Accelerated Experiential-Dynamic Psychotherapy integrates experiential, relational and psychodynamic elements. Deep authentic affective experience and its regulation through coordinated emotional interchanges between patient and therapist are viewed as key transformational agents. When maintaining attachment with caregivers necessitates excluding particular affects, patients' capacity to regulate emotion becomes compromised. Being in an emotionally alive therapeutic relationship enables patients to better tolerate and communicate affective states; doing so, in turn, fosters security, openness, and intimacy in their other relationships. A clinical vignette will illustrate how using the therapist's affect, and focusing on the patient's experience of it, contributes to the repair of affect regulatory difficulties.

The goal of this paper is to show (i) how the moment-to-moment tracking and processing of emotion to completion-in an emotionally engaged patient-therapist dyad where the individual feels safe and known-constitutes a powerful mechanism of therapeutic transformation, and (ii) how positive emotions are sensitive affective markers of that transformational process. Evidence from transformational studies is used to elaborate the vital role of positive emotions in the process of change in general, and, more specifically, in the course of therapeutic work with painful and overwhelming emotional experience. It is proposed that these emergent positive emotions are affective markers which signal the operation of healing transformational processes in psychotherapy. Several types of positive emotion that arise spontaneously during moment-to-moment experiential therapeutic work will be described and their role as markers of different transformational processes will be elucidated. The paper begins with examples of clinical work with emotion in AEDP (Accelerated Experiential-Dynamic Psychotherapy), an emotion-focused and attachment-based model of therapy that places the dyadic regulation of affect at the centre of both theory and practice. Copyright © 2004 John Wiley & Sons, Ltd. * Correspondence to: Dr Diana Fosha, 80 University Place, 5th floor, New York, NY 10003, USA. Tel. 212 645-8465. E-mail: dfosha@aol.com 1 The title of this paper comes from Eugene Gendlin's book Focusing (1981). Here is a larger excerpt of the text from which the title sentence comes: 'You feel better because your body feels better, more free, released. The whole body is alive in a less constricted way. . . . No matter how frightening or intractable a problem looks when it first comes to light, . . . at the very next shift it may be quite different. Nothing that feels bad is ever the last step ' (pp. 25-26). Sam, a man with a history of early abuse, rejection and betrayal sought treatment for the severe depression that followed the break-up of a relationship. Intensive psychotherapeutic work cleared his depression and led to a long period of being symptom-free and feeling well. However, Sam arrives for the session described below having felt worse in the days preceding it than he had in a long time. Positive EmotionsIn the session, Sam reports that, for days, he has been in the grips of an emotional pain that he has experienced in his body, with no thoughts about the reasons for it. I focus on Sam's somatic pain, e.g. exploring where and how he feels it, and encourage him to stay with his experience of it. Tracking his experience moment-to-moment, some possible links emerge between his somatic state and some recent events. By staying connected with and pursuing the painful reactions, the message is that in the therapeutic relationship, deep feelingshis and mine-can be tolerated without the disconnection and humiliation with which his early attachment figures had met his emotions. As his affect deepens, Sam starts to thaw. Thoughts begin to flow. Gradu...

In this paper, the authors compare and contrast two psychotherapy paradigms for the treatment of complex posttraumatic stress disorder (PTSD): a behavioral therapy (prolonged exposure; PE) and an experiential therapy (Accelerated Experiential Dynamic Psychotherapy; AEDP). PE has received strong research support as an effective treatment for PTSD. The scientific evidence for experiential therapy is sparser, but also positive. In addition, clinical and research evidence suggest that (a) experiential processes are inherently embedded in PE, and may influence PE outcomes; and that (b) AEDP addresses several clinical and relational factors that are negative prognostic factors for PE (e.g., affect dysregulation, disorganized attachment, sense of alienation and mental defeat, dissociation, and disorders of the self). Suggestions are provided for further empirical exploration of the process and efficacy of AEDP and experientially informed PE for complex cases of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

While many models of individual psychotherapy acknowledge the significance of attachment theory for clinical work, Accelerated Experiential Dynamic Psychotherapy (AEDP) seeks to operationalize the intersection of attachment and affective neuroscience to introduce innovations in its clinical practice. AEDP's stance and techniques aim to (a) foster attachment security through the clinical process, and (b) harness the transformative resilience of secure attachment to potentiate deep and lasting psychological change. Viewing secure attachment as a transformative experience, case vignettes offer examples of AEDP attachment-based work: moment-to-moment experiential work processing attachment security as a powerful new experience; andthen, its metatherapeutic processing. Integrating a new, positive relational experience in the here-and-now organically evokes the painful experiences of the original relational trauma. Thus, traumatic memories are also worked through in the service of positive psychological transformation.

Three ideas are discussed from the vantage point of accelerated experiential dynamic psychotherapy (AEDP): Quantum changes operate not only in trauma, but also in healing; attachment plays a major role in whether fear or excitement is the response to novelty; experientially exploring the experience of transformation can itself lead to quantum change. Vignettes from an AEDP session show a patient's grappling with the startling novelty of experience that the transformational process, particularly when occurring in quantum leaps, evokes, and illustrate the phenomenology of cascading transformations. They illustrate how the therapist's emotional engagement and attachment orientation, experiential techniques, and metatherapeutic processing activate state transformations and entrain adaptive healing processes.