not so much the de-repression of buried feelings, but the transformative experience of powerful affects within a secure attachment with the therapist. This transformative experience “unlocks” the patient’s adaptive strivings and deep motivation for change. Psychopathology is understood as the product of a compromised capacity to process affect—a result of a poor attachment in which the patient had to bear an experience alone. Hence, undoing aloneness is at the center of the therapeutic process.

AEDP moves from an intrapsychic to a relational perspective. For instance, an entire chapter is devoted to relational strategies. The therapist will explicitly track how the patient is taking her in, how the patient experiences her support, how the patient reacts to her empathy, her disclosures of affect, her disclosures of how the patient has affected the therapist. The therapist may ask, “what do you see in my eyes?” In all these ways, an AEDP therapist explicitly focuses on non-verbal, relational adaptive action tendencies, what Fonagy refers to as “the present unconscious.”

AEDP therapists also do restructuring. However, this term has an entirely different meaning. They do not mean a restructuring of the ego (Davanloo) or of the defenses (McCullough). Instead they restructure defensive affective and relational patterns through an experiential focus on the visceral experience of “open” and “defensive” relational patterns. Defenses are understood as adaptive ways of maintaining attachments to troubled caretakers. The therapist will track aversive affects such as anxiety and shame which trigger defenses, outline the costs and benefits of defenses, and reassure patients that they need not approach feared situations until they feel ready to do so. At the same time the therapist encourages the patient to persist in facing what they have feared. In AEDP the therapist explicitly explores the patient’s cognitions and fantasies related to their experiences of shame and anxiety in the here-and-now to find meaning and make sense of them. This clears the way for more adaptive strivings, “green signal affects”, to emerge more freely.

The therapist focuses a great deal on helping patients experience positive affects, particularly within the context of the therapeutic relationship. The emphasis is not only intrapsychic: “What are you feeling inside?”, but, equally important, relational: “What is that like for you to feel that feeling here with me?”, or “What is that like for both of us to experience this emotion together?”

In AEDP, the core belief is that offering unconditional acceptance of the patient where she is will trigger core affects and inhibiting affects based on the attachment history. Working through of inhibiting affects within the climate of affirmation facilitates the emergence of core affects. The experience of core affects leads to the patients’ experience of the core self and the experience of that core self changing in the context of a secure attachment with the therapist.