A Bridge Over Troubled Water: Commentary on Paul Blimling’s Case of "James" Integrating Music Listening into AEDP

Abstract

The integration of music listening into Accelerated Experiential Dynamic Psychotherapy (AEDP) is explored through discussion of Dr. Paul Blimling’s (2019) composite case study, "James." AEDP is a healing-oriented, non-pathologizing, experiential therapy model in which the therapist actively seeks to harness glimmers of resilience from the outset of treatment, and to co-engender safety within the therapy relationship in order to unleash the transforming power of attachment and emotion (Fosha, 2000, 2003, 2009, 2018). Blimling’s incorporation of music listening into the treatment of a highly defended, initially hostile patient helped bypass defenses, foster attachment within the therapy relationship, and access and co-regulate the patient’s affective experience. Key AEDP change mechanisms in the treatment included: undoing aloneness; affirmative work with defenses; dyadic affect regulation; emotion processing; and (to a lesser extent), metatherapeutic processing (metaprocessing for short). The latter is a unique and important contribution of AEDP to our field. Since the publication of Fosha’s The Transforming Power of Affect (2000), AEDP itself has evolved from an attachment- and emotion-focused model to also focus increasingly and explicitly on transformational experience as an agent of change. The experience of positive change itself is now seen as an equally important AEDP change mechanism, alongside attachment and emotion processing. Metatherapeutic processing of patients’ experiences of positive change, which involves a recursive alternation between exploration of new experience and reflection on that experience, frequently results in an expansive spiral of the transformational processes and affects identified by Fosha (2009, 2018). In addition to affirming Blimling’s choice of AEDP and his sensitive and skillful integration of music listening into the treatment, I envision how the transformational process described in the case study might have been further expanded, deepened, and consolidated, had the therapist more assiduously and experientially explored the patient’s experiences of positive change.

Facing the Music: Further Thoughts on Integrating Music into Psychotherapy

“…The thoughtful commentaries submitted by Skean, Harrison, and Adams affirm several ways in which facets of patient-chosen collaborative music listening are aligned with such therapeutic goals and techniques. Harrison (2019) points out how the use of "metaprocessing" may be beneficial in expanding and deepening the work. However, I have argued that such a technique would need to be skillfully and judiciously employed with a patient as hostile and defended as James, and that the shared experience of collaborative music listening may implicitly represent a kind of metaprocessing in itself.…”

Termination in 16-session accelerated experiential dynamic psychotherapy (AEDP): Together in how we say goodbye.

“…Unfortunately, in earlier relational environments, many patients learned to defensively exclude their emotions in response to cues from early attachment figures (Bowlby, 1988). Hence, throughout the termination process, AEDP therapists aim to foster corrective emotional/relational experiences, that is, new experiences of emotion in connection (Harrison, 2019) that disconfirm patients' attachment-based expectations. Doing so is predicted to facilitate attachment security and revise inner working models (Frederick, in press; Pando-Mars, in press).…”