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Comparing ISTDP and AEDP

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84 views3 pages

Comparing ISTDP and AEDP

Uploaded by

Mario Colli
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Comparing ISTDP and AEDP

by Hans Welling

Introduction

AEDP is one of the therapies, like AET and Affect Phobia that sprung from ISTDP origin.
It may be interesting to see after almost 20 years of development of both what the
differences are. In this little piece I will look at some differences between what ISTDP and
AEDP practice as obtained from the written work and vignettes from John Frederickson and
Allan Abbass (ISTDP) and Diana Fosha (AEDP).

Key Strategy

The key strategy in ISTDP is to help the self to turn against the defenses that are seen as the
main cause of emotional suffering.

The key strategy in AEDP is creating a safety attachment relationship in which defenses will
melt and exploration & healing tendencies will naturally appear.

Therapist Stance

The therapist stance in ISTDP is more task oriented to clarifying the role of the defenses thus
more confrontational and pressuring (annoying helper). This stance has the risk of inducing
shame of doing it wrong. Explicit presence if the therapist such as self-disclosure of sharing
of affect are less common then in AEDP.

The AEDP, as focused on as primarily focused on the the attachment role of the therapist, is
characterized by a softer, warmer therapist stance (the wiser and older). This validation and
“nice” approach however seems to have limitations when dealing with passive aggressive,
victimizing or narcissistic character pathology.

Conceptualization

ISTDP classifies different types of defenses (projection, externalization, not taking


responsibility, self-attack) patient pathology (fragile, resistant), anxiety (striated or ??
muscles). This classification helps the practitioner to recognize more easily when defenses
or anxiety occur.

AEDP takes the ISTDP’s classification of defenses and anxiety for granted or at least doesn’t
teach it. AEDP does classify a lot of different transformational states and positive affects,
helping to track the earliest signs of change and transformation.
Process
ISTDP is a more closed system of structured if-then intervention, which may be felt as rigid
and repetitive, but gives clear structure.

AEDP is a largely intuitive and organic process with open ended outcome, that may have the
advantage of being more flexible, but the therapist may more easily feel lost.

Techniques

-For defenses
ISTDP will whenever possible point out the occurrence and emphasizing the problematic
nature and cost of defenses.
AEDP will restructure defenses similarly, pointing out their costs when defenses are
entrenched, but will avoid (“toxic”) labeling of defenses. It’s preferred approach to defenses
is the technique of bypassing defenses by dyadic relatedness (Fosha 2003) safety, validation,
and emphasizing the adaptive value of defenses.

-For Anxiety
ISTDP may increase the level anxiety by pressuring for affect in highly defensive patients.
AEDP in general will choose to regulate anxiety

-For enactments
Both use portrayals/portraits. In ISTDP the focus is on body, feeling and impulse expression,
in AEDP the is more verbal expression in the portrayals. ISTDP conceptualizes a sequence for
the portrayal of anger-guilt-love, whereas AEDP has a more open-ended flexible
transformation of processing very many types of emotion to completion.
It is remarkable how in ISTDP portraits the imagined expression of feeling is almost
exclusively non-verbal, whereas e.g. in EFT chairwork expression is almost exclusively verbal.
AEDP seems to be in the middle of these strategies

-For pressure
ISTDP uses more direct pressure by repeatedly focusing on the emotional/physical
experience
AEDP pressures with empathy & validation to get to core feeling.

Content

When reading theory and vignettes different emphases can be found in terms of content.
ISTDP focusses more on anger & guilt, whereas AEDP more on shame, grief & loneliness

ISTDP creates a lot of space for exploring negative transference in the relationship with the
therapist also as a way to unlock the unconscious to similar past experiences. AEDP
emphasizes and spends more time on the “real” relationship (positive transference) and
sometimes seems a bit afraid to leave the typical warm and nice interaction, and move into
“darker” realms of feeling anger for the therapist.

Curative factors*

In ISTDP cure comes from unlocking the unconscious and accessing past conflicts. The
current therapeutic relationship is a means to unlock the past experience.
In AEDP cure (transformation) can come from reprocessing past trauma, but also from a
corrective emotional experience in the current relationship with the therapist. Thus AEDP
has an additional focus on processing the present relational experience, both expressive and
receptive.

Conclusion

I think it is worthwhile to do some reintegration between ISTDP & AEDP as it seems to me


they have some things to offer to each other as I feel some complementary strategies in
each. Definitely the work of Abbass & Frederickson has been influenced by Fosha’s, having
made it more relational. May be it is also time to see again what the current ISDTP
therapists have to offer especially in making more room for anger & guilt and the detection
and undoing defenses without shameful labelling.

References

Abbass, A (2015). Reaching through Resistance: Advanced Psychotherapy Techniques.


Kansas City: Seven Leaves Press, 2015.

Fosha, D. (2000). The Transforming Power of Affect: A Model for Accelerated Change. Basic
Books.

Fosha, D. (2003). Dyadic regulation and experiential work with emotion and relatedness in
trauma and disordered attachment. In M. F. Solomon & D. J. Siegel (Eds.). Healing trauma:
Attachment, Mind, Body, and Brain, pp. 221-281. New York: Norton.

Frederickson, J. (2013). Co-Creating Change: Effective Dynamic Therapy Techniques Kansas


City: Seven Leaves Press, 2013.

*I thank Steve Shapiro for alerting me for this aspect (personal communication 20190929)

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