Diana Fosha is a faculty member in the Department of Psychiatry and Psychology of both NYU and St. Luke’s/Roosevelt Medical Centers in New York City. Her primary interest is in the phenomenon of transformative experiences, and she is on the cutting edge of both research and practice in this area. She is most well-known for her creation of accelerated experiential dynamic psychotherapy (AEDP) and the affective model of change which provides the theoretical underpinning for this therapy. Fosha’s development of the affective model of change began with the observation that affect has enormous transformative power. Unlike other agents of change that are often slow and cumulative, affect can result in intense change very rapidly. The primary goal of the affective model of change is to identify, make sense of, and utilize its power in the context of a therapeutic relationship. This relational feature of the affective model of change draws heavily from literature on attachment, and the notion that our early attachment styles pervade our way of relating to the world as adults. Fosha argues that by synergistically linking emotion and attachment, the transformative power of affect can be harnessed in the relational process of psychotherapy and utilized in a manner that results in lasting therapeutic change. PARAGRAPH ON HOW AEDP ACHIEVES THIS • Together, therapist and patient examine not only a situation that the client was involved in, but also the client’s experience of the event. This is done in the relational context of the therapeutic relationship, allowing experiences to evolve and for deepening and articulation to cause change. • Importance of affective competence Affect and Transformation Fosha defines affect as “a wired-in, adap... ... middle of paper ... ...the patient’s feeling it and knowing it.” In other words, the therapist must attend to both the client’s core affective experience and what makes that experience frightening or painful. This stance is informed by the affective phenomena of empathy, affect contagion, affective attunement and resonance, and the reaching of a coordinated affective state. Ultimately, the therapist’s affective response to the client’s experience serves to amplify the client’s affective state. The therapist must come alongside the client, allowing the client to feel deeply understood and as though someone is offering to help. The client no longer feels an unwanted experience of aloneness and the anxiety that accompanies it. This stance effectively eliminates resistance on the client’s part, and the patient finds him or her self naturally wanting to share even the hidden parts of the self.
Stickley, T. & Freshwater, D. (2006). “The Art of Listening to the Therapeutic Relationship” Journal of Mental health Practice. 9 (5) pp12 - 18.
Regardless of the therapeutic approach utilised, an indispensible and communal component of most therapeutic approaches is the therapeutic relationship (Sparks, Duncan, & Miller, 2008). Norcross and Hill (2002) defined therapeutic relationship as the cooperative alliance between a therapist and the client. It is found to be influential in the success of a therapy (Lambert & Bergin, 1994). Hence, researchers began to investigate therapeutic relationship.
The therapist would then interpret this information, which consists of teaching, pointing out and explaining what the therapist is noticing through this free association (Corey, 2013). One of the key factors in a therapeutic process is the client-therapist relationship. Without this relationship, transference cannot be assessed.
These different tools are useful in building and maintaining a therapeutic relationship. Paraphrasing includes repeating the content that has been expressed in a different way, this method can provide the client with a feeling of importance and recognition. Reflection of feelings/content involves identifying the feelings and/or content in what has been said (highlighting the key aspects of the story). Again, this method encourages the patients to be validated and heard. The relationship between the person seeking help and the nurse/counsellor should be appropriate for producing therapeutic change, to ensure that the patient maximizes the therapeutic relationship.
This process creates rapport, understanding, and empathy with the client. The therapeutic process of engagement is important to both voluntary and involuntary clients. Practitioners have the ability to utilize several evidence-based techniques to engage their client in treatment. Alyssa’s treatment took on a client-centered approach that engages in open-ended questioning, active listening, and validation and feedback.
“In order to engender empathetic understanding, a counselor or therapist attempts to sense the feelings and personal maeaning that a client experiences on a moment-by-moment basis in the therapy process” (Rogers 1966)
The therapeutic process requires a focus on the emotional experience of clients and involves developing clients’ recognition of their emotional patterns and needs. The exploration of clients’ emotional experiences and establishing “links between self and environment”, plays a pivotal role in the emotional change process. (Greenberg, Rice, & Elliott, 1993, p. 54).
Firstly, the methods interpret the reason for the client’s difficult situation differently, one being due to relationships the other due to perspective. Secondly, the way in which the techniques attempt to fulfill the client are in different areas, with one being more about reconnecting with others and the other being reconnecting with oneself. Reality therapy identifies the reason for the client’s issues stems from their principle belief, which is that all the problems we face as humans are derived from unsatisfying relationships. In an issue from the International Journal of Choice Theory and Reality Therapy highlights this “Humans are social animals. Even the most stoic individuals desire interaction, community and love. Almost everyone becomes close to others and it is the management of their relationships that determines healthy or unhealthy functioning.” (Julan 2015) Narrative therapy focuses on the story regarding how the client ended up in this position, and how the counsellor can change the client’s way of realizing that there are positives to derive among the negatives. Martin Payne narrates this further in his journal article “People tell stories to make sense of their experience and they find meaning by telling the story to others. Life stories are continuously modified by experience and by the reaction of each listener. The reaction of a listening doctor
Norton, J. (2003). The Limitations of Attachment Theory for Adult Psychotherapy. Psychotherapy in Australia, 10(1), 58-63.
The basic approach to contemporary relational theory is fostering relationships through a two person, client and therapist, approach to treatment. The use of self-disclosure is a method to utilize to foster the relationship with the client in therapy. Enactments in relational theory are the interactions between the client and therapist that reenact the client’s past experiences with others. These enactments occur at an unconscious level and can be managed in therapy by recognizing that the transference of the client’s feelings and unconscious reaction experiences. According to Berzoff et al (2016), “transference always needs to be viewed as a joint creation between the therapist and patient” (p. 253). In the case of Donna, enactment may be
According to Messer (2013), there are three mechanisms of change in psychodynamic therapy: insight, affect, and alliance. The mechanisms are the fulfillment of insight, particularly within the transference; a focus on the patient’s emotion and her resistances against its expression; and the nature of the therapeutic relationship that allows the therapy to progress and eventually succeed (Messer,
It’s a similar process that an attuned Mother has with her child. The Mother will notice her childs distress and offer steps to comfort her child. In the therapeutic relationship attunement is about giving appropriate responses ( Finlay). The therapist tunes into ways the client is different rather than projecting their own experiences e.g” I know how you feel because I have a similar relationship with my daughter”. The therapist will respond to the clients perception of their reality at that moment. A good rapport between therapist and client is required for empathic attunement to occur and this is something that may develop over time (Ferraro). Trust will need to be built between the therapist and client so that the client can explore their feelings and concerns knowing they are in a safe enviroment. Fear and anxiety may cause the client to stop exploring along with misattunement and non attunement on the therapists part ( McCluskey, Hooper & Miller). Effective empathic attunement requires the therapist to focus on the clients process whilst being aware of their internal processes along with recognising the boundaries between the client and themselves ( Erskine,
Attachment is a strong connection, formed by an emotional bond, which helps to develop between infants and their caregivers. There has been evidence that supports the view that attachments that were formed into early infancy have been a guideline for the formation of relationships during the periods of adolescence, which is the term in which an individual is flourishing into becoming an adult and adulthood. The influence of early attachment, which has an impact on future relationships, can be both positive and negative. The experience that derives from childhood leads to the development of mental portrayal of the opportunity and authenticity of people that we have trust in (Merz and Jak, 2013). For example, if an individual experience a childhood in which they had only received a cold treatment, they may end up with people in
The Therapeutic Relationship: A therapeutic relationship between a counselor and client is a professional relationship in which the counselor helps the client to make positive changes in his or her life. Research consistently shows that it is the quality of the therapeutic relationship that best predicts a client’s ability to use therapy to help themselves make positive life changes. It is a unique relationship in that while the client typically shares very personal information with the counselor, in an atmosphere of warmth and trust, the relationship takes place within the fifty-minute therapy appointments and within the boundaries of the therapeutic contract. It is the adherence of these boundaries which make therapy possible
Empathy and acceptance are partners in valuing the client, enabling the promotion of essential worth (Mearns and Thorne, 1999). Egan (2007) explains having an empathic presence is possible by being noticeably attuned to the client. This requires behaviours that are not always verbal in nature. The face and body can communicate even when there is silence. Body position, facial expressions and voice inflections all contribute to the mood of the communication and are important in increasing the empathetic environment (Egan, 2007). It is essential that all of these processes be presented authentically. Self-regard is a major constituent in the discovery of the client’s self-concept. Research shows that successful therapy is the product of a client obtaining an attitude toward the self that is significantly positive (Rogers and Witty, 2008; Seeman and Raskin,