AEDP West Sunday Seminar
with AEDP Senior Faculty Member Ben Lipton, L.C.S.W.
October 4, 2009
San Anselmo, CA

A.E.D.P. And L.O.V.E.: The Transformational
Process of Catalyzing Secure Attachment

REVIEW by Kelley L. Callahan, Ph.D.

On October 4, AEDP West had the pleasure of hearing Benjamin Lipton, LCSW, present “A.E.D.P. and L.O.V.E.: Harnessing Loving Relationships to Transform Trauma and Catalyze the Self-at-Best.” For those of you who read the posts by David Mars and Jennifer Imming on October 10, 2009, you had a sneak preview of both the depth of Ben’s presentation and the power of openly and directly acknowledging love – compassionate love – when it is present in attachment-based psychotherapy. I have done my best to give you the play by play, so you might want to save this post for a rainy/snowy day when you have some time - it is beefy. I apologize for the delay and I hope you enjoy - I know I certainly did!

Ben began his presentation with poetry, including two poems that so inspired me I looked them up so I can share them with you. They bring into the full light of day the centrality of love for each of us; how we are organized by it and how we thrive and transform in its presence. They also set the tone for what we speak of when we talk about the transforming power of love in psychotherapy. So without further ado, courtesy of Ben and the great Sufi poet Hafiz by way of the members of his Seattle AEDP Core Training group . . .

Admit something:
Everyone you see, you say to them, "Love me."
Of course you do not do this out loud, otherwise someone would call the cops.
Still, though, think about this, this great pull in us to connect.
Why not become the one who lives with a full moon in each eye
that is always saying,
with that sweet moon language,
what every other eye in this world is dying to hear?

Sigh . . .

Love Is the great work
Though every heart is first an
That slaves beneath the city of Light.
This wondrous trade,
This magnificent throne your soul
Is destined for - You should not have to think
Much about it,
Is it not clear
An apprentice needs a teacher
Who himself
Has charmed the universe
To reveal its wonders inside his cup.
Happiness is the great work,
Though every heart must first become
A student
To one
Who really knows
About Love.

From The Gift -- versions of Hafiz translated by Daniel Ladinsky

Ben then boldly asserted the wish to reclaim and become comfortable with the accuracy of the term love, meaning compassionate love, as the best descriptor of what therapist and patient experience in important clinical moments in attachment-based psychotherapy. While terms like attunement and empathy allude to what transpires, they remain experience-distant and clinical. Moreover, the actual naming of the experience as love has the potential to harness powerful memories of compassionate love and/or lays down new explicit experiences of compassionate love to build on for the future.

Ben explained that his own journey in (re)claiming love began as he facilitated core training weekends in California and Seattle. He would get comments/questions on the side about how “ . . . this is really all about love, isn’t it?” to which he admittedly had a split reaction. His left-brain was ready with multiple theoretical treatises about how it is so much more “complex” than that, while there was a right-brain, felt sense that “love” really did capture an essential aspect of this work. Thus began his journey of exploration of why the strong reaction to the notion of love in the therapeutic relationship, how to define love, and how it relates to AEDP.

Ben highlighted that there are many reasons why we might be uncomfortable with the notion of loving our clients. There is a cultural confusion between romantic love or eros, which has a distinct biological system we are more familiar with, and other types of love including agape (a selfless, volitional, affectionate, and thoughtful love that can be of a spiritual nature but is non-sexual) and philia (a friendly, neighborly, virtuous regard based in equality and familiarity). Because of the potential for confusion within the therapist and/or the dyad where love could become sexualized and boundaries could be transgressed, there seems to be a stigma against acknowledging and labeling the entirely appropriate, powerful, and restorative love that can occur between therapist and client. Our field’s earlier conceptualizations of transference and countertransference further obscured the prevalence, relevance, and transformative value of the authentic exchange of emotional experiences in psychotherapy. In addition, the association of “love” with the self-help and new age movements likely marginalized the term even further from rigorous discourse about psychotherapy as there is a definite bias in our field toward the rational and scientific rather than the felt sense and emotional experience of the therapist.

Ben also posed the question to the audience, “why are we uncomfortable with love (in psychotherapy)?”  Responses included the acknowledgement that to speak of such feelings runs the risk of not being met, received, or reciprocated, and that once love is declared we run the risk of losing it. It means bringing an even greater vulnerability to our work, and that it can be plain scary to be that real with clients. In addition, openly speaking of love runs counter to the legacy of therapeutic neutrality, more current ideals of professionalism, and the conflict between what may be appropriate for public versus private spheres. Love conjured for some the notion of disorganization, chaos, and an association with the counterculture.  There was also an open question about the difference and similarity between love (an emotion) and attachment (a process).

Ben shared with us some working definitions of love meant to be the starting off point for conversation. He posited that although it is informed by theory and technique, it is much more than these ingredients. It can be an intra-relational (self-to-self) and/or intersubjective (self-to-other) phenomenon. From a more Eastern philosophical view love can be about “being” or from a more Western framework love can be more about “doing.” He referenced Nathanson’s definition of love as “accumulated scenes of urgent need and solacing relief and accepting the resulting positive affects.” Ben further described love as having an embodied, felt sense that can be ineffable but that feels “fundamentally right, good and positive,” while also possessing a “shyness, vulnerability, (or) on the edge of shame” quality.  Moreover, love can be “bi-directionally resonant, (accompanied by) the healing affects of gratitude, openness of gaze sharing, expressions of relief and deep calm, (as well as) articulations of openness, love and appreciation of Self and Other.”

While immersed in these musings, Ben did a Google search on love and found many of the descriptions and definitions mapped incredibly well on central AEDP tenets and practices. For example, whereas “love lays the groundwork of safety and security,” AEDP lays the ground work for and fosters secure attachment. “Love is an act of will, an intention and an action,” just as AEDP entails “active affirmation and creating a positive experience from the get-go, a loving stance.” “Love is flexible and reaches beyond boundaries,” while AEDP calls for us to go “beyond mirroring and actively helping” our patients. “Love is an extension of the Self rather than a sacrifice of the Self.” AEDP calls for us to develop and maintain “intact reflective self functioning” and it seeks to achieve a meeting of True Self to True Other. Love is a powerful “affective experience” and it “requires emotional commitment, (but it) is not a feeling by which we are overwhelmed. It “requires the exercise of wisdom.” Similarly, AEDP fosters a “deep visceral connection to emotion,” and “feeling and dealing simultaneously” with the help of the “older, wiser other.” The “principal form of work that love takes is attention” while a principal action in AEDP is attunement. With love there is reciprocity; the “receiver gives and the giver receives, (and) feelings of love may be unbounded.” In AEDP there is a “dyadic processes of affective attunement, resonance and transformation” as well as core state. I might add here that not only does the patient experience transformation and core state, but so too does the therapist.

Ben also put forth the idea that shame is the opposite of love. That in the experience of shame one has the belief that they are not loved and are not lovable. To this end Nathanson (1992) writes, “shame haunts our every dream of love . . . It is to protect ourselves from loss of love that we withhold interest and remain aloof and immune to entreaties of possibly loving but possibly unloving others.”

So just what role does love play in AEDP? Ben suggested that in the face of patient’s anxiety, defense, and/or shame in State 1, the therapist ultimately meets them from a stance of love (remember back to my definition of agape love as a volitional, affectionate, and thoughtful love). This stance helps to soften defenses, regulate anxiety and transform shame. In State 2, during core emotional and relational experience, the therapist maintains a loving stance of attunement plus moment-to-moment tracking that strives to achieve authentic moments of True Self and True-Self-to-True-Other meeting. These moments occur via visceral experiences of emotional and relational depth. In the transformational experiences of State 3, while being on the other side of new emotional and relational experiencing it is not uncommon for gratitude toward the therapist to emerge as well as the spontaneous and reciprocal experience of love. In State 4, we see “the embodiment of love all over again” in Core State. There is “wisdom, truth, compassion, confidence, creativity, and expansiveness (i.e., connection with something larger and/or greater). So in reviewing this, it is not that Ben is saying that all AEDP is, or all we have to do, is love our patients. But loving our patients and approaching them from that place of love is essential in each stage of the process.

Ben then explored why it might be important to use the experience-near term of love when it is experientially accurate rather than using the technical terms we bandy about or using euphemisms with clients. He stated that “love frees (him) up to be brave, to engage with deep authenticity without the taboo of irresponsible, unethical practice detrimentally constraining (him) . . . (because) love is not a free for all, but (it)emerges from the procedural embodiment of specific stance and technique of AEDP.” It allows him “to feel more and more deeply. It does not draw (him) into undisciplined, dangerous places. It is because (he) can (openly) love that (he does) not fall in love with (his) patients.” Naming what occurs as love allows him “to give and receive at the deepest levels of both compassion and enjoyment.”

In discussion with the audience Ben further clarified that feeling and expressing love is not an unbounded or out of control experience when our self-reflective function is on-line. It is the affective competence of the therapist that allows us to welcome and inquire about clients’ experience of love toward the therapist and express our own. Ultimately we have a choice as therapists what we focus on in our patients. Do we track for loving feelings or do we track for gratitude? And do we call our stance attunement or loving? On a different note, it was suggested by a few audience member that love goes beyond a phenomenological experience, that it is an actual material, energetic, neurological, and psychophysiological event [Emoto’s water crystal experiments and a measurable decrease in cardiac rhythms (decreased SNS response) were cited as support for this].

Ben showed clips of work with two different clients to illustrate how he artfully works with love to deepen the work. The first clip demonstrated working with the interpersonal experience of love and the second clip gave an example of facilitating an intra-relational experience of love. The fist client was a woman in her fifties who initially presented with symptoms of depression following the death of her mother, the end of a relationship, and a downturn in her business. At the point we meet her she is six months into treatment with Ben and during the previous session she had expressed despair and suicidal ideation.  Ben had disclosed that he would be devastated if she acted on her ideation. Two days later, she wrote Ben an email saying that she was feeling better. [I should note here that what follows is a summary of my copious shorthand notes. I have preserved much of the patient’s words, but the transitions, articles, and some of the verbiage has undoubtedly been lost or altered, so most of the time I am not using quotes. However, unless otherwise noted, it is virtually all Ben and his client’s language.]

In the their next session, we observe her saying that she had been really depressed, but after coming out of it she is feeling amazingly good. Before, she felt like a really unhappy and self-destructive part of her had taken over. It had gotten to the point where she had printed out literature from the internet on how to kill herself. However, when Ben said in the previous session how her suicide would impact him, she was shocked and it was really good. Ben interrupts her, asking her to hold on as he was seeing a lot of feelings, and he asks her what the emotion is. She says that she feels glad that he cares, that it is sweet, not just professional, and her tears start to flow. She states that it made a difference to her that Ben said that he would be devastated. Ben asks her to stay with her tears and she says that she was shocked because she knew that Ben really meant it. She was touched, surprised, and strengthened. She thought to herself, “wow, Ben would be really upset and maybe a few of my other good friends would be really upset too.”

Ben asks her what his reaction told her about herself. She says that he was so empathic, concerned, and caring. Ben asks again and this time she says that “Ben really cares about me.” To which he responds, “Ben loves you.” She says that it feels presumptuous for her so say that, to which he responds that he just said it. He goes on to ask what it is like for him to use the word love. She says that she needs to put quotations around it, that it is hard for her to accept it. He asks what makes it hard, and she says she didn’t know if therapists love their patients, but then catches herself backing away from the question. He asks what if she doesn’t step back? He articulates that it doesn’t mean that he’ll behave irresponsibly, but he notes that she has a lot of feeling and invites her to give herself a moment for the feeling.

She says that the thought comes into her head that she didn’t expect him to care, followed by this sense that this doesn’t happen – that she doesn’t expect anybody to love her, that it is not the norm. She becomes aware that friends love her too, but she notices that she is quick to follow those thought with a “yeah, but…” that undoes the felt sense of being loved, that devalues it and pushes it away. Ben asks, “and if you don’t do that just for a moment?” And then after another round of the same he asks, “If you imagined not doing that, or even with me not doing the ‘yeah, but,’ but instead said ‘yes’ to it. What’s that like?  Is it possible?  Ok?” When she struggles with that he asks, “what does the ‘but’ need us to know? Is it trying to protect you, take care of you in some way?” She recognizes that it has to do with her tendency to hold back, to isolate, but she doesn’t know what that is about. Ben goes on to inquire if she can ask it what its job is in her life – what would be dangerous to deny yourself the love around you?

The patient courageously states that to need love or to show that she wanted it would be dangerous.  Ben thanks her for her bravery and asks if they can stay with it. The patient says it is safer not to need things. She articulates that her whole platform of self-reliance, not feeling, not trusting other people and only trusting herself is built on the belief that “It is better not to need other people because they won’t be there. They can’t be relied upon.” Ben then asks her, “what is it like to be in relationship with me, where you are relying on me? Or are you?”  She says “it feels good with you, but . . . there’s the but!” He genuinely says, “I’m glad we can welcome the ‘but” too.” The client notes that she wants to play it down, but then she goes on to connect the “but” with the pattern with her ex-partner and with her propensity to diminish friendships. She says, “I’ve built a whole life around feeling that way. . . always looking at the bad so wanting to isolate,” and believing that “nobody loves me and nobody ever will.” She recognizes that shifting this outlook, making room for appreciation of the good qualities of friends, to see what is good in herself and in others, is the key to happiness.

In true AEDP fashion, Ben eventually brings it back to their relationship and they metaprocess his use of the word love and he explicitly checks in to see if any part of her was uncomfortable with their session.  What is amazing is that by simply staying connected with her in a loving way and naming that, he gently bypasses defenses in a way that allows her to explore her early maps that continue to cause her to isolation and feel despair. In an affectively present way she articulates her avoidant attachment style as she bumps up against it with Ben. She feels from the inside out, or from the bottom up, how she wants to let love in and what a difference it makes when she does.

The second video Ben showed was the 8th session with a 54 year old gay man presenting with anxiety in intimate relationships. He has a history of emotional and physical abuse by an alcoholic father who also abused the patient’s mother and sister. The patient says that what struck him from the previous session is that things that happened in the past influence who we are today. Ben subtly but efficiently attempts to bring him down out of his head by asking him questions like, what internal sensations he is aware of in the absence of anxiety, and if the patient feels Ben with him now and what that is like. The patient struggles to go inward and at one point goes back to the general observation that he doesn’t know how to resolve stuff from his past with his father. Ben asks what stories come to mind when he thinks about that. He then inquires about the sensations that come up and what those sensations might be saying. He provides overt support with statements like, “it’s a big deal – you’ve never talked about it before.” When the patient wonders if he is “making a mountain out of a mole hill,” Ben assures him that, “if anything, your propensity is to make a mole hill out of a mountain.” The patient earnestly asks why he does that, and Ben speculates that it likely has something to do with how he learned to survive when he couldn’t rely on his dad and mom.

After a bit, Ben directly asks about what did happen with his dad and asks the patient to try and pay attention to what he is feeling inside as he is telling him about it. Ben interjects intermittently with questions like: What are you feeling? What do you notice? What do you imagine the tension is saying?  The patient’s tension is saying to him that it is difficult to talk about this (physical abuse) and then he observes that he is shutting down – trying to distract himself. Ben asks what the patient thinks is the hardest part about talking about these memories and how his body is feeling. The patient reports that his mind is saying that “this isn’t important, it was so long ago.” Ben asks if the patient’s mind is trying to protect him. Following this the patient discloses a particular event of physical abuse. Ben asks him if he can bring himself to seeing that little boy lying on the bed, if he could bring himself back to that room, and asks him what he would want to do. He invites the patient to tell him everything; what he would do, what he would say. The patient, deep in tearful emotion, says that he would comfort the kid, hold him.  He gets how this boy was all alone. Ben asks what he would say to the boy as he is holding him really tight. The patient spontaneously says, “That it is okay. I’ll protect him, help him, be his friend, because he is all alone. But I am not there to do that. I think he was alone pretty much all his life.  He doesn’t want to be, but he is.” Ben reflects that he has been alone for so long, and then asks what is happening inside. The client says that he is closing down.

Ben asks the patient if he can see Ben there with him. He asks him to look at him and tell Ben what he sees. The patient adjusts his glasses, looks very carefully, and says that he sees concern and empathy. He says that he is bring himself back to now, that he was really back there (in the past). Ben says that it feels so important that the patient and Ben have found the boy, that he has been so alone. The patient responds by saying, “but that doesn’t change anything.” Ben says that it won’t change what was (what happened), but he asks if the boy has to stay there? The patient says that he didn’t know that he was stuck there and asks how that can be. After providing some psychoeducation, Ben asks if they can go back to the boy, if that would be okay. He expresses concern that they left him so quickly that he might not know that it isn’t still happening.

The patient goes back to the scene, but as a ghost. He struggles saying that he (the adult) is not there, that he is the kid and that there was no one there at the time. Ben asks if he himself could be there.  The client says it is hard to do because he can’t put people there who weren’t there. Intrepidly, Ben asks what is stopping the patient from doing that. The patient says it is “because it is make-believe.” Ben artfully says, “In a way, its all make-believe. In a way it could be forcing, and in a way it could be that you and I are so fiercely determined to let him know that he doesn’t have to be alone anymore. The client says that he feels very protected and that it is too bad, what happened. The patient erupts in a huge wave of core terror that has been suppressed for decades followed by a visible, palpable shift to a state of relief and relaxation. Ben reflects that it was so tragic. The patient say that there is a lot happening. Ben ask him to share what is going on. The patient reports that the adult him is holding the little him while Ben is standing next to them. The younger part feels safe and comforted. Ben responds that that is a beautiful picture and that is the way it should be. The patient experiences another big wave of mourning for the self over what  needed to have been, but never was. After metaprocessing this wave, Ben goes on to appreciate what they have discovered about who the patient is and what he has lived through, that he can share it with Ben and that together they can make it better, that they could do that for the kid. The patient is glad too that he can do this for his younger self.

This work was a beautiful and poignant example of how a loving other provides interactive regulation. When the client starts to retreat back into his head after initially dropping into intense affect (which I assume was overwhelming, hence the need to reinstate familiar defenses), Ben invites him to orient to and essentially ground in the here and now, not just generally, but in relation to Ben’s loving presence. And in the face of his soft defenses about fantasy “make-believe,” Ben does not give up, he lovingly challenges the patient not to leave this child all alone again, urging him to go back. If you love someone, you don’t give up on them. Ben, the “older and wiser other” trusted that if they went back to the scene together, that  no matter what evolved, they could find their way through it. And in this parallel process the client does not give up on the kid, he finds a way to be with him, to love and comfort him.  Magnificent!

Following this experience with Ben, I know that I personally have been emboldened to speak more directly about my love with some clients. I have found that it helps me be deeper in the AEDP stance while at the same time intensifying the power of the unfolding process. I hope that you too are inspired to think about the role and use of love in your practice.

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

Benjamin Lipton, LCSW is a Senior Faculty member of the AEDP Institute who has been trained and supervised in AEDP by Diana Fosha. Currently, Mr. Lipton is the lead supervisor of the AEDP Northwest Core Training as well as an individual and small group supervisor for clinicians learning AEDP in New York City. For the past three years, he was also the lead supervisor for the Bay Area AEDP Faculty Core Training. He leads AEDP workshops and trainings around the country and abroad.

Mr. Lipton and Diana Fosha recently co-authored Attachment as a Transformative Process in AEDP:  Operationalizing the Intersection of Attachment Theory and Affective Neuroscience which will appear in the Journal of Psychotherapy Integration. In addition, he is the editor of From Crisis to Crossroads: Gay Men Living with Chronic Illness and Disabilities (Haworth Press, 2004), and has published many clinical articles and book chapters in psychology and social service journals.

Mr. Lipton previously held an adjunct faculty appointment at Columbia Presbyterian Department of Psychiatry and New York University School of Social Work and was the Director of Clinical Services at Gay Men’s Health Crisis (GMHC), the world’s first and largest HIV/AIDS service organization. He maintains a private practice in New York City.