AEDP West Sunday Seminar
with AEDP Institute Faculty Member NATASHA PRENN, L.M.S.W.
MAY 31, 2009 | San Anselmo, CA
What do I say and how do I say it? And now what do I do?: Learning the Experiential Language and Protocol of AEDP

REVIEW by Kelley L. Callahan, Ph.D.

I have the pleasure of summarizing Natasha Prenn’s delightfully practical and deeply moving presentation to the AEDP West community on May 31. There were over 50 people in attendance to hear her talk titled “What do I say and how do I say it? And now what do I do?: Learning the Experiential Language and Protocol of AEDP.” However, much to our surprise and delight, Natasha also shared with us her recent thinking, writing, and clinical work in the area of self-disclosure. She began by inviting us to track our thoughts, feelings, and body sensations as we got to know her across our developing relationship, which we would check back in on over the progression of the afternoon. She also promised us a presentation in the true experiential nature of AEDP, where we would leave the world of complicated theory and inverted triangles behind, and engage in a bottom-up analysis of the nuts and bolts of literally what is said and how to say it through viewing the work. Regarding the triangles, she nearly accomplished this impossible feat save one tiny reference! Natasha then shared that as she was learning AEDP from the masters, she began writing down, word for word, what they were saying in their sessions and studying their prosody and tone for how to say it. She then sought to metabolize this, apply it to her practice, and ultimately share the fruits of her labor with us. What follows is my attempt to deliver this to you, knowingly sacrificing brevity for the richness of what to actually say.

As to the “How to Say It,” Natasha identified that it is paramount to slow way down (pacing) and bring the voice lower down (tone). Synthesizing feedback and pearls of wisdom across her training and experience, her guidelines for the AEDP therapist are to 1) say half as much as you would have once said, and 2) say it seriously, with conviction, like you mean it (a la Ron Fredrick), and then stop. She noted that she often begins early in the session asking the client, “Can we slow this down together?” which is a most simple and rich intervention fostering collaboration while deepening the client into their experience.

As to the “What to Say,” Natasha described some of the hallmarks of what she called experiential language.  Experiential language is different from the language of thinking, interpretation, and the left brain. Speaking the language of experience necessitates a shift from the language of thinking to the language of feeling, from the language of the mind to the language of the body, from long Greco-roman words to short Germanic words, and from words reflecting the linear and logical to a reflection of the emotional and imagistic. There is also a shift from “then and there” to the “here and now,” and movement away from talking about experience to being in an experience together. Natasha talked about her desire to catalogue words that are more evocative, like the example of shifting from saying, “That’s interesting” to “That’s important.” Also important are the use of what some have termed “therapist’s noises,” to make contact and space for the client’s experience without the use of words. It is not about being clever and saying something new and insightful every time, but instead it can be simple and repetitive, entraining clients into an experiential process.

Natasha noted her frustration with an abundance of work that talks at length about applying theory to practice, but then does not say a single thing about what is actually said. These authors tend to assert that the work is more complicated, that they can not write about what to say in sessions because attachment-oriented treatment is not a one-size-fits all approach and that their book or article is not a how-to “cookbook” (as if that were the worst of all possible things!). In contrast to this, Natasha proposed that while there is no exact recipe, there is language that is more effective in taking people into their experience and that this can be taught. To this end, she shared her illustrative, concise and practical synthesis of the central aspects of AEDP work, which she has dubbed the “AEDP Protocol” (and she did this without the use of a triangle or use of the phrase “state transformation”). Her stated goal was to leave us with practical information about what to say that we could integrate into our practice, and she did just that with a two-page, double sided hand out with multiple examples of AEDPish language; a veritable goldmine of experiential language.

The first point in the “AEDP Protocol” is to engage in moment-to-moment tracking and to “Notice and seize” (a la Ron Fredrick) the moment. Some examples of statements that accomplish this include the bottom-up question, “What is coming up?” or the observation, “There is a lot of feeling/pain here.” The language is calling the client to be in this moment, and to be feeling in the here and now. For example, “What do you notice in this moment?” or “Are you feeling that now?” Natasha humbly pointed out that you don’t have to be very clever, but really to just notice and be somewhat vague, inviting the client to notice and be with their experience with you.

The second and third mandates of the “AEDP Protocol” ask the client to stay with what comes up and then explore and expand the experience. The language for this first calls for simple questions such as, “What is there?” “Can we let it be/allow it” or “Can we stay here?”  Another example that makes the collaborative relationship more explicit asks, “Could we be here with this together?” To explore, expand, and deepen into experience one can direct the client to “Tell me more,” and/or ask the client “What is that like?” Asking the body for help is another way to expand and explore the experience with questions like, “What are you experiencing in your body/physically?” and “Where do you feel that in your body?”

The fourth aspect of the “AEDP Protocol” calls for the therapist to always be affirming, to ask permission, and to invite collaboration. Natasha suggested that it is important to be explicitly affirming with statements like, “You are doing such a good job,” or “You are feeling/telling me a lot.”  Other examples include a bit of self-disclosure (a preview of the second half of the presentation) including, “I love how you are . . . in this” or “I appreciate your tears/work/smile/etc.” In addition, working collaboratively can involve directly asking for permission, like asking, “Can we stay with this for a minute or two?” or “Would it be okay if we looked at this together?” It can also look like asking the client for clarification: “Something is going on inside, can you check in with yourself?” or “Sounds like you feel . . . ; is that right?”

The fifth directive of the “AEDP Protocol” is to let core state be and not interfere. This may sound simple and easy, but can be hard for many of us to unlearn the propensity to be active or interpretive at this point. The “What to say” of core state is a lot of “uhuh/mmm/ya/yeah/uhuh” with an occasional “is there more?” peppered in. This is in contrast to the sixth component of the AEDP Protocol which gives language to the processing/metaprocessing of AEDP.  Here we do want to ask, “What is it like?” followed by “What is it like to do/share this with me?” or “What is it like to hear . . . from me?”

Natasha then showed us a bit of tape where she was working with a 22 year-old woman, in their second session together, though she was 45 minutes late to her first appointment. It was an excellent example of how to get started with someone, acclimating them to the process of AEDP, and it illustrated the power of these simple techniques and experiential language. For this client, intellect and words are important and she expressly tells that to Natasha. Natasha asks the client, “Where do you feel it physically? Just notice.” She responds that she is “embarrassed” and continues to talk. Natasha then notes to her that something has shifted and she again asks, “What do you notice physically?” The client responds that “it’s in her childhood” and says more. After a third attempt at the question the client says that she “feels nostalgic,” and Natasha asks her to “Just stay with that . . . let it be.” She goes on to wonder again, “What is that feeling inside, what happens inside?” It is only then that the client is able to drop down into her felt experience and describe it to Natasha (clenched throat, hard time breathing, physical tightness, etc.), after which she asks if they can just stay with her experience. Shortly after that, the client notes that she is bothered by the situation and can not brush it off.  Natasha tracks the client’s hand gesture as she was speaking and observes it by saying, “You made that hand gesture, what do you imagine if you stay with that?” In just a few short minutes, they are out of ordinary consciousness and into her experience. Natasha is able to help this young woman slow down and deepen in. She does this with somewhat repetitive and simple questions, the result of which is an atmosphere of collaboration and the shared sense that not only are the client’s intellect and words are important, but also her emotions and felt sense/experience.

This section of tape also highlighted Natasha’s “Top 10 Interventions” (I actually counted a few more I’ll include here for you):
1) “What are you experiencing physically?”
2) “This touches something;”
3) “Stay with it;”
4) “I see feeling coming up;”
5) “What do you notice;”
6) Where do you feel it?”
7) “Just notice…what do you notice?”
8) “Where do you feel it physically? Just notice.”
9) “Something shifted.”
10) “Just stay with that.”
11) “Let it be.”
12) What’s that feeling inside/what’s happening inside?”
13) “Let’s look at that together.”

Natasha then transitioned to showing her work with a middle-aged man. At the time of the sessions we viewed, she had been working with him twice a week for approximately two years. When he began treatment he had severe depression accompanied by suicidal ideation.  The series of clips we saw highlighted the importance of privileging the positive and deepening into experiences of good feelings that we and our clients too often rush past to focus on what is not going well. They also showed the brilliance and healing that can emerge as a result of simple statements encouraging the client to stay with their experience, including the loving support of their therapist, as they engage on the therapeutic journey together.

As this particular session begins, the client reports that he had noticed himself humming and singing – not feeling too sad, which actually felt “really grand.” Natasha asked if they could just stay with that for a minute because it had been a long time in coming, and then asked what it felt like. The client responded by noting that the other stuff was still there (presumably the distressing affect/hardship).  After briefly acknowledging that, she asks about the experience and feelings he had opened with and referenced back to a particular time in his life when he had felt grand (conjuring up a state-specific memory of Paris). Although he struggles a bit, she asks him to “stay with this” as it “touches something.” As he stares downward, she invites him to look up, noting that he does “not have to go away,” and she asks him to describe the feelings inside himself right then and there with her, knowing that she cares. After some silence, she asks, “ . . . and if you really look and see, take it in and see it’s making me tear a bit, ummm.” After gazing for a moment, he says he can’t put it into words, but “it is big.” He says that “there is an acknowledging of this truth, that someone could actually see what he was going through, what (he has) done.” He states that it is “touching” and that the “closeness gets (him) a little choked up.” She invites him to focus on what he feels physically in his body, which leads to deeper articulation of his experience. After he comments on how hard it is to describe, Natasha says that she thinks he is “doing quite a brilliant job actually,” and then she asks him what it is like to take that in, because she feels “that it is quite true.” Then, while holding her gaze, nodding, and smiling warmly for quite a long time, he responds that it is “great, really great.” In those moments of mutual admiration, over the course of the first five to ten minutes of the session, as an observer I felt as if I could actually see the non-verbal healing unfolding and the reorganization taking place within this client.

This dance continues with the client trying to “wriggle away” from the positive affect and Natasha drawing him back in, challenging him to tolerate a bit more. In acknowledging the depth and beauty of what he has experienced and accomplished in his recovery, the client arrives at a place of truly recognizing how awful and scary the past couple of year have been. He also begins to mourn what he did not get as a child. Natasha’s tender pacing but relentless asking of the client to “ . . . make room for it, a tiny bit more space for it,” and wondering if there “is there more that needs to come up?” holds his feet to the fire. She tells him, “I feel like you are this close, really, to letting yourself . . . It is me . . . What did you want to say, can you say it to me, if you said what you wanted to say?”  This eventually helps him arrive at an image of a four year-old part of himself. However, it is only after that Natasha begins to cry herself, and to reach for a tissue while asking him, “what is like for (him) to have (her) need a tissue,” that he is eventually able to find his way to his own tears and reflect on his relief, anger, and joy. He is able to articulate that he is crying for the little kid that he was, knowing that he “wasn’t as bad” as he was made out to be, that “he really was okay; just an innocent little boy.” Natasha wonders what it is like for the little kid to hear himself described as a good kid and that he genuinely likes him.

In observing this work, it was so beautiful to behold the parallel process where Natasha so clearly and authentically appreciated and loved her client, as he was feeling those same feelings for the child part of himself, which in turn was transforming his whole relationship to himself and what he expected and deserved in the world. In this session he is able to clearly see where he has been and where he is going, and to believe that there are good things in store for him.  He articulates relief, joy, and sadness as well as his appreciation for having Natasha as a companion on this journey, and she of course tells him how “really amazing” it has been for her as well. It was a profound example of how the secure attachment relationship created with Natasha allowed him to stay in a deep place, experience more of his emotions, and truly shift his internal experience. And more to Natasha’s point, this was not accomplished with fancy interpretation, but with simple statements coming from a place of empathic attunement and a genuine regard for the depth of the client’s experience.

After the break, Natasha set the stage with Frieda Fromm-Reichmann’s quote, “The patient needs an experience, not an explanation.” She then reviewed more essential and experiential interventions aimed at helping the therapist and client get there. She did say that there is a place for the left-brain in this work, and she described the Platforming intervention where the therapist organizes what is going on. This might look like the therapist saying, “This is what I am seeing . . .,” or “My understanding of this is . . .”  Another versatile intervention is the Interruption, where the therapist says something like, “What are you feeling as I’m speaking,” or “I’ll stop here; you’re having a reaction as I am saying this?” The interruption is an especially effective tool when we realize that we have slipped into our procedural learning related to interpreting or explaining rather than helping the client to have an experience of what is going on for them and between us. Other essential AEDP interventions include: Putting the Defense Aside, “Can you put your anger aside” or “If you put your critic aside, what is there?”; Anxiety Regulation, “what are you feeling inside physically, can you describe it?”, “Describe what you are noticing, give me the texture of it,” or “Where is the anxiety? What is it like?”; The Portrayal, “paint the picture: where are you, what do you say, what do you do?” and “What does s/he look like as you . . .?”; Undoing Aloneness, “Can we do this together?”, “Can you look at me?” or “What do you imagine I am feeling/thinking; and Sharing Affect, “I am moved/touched”, “this brings tears to my eyes,” or “Oh, this makes me so angry on your behalf.” These last two interventions offered a seamless transition to the Self-disclosure portion of her presentation.

Natasha shared that she sees self-disclosure as the most quintessential aspect of AEDP. It has been the recent focus of her study and the topic of a book chapter she authored titled “I second that emotion! On self-disclosure and its metaprocessing,” in Psychotherapist Revealed: Therapists Speak About Self-Disclosure in Psychotherapy by Bloomgarden and Mennuti (2009). She described that self-disclosure begets self-disclosure and creates safety in the relationship. The therapist’s bravery and risk taking engenders the client opening up and makes room for both to be brave in the work. In her opinion, it is the quickest way to help the client to have an experience, create a real relationship, and promote the attachment experience from which new neural pathways can emerge. Therapist’s self-disclosure is a jumping-off point into something happening between client and therapist and it offers opportunity for metaprocessing. And therapists need not be afraid of or disappear in the face of the client who responds, “I thought this was about me!” Instead, this response is welcomed as it offers a beginning point for processing the experience of misattunement and for repair to begin. It evokes a “dance of awareness” where there is not a “me or a you, but a we” that are engaged in the work together.

I would like to take a moment to comment on the passionate and positive energy Natasha brought to this discussion.  Her quest to bring self-disclosure into the light of day and make it something that we can actively learn to do as an effective intervention rather than a momentary lapse was palpable. She invited us to thoughtfully, heartfully, and regularly bring ourselves into the treatment process through self-disclosure. She did, however, give a few guidelines to help shape how that might unfold.  She suggested that self-disclosure should always be directly related to what is going on in the work, and that it should be in judicious service of the client. In addition, the self-disclosure of which she speaks is not the casual story communicated in ordinary consciousness, but it is instead the mindful sharing of the therapist’s experience to deepen the work or to more authentically show up in what can become transformative moments of meeting.

Theoretically speaking, Natasha organized self-disclosures into two different categories, the first being Self-Involving/Here-and-Now/Process Self-Disclosures. Under this rubric she has four types of interventions. The Tracking Interventions sound something like, “I felt that, something shifted,” I feel you . . . move away, relax, come forward, shift, tense up,” or I want to share with you something I am noticing… would that be alright?”  The Emotional Sharing/Relational Interventions include statement like, “I feel touched/moved”, “This is emotional,” or “Do you feel?” The Sharing my Dilemma Interventions include “I am not sure what you are feeling,” “I feel distant from you when you say . . .," “I see so much feeling, and yet . . .," or “I don’t know where to go. Can you help me?” The Affirming Interventions noted before are also a form of self-disclosure; “I so appreciate all that you are doing,” “You are helping me . . ." or “You are doing a great job.”

The second category of self-disclosure is Self-Revealing/Actual Life/Shared Experience Disclosures. In this category the therapist would say “I see/feel . . .,” “I get that/I have felt that,” “My experience is . . .,” or “My association to that is . . .”  And of course, the Metaprocessing Interventions are an essential part of the self-disclosure process.  It is paramount to follow-up and ask the client, “What is it like to know this about me?” “What is it like to have me notice?” or “How are you feeling toward me, is it alright to ask?” In self-disclosure and its metaprocessing, there is a humanizing and equalizing of sorts between the therapist and client, inviting the client to bravely identify and share their experience. However, the therapist maintains the role of therapist because the work continues to be about the client and for the client.

In the true fashion of walking the talk, and after checking in with herself and with us about the relational container in the room at that point, Natasha proceeded to self-disclose to us and then show a most beautiful and evocative clip of work with the male client referenced above. In setting up the video, Natasha shared with us how being with her mother at her time of death, literally breathing her last breaths with her in a deeply attuned, dyadically regulating experience, was a profoundly transformative and healing process for her. She also shared that she had disclosed to this client that she was returning to London to be with her dying mother and, having experienced the loss of his own parent, he offered some heartfelt advice and recommended a book to her. Natasha had genuinely found his input to be incredibly helpful throughout her own process. This clip continues on in the vain of deepening into the positive experience of being revered and loved by another, but it is taken to a whole new level by Natasha’s willingness to self-disclose in multiple ways.

At the beginning of the clip, the client says that in the previous session he felt Natasha with him in a way he had not felt before, he then segues to say that in spite of this he has a pervasive experience of aloneness. Natasha responds that to her thinking, when he sends her an e-mail he is not in such a state of aloneness, and that at those moments she is “really glad that (he) is holding (her) in his heart and mind” when they are not together – that she has “been feeling (this) happen gradually.” She immediately follows this self-disclosure by asking how he is doing and what it is like for him to hear this.  He responds by saying that it is “uncomfortable,” but “in a good way.” She goes on to say that they are “very connected” with each other, and although it might make him uncomfortable, she asks if he “might find a way to take it in little by little.” She then states that she can’t read him. He wriggles physically and is silent. Then, in a most honest and brave moment, Natasha says, “if we cut the bullshit, go back to where we were before . . . that I love you and think about you outside of session . . . ,” he acknowledges with a sweet and brimming grin that he feels “squirmy” but also “f*%k#^g fantastic.” He then shares that when he was talking to Natasha about her preparing to cope with the passing of her mother, it was hard to know how much she felt would be appropriate, but he took a risk and offered support, advice, and a reading recommendation. Natasha then gently asks what is there if he can “just let the uncomfortable be,” to which he responds that it makes him “feel bigger” and quite “emotional.”  As she invites the emotions to “come forward a little bit,” and perhaps even “let (himself) get a little carried away,” he comes up against his fear that he might become “overwhelmed” by the energy of his “messy” emotions. As he struggles with this, she discloses that she has the feeling of wanting to reach out her hand, wanting him to be more there and connected with his experience. He does not take her up on this and he talks a bit more, avoiding the deeper connection with both himself and with her. She again makes an attempt at helping him drop in deeper by talking about their connection, acknowledging “it’s got energy in it – like I’m saying I love you and can you get what that is like?  And I do mean you, and not the guy behind you (a reference to his earlier comment). What’s the emotion?”  He continues to both bask in a feeling of being revered and struggle with giving over to it fully, though with each round of processing one could see him taking in and receiving a bit more love and glowing in the experience.

As one might imagine, audience members shared an array of reactions ranging from admiration and delight to fears about the internalized “psychoanalytic police” – though a deep gratitude for Natasha’s openness and bravery seemed to be a universal response.  One comment appreciated how the clip speaks to questions of how we help the client experience themselves as lovable and able to love, which is at the very core of much of our work. Another comment expressed concern that there was flirting going on, to which Natasha shared that she herself did not feel sexual feelings in this exchange, and that to her, this client feels very young. Other comments highlighted that the session appeared to entrain all that comes with the earned-secure attachment, that the client had the experience of feeling loved and worthwhile, of being valued and being of value, not just intrapsychically, but physiologically – in the felt sense of his body. Although discussion was cut short due to time limitations, Natasha did say that there are male and female patients that she definitely would not say “I love you” to for different reasons – likely related to their developmental feel and attachment style. For example in working with more dependent clients the work would be focusing more on lovingly setting boundaries than challenging them.  Natasha closed with a quote from her book chapter, advocating that “self-disclosure take its place as an essential, integral, teachable part of the fabric of every treatment and that we question why we didn’t disclose as much as we have traditionally examined why we did!” (Prenn, 2009; p.98).

In short, I realize that there is nothing short about this write-up of Natasha’s presentation. I hope that you have been able to bear with me because the point of the presentation (and this write-up) has been to capture what one actually says, and to convey the simplicity, depth and beauty of Natasha’s work.  And I hope to have made it clear that based on the lively discussion and the energy in the room, her presentation as well as her own self-disclosure, transparency, and humor were helpful, evocative, and greatly appreciated by all.

Kelley L. Callahan, Ph.D.
Clinical Psychologist - CA License # PSY 21875
P.O. Box 6373    Albany, CA  94706
Phone: (510) 926-5715

Natasha Prenn, LMSW, began her career as a psychotherapist working with at-risk adolescents. She was a patient advocate in New York City hospital emergency rooms through the Mount Sinai Sexual Assault Violence Intervention program. In a previous life, she was a lecturer in Classics at New York University, a college counselor, and teacher. Natasha was drawn to AEDP because of its focus on how to actually help people change! She is currently writing and presenting on self-disclosure, eating disorders and AEDP, experiential language, and how to teach AEDP to clinicians from all backgrounds. She has a chapter called, “I second that emotion! Self-disclosure and its metaprocessing” coming out in a forthcoming book: The Psychotherapist Revealed (Routledge 2009). She supervises AEDP and has a private practice on the Upper West Side of New York City.