Learning Objectives:

After reviewing this article, you should be able to:

1. Identify the core principles and techniques of Accelerated Experiential-Dynamic Psychotherapy (AEDP).

2. Differentiate AEDP from other therapeutic modalities.

3. Recognize the application of AEDP principles and interventions in clinical scenarios. 

CPTR: What is Accelerated Experiential-Dynamic Psychotherapy (AEDP)?

Dr. Palgi: AEDP is an experiential psychotherapy, meaning that the therapist helps the client to bring their attention to, and stay with, moment-to-moment physical and emotional experiences that arise during the therapy session (Fosha, D. Undoing Aloneness & the Transformation of Suffering Into Flourishing: AEDP 2.0. American Psychological Association; 2021; Fosha D, J Clin Psychol 2001;57(2):227-242). It is grounded in attachment theory and developmental psychology, which established how attuned and responsive infant-caregiver interactions promote safety, growth, and exploration. 

CPTR: How do you accomplish a sense of security with your clients?

Dr. Palgi: A core principle of AEDP is that we all have an innate capacity for psychological healing. We convey that by being present and empathetic, and by mirroring and accompanying clients with their pain. AEDP focuses on regulating anxiety and allowing your patient to feel core emotions and bodily sensations, which releases the healthy biological drive to act on one’s behalf. The cognitive and narrative portion of therapy is also very important, and it tends to come after an emotional experience in session.

CPTR: How does AEDP differ from other therapeutic modalities?

Dr. Palgi: It focuses on emotional and bodily sensations in the present moment rather than on thoughts and behavior. In AEDP, affect is the transforming agent, and insight follows transformation. For example, the therapist might ask the client, “What do you notice inside?” and “Can we stay here?” as they discuss an experience and then talk later about the experience to organize it cognitively. The aim is not only to alleviate suffering but also to bring about positive flourishing. The therapeutic relationship is an important part of the therapy, so relationship dynamics come to the fore more quickly than in other therapies. AEDP techniques unpack what’s happening in the relationship, in the present moment. This builds secure attachment and provides clients with a new experience that alters old internal working models or creates new and healthy ones. 

CPTR: What is the history of AEDP? And how does it expand upon its predecessors?

Dr. Palgi: AEDP developed out of short-term dynamic psychotherapies. However, the focus of AEDP is more explicitly on the potential to heal, rather than identifying and working through psychopathological processes, such as maladaptive defense mechanisms. AEDP understands psychopathology to be the result of unwilled and unwanted aloneness in the face of overwhelming emotions. The “Accelerated” part refers to the change process, which at times happens abruptly, in a non-linear way.

CPTR: What makes someone a good candidate for AEDP therapy?

Dr. Palgi: Anyone who is interested in psychotherapy is a good candidate for AEDP. We all have a need to experience secure attachments. “Secure attachment” in childhood is characterized by the child’s confidence in the caregiver’s availability and responsiveness, which tends to support confidence, exploration, sociability, and adaptation. Children who are securely attached tend to develop into adults who are capable of more stable and satisfying social and intimate relationships (Zeifman DM, Curr Opin Psychol 2019; 25:139-143). We all have emotions and sensations in our bodies, and we all have anxiety and defenses to protect against feelings. We also all have an innate motivational drive toward healing. Therefore, we all can benefit from this type of psychotherapy.

CPTR: Has it been studied across populations?

Dr. Palgi: AEDP is largely an adult-oriented treatment, with modifications for use with children and adolescents. It is currently being utilized and studied internationally, with people of many cultural, ethnic, and racial groups, and people of all genders and sexualities (Iwakabe S et al, Psychotherapy (Chic) 2022;59(3):431-446).

CPTR: For what types of psychiatric conditions is it most useful?

Dr. Palgi: AEDP is well-suited to people struggling with anxiety and depression. It is very useful for people with trauma, whether it be a single, time-limited event such as a car accident or assault, or traumatic experiences that occur over longer periods of time, such as childhood abuse or living in conditions of war. AEDP is also useful with people with other diagnoses in which underlying difficulties can be well addressed by moment-to-moment tracking of physical sensations and emotions, practicing affect regulation within the session, and learning how to talk about these specific moment to moment emotional experiences (Lilliengren P et al, Psychotherapy 2016;53(1): 90–104; Iwakabe S et al 2022).

CPTR: What is “transformance” in AEDP? Can you give us a real-world example of how it plays out in an actual therapy session?

Dr. Palgi: Transformance is AEDP’s term for the innate motivational drive to heal and flourish that is present within us all. It reflects the brain’s capacity to change for the better. Transformance is the counterpart of resistance. AEDP believes that we all have what we need to heal, and we need to set that drive, transformance, in motion. This happens within a secure attachment relationship, within conditions of safety (Fosha D, Ann N Y Acad Sci 2009;1172:252-262). It may first require that defenses, or protective mechanisms, be worked with so the client can take in a new attachment figure, particularly if there is a history of relational trauma.

CPTR: How does the therapist support or encourage this process?

Dr. Palgi: The AEDP therapist is always looking for strengths that are already present in a client – the therapist is a “transformance detector.” We look for glimmers of strength or change for the better, notice and amplify them, and work with them in the present moment by using language that orients the client into their emotions and somatic or bodily experience.  For example, a client says energetically, “I really wanted to say x, y, and z to her… (energy drops) … but I don’t know.” The therapist might say, matching the client’s initial energy, “you do know, you said x, y, and z – you said it exactly!” 

CPTR: What specific techniques or interventions are commonly used in AEDP therapy? Can you walk us through how they are typically applied with patients?

Dr. Palgi: In AEDP we use the concept of a “change triangle” as a map to identify (1) a client’s defenses (protective strategies) and (2) inhibitory emotions (anxiety, shame) that prevent them from experiencing their core emotions (ie, happiness, grief, anger). When core emotions become too intense and painful, inhibitory emotions block them to prevent us from overwhelm. The third part of the triangle are (3) the adaptive actions that can flow from core emotions when they are fully felt. Interventions are chosen based upon where a client is in the change triangle, and all techniques ultimately support a client with accessing and experiencing core emotions, the transformational experiences and adaptive actions that flow from them, and the experience of open-heartedness and truth that follow. AEDP therapists are affirming, validating and empathic, and explicit about being fully present with clients. We don’t explain or interpret to clients, we invite exploration and experiencing in real time. For example, a therapist might ask a client, “What are you feeling inside right now as you’re telling me about your argument with your friend?”

CPTR: Can you tell us a little more about how this plays out in practice?

Dr. Palgi: The AEDP therapist engages in “moment-to-moment tracking,” or careful observation of the client to notice and seize glimmers of change, emotion, or cues from the body. This allows the therapist to support the client in staying with emotional experiences that are important to feel but could be too overwhelming to process alone. Over time, the regulating strategies of the therapist-client dyad become internalized by the client (Fosha D, 2001). AEDP therapists use language that is attachment-oriented, which helps clients shift from left brain thinking to right brain feeling, from the language of words to the language of emotion rooted in the body, from talking about experience to experiencing. This is done using smaller words, using short statements or questions rather than interpretations, slowing down the pace, asking the patient for specifics, and shifting from linear and logical to emotional and imagistic (Prenn N, J Psychother Integr 2011;21(3):308–329; Fosha, D. Undoing Aloneness & the Transformation of Suffering Into Flourishing: AEDP 2.0. American Psychological Association; 2021). 

CPTR: Can you give us some example language? 

Dr. Palgi: Sure. For slowing down, you could say: “Let’s slow this down,” or “let’s pause here.” To undo aloneness, consider: “I am here, you’re not alone.”  You can ask “What’s happening inside, physically?” to have the patient ask the body for help; and “Is there more… can you fill that out?” to encourage them to explore and expand their thoughts. And, you can seize on moment-to-moment tracking of a glimmer of affect by noting: “A feeling… something shifted… you made a fist.”

CPTR: What are some of the other important ingredients of AEDP?

Dr. Palgi: Metaprocessing or talking with clients about the process of therapy itself is an important component of AEDP. This happens on the macro level: “What’s it like to have done this work with me today?” And/or as a way of fine-tuning the micro or moment-to-moment interactions within a session: “What’s it like to hear me say this?” (Fosha D et al, Psychotherapy (Chic) 2020;57(3):323-339).

CPTR: Any others? 

Dr. Palgi: Self-disclosure is an important attachment-creating intervention. AEDP therapists may make self-involving self-disclosure, which is about the process itself, in the here and now. This can be about therapist error or vulnerability. Additionally, there is self-revealing self-disclosure of actual experience that is similar or dissimilar to that of the client. Self-disclosure is always followed by metaprocessing or reflecting together to explore the client’s experience of the disclosure, which will inform the therapist about how to best use this technique going forward. 

CPTR: Could you share a success story where AEDP was used to help a patient process trauma? What steps or interventions were crucial in that journey?

Dr. Palgi: A woman in her mid-40s suffered horrific sexual and emotional abuse over the course of her childhood and adolescence. She was struggling with depressed mood, anger, irritability, hypervigilance, and nightmares. She coped by withdrawing and isolating herself from loved ones and work. I welcomed her, expressed interest in her previous positive experience in psychotherapy, as well as with close friendships that also provided her with needed maternal attachment figures. As I appreciated her strengths, I also communicated the desire to help with her pain and suffering, wanting to hold it with her and go at a pace that felt most tolerable. Building safety through the development of a secure attachment was a crucial first step. This meant being attuned, validating her defenses or protective mechanisms, and being empathic and affirming. As she felt me there with and for her, anxiety decreased, and she was able to experience more emotion in session.

CPTR: It sounds very much like the establishment of basic trust is at the foundation of AEDP? What happened next?

Dr. Palgi: Moment-to-moment tracking and dyadic regulation of affect were critical as memories and feelings about her traumatic past arose. Metaprocessing small pieces or rounds of work provided opportunities for us reflect on what arose emotionally and somatically and allowed us to organize and put language to her experiences. It also gave us opportunities to know together how we were doing and for her to communicate what she needed more or less of at a given time. As she felt more accompanied by me, she was receptive to working with different parts of herself and engaging in portrayals, or imaginal scenarios that she created to release unexpressed emotion and do, say, or feel what she previously had been unable to, in order to survive. Throughout the treatment I delighted in her strengths as I empathized with her pain, and I became a model of a caring figure that came to know, see, and feel for her in ways that were safe, attuned, and true.

CPTR: This sounds like a very inspiring and effective treatment. How did the therapist facilitate this?

Dr. Palgi: In AEDP, the therapist is engaged and present, rather than hidden or shielded. The AEDP therapist serves as an attachment figure and secure base for the client. This means that the therapist is active, emotionally engaged, confident, and a wise and brave other for the client. The therapist is attuned and initiates repair when attunement is disrupted. The AEDP therapist is explicitly helpful, leads the way, and can also follow the patient’s lead (Prenn N, 2011).

CPTR: Can you say a little more about the role of the therapist in AEDP therapy? 

Dr. Palgi: The role of the therapist is that of a partner, collaborator, and a secure therapy base for the client to explore their inner emotional and relational worlds. The therapist supports processing trauma and pain, while also making space for sharing in the positive and expanding glimmers of transformance and change for the better. The therapist’s role can change within a session or from session to session as what’s needed by the client changes. The therapist may be witnessing, facilitating, accompanying, regulating affect, regulating anxiety, undoing aloneness, making the implicit explicit, and/or working with defenses.

CPTR: What resources are available to help therapists cultivate these skills?

Dr. Palgi: The AEDP Institute offers many resources to support therapists in cultivating the skills and techniques needed to practice this type of psychotherapy. The Institute website (www.aedpinstitute.org) is a great starting point. It lists publications and research, including links to articles, some of which offer de-identified transcripts from sessions. It also lists a variety of trainings, including the path to certification as an AEDP therapist, and it offers a way to become part of the AEDP community. Two primary texts in AEDP are: Fosha, D. (2000). The Transforming Power of Affect: A Model for Accelerated Change. Basic Books and Fosha, D. (2021). Undoing Aloneness & the Transformation of Suffering Into Flourishing: AEDP 2.0. American Psychological Association.

CPTR: To wrap up, how do patients typically respond to AEDP therapy? How can therapists best address their concerns?

Dr. Palgi: Patients come to AEDP, as they do to psychotherapy in general, with the inborn tendency toward healing and self-righting, as well as with a range of suffering, anxiety, and defenses, or protective strategies. While the manifestation is unique to each client, and client/therapist dyad, people typically respond very well to AEDP because it is an attuned psychotherapy. It is not a manualized treatment – it’s adapted to the patient. It is about creating safety and supporting a client in feeling seen, known, and responded to, based in science that demonstrates the necessity of that for transformation and change for the better (https://pubmed.ncbi.nlm.nih.gov/35653751/). From there, AEDP therapists have a range of techniques and interventions available to them that are utilized based upon the needs and goodness of fit with a client. The use of moment-to-moment tracking in AEDP helps the therapist notice when a patient has a response or reaction to something. Then, the therapist is explicit about that awareness, and metaprocesses it with the client to understand their experience, which makes it a useful part of the treatment and provides guidance for how a therapist will move forward. 

CPTR: Thank you for your time, Dr. Palgi. 

Acknowledgment: Thanks to Anthony Charuvastra, MD, for assistance with this interview.

References in order of appearance in this article:

Fosha, D. Undoing Aloneness & the Transformation of Suffering Into Flourishing: AEDP 2.0. American Psychological Association; 2021; Fosha D. Journal of Clinical Psychology 2001;57(2):227-242.

Fosha D. (2001). The dyadic regulation of affect. Journal of clinical psychology, 57(2), 227–242. https://doi.org/10.1002/1097-4679(200102)57:2<227::aid-jclp8>3.0.co;2-1.

Zeifman D. M. (2019). Attachment theory grows up: a developmental approach to pair bonds. Current opinion in psychology, 25, 139–143. https://doi.org/10.1016/j.copsyc.2018.06.001.

Lilliengren, P., Johansson, R., Lindqvist, K., Mechler, J., & Andersson, G. Psychotherapy 2016; 53(1): 90–104.

Iwakabe S, Edlin J, Fosha D, Thoma NC, Gretton H, Joseph AJ, Nakamura K. Psychotherapy 2022; 59(3):431-446.

Fosha D. (2009). Positive affects and the transformation of suffering into flourishing. Annals of the New York Academy of Sciences, 1172, 252–262. https://doi.org/10.1111/j.1749-6632.2009.04501.x.

Prenn, N. (2011). Mind the gap: AEDP interventions translating attachment theory into clinical practice. Journal of Psychotherapy Integration, 21(3), 308–329. https://doi.org/10.1037/a0025491.

Fosha, D. Undoing Aloneness & the Transformation of Suffering Into Flourishing: AEDP 2.0. American Psychological Association; 2021.

Fosha D, Thoma N. Metatherapeutic processing supports the emergence of flourishing in psychotherapy. Psychotherapy (Chic). 2020;57(3):323-339. doi:10.1037/pst0000289.