Accelerated experiential dynamic psychotherapy

1. Introduction

Version followed: AEDP 2.0. That means the four-state, three-transformation map (Fosha 2009; Fosha ed. 2021; AEDP Institute glossary and training objectives), combined with the intervention taxonomy of AEDP 1.0 (Fosha 2000, 2001, 2002). Where AEDP 1.0 described three states (defense → core affect → core state), this guide flags the difference. [source: Fosha 2002; Fosha & Yeung 2006; Fosha 2009; AEDP Institute glossary]

Accelerated experiential dynamic psychotherapy (AEDP) is a healing-oriented, attachment-based, experiential-psychodynamic therapy developed by Diana Fosha. It descends from Davanloo/Malan short-term dynamic therapy and draws on Gendlin's and Greenberg's experiential work, affective neuroscience and infant-caregiver research. [source: Fosha 2001]

Theory of change. Psychopathology comes from overwhelming emotion that was faced alone, without a regulating attachment figure. Defenses and the inhibiting affects (anxiety, shame) were built to exclude that emotion. Change has two engines:

• Undoing aloneness. The patient is no longer alone with emotion, because the therapist explicitly co-regulates it (dyadic affect regulation).
• Processing to completion. Core affect is experienced viscerally and worked through until it releases adaptive action tendencies. The new experience of change is then itself processed (metatherapeutic processing) until it settles into core state, a calm, coherent, integrated state.

AEDP assumes a wired-in drive toward healing, called transformance. The therapist looks for it and works with it from the first minute. [source: Fosha 2001; Fosha 2009; Yeung, Transformance journal; AEDP Institute glossary]

2. Framework

Structure. AEDP has no fixed treatment phases. It uses a moment-to-moment map of four states joined by three state transformations. The cycle can run several times in one session and recurs across treatment, with each pass deepening the last. [source: Fosha 2009; AEDP Institute glossary; Immersion learning objectives]

[source: Fosha 2009; AEDP Institute glossary; Fosha & Yeung 2006; Lamagna 2022]

AEDP 1.0 vs 2.0. In 2002–2006 the model had three states: defense, core affect and core state. Healing affects counted as a marker of the second transformation, and metatherapeutic processing sat inside core state. Version 2.0 makes metaprocessing its own State 3. [source: Fosha 2002; Fosha & Yeung 2006; Fosha 2009]

Session count and format.

• Format is individual, face to face (or video), with the chairs set up to allow eye contact. Fosha, Prenn and Yeung all stress mutual gaze, voice and rhythm.
• The model began as short-term. Fosha's 2002 handbook chapter frames it within short-term dynamic therapy and uses trial therapy as the main assessment.
• No primary source gives a standard session count or session length. In practice, length is set clinically and AEDP is used in both brief and open-ended work. [uncertain]
• Recording sessions on video for review and supervision is a strong training norm. [source: Fosha 2000 meta-therapeutic paper; Fosha 2002]

Assessment and selection (AEDP 1.0 criteria).

• Trial therapy starts from the present problem, asks for a specific example, and explores somatic and relational experience. The aim is a visceral moment of self-at-best inside the dyad in the first session. [source: Fosha 2002]
• Suitability rests on capacity for affective engagement, not on severity.
• Fosha's 2002 chapter lists as poorer fits: psychosis, bipolar disorder, major depressive disorder, impulse disorders, marked acting out, substance abuse, and fragile structure seen during the trial.
• Later AEDP literature describes work with trauma and depression, so these exclusions may be dated. [uncertain]

Criteria for moving between states. Don't move on because of the clock or the content. Read the markers:

• State 1 to 2: heralding and green-signal affects, softer defenses, the patient able to stay with feeling while in contact.
• State 2 to 3: a wave has peaked and subsided, adaptive action tendencies appear, relief or lightness.
• State 3 to 4: after rounds of metaprocessing, calm, ease, clarity and the truth sense; the narrative becomes coherent.
• Back to State 1: if red-signal affects, defenses or a relational "jangle" reappear, return to State 1 work: regulation, repair and defense work. [source: Fosha 2001; Fosha 2009]

3. Guiding principles

[source for this section unless tagged: Fosha 2000, 2001, 2002, 2009; Prenn 2011; Prenn, "How to Set Transformance Into Action"; AEDP Institute glossary]

• Transformance before pathology. Look for and amplify what is already healthy and healing. Meet the patient's resilience in the first exchange.
• Healing from the get-go. Aim for a corrective experience in session one, not after a long assessment. [source: Immersion objectives; Fosha 2002]
• Undoing aloneness. The decisive variable is that the patient is not alone with the feeling. Say so, show it, and check that the patient registers it.
• Dyadic affect regulation. Regulate arousal together: match the patient, then slow down slightly, and use gaze, tone and rhythm. The aim is co-regulation, not self-soothing alone. [source: Fosha 2001; Prenn 2011]
• Safety first, via a secure-base stance. Defenses arise where attachment did not provide safety, so safety lowers the need for defenses. Build safety deliberately.
• Explicit empathy, care and affirmation, not neutrality. Say out loud that you care and what you feel about the patient's suffering and strengths.
• Be a "true other," not a perfect one. Respond to what the patient needs now. Misattunement is expected and repairable. [source: Prenn 2011]
• Rupture and repair build attachment. Watch for relational "jangle" (flatness, distance, stuckness) and repair it openly. [source: Fosha 2001]
• Moment-to-moment tracking. Each intervention follows from the patient's last nonverbal or verbal shift, and its effect is checked right away.
• Experiential over explanatory. Explore, don't explain. Short phrases, one at a time, then wait. Statements often work better than questions. [source: Prenn 2011]
• Process emotion to completion. Ride a wave until it crests and releases adaptive action. A half-processed wave leaves the patient worse off than an untouched one. [synthesis from Fosha 2001; Fosha 2009]
• Re-experiencing alone is not therapeutic. Painful affect is worked with only when the patient is taking in the therapist's presence. [source: Fosha 2002]
• Defenses were once adaptive. Respect them, name their function and cost, and invite the patient to set them aside together. Don't attack them.
• Collaboration and permission. Ask before going deeper and use "we" language. The patient is the expert on their own experience.
• Privilege positive affect and the new. Explore good feelings as thoroughly as painful ones. What is new and good is fragile and needs attention to last.
• Metaprocess what changes. Every change, disclosure or piece of work is followed by "what is that like?". The unit of intervention is the intervention plus its metaprocessing. [source: Prenn 2011]
• Alternate experience and reflection. Move between right-brain experiencing and left-brain meaning-making to integrate the change. [source: Fosha 2009]
• Work from self-at-best. Approach the self-at-worst from the patient's resourced self, and the therapist's.
• Therapeutic courage. The therapist's willingness to take emotional risks increases the patient's safety. [source: AEDP Institute glossary]
• Cultural humility and power. Name differences of race, culture, gender and privilege as part of building safety. The Triangle of Social Experience maps racialized experience. [source: Immersion objectives; detail uncertain]

4. Intervention inventory

AEDP sorts its interventions into four families: relational, experiential-affective, restructuring (defense, anxiety and shame work), and integrative-reflective, which includes metatherapeutic processing. This guide groups them the same way. [source: Fosha & Yeung 2006; Fosha 2002]

Notes on sourcing:

• The full intervention table in Fosha 2000 (book) and Table 13.3 of Fosha 2002 are not drawn on. The list below is built from the papers drawn on, so a few sub-techniques named only in the book may be missing. [uncertain]
• Quoted phrases are short verbatim quotes from the cited source. Everything else is labelled (illustrative).

A. Relational interventions

A1. Explicit empathy and expressed care

• Purpose / when: From the first minute and throughout. Explicit empathy undoes aloneness and lowers anxiety, so defenses are less needed. Use it especially when the patient is in pain, ashamed, or braced for judgment. [source: Fosha 2001; Fosha & Yeung 2006]
• Steps:
  1. Notice the patient's suffering or effort.
  2. Say out loud your own feeling about it, using affect words, in a warm, slowed tone.
  3. Pause.
  4. Check whether the patient took it in (see A6).
• Example language: "I feel sad hearing this" [source: Prenn 2011]. "I'm right here with you in this" (illustrative).
• Watch for:
  • Working: softening, eye contact, tears, a sigh, "no one has said that before."
  • Not working: a deflecting joke, a stiffening body, "you're just paid to say that." Treat that as a block to receiving and explore it (A6, C5).

A2. Affirmation, validation and delight

• Purpose / when: To recognise the patient's strengths, efforts, resilience and moments of courage, which are transformance glimmers. Use it whenever the patient does something new or brave, including in session one. [source: Fosha 2000 meta-therapeutic paper; Prenn 2011]
• Steps:
  1. Catch the specific act, such as staying with a feeling or speaking a need.
  2. Name it concretely and with feeling.
  3. Let your delight show in your face and voice.
  4. Metaprocess it (D1).
• Example language: "you are doing great" [source: Prenn 2011]. "I am also so struck how open you've been with me" [source: Fosha 2000 meta-therapeutic paper].
• Watch for:
  • Discomfort, minimising or false modesty. This is a block to receptive experience, so explore it rather than repeating the praise.
  • Don't force positive affect. It should emerge from the work. [source: Prenn 2011]

A3. "We" language, collaboration and asking permission

• Purpose / when: To build shared ownership and a secure base. Use it before deepening any affect and whenever anxiety rises. [source: Prenn 2011; Prenn, Transformance protocol]
• Steps:
  1. Frame the work as joint.
  2. Ask before moving toward feeling or the body.
  3. Respect a "no": slow down and explore the hesitation.
• Example language: "is it all right for us to stay with this?"; "Can we look at this together?" [source: Prenn 2011; Prenn, protocol]
• Watch for: Compliance without contact. If the patient says yes but goes flat, metaprocess the yes.

A4. Affective resonance, mirroring and anticipatory mirroring

• Purpose / when: Nonverbal and verbal attunement that co-regulates arousal and shows the feeling is shareable.
  • Resonance: match tone, posture and facial expression.
  • Anticipatory mirroring: voice the emotion the patient would likely feel if they could.
  • Use these when affect is near but unspoken. [source: Fosha 2001]
• Steps:
  1. Match the patient's pace, pitch and intensity.
  2. Then lead slightly slower and lower.
  3. For anticipatory mirroring, offer the likely feeling tentatively, with an exit.
• Example language: "how sad" [source: Prenn 2011]. "I wonder if..." plus an exit such as "please just put it to the side" if it doesn't fit [source: Prenn 2011].
• Watch for:
  • Mismatch from slowing too much. [source: Prenn 2011]
  • Anticipatory mirroring that runs ahead of the patient. If they correct you, follow their word.

A5. Therapist self-disclosure: affect, impact and self-revealing

• Purpose / when: To show the patient their impact on you, model that affect is bearable, and undo aloneness.
  • Self-involving disclosure: your feelings now, toward the patient or their story.
  • Self-revealing disclosure: relevant life experience. Use it sparingly, to reduce aloneness or shame. [source: Prenn 2011; Fosha 2001]
• Steps:
  1. Disclose briefly and specifically: what you feel and why.
  2. Immediately metaprocess the disclosure. Disclosure plus metaprocessing is the unit.
  3. If the patient feels burdened, intruded on or numb, make that the focus.
  4. Tailor to attachment style: with dismissing patients emphasise similarity; with preoccupied patients emphasise difference. Early in treatment emphasise similarity, and introduce difference later. [source: Prenn 2011]
• Example language: "I teared up. What was that like for you?" [source: Prenn 2011]. "I feel so angry on your behalf" [source: Prenn 2011].
• Watch for:
  • Disclosure that serves the therapist's needs, or that turns into social chat.
  • Prenn treats disclosure as high-risk and an experiment: if it doesn't land, move on. [source: Prenn 2011]

A6. Exploring receptive affective experience

• Purpose / when: It is not enough to give empathy. The patient must receive it. Use this right after empathy, affirmation or care. [source: Fosha 2001; Fosha 2002; Immersion objectives]
• Steps:
  1. Ask what it is like to feel understood, seen or cared for, here and now.
  2. Track the body.
  3. If it registers, deepen it.
  4. If it doesn't, explore what blocks it (fear, shame, mistrust) as State 1 work.
• Example language: "You have a feeling about my recognizing this about you?" [source: Fosha 2000 meta-therapeutic paper]. "What's it like to let in that I get this?" (illustrative)
• Watch for:
  • Working: warmth, moist eyes, an uplifted gaze, being moved.
  • Blocked: deflection, quickly changing the subject.

A7. Focusing on the patient's experience of the therapist

• Purpose / when: To make the attachment relationship explicit and process it experientially, for example what the patient sees in your face. Use it when the relationship is alive or tense. [source: Fosha 2001; Prenn 2011]
• Steps:
  1. Invite the patient to look at you.
  2. Ask what they see or sense.
  3. Explore the gap between what they expect and what they perceive.
• Example language: "What do you see when you look in my eyes?" [source: Prenn 2011]
• Watch for:
  • Shame at gaze. Offer to look away or titrate.
  • Projections from past figures, which are useful material for the triangle of comparisons (C6).

A8. Rupture recognition and repair

• Purpose / when: Disruption followed by repair builds security. Use it at any sign of relational "jangle": flatness, distance, irritation, stuckness, or a sudden shift after your intervention. [source: Fosha 2001; Fosha & Yeung 2006; Prenn 2011]
• Steps:
  1. Notice the shift and stop.
  2. Name it as possibly caused by you.
  3. Take your part without defensiveness.
  4. Invite the patient's experience.
  5. Metaprocess the repair itself.
• Example language: "we have some repair to work on" [source: Prenn 2011]. "You are having a reaction to my saying that?" [source: Prenn 2011]
• Watch for: A return of "hum" (positive relational affect) and deeper material after the repair. Fosha (2001) calls the signs of good coordination positive relational affect, or "hum."

A9. Nonverbal dyadic regulation: matching, slowing, gaze, voice

• Purpose / when: Right-brain-to-right-brain regulation of arousal. Use it continuously, and especially when arousal is too high or too low. [source: Fosha 2009; Prenn 2011; Fosha & Yeung 2006]
• Steps:
  1. Sit face to face.
  2. Match the patient's rhythm, then slow down.
  3. Use simple, sensory, imagistic language.
  4. Lower and soften your voice for deepening.
  5. Use more energy and animation to lift a collapsed patient. [synthesis for the last point]
• Example language: "Let's slow this down"; "we have time" [source: Prenn 2011].
• Watch for: Breathing, voice and posture settling toward a regulated middle, rather than flooding or shutting down.

A10. Touch and physical proximity in one published case (not a technique; see harm account below)

• Purpose / when: Fosha & Yeung (2006) report a case in which the therapist, who had earlier been the patient's family physician, asked permission to sit closer, then held the patient's arm and applied pressure to his sternum. The transcript records explicit consent only for sitting closer, not for the touch itself; see the harm account below. [source: Fosha & Yeung 2006]
• Steps: No procedure is given in the sources. This is not a standard AEDP technique to imitate.
• Current limits [synthesis]:
  • Many licensing boards and liability carriers restrict touch.
  • If proximity is used at all: ask explicitly, accept a no, consider trauma history and culture, document it, and metaprocess it.
  • Do not use physical pressure without specific training and supervision.
• Watch for: Freezing, compliance, or sexualised or boundary confusion. Stop and repair.
• Example language: "Can I sit beside you…nearer to you…?" [source: Fosha & Yeung 2006]

Harm account: therapeutic touch in the published AEDP case (Fosha & Yeung 2006)

Scope. The published case reports no injury, and the patient described relief. This account sets out what the transcript shows was done. It then covers the documented harms of comparable non-erotic touch in psychotherapy, and why the case is not a template to copy. [synthesis]

What was actually done

• Setting. Session 12 of individual AEDP. The patient, "Gary", was a 30-year-old insurance broker with several years of daily low mood and poor concentration, motivation, memory, sleep and decisiveness. The therapist (DY) was male and a family physician by training, and had been the patient's family physician before therapy began. [source: Fosha & Yeung 2006]
• Proximity. The therapist asked "Can I sit beside you…nearer to you…?". The patient said "Okay…", and the therapist moved beside him. This is the only explicit consent request in the transcript. [source: Fosha & Yeung 2006]
• Holding. The therapist held the patient's right forearm "gently and firmly". The authors call this implicit support through body language. [source: Fosha & Yeung 2006]
• Chest and solar plexus. The patient said he had wanted to cry while describing his mother. The therapist asked "Where is the feeling located?" and touched his sternum, and the patient nodded "Yes…". The therapist then laid a hand on the sternum and applied pressure gradually. Next came gentle pressure on the solar plexus with each out-breath, while the therapist directed "Look at your mom's eyes" and "Don't block it". The patient's eyes were closed, his breathing grew heavier and he wept. [source: Fosha & Yeung 2006]
• Neck. Later, with the patient's eyes still closed in grief, the therapist laid a hand behind his neck "with gentle stroke" and again held his forearm. [source: Fosha & Yeung 2006]
• Afterwards. The patient said the tense feeling in his chest "seems to disappear". He called the chest pressure "the most touching moment" and linked it to his mother's face. [source: Fosha & Yeung 2006]
• Authors' framing. Footnote 2 states that touch "is not an issue that we will address here". It grounds the touch in the prior physician relationship, citing "the naturalness of physical touch in their relationship". No consent procedure, risk discussion, documentation or follow-up of the touch is reported. [source: Fosha & Yeung 2006]
• What the transcript shows about consent. Explicit consent was asked for and given only for sitting closer. The patient's "Yes…" during the touch answers a question about where the feeling is located, after the touch had begun; it is not agreement to be touched. (An earlier version of A10 in this guide wrongly said the sternum pressure was applied with consent; that has been corrected.) [source: Fosha & Yeung 2006] [synthesis]

How it caused harm. No harm is documented in this case. These are the mechanisms and harms documented for comparable touch.

• Assent under arousal is not informed consent. The chest, solar-plexus and neck contact came during peak affect, with the patient's eyes closed and under directive instructions. Body-psychotherapy ethics warns that a client "may say yes while meaning no". Freezing, trembling at the start of touch, a held breath or partial disembodiment may be the real answer. [source: Phillips 2002] [synthesis]
• Role mixing. The justification rests on a prior doctor–patient relationship. That turns a medical-examination licence into a psychotherapy licence. Readers without such a history have no comparable basis, and the patient may find it harder to refuse a former doctor. Dual relationships are a recognised route to boundary harm. [source: Gutheil & Gabbard 1993, citing Borys & Pope 1989] [synthesis]
• Re-enactment and abreaction. Touch can replay a client's earlier touch history and trigger abreactions. It can also be experienced as sexual whatever the therapist intends. Undisclosed sexual-abuse histories are a named risk factor. [source: Phillips 2002; Warnecke 2009]
• Gratification in place of mourning. A therapist who supplies parental contact may short-circuit the mourning of childhood deprivation. Patients may then expect further gratification, and the line between the symbolic and the concrete can collapse. This bears directly on this session, whose content was grief about the patient's mother. [source: Gutheil & Gabbard 1993] [synthesis]
• Slippery slope. Body contact such as pats, massage and then hugs is described as an early step in sequences that end in sexual misconduct. Not every crossing leads there, but the model "helps therapists think about early warning signals". Therapists who went on to violate boundaries had often "deluded themselves into thinking that behaviors in their self-interest are really altruistic". In a survey of 460 physicians, those more open to non-erotic contact with patients were statistically more likely to report erotic contact. [source: Gutheil & Gabbard 1993; Gabbard 2001; Kardener et al. 1976] [uncertain: author names for the 1976 paper not shown on the page]
• A documented escalation (not AEDP). In a 2025 BACP case, a counsellor first held a client's hands and stroked her arm. His hugs became more frequent and longer, and then progressed to kissing and groping as she tried to leave. She said she "froze" and tried to "laugh it off". The panel found harm to a vulnerable client and a breach of trust, and withdrew his membership. [source: BACP conduct notice, April 2025]
• Harm at the sexual endpoint. In Pope & Vetter's survey of subsequent therapists, about 90% of patients who had sexual involvement with a therapist were harmed. About 14% attempted suicide, about 1% died by suicide and about 11% were hospitalised. Only 17% of those harmed recovered fully. [source: Pope 2001]
• Complaints and liability. Fact-finders may treat non-sexual boundary violations as evidence that sexual misconduct occurred. One insurer settled a claim over a therapist's practice of hugging only at the start and end of sessions. [source: Gutheil & Gabbard 1993]
• Counterweight. In a UK survey of 6,878 people who had therapy, roughly a quarter to 30% reported being touched. Of those, 81% rated it positive, 14% neutral and 5% negative, and 3–5% found it inappropriate. Anxious attachment and disliking touch predicted "inappropriate" ratings. Abuse history was not measured. Harm is a minority outcome, but it clusters in clients you can identify in advance. [source: Tanzer et al. 2025] [uncertain: the paper's own denominators differ]

Recognising it today

• Labels. Watch for "corrective" or "reparative" touch, "co-regulation through touch", "somatic holding", "reparenting", "putting a hand where you feel it", or "helping the body release". These appear in experiential, attachment-focused and somatic trainings, and in case write-ups that cite this one. [synthesis]
• Red flags in a colleague's or service's practice:
  • touch introduced in the middle of intense affect rather than negotiated beforehand;
  • consent given for one thing (sitting closer) and stretched to cover another (chest, neck, stroking);
  • touch to the torso, chest, neck, face or hair;
  • touch while the client's eyes are closed, or combined with directive commands such as "don't block it";
  • touch justified by a special relationship ("we've known each other for years", "I'm a doctor");
  • touch that grows in frequency or duration over time;
  • touch absent from the notes or from supervision. Secrecy and reluctance to discuss touch with colleagues are named warning signs.
  [source: Phillips 2002; Gutheil & Gabbard 1993; BACP 2025] [synthesis]
• How legitimate practice differs. Legitimate touch is agreed as a modality in advance and outside heightened affect. The client is told the type and location of contact, can withdraw at any time, and is checked with during contact. The clinician is trained in a touch-based method, works with supervision, documents the touch and processes it with the client afterwards. Touch-based therapies where the client expects and consents to contact are not violations in themselves. AEDP's own teaching on touch frames it as case-specific and "negotiated by the patient-therapist dyad", requiring the clinician to "think through when it could be helpful and when it could be harmful". [source: Gutheil & Gabbard 1993; Warnecke 2009; Hendel 2015, AEDP Transformance Talk 7] [synthesis]

What to do instead / helping those harmed

• Alternatives within AEDP. Make your presence explicit in words ("I'm right here with you"). Use voice prosody, eye contact and leaning in. Invite the client's own hand onto their chest ("put your hand where you feel it"). Use imagery of being held, or a cushion as a contact surface. [source: Warnecke 2009 for cushions] [synthesis]
• Default. Under risk-management principles, a handshake is "about the limit" of social contact. Gently discourage most hugs through words and positioning. [source: Gutheil & Gabbard 1993]
• If touch is ever considered: check your licensing board, ethics code and liability insurer first. Get specific, revocable, documented consent in a calm state. Screen for abuse history, anxious attachment and dislike of touch. Track for freezing or compliance, and metaprocess the touch in the same session. [source: Phillips 2002; Tanzer et al. 2025] [synthesis]
• Assessing clients who were touched in previous therapy:
  • ask neutral, open questions: what contact occurred, who started it, whether they felt free to refuse, whether it escalated, and how it ended;
  • many clients experienced touch as positive, so neither assume harm nor dismiss it;
  • screen for ambivalence, guilt, suppressed anger, impaired trust, boundary or role confusion, sexual confusion, emptiness and suicide risk. Clients may protect the former therapist or have been asked to keep the contact secret.
  [source: Pope 2001; Tanzer et al. 2025] [synthesis]
• Ethical and reporting duties. Confidentiality usually means the client decides whether a complaint is made. Inform them of the relevant regulator (BACP Ethical Framework paras 33a and 34; APA standards on multiple relationships and sexual intimacies). Consult before acting. Some jurisdictions impose specific duties when a client discloses sexual contact with a previous therapist; California, for example, requires the therapist to provide a standard brochure. [uncertain: verify local law] [synthesis]

B. Experiential-affective interventions

B1. Moment-to-moment tracking ("notice and seize")

• Purpose / when: This is the backbone of every AEDP move. It detects transformance glimmers and emerging affect, and shows the effect of each intervention. Use it continuously. [source: Prenn, Transformance protocol; Prenn 2011; Fosha 2002]
• Steps:
  1. Watch for:
     • somatic cues: throat tightening, breath changes, fists, leg movement, tears;
     • shifts in voice and gaze;
     • cognitive disruption: tangled speech, sudden topic change near feeling;
     • sighs, small smiles and head nods, which are positive somatic markers.
  2. Name what you see, briefly.
  3. Invite attention to it.
• Example language: "I see tears"; "you made a fist"; "something shifted" [source: Prenn 2011].
• Watch for:
  • Positive markers (deep sigh, fleeting smile, nod) signal the work is on track. [source: Fosha 2009]
  • Naming a cue the patient experiences as exposure can trigger shame. If so, regulate it (C3).

B2. The interruption: halting the action at the first sign of affect

• Purpose / when: To put the patient's live process ahead of the content or story. Use it when affect flickers while the patient narrates, or while you are talking. [source: Fosha 2002; Prenn 2011]
• Steps:
  1. Stop mid-sentence, yours or theirs (gently).
  2. Name the shift.
  3. Shift focus to the felt experience.
  4. Return to content only deliberately.
• Example language: "Let's pause here" [source: Prenn 2011]. "Hold on — something just happened in your face. Can we stay with that?" (illustrative)
• Watch for: The patient feeling cut off or controlled. Ask permission, and metaprocess the interruption if needed.

B3. Slowing down and staying

• Purpose / when: To shift from talking about feelings to feeling them, and to help a wave build. Use it when affect is present but the patient keeps moving on. [source: Prenn 2011; Prenn, protocol; Fosha 2001]
• Steps:
  1. Use short, often one-syllable invitations.
  2. Slow your own pace.
  3. Allow silence.
  4. Repeat "stay" as needed while staying in contact.
• Example language: "let's stay here"; "stay with it"; "can you/we be with it?" [source: Prenn 2011]
• Watch for:
  • Working: deeper breath, sobering affect, slower speech. [source: Fosha 2001]
  • Overwhelm: switch to regulation (C3, B10).

B4. Somatic focusing ("ask the body to help")

• Purpose / when: To ground affect in the body, find a "handle" (felt sense), and allow a body shift. Use it when the patient intellectualises or when feeling is vague. [source: Fosha 2002; Prenn, protocol; Yeung, Transformance]
• Steps:
  1. Ask what the patient notices physically and where.
  2. Ask about its quality: size, temperature, movement.
  3. Invite them to stay with it and let it do what it wants.
  4. Track the shift.
• Example language: "What are you experiencing physically?" [source: Prenn, protocol]. "Where in your body?" [source: Fosha 2002]. "Let's ask the chest" [source: Yeung].
• Watch for:
  • Numbness or dissociation. Titrate, ground in the relationship, and orient to the room (C3).
  • Somatic focus is not the goal in itself. It is a route to core affect.

B5. Therapist vagueness, patient specificity

• Purpose / when:
  • Therapist vagueness: name feeling without specifying it, so the patient fills it with their own experience.
  • Patient specificity: ask for concrete detail (a specific example, a scene, an image), which makes emotion vivid.
  • Use these when the narrative is general or abstract. [source: Prenn 2011; Fosha 2002; Yeung, Transformance]
• Steps:
  1. Offer an open affect label ("a lot of feeling").
  2. Ask for one specific instance: when, where, what was said, what their face looked like.
  3. Slow down at the emotionally loaded detail.
• Example language: "Can you give me a specific example?" [source: Fosha 2002]. "I see pain"; "can we add more texture?" [source: Prenn 2011].
• Watch for: Detail producing a visible affective response. If it produces more story and no feeling, switch to the body (B4).

B6. Naming, acknowledging and labelling affect

• Purpose / when: To link right-brain experience with words and to validate it. Use it once the affect is felt, not before. [source: Fosha 2000 meta-therapeutic paper; Fosha 2002]
• Steps:
  1. Reflect the affect in simple words.
  2. Acknowledge that it makes sense.
  3. Let the patient correct or refine the label.
• Example language: "That's grief. Real grief." (illustrative)
• Watch for: A label that is premature or intellectual can pull the patient up into their head. Prefer "important" over "interesting." [source: Prenn 2011]

B7. Exploring and expanding ("is there more?")

• Purpose / when: To deepen and broaden emerging affect or a new positive state. Use it when a wave is building, or after a shift. [source: Prenn 2011; Prenn, protocol; Fosha & Yeung 2006]
• Steps:
  1. Invite more.
  2. Ask what happens next inside.
  3. Keep the patient in the experience rather than moving to explanation.
• Example language: "is there more?"; "say more" [source: Prenn 2011]. "Seems like there is more…" [source: Fosha & Yeung 2006]
• Watch for: Diminishing returns. If the wave has subsided, move to metaprocessing (D1).

B8. Processing core affect to completion: riding the wave

• Purpose / when: The central State 2 task. Help a categorical emotion (grief, anger, fear, joy), an attachment longing or an authentic self-state crest and subside. That releases its adaptive action tendency: strength from anger, clarity of needs, trust from closeness. [source: Fosha 2001; Fosha 2009; AEDP Institute glossary]
• Steps:
  1. Access the feeling (B1–B5).
  2. Deepen it while staying in contact.
  3. Keep regulation in the window: not flooding, not shut down.
  4. Encourage the feeling and don't block it.
  5. Follow the wave until it peaks and eases.
  6. Notice the post-breakthrough affects: relief, lightness, strength.
  7. Ask what the body wants to do, or what the patient now knows they need.
  8. Then metaprocess (D1).
• Example language: "Don't block it…" [source: Fosha & Yeung 2006]. "Go with that" [source: Yeung]. "Let it come, I'm right here" (illustrative).
• Watch for:
  • Completion markers: a natural ebb, a deep breath, words like "lighter" or "clearer" or "stronger," an emerging action impulse.
  • Danger signs: spiralling without resolution, or pathogenic affects such as helplessness, collapse or toxic shame. Those mean the patient is alone or in self-at-worst. Shift to C7 or C8.
  • Psychoeducation that feelings come in waves and complete can help. [source: Prenn, protocol]

B9. Portrayals

• Purpose / when: An imagined, vivid, specific scene, real or imagined, past, present or future, in which the patient says and does what could not be said or done then. Portrayals:
  • heighten affect and carry it through to completion;
  • let the patient have reparative, feared or longed-for experiences;
  • can reunite the patient with a younger self.
• When: When core affect toward a specific other is present (anger at an abuser, longing for or grief over a parent) or when an action impulse emerges.
• Types: AEDP describes three types of portrayal, but the sources do not name them. [uncertain] [source: Fosha, Portrayals seminar page; Medley 2021 via Transformance Talk 23; Prenn, protocol; Yeung, Transformance]
• Steps: The sources describe three stages: setting up, processing through, and completion. The specific steps below are synthesis. [synthesis]
  1. Get permission.
  2. Set the scene in sensory detail: where, when, what the other looks like.
  3. Let the impulse or emotion express itself in imagination, in words or action, while you track the body.
  4. Follow it all the way through, including the aftermath: what happens to the other, what the patient does next.
  5. Bring it to completion. This may include caring for the self or the younger self, a goodbye, or a new ending.
  6. Return to the room.
  7. Metaprocess.
• Example language: "In your mind's eye, where are you? What do you see in his face?" (illustrative). "Let your anger do what it wants to do, in your imagination" (illustrative).
• Watch for:
  • The portrayal is not a rehearsal for real-world action. Prenn says it can rehearse adaptive action without being a rehearsal for action. Clarify this if the patient fears they will act on it. [source: Prenn, protocol]
  • Watch for guilt or fear after aggressive portrayals, and for dissociation. Slow down and titrate.
  • Working: relief, strength, tenderness, self-compassion.

B10. Titration, including time-limited exposure to intense feeling

• Purpose / when: To keep intense affect within tolerance, for example "just for a few seconds." Use it with trauma material or when the patient fears being flooded. [source: Prenn, protocol]
• Steps:
  1. Agree on a short window.
  2. Feel together.
  3. Step back and check in.
  4. Repeat, extending the window as tolerance grows.
• Example language: "Let's just touch it for a moment, together, and then we'll come back up" (illustrative).
• Watch for: Better tolerance with each round. If tolerance falls, stop and regulate.

B11. The platform

• Purpose / when: A brief left-brain summary that organises what was just experienced, before going further or ending. Use it after a wave, or when the patient seems lost. [source: Prenn 2011]
• Steps:
  1. Pause.
  2. Summarise in simple experiential words what happened and what it means.
  3. Check that it fits.
• Example language: "here is what I am seeing"; "this is meaningful" [source: Prenn 2011].
• Watch for: The platform turning into an intellectual lecture. Keep it short.

B12. Psychoeducation (brief, experiential)

• Purpose / when: To lower fear of feeling by explaining waves of emotion, freeze responses, or why defenses developed. Use it when fear of emotion blocks access. [source: Prenn, protocol]
• Steps:
  1. Give one or two sentences.
  2. Link them to the patient's experience.
  3. Return to experience.
• Example language: "Feelings come in waves. If we let this one crest, it will pass" (illustrative).
• Watch for: Psychoeducation used as a defense by therapist or patient.

C. Restructuring interventions: defenses, inhibiting affects, schemas

C1. Mapping the triangle of experience

• Purpose / when: To orient yourself, and later the patient, to what is happening now. The triangle of experience is AEDP 2.0's version of Malan's triangle of conflict:
  • top: defenses, plus inhibiting affects (anxiety, shame, guilt) shown as red-signal affects;
  • bottom: core affective experience. Adaptive core affect needs completing; maladaptive (pathogenic) affect needs transforming.
  • The self-at-best version has green-signal affects (hope, curiosity, trust) on top, which point toward feeling.
  • Use it for case formulation and to choose the next intervention: a defense calls for defense work, anxiety for regulation, core affect for deepening. [source: AEDP Institute glossary; Fosha 2002; Fosha & Yeung 2006]
• Steps:
  1. In the moment, ask which corner the patient is in.
  2. Respond to that corner: defense → C2–C4; red-signal affect → C3–C4; core affect → B8; pathogenic affect → C8.
  3. When it helps, share the map with the patient in simple words.
• Example language: "When the sadness gets close, the anxiety comes in, and then the joke shows up to protect you" (illustrative).
• Watch for: Using the map to lecture. It mainly guides you.

C2. Identifying, labelling and clarifying defenses

• Purpose / when: To make automatic defenses visible and ego-dystonic. Defenses include:
  • isolation of affect, numbing, joking, pressured speech, vagueness, withdrawal, walling off;
  • hyper- or hypo-focus on self or other;
  • denial of change and false modesty.
  • Use this when a defense blocks contact or feeling. [source: Fosha 2001; Fosha 2002; Fosha & Yeung 2006]
• Steps:
  1. Notice the defense as it happens.
  2. Name it neutrally and with compassion.
  3. Ask whether the patient notices it too.
  4. Explore what it protects against.
• Example language: "Did you notice — just as the tears came, you swallowed and smiled?" (illustrative)
• Watch for:
  • Labelling heard as criticism, which adds shame. Pair it with empathy and affirm the defense's original function.

C3. Regulating anxiety and red-signal affects

• Purpose / when: To lower anxiety and inhibitory affects enough that core affect becomes approachable. Use it when the patient is anxious, shaky or tense, or when anxiety spikes as feeling approaches. [source: Fosha 2002; Fosha 2009; Immersion objectives]
• Steps (the specific methods are synthesised from the sources) [synthesis]:
  1. Slow down and co-regulate (A9).
  2. Explicitly undo aloneness.
  3. Explore the specific fear ("what's the worst part?") and correct catastrophic expectations.
  4. Track the anxiety in the body.
  5. Ask permission and titrate (B10).
  6. Give brief psychoeducation (B12).
  7. Affirm the patient's courage.
  8. Once anxiety drops, invite the feeling it was signalling.
• Example language: "You're not alone with this. We can go as slowly as you need" (illustrative).
• Watch for: Anxiety dropping and green-signal affects appearing (curiosity, a softer gaze). Anxiety rising as feeling approaches means you went too fast.

C4. Working with shame

• Purpose / when: Shame, especially shame about the essential self, is the most disruptive inhibiting affect. AEDP addresses it by countering aloneness and through affirmation from a caring other, not by having the patient re-experience it alone. Use it with self-attack, hiding, or averted gaze. [source: Fosha 2002; Fosha & Yeung 2006; Yeung, Transformance]
• Steps:
  1. Notice shame markers: gaze aversion, shrinking, blushing.
  2. Slow down and soften.
  3. Name it gently, or don't, if naming would increase exposure.
  4. Offer explicit acceptance and affirmation.
  5. Challenge self-abasement. [source: Yeung]
  6. Explore what it's like to be accepted here (A6).
  7. Reduce gaze demands if needed.
• Example language: "There's nothing you could tell me that would make me think less of you" (illustrative).
• Watch for:
  • Shame transforming into pride or joy, the mastery affects. [source: Fosha 2009]
  • Shame deepening into collapse. Move to C8.

C5. Cost-benefit work and helping the patient let go of defenses

• Purpose / when: To help the patient see that a once-adaptive defense now costs them (loneliness, depression, symptoms) and to let it go collaboratively. Use it with entrenched defenses. [source: Fosha & Yeung 2006; Fosha 2002; Module 1–3 objectives]
• Steps:
  1. Honour what the defense protected the patient from, and when.
  2. Explore its cost now.
  3. Ask whether the patient wants to try something different here, with you.
  4. If yes, invite them to set the defense aside (C6).
  5. If no, validate the resistance and slow down.
• Example language: "That wall kept you safe back then. I wonder what it costs you now, being behind it" (illustrative).
• Watch for: The defense becoming ego-dystonic: the patient themselves wants to drop it.

C6. Bypassing or softening defenses

• Purpose / when: In AEDP, defense work starts from acceptance. Bypassing means going around the defense to the affect beneath it, rather than confronting it the way Davanloo does. Fosha (2002) describes both confrontational and accepting, pressure-reducing approaches, and favours small steps. Use it when there is enough safety and the affect is near. [source: Fosha 2002; Fosha & Yeung 2006; Prenn, protocol; Yeung]
• Steps:
  1. Invite the patient to put aside the defensive response (embarrassment, the "civilised" reply, the smile).
  2. Go straight to the faint sensation or emotion beneath it.
  3. Support them with your presence.
• Example language: "Don't fight them. Don't fight them." (about tears) [source: Prenn, protocol]. "You don't need to be so brave." [source: Prenn, protocol]
• Watch for:
  • Heralding affects breaking through, the first state transformation. Fosha & Yeung call these heralding affects the "last hurrah of the resistance."
  • If the defense hardens instead, return to safety and cost-benefit work.

C7. Self-other-emotion triangle work and the triangle of comparisons

• Purpose / when:
  • The self-other-emotion triangle maps how the self, the other and the emotion between them were configured in early attachment, in both self-at-best and self-at-worst versions. It is used to formulate and to target relational interventions.
  • The triangle of comparisons links patterns across therapist (T), current others (C) and past others (P).
  • Use them when relational patterns repeat with you. [source: Module 2 objectives; Fosha 2002. The details of both triangles come from Fosha 2000.] [uncertain]
• Steps [synthesis]:
  1. Notice the patient's expectation of you (for example, that you'll be bored or critical).
  2. Contrast it experientially with how you actually respond.
  3. Link it to past and current relationships when the patient is ready.
  4. Metaprocess the difference.
• Example language: "What's it like that I'm not pulling away right now, when you expected I would?" (illustrative)
• Watch for: Insight with no felt sense. Bring it back to here-and-now experience.

C8. Intra-relational work with pathogenic affects (Lamagna)

• Purpose / when: Use it when pathogenic affects dominate (unbearable shame, fear, helplessness, aloneness, despair: self-at-worst) and the patient cannot take in the therapist's presence. [source: Lamagna 2022, AEDP Institute]
• Steps (Lamagna's sequence, paraphrased):
  1. Start with standard dyadic regulation.
  2. If the pain is too acute, shift to intra-relational work.
  3. Help the patient differentiate their present self from the pathogenic state, and track small positive shifts such as easier breathing.
  4. Maintain that separation. Watch for self-attack, urgency to fix, and intellectualising.
  5. Foster empathic, compassionate contact between the present self and the suffering part.
  6. Use distance in time and space, for example placing the younger self across the room.
  7. Watch for re-blending and invite the part to step back.
  8. Metaprocess the change.
  • Lamagna borrows from empty-chair work, IFS unblending, RAIN, psychodrama and psychosynthesis.
• Example language: "Can we bear witness to these old feelings with one foot in 2013?" and "See if she would be willing to step back just a little bit." [source: Lamagna 2022]
• Watch for: Warmth or tenderness toward the part (core affect) is the sign it is working. Merging and collapse means re-blending.

C9. Working with self-at-best and self-at-worst; consulting parts

• Purpose / when: To work with the self-at-worst from inside the self-at-best, for example letting the wiser or stronger part help the frightened part. Use it with chronic self-criticism or conflicting self-states. [source: Fosha & Yeung 2006; Yeung, Transformance]
• Steps:
  1. Help the patient find and feel a resourced state (a time of strength, the felt sense of a good relationship).
  2. From there, turn toward the struggling part.
  3. Ask what the resourced part feels toward it and wants to offer.
• Example language: "From this steadier place, how do you feel toward the part of you that panics?" (illustrative)
• Watch for: Compassion is the sign it is working. Contempt means another defense or part is active; work with that first.

D. Integrative-reflective interventions: metatherapeutic processing and core state

D1. Small-m metaprocessing (after any intervention)

• Purpose / when: To explore the patient's experience of what just happened: a disclosure, a piece of work, or a new feeling. It consolidates change and catches blocks. Use it after every significant intervention and every self-disclosure. [source: Prenn 2011]
• Steps:
  1. Pause.
  2. Ask what it is like, here and now, to have just done or felt or heard X.
  3. Track the answer in the body.
  4. Follow whatever emerges, positive or negative.
• Example language: "What is it like to know this?"; "your reaction to my sharing this with you?" [source: Prenn 2011]
• Watch for: Metaprocessing turning into social chat or a cognitive debrief. Keep it experiential. [source: Prenn 2011]

D2. Metatherapeutic processing (capital M): rounds of State 3 work

• Purpose / when: After a completed wave, or at the end of a piece of work, a session or treatment. Make the experience of change the focus. This sets off a cascade of transformational affects and integrates the change into the self. [source: Fosha 2000 meta-therapeutic paper; Fosha 2009; Prenn 2011; AEDP Institute glossary]
• Steps:
  1. Name and affirm the change.
  2. Ask what it is like to have experienced it, or to have done it with you.
  3. Track the transformational affect that arises.
  4. Explore it experientially until it peaks.
  5. Reflect briefly on its meaning.
  6. Ask again what it is like to notice that.
  7. Repeat for several rounds, alternating experience and reflection, until calm, ease and the truth sense indicate core state.
• Example language: "What is it like for you to do this with me?" [source: Fosha 2002]. "What is it like for you to have done this with me?" [source: Prenn 2011]. "What feels different in your body now compared with when you came in?" (illustrative)
• Watch for:
  • The six transformational affects. [source: AEDP Institute glossary]
    • Post-breakthrough affects: relief, lighter, clearer, stronger.
    • Mastery: pride and joy.
    • Emotional pain: mourning the self.
    • Healing affects: being moved, gratitude, tenderness.
    • Tremulous affects: fear or excitement, curiosity, positive vulnerability.
    • Healing vortex: oscillating or vibrating sensations.
  • Yeung's seminar also lists "realization" and "enliven" affects. The categories differ between sources. [uncertain]
  • Resistance to the positive: guilt, unworthiness, fear of losing good things. Work these through as they come. [source: Fosha 2000 meta-therapeutic paper]

D3. Acknowledging mastery

• Purpose / when: The patient recognises their own role in overcoming an obstacle. The marker is joy, pride or exuberance. Use it after a breakthrough or a courageous act. [source: Fosha 2000 meta-therapeutic paper; Fosha 2009]
• Steps:
  1. Point to the patient's agency in what happened.
  2. Show interest in how they did it.
  3. Affirm it.
  4. Explore the pride or joy in the body.
• Example language: "You did that. You stayed with something you've run from for years. What's it like to know that?" (illustrative)
• Watch for: Deflecting to luck, or to the therapist. Gently return to the patient's agency.

D4. Mourning the self

• Purpose / when: Grief for what the patient missed, lost, or never had, often for years spent behind defenses. The marker is emotional pain. Use it when contrast with the new experience surfaces old losses. [source: Fosha 2000 meta-therapeutic paper; Fosha 2009; Yeung, Transformance]
• Steps:
  1. Stay empathically with the pain; don't steer away from it.
  2. Explore it in detail.
  3. Help the patient contact the needs and longings beneath it.
  4. Hold compassion for the self who went without.
• Example language: "It's time for you" [source: Fosha 2000 meta-therapeutic paper]. "That little girl never got this. It makes sense to grieve for her" (illustrative)
• Watch for: Mourning-the-self is a transformational affect, not depression. It moves toward compassion and acceptance. If it turns into despair or self-blame, it has become pathogenic: go to C8.

D5. Receiving affirmation: working with the healing affects

• Purpose / when: The patient feels deeply seen and helped. Healing affects follow: being moved inside, and gratitude, love and tenderness toward the affirming other. Markers include moist, clear eyes, an uplifted gaze, a welling-up sensation, a shy smile, and "truth tears" or "happy tears." [source: Fosha 2000 meta-therapeutic paper; Fosha 2009]
• Steps:
  1. Recognise the healing affect as a sign things are going well.
  2. Make the affirmation explicit.
  3. Ask about the patient's experience of it.
  4. Mirror and label it.
  5. Stay with it rather than turning to the painful contrast.
  6. Receive the patient's gratitude openly, disclosing your own feelings and avoiding false modesty.
• Example language: "Where are these tears coming from?"; "Tell me what that sense of relief feels like"; "Thank you. Thank you." [source: Fosha 2000 meta-therapeutic paper]
• Watch for: Your own discomfort at being thanked or loved. Fosha recommends exploring it personally and reviewing tapes.

D6. Tremulous affects: the crisis of healing change

• Purpose / when: Fear and excitement, startle, curiosity and positive vulnerability as the patient steps into the unfamiliar new. Use it when a change brings shaky excitement or anxious pleasure. [source: Fosha 2009; AEDP Institute glossary]
• Steps [synthesis from the sources' description]:
  1. Normalise the tremulous feeling as part of healthy change.
  2. Co-regulate it.
  3. Separate it from old red-signal anxiety.
  4. Explore the curiosity and excitement within it.
• Example language: "Scary and exciting at the same time — like standing somewhere new" (illustrative).
• Watch for: A slide back into defensive anxiety. If that happens, slow down and return to State 1 work.

D7. Core state: "let it be" and integrative-reflective work

• Purpose / when: Use this once calm, clarity, ease, compassion and the truth sense emerge. The therapist's job is to:
  • let it unfold;
  • be a witness or collaborator;
  • help the patient build a coherent autobiographical narrative;
  • reflect on what the therapy has meant, linking the new to the old and to the future. [source: Fosha 2002; Fosha 2009; Fosha & Yeung 2006; Prenn, protocol; AEDP Institute glossary]
• Steps:
  1. Reduce your activity and allow silence.
  2. Follow the patient's own reflections.
  3. Invite them to put the experience into words, tell its story, and say what they now know about themselves.
  4. Consider how it might carry into life outside the session.
• Example language: "Let it be." [source: Prenn, protocol]. "What do you know now about yourself that you didn't when you walked in?" (illustrative)
• Watch for:
  • Markers: "I feel like myself," calm, a truth sense, "we" experience. [source: Fosha & Yeung 2006; Fosha 2001]
  • Don't push for more feeling here. Core state is the place for integration.

E. Assessment and session-one interventions

E1. Trial therapy and "healing from the get-go"

• Purpose / when: In the first session, assess the patient while also giving a corrective experience. The aim is a visceral moment of self-at-best inside the dyad. [source: Fosha 2002; Immersion and Module 1 objectives]
• Steps:
  1. Ask what brings them now.
  2. Ask for a specific example (B5).
  3. Track affect and transformance (B1).
  4. Lead with explicit empathy and affirmation (A1, A2).
  5. Test the response to empathy, to bypassing a defense, and to deepening.
  6. Note what helps the session flow and what stalls it.
  7. Metaprocess the first session itself.
• Example language: "What brings you here now?" [source: Fosha 2002]. "This is what we do here." [source: Fosha 2002]. "What's it been like to tell me this today, for the first time?" (illustrative)
• Watch for: Capacity for affective engagement, and signs of fragile structure such as fragmentation under mild deepening or dissociation. These argue for more regulation-first work, or for another approach. [source: Fosha 2002]

5. Handling problems

Items tagged [source] come from the primary texts. Items tagged [synthesis] are my own guidance, consistent with AEDP principles but not stated in the primary sources.

Stuck: talking about feelings, no feeling.

• Stop the narrative (B2).
• Ask for one specific example (B5).
• Go to the body (B4) and slow down (B3).
• Prefer "important" to "interesting," and statements to questions. [source: Prenn 2011; Fosha 2002]
• If the patient is still stuck, metaprocess the stuckness itself: "What's it like right now, when nothing seems to come?" (illustrative). Watch for shame about "doing it wrong" (C4). [synthesis]

Defenses that won't budge ("resistance").

• Validate the resistance and honour its original function. [source: Yeung, Transformance; Fosha & Yeung 2006]
• Do cost-benefit work (C5) and offer the choice. Increase safety rather than pressure, because safety makes defenses unnecessary. [source: Fosha 2002]
• AEDP's concept is transformance versus resistance. Look for the glimmer of the part that wants to heal, and ally with it. [source: Fosha 2009; Immersion objectives]
• Avoid escalating confrontation in the Davanloo style unless you are trained in it and the alliance is strong. [synthesis; Fosha 2002 mentions confrontational work as one option but favours small, accepting steps]

Overwhelm, flooding or dysregulation.

• Increase dyadic regulation: slow down, soften your voice, make eye contact, "I'm right here" (A9).
• Titrate (B10). Shift from deepening to regulating (C3).
• If pathogenic affects take over (unbearable shame, helplessness, despair) or the patient cannot take you in, move to intra-relational work (C8). [source: Lamagna 2022]
• Before ending, re-orient to the present and make sure the wave is completed or contained. [synthesis]
• Never leave the patient re-experiencing alone. [source: Fosha 2002]

Dissociation or shutdown. [synthesis, not specifically addressed in the sources]

• Raise your energy rather than slowing further.
• Orient to the room and to your face and voice.
• Use short, concrete invitations (feet on the floor, "can you see me?").
• Reduce affective depth.
• Then metaprocess what helped the patient come back.
• With chronic dissociation, consider structured trauma-informed stabilisation alongside AEDP, and get supervision.

The patient rejects or can't take in care or affirmation.

• Treat the block as State 1 material. Explore what makes receiving hard: fear, mistrust, unworthiness, guilt, fear of losing it. [source: Fosha 2000 meta-therapeutic paper; Module 2 objectives]
• Don't escalate the warmth. Calibrate to attachment style: less closeness and more similarity for dismissing patients; more boundaries and difference for preoccupied patients. [source: Prenn 2011]

Too much positivity, or a "flight into health." [synthesis]

• Positive affect that comes too early, with no processed wave behind it, can be defensive.
• Test it by metaprocessing: genuine transformational affects deepen and settle when explored; defensive cheer thins out or shifts away.
• Fosha (2001) notes that positive affect after expressed negative affect is usually core relational affect, not defense.

Ruptures. Use A8: notice, name, own your part, invite the patient's experience, and metaprocess the repair. Treat each repair as attachment-building, not as a failure. [source: Fosha 2001; Prenn 2011]

Self-disclosure backfires (the patient feels burdened or intruded on). Make that reaction the focus. Acknowledge it, take responsibility, and metaprocess. Treat disclosure as an experiment. [source: Prenn 2011]

Non-adherence.

• AEDP has no homework, so adherence problems show up as missed sessions, lateness, or avoiding emotional topics.
• Explore these here and now as relational communications, with curiosity, not interpretation-as-accusation.
• Ask what the patient anticipates or fears about coming. Repair if something in the last session felt like too much. Metaprocess the previous session at the start of the next one. [synthesis]

Contraindications and fragile structure.

• Fosha (2002) lists poorer fits: psychosis, bipolar disorder, major depression, impulse disorders, marked acting out, substance abuse, and fragile structure on trial.
• With such patients, put regulation, safety and intra-relational work first, keep deepening minimal, and consider coordinated care. [synthesis; the current AEDP stance on these exclusions is uncertain]

Suicidality or risk.

• AEDP's stance does not replace standard practice. Run a standard structured suicide risk assessment and safety planning per your setting's protocol whenever risk emerges, and pause deepening work until risk is addressed. [synthesis]
• Fosha (2001) describes a chronically depressed patient with suicidal ideation treated with affect-focused interventions. That case is not a risk protocol.

Cultural and power differences.

• Name the differences as part of building safety.
• Ask how they affect what the patient can feel and say with you.
• Use the Triangle of Social Experience to map racialized trauma, including internalised inferiority or superiority. [source: Immersion objectives; detail uncertain]

Therapist-side difficulties. These include:

• discomfort with intense affect, with being thanked or loved, or with eye contact;
• false modesty;
• your own momentary defenses.

Responses: video review of sessions, supervision, and personal work. Notice and correct your own defense in the moment. [source: Fosha 2000 meta-therapeutic paper; Fosha & Yeung 2006]

Touch and boundaries. See A10. Consensual touch appears in one published case. It is not a technique to adopt without training, jurisdictional clearance and documentation. [synthesis]

Sources

Sources

• Fosha — The Activation of Affective Change Processes in AEDP (2002, Comprehensive Handbook of Psychotherapy chapter, preprint)
• Fosha — The Dyadic Regulation of Affect (J Clin Psychol/In Session, 2001)
• Fosha — Meta-therapeutic processes and the affects of transformation: Affirmation and the healing affects (2000)
• Fosha — Positive affects and the transformation of suffering into flourishing (Annals NYAS, 2009)
• Fosha & Yeung — AEDP exemplifies the seamless integration of emotional transformation and dyadic relatedness at work (2006)
• Prenn — Mind the Gap: AEDP interventions translating attachment theory into clinical practice (2011)
• Prenn — How to Set Transformance Into Action: The AEDP Protocol
• Yeung — Transformance and the Phenomenology of Transformation (Transformance journal)
• Lamagna — Making Good Use of Suffering: Intra-relational Work with Pathogenic Affects (2022)
• AEDP Institute — The AEDP Model of Psychotherapy Glossary of Terms
• AEDP Institute — Immersion learning objectives
• AEDP Institute — Module 1: Healing from the Get-Go, Undoing Aloneness & the Clinical Roadmap (training modules 1–5)
• AEDP Institute — What Went Right? Metatherapeutic Processing seminar (Yeung, 2023)
• AEDP Institute — On Demand AEDP Portrayals (Fosha)
• AEDP Institute — Transformance Talk 23: Portrayals in AEDP (Medley, 2025)

Books cited, not drawn on

• Fosha, D. (2000). The Transforming Power of Affect: A Model for Accelerated Change. Basic Books.
• Fosha, D. (Ed.) (2021). Undoing Aloneness and the Transformation of Suffering into Flourishing: AEDP 2.0. APA Books. This includes the Medley chapter on portrayals and chapters by Pando-Mars, Frederick, Lamagna and Yeung, cited via the AEDP Institute pages.
• Fosha, D., & Pando-Mars, K. (2025). Tailoring Treatment to Attachment Patterns. Seen in search results only, not used for content. [uncertain]

Sources for the touch harm account (A10)

• Gabbard — Commentary: Boundaries, Culture, and Psychotherapy (J Am Acad Psychiatry Law 29(3):284–6, 2001)
• Pope — Boundaries in Psychotherapy (summary page drawing on Gutheil & Gabbard, The concept of boundaries in clinical practice, Am J Psychiatry 150:188–196, 1993)
• Characteristics of "erotic" practitioners (Am J Psychiatry 133(11):1324, 1976; abstract only) [uncertain: attributed to Kardener et al.]
• Pope — Sex Between Therapists and Clients (Encyclopedia of Women and Gender, 2001)
• Tanzer et al. — Touch in psychotherapy: Experiences, desires and attitudes in a large population survey (Psychotherapy Research, 2025)
• Phillips — Somatic Tracking and the Ethical Use of Touch (USA Body Psychotherapy Journal 1(2), 2002)
• Warnecke — The therapeutic modality of touch and statutory regulation (Self & Society 37(2), 2009)
• BACP — Professional conduct notice, withdrawal of membership, April 2025 (KS, ref. 00921075)
• AEDP Institute — Transformance Talk 7: The Judicious Use of Touch in an AEDP Treatment (Hendel with Lipton, 2015)