AET refines the time-tested ways people connect with one another in order to make them conscious and powerful. Both therapist and patient begin to recognize weak as well as strong body sensations. We learn our own unique triggers and how to read our bodies from moment to moment.

AET techniques can be a valuable addition to every therapist’s toolkit. From our earliest days, we connect with others through empathy. Without words, we begin to feel what others are feeling. We read their eyes, their expressions, and the tone of their voice to learn what they are feeling.

People who are in touch with the complete range of physical body sensations have a rich emotional life. They fully experience both joyful love and poignant loss as they encounter the connections and disconnections of their unfolding life.

Therapists have long known that they will know their patients better if they imagine facing the challenges their patients face. The effect is magnified if they can physically feel what their patients feel. Experiencing the physical sensations of another person enables you to understand their emotions and help them to handle these feelings.

We can also learn to know ourselves better through empathizing with others. We not only begin to feel and share their emotions, we also become more aware of their reactions to us. Empathic interaction is a powerful therapeutic tool for both patient and therapist.

The key to empathy rests in familiarizing yourself with your own body sensations. This is where the “Science of Sensations” teaches you where to look and how to make use of your observations.

If we view our body sensations negatively, we tend to avoid these sensations – maybe even fear them. But, over the long haul, if we cut ourselves off from the signals our body gives us, we tend to lose touch with the highs as well as the lows that define a full life. When body sensations are kept out of sight, life itself may seem flat and routine.

If we cut ourselves off from body sensations, they become unfamiliar and may even produce anxiety when we bump up against them again. This is an example of how the defenses we erect against these sensations cause dysfunction. Additionally, by damping down our awareness of negative body sensations, we inadvertently “turn down the volume” on other body sensations. We sometimes cut ourselves off from both energizing and calming sensations that can sustain us in our times. Think about simple acts such as letting your hands run through a moving stream of water or over a patch of cool green grass and how they put you in touch with body sensations that uplift you.

Most of us intuitively know that if a loved one is experiencing profound grief, we should hug them, hold or stroke their hands, and look at them with feeling in our eyes. Failing that, we try to be there for them, to console them, bring them food, or offer help. In one way or another, we try to show them that we care and invite them to connect.

AET refines the time-tested ways people connect with one another in order to make them conscious and powerful. Both therapist and patient begin to recognize weak as well as strong body sensations. We learn our own unique triggers and how to read our bodies from moment to moment.

Accelerated Empathic Therapy was developed by Michael Alpert, MD, MPH. He practices AET in New York City and Denville, New Jersey, and he teaches and supervises through the New York/New Jersey STDP Institute, www.stdp.org. He can be contacted at info@stdp.org or malpert@stdp.org.

Accelerated Experiential Dynamic Psychotherapy (AEDP), developed by Diana Fosha, is a transformation-based, healing-oriented model of treatment. Unlike traditional models of therapy that are psychopathology-based, AEDP as a clinical practice roots itself in transformational theory, a change-based theory of therapeutic action. Transformance, a construct introduced by Diana Fosha, identifies and names the wired-in motivational drive toward healing and self-repair present in all of us. It is at the core of this work.

By studying naturally-occurring transformational processes—in babies and their caregivers, in moments of meeting, in Tibetan monks, in intense emotional situations, in resilient individuals, in people in love—AEDP seeks to apply their lessons to a clinical process where change can, and does, emerge by leaps and bounds. The methodology of AEDP has patient and therapist deeply and emotionally engaged. Closely following the edge of emergent transformational experience, both are involved in the moment-to-moment tracking of subtle and not so subtle fluctuations in experience, energy, and connection. AEDP emphasizes the co-creation of safety: with accompaniment, patients can risk revisiting past trauma and suffering. Healing and neuroplasticity are set in motion through fully experiencing previously-feared emotions in a secure relationship, and through gentle, yet focused, explicit attention to the experience of healing within the patient-therapist relationship. Processing both traumatic and restorative emotional experiences to completion, the AEDP process culminates in vitality, energy, and the non-finite spirals of positive emotion, resilience, well-being and creativity that are so highly correlated with health. The phenomenology of transformational experience thus describes an elegant arc, the transformational work of AEDP seamlessly linking suffering with flourishing.

With the goal of helping clients connect to their own vitality, AEDP engages them in experiential practices designed to integrate mind and body. The therapeutic relationship is used to co-construct safety and then to help bring enhanced vitality and awareness to clients’ felt sense by:

• learning ways to witness and accept emotional processes;

• discovering the glimmers of growth in the midst of a trauma narrative;

• tracking moment-to-moment shifts in emotional connection through dyadic mindfulness;

• deepening the therapeutic alliance through meta-processing; and

• recognizing emergent transformational experience in the consulting room.

To read more about AEDP, go to www.aedpinstitute.org

Affect Phobia Therapy (APT) was developed by Leigh McCullough, and integrates aspects of Davanloo's ISTDP with learning theory and the affect theory of Silvan Tomkins.

APT is based on the premise that internal conflicts about feelings underlie most psychologically based disorders. The affect phobia therapist views these conflicts as “Affect Phobias,” a phobia about feelings. Similar to external phobias, a patient with an affect phobia avoids the experience and expression of certain feelings like anger and grief in a same way a person with a phobia about bridges would avoid bridges. These patients adopt avoidant feelings, thoughts and behaviors to an extent that they are unaware that there is an underlying feeling that they are avoiding.

The Affect Phobia Therapist helps his/her patient recognize the avoided feelings as well as their method of avoidance. They use Malan’s Triangle of Conflict and Triangle of Persons to see the affect phobia, understand its’ origin and impact on present day relationships.

The Affect Phobia Therapist uses a variety of techniques in order to help the patient expose oneself to the avoided feeling in a step-by-step process using anxiety regulation and gentle confrontation of defenses.

For more information, contact Kristin Osborn at kristin@kristinosborn.com or go to www.affectphobiatherapy.com.

Robert Neborsky's AB-ISTDP applies the clinical insights and techniques of Davanloo's ISTDP, informed by research on attachment and right hemisphere processes of emotional regulation.

Disrupted secure attachment bonds at critical phases of a child’s development are seen as the cause of adult psychoneurosis and some aspects of character pathology. The therapist leading the patient’s awareness of the moment-to-moment experience of his emotions promotes change. Using the non-interpretive tools of moment-to-moment tracking of emotional experiencing along with pressure to feel, challenge of defenses, and choice between feeling or defense, this therapy is able to help people recover from acute and latent trauma and repair their damaged internal working models of attachment.

The cornerstone of this therapy is the Reparative Dynamic Sequence. The phases of the Reparative Dynamic Sequence are: Inquiry, Psycho-diagnosis (Meta-cognitive Monitoring), Identification of Therapeutic Task and Resistance, Overcoming Therapeutic Task Resistance, Creating An Intra-psychic Crisis, Linking The Past and Present, Working Through of Core Emotions (Achieving Core State), and Termination (Debriefing and stage setting for the next session and/or life tasks).

The central curative factors are seen as the de-conditioning of anxiety over trauma-based emotional experiences. Afflicted individuals avoid, preoccupy, or disorganize around the experience of their genuine emotions in the presence of any caregiver. Instead of receiving comfort, they self-regulate through the self-administration of the same painful affects they received as a child from their original caregiver, or they use the same rigid habitual defenses that comforted them as a child. Awareness (attention to the moments of feeling) of this process and the activation of latent capacities for secure attachment are mobilized against this painful form and constricting form of self-regulation. Finally, emotional experiencing, visualization, and verbalization of feeling to visually imagined traumatizing figures and to the formerly traumatized self are used to consolidate therapeutic state changes to long lasting trait (symptom and character) changes. Thus, movements from insecure states of mind to earned secure states are facilitated by the empathic attunement of the therapist to the discrete psychic structures.

Attachment-Based ISTDP systematically incorporates and operationalizes insights from interpersonal neurobiology and affective neurosciences.

More information can be found at www.istdp.com or contact istdp@pacbell.net.

Dynamic Emotion Focused Therapy (DEFT), developed by Susan Warren Warshow, is based on decades of clinical observation of the effects of dysregulated shame reactions on the therapeutic alliance and outcome. DEFT seeks to access and help integrate affects that are blocked by toxic forms of shame, anxiety, guilt and defensive process (including defense mechanisms and defense driven affects). To accomplish this, DEFT interventions place shame-sensitivity at the forefront and highlight therapeutic elements and therapist qualities that support an egalitarian partnership and strengthen an individuated sense of self.  It also delves deeply into how the therapist helps to generate compassion for self through embodied as well as verbal responses, sustains hopefulness, and co-creates an ongoing therapeutic alliance, as all are catalysts for change. DEFT gives special attention to the indicators that the therapist is neurobiologically attuned.  It emphasizes the use of language (how an intervention is worded) and employs metaphor to bring interventions to life, making them clearer and more memorable. Prosody (voice inflection and tone) is also a key factor in the approach. The DEFT training also places great importance on the therapist’s non-shaming self-reflection, compassion towards self and community support. Intuition, creativity and appropriate play are are also valued and encouraged in DEFT.

As with ISTDP, treatment involves:

• Processing of unconscious complex feelings towards past and current figures and consolidating the insights that result; exploring practical application.

• Distinguishing self-limiting from self-enhancing parts of the self and developing capacity for self-care.

• Moment-to-moment tracking of physiological sensations, including careful attention to manifestations of anxiety. DEFT also emphasizes physiological manifestations of shame and guilt.

•  Mobilization of will to attend to the self.

• Resolving toxic forms of guilt over feelings.

Signature features of DEFT:

• Embraces attachment theory. All interventions seek to convey compassion, sense of safety and respect through verbal and non-verbal, embodied responses. The authentic quality of the therapeutic relationship is given primary importance.

• Emphasizes building an individuated sense of self and therefore adopts a non-authoritarian, collaborative therapeutic stance.

• Highlights client strengths over deficits.

• Views all new and difficult types of self-disclosure as “breakthroughs to intimacy.” DEFT encourages therapists to see great therapeutic value in enhanced awareness of internal process and causality, as well as any new levels of emotional engagement. Full breakthroughs to complex feeling are not seen as the only path for healing to occur, although these are regarded as highly valuable for many clients.

• Distinguishes between the therapist’s ability to feel compassion and the ability to convey and express compassion in a palpable way, which is believed to increase the client’s ability to internalize self-compassion.

• Values and encourages therapist spontaneity and creativity.

• Sees the therapist’s willingness to self-reflect, be vulnerable and participate in the growth process as central to the most effective therapeutic relationship.

• Utilizes play and humor, which can help reduce defense and form connection.

• Uses vivid language and metaphor to enhance therapeutic impact (e.g., the perpetrator system might be described to a client as a “parasitical vine wrapped around a healthy tree trunk.”)

• Relies on clinical intuition and “instinctive knowing” alongside theoretical grounding.

DEFT regards shame as a primary inhibitory affect that is often neglected or poorly responded to in treatment.

• Shame often has similar manifestations to anxiety and needs to be recognized and titrated in similar ways. Shame is frequently evoked through attention to internal process.

• Prosody, body language, facial expression and eye gaze carry important implicit communication regarding acceptance, safety and empathy.

• Subtle relational factors impact the reduction of shame, for example:

  • Therapist self-disclosure of shared vulnerability.

  • Use of play and humor.

  • Eschewing the role of expert, e.g. collaboratively seeking choice of focus and making meaning of the therapeutic experience.

  • To reduce their own shame, therapists are urged to remember that they are only one half of the therapeutic partnership and that all humans suffer from trauma. Growth is a shared journey.

In dealing with defenses, DEFT recommends the following:

• Present defenses in developmental context, i.e. as protective and resourceful mechanisms/habits learned in childhood. Rather than “turn against” defenses, clients are encouraged to release them as a vestige of childhood no longer serving their purpose.

• Avoid “you” language, e.g. “You’re digressing again!” which can more readily be perceived as shaming and blaming, especially depending on tone. The sad cost of defenses is highlighted with appropriate inflection.

• Frame defenses as neither intentional nor fixed parts of self.

• Instill hope. Strengths are typically commented upon alongside defense interruption, e.g.: “You’ve successfully broken other habits in your life.”

• Emphasizes the attachment relationship: “You no longer need to be alone with these intense feelings. Do you recognize that I am here with you? How is it for you to feel my presence?”

DEFT, like ISTDP, recognizes the existence of the punitive superego rising from guilt over rage towards primary figures. DEFT also holds the view that trauma, symptom formation and self-damaging behaviors can derive from modeling and internalizing shaming treatment originating not only from family of origin but also from cultural, religious, peer group, educational experiences and others (e.g. gang cultures, severe childhood bullying, abusive institutions, poverty, the horrors of war, irresolvable medical conditions, physical disabilities and abnormalities). In DEFT, the therapist is advised to remain open to the origins of the individual’s suffering.

DEFT resists strict adherence to any model, including its own. The complex mystery of the human psyche is never to be fully known and therefore, DEFT embraces a state of humility. The response to intervention is believed to provide the therapist with the information that matters the most.

Emotional Awareness and Expression Therapy (EAET) was developed by Mark Lumley and Howard Schubiner. EAET was designed to represent a significant evolution in the treatment of primary chronic pain conditions, such as fibromyalgia, irritable bowel syndrome, and chronic musculoskeletal pain (e.g., low back and neck pain), as well as other functional somatic symptoms.

EAET is described by its developers as a "simplified form of ISTDP," as it is manualized, time-limited, focused primarily on rapid symptom reduction (with character change more of a secondary focus), and supplemented by a variety of written patient handouts and homework assignments that are informed by the latest models of pain psychology and neuroscience. EAET also builds upon the work of John Sarno, who was himself influenced by Davanloo’s ISTDP.

A unique aspect of EAET is that it was developed in the context of an NIH-funded clinical trial and has since been extensively studied in randomized controlled trials, with several large trials (in the range of 200-700 patients) in process. Trials have shown EAET to be more effective than education-based interventions and, in several studies, superior to cognitive-behavioral therapy in reducing pain severity and related mental health symptoms. Research has demonstrated large effect size improvements in pain, physical functioning, and psychological symptoms, with benefits maintained at long-term follow-up. The therapy has been successfully tested in various formats and populations, with high patient retention rates and rare adverse events. Based on this research, EAET was recently designated as a "best practice" by the U.S. Department of Health and Human Services for helping patients with chronic pain.

Key References:

Lumley MA, Schubiner H. Emotional Awareness and Expression Therapy for Chronic Pain: Rationale, Principles and Techniques, Evidence, and Critical Review. Curr Rheumatol Rep. 2019;21(7):30.

Yarns BC, Jackson NJ, Alas A, Melrose RJ, Lumley MA, Sultzer DL. Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans: A Randomized Clinical Trial. JAMA Netw Open. Jun 3 2024;7(6):e2415842. doi:10.1001/jamanetworkopen.2024.15842

Ferruccio Osimo developed the Intensive Experiential-Dynamic Psychotherapy (IEDP) model on the basis of Davanloo’s ISTDP and on clinical studies on the quality of results obtainable by Short-Term Dynamic Psychotherapy, he carried out at the Tavistock Clinic with David Malan, and at Harvard Medical School with Leigh McCullough.

IEDP has a unique emphasis on explicit exploration of the real relationship between therapist and patient, as a basis on which therapeutic techniques can build. The encounter of two people creates a unique interpersonal current, flowing in largely unconscious ways. This represents a fundamental part of the actual relationship as well as of the transformational process.

Learning how to tune in to these personal aspects of the therapist-patient relationship will significantly empower a therapist’s technical kit.

Consistently with the centrality of the real relationship, IEDP identifies 9 therapeutic ingredients, to be administered and dosed according to the unfolding of the real relationship:

• RE Tuning to + Exploring Real Relationship

• MI Active Mirroring

• HP History + Perspective/Portrayal

• AA Anxiety Regulation

• AD Defence Restructuring

• AX Emotional Maieutics

• SE Super-ego + Inner Saboteur Restructuring

• TCP Psychodynamic links

• SO Self-Other Restructuring

These activities are theoretically and operationally described in two books, and their codes are used to code sessions for research purposes. Two therapeutic techniques introduced by Osimo are:

(1) Emotional Maieutics, paving the way to the good-enough experience and expression of painful + conflicting feeling (Maya = midwife in Ancient Greek)

(2) Character Hologram, a comprehensive approach to character pathology, capable of mobilizing unconscious emotion. 

When training in this model, therapists will be helped to achieve a high level of harmonious interplay between the real relationship developing with each patient and the use of techniques.

Malan, D.H. & Osimo, F. (1992). Psychodynamics, training, and outcome in Brief Psychotherapy. Oxford: Butterworth-Heinemann.

Osimo, F. (2003). Experiential Short-Term Dynamic Psychotherapy, a manual. Bloomington: Authorhouse.

Osimo, F. & Stein, M.J. Eds. (2013). Theory and practice of Experiential Dynamic Psychotherapy. London: Karnac.

Ferruccio Osimo, MD can be contacted at: ferro.osimo@gmail.com.

ISTDP was developed by Habib Davanloo, MD, working at McGill University in Montreal, starting in the 1960s and continuing in the following decades. It was a groundbreaking departure from previous short-term dynamic therapies because of its strong emphasis on the experience of deep emotion. All the other EDTs described here derive from it, to one degree or another.

In his early work with highly resistant patients, Davanloo showed that transformative and lasting therapeutic change can be achieved when patients

• are able to fully experience their unconscious complex feelings toward early attachment figures; and

• have sufficient insight into the defenses that they have habitually used to avoid these feelings, and avoid emotional closeness with others.

Davanloo describes two competing forces within each patient, which he calls the resistance and the unconscious therapeutic alliance (UTA).  When patients enter therapy, resistance is dominant; the task of therapy is to mobilize the UTA to the point where it is able to dominate the resistance and support a new, healthy adaptation to the patient’s life. One of Davanloo’s central insights is that this can be achieved by rapid mobilization of both the resistance and “complex transference feelings”: that is, the mixed feelings that arise toward therapists as a result of their persistent efforts to relate directly to the patient rather than the patient’s destructive defenses.

Davanloo discovered that when patients experience these complex feelings, the resulting state of low unconscious anxiety results in an “unlocking” of the unconscious, allowing patients and therapists to understand the origins of patients’ problems, and also to achieve lasting therapeutic change.  Davanloo’s method for achieving this unlocked state and exploiting its therapeutic potential are summarized in his “central dynamic sequence.”

After achieving these insights with highly resistant patients, Davanloo went on to modify his technique so that it is safe and effective for patients with depression, somatoform disorders, and fragility, based on his understanding of “discharge pathways of unconscious anxiety.”

In the years since Davanloo developed ISTDP, an impressive body of research has shown that it can lead to rapid, lasting change for patients with a very broad range of clinical conditions.

The unified model of personality-guided relational therapy was developed by Jeffrey J. Magnavita, a theorist/clinician who has developed various models of psychotherapy including Short-Term Restructuring Psychotherapy (STRP).  STRP is primarily concerned with intrapsychic and dyadic process was based on the pioneering work of Habib Davanloo, David Malan, Wilhelm Reich, and other figures of the Short-Term Dynamic Psychotherapy movement, as well as self-psychological and objects relations theory and methods. Later, he developed a model termed Integrative Relational Psychotherapy (IRP), which added an additional triangular configuration based on the work of Ludwig von Bertalanffy, Murray Bowen, Nathan Ackerman, Salvador Minuchin, and other pioneering figures of family therapy.

Most recently, Dr. Magnavita has developed an evolving model of emotional dynamic psychotherapy, personality theory and psychopathology based on an examination of processes and structures at four levels of the personality system. These are embedded subsystems which move from the microscopic to the macroscopic level of organization. There are four matrices which can be addressed using a unified approach:

• biological-intrapsychic

• interpersonal-dyadic

• relational-triadic

• sociocultural-familial

Dysfunctional personality adaptations are caused by traumata, developmental insults, and multigenerational transmission processes which are nonmetabolized and create multi-systemic problems in adaptation. One of the primary connections among the subsystems is the affective processes that occur at the intrapsychic, dyadic, triadic, familial, and societal levels. Methods of restructuring these dysfunctioning subsystems are selected from an array of techniques based upon the level of differentiation and integration among the various component subsystems (i.e., defensive-affective-cognitive, attachment system, neurobiological system, relational system).

Modalities of therapy are selected and combined, when indicated, to enhance the potency of the treatment by intervening at the various fulcrum points within a system. Thus, a tipping point can be achieved whereby the system reorganizes at a new level of function and process which is more adaptive.

Jeffrey J. Magnavita. Ph.D., ABPP can be contacted at: MagnaPsych@aol.com.