Dr. Diana (00:00:00):

I think the question that you said that parents have, oh my goodness, I wasn’t securely attached. I have this history. Am I doomed? Am I fated to repeat? Am I fated to transmit this to my child unless I have five years of psychotherapy or something like that? Now, I’m a huge fan of psychotherapy, but our answer is that much as that potential to heal is wired in, the potential for secure attachment is wired into us.

Dr. Sarah (00:00:38):

Attachment patterns shape the way that we connect, communicate, and heal. But what if the way we think about attachment isn’t telling the full story? In this episode, I’m joined by AEDP developer, Dr. Diana Fosha and AEDP Institute faculty member and psychotherapist, Karen Pando-Mars. And we’re going to explore how attachment informed therapy can help break cycles of trauma and foster deeper, more secure relationships. Their new book, Tailoring Treatment and Attachment Patterns: Healing Trauma in Relationships blends attachment theory, AEDP, methodologies and trauma recovery to provide a roadmap for healing. Together, we talk about how you can deepen your emotional awareness, why repair is at the heart of secure attachment, and what research reveals about overcoming attachment ruptures. But we also talk about the important parallels between healing trauma in a therapy treatment and parenting a child in a way that supports healthy emotional development because they may have different aims, but the strategies actually look very similar. So we are going to offer parents or therapists or anyone who’s ready to break free from insecure attachment patterns, some practical tools and research backed insights that we can use to strengthen our relationships, break free from old cycles that aren’t serving us and move towards greater security and connection.

(00:02:09):

Hi, I’m Dr. Sarah Bren, a clinical psychologist and mom of two. In this podcast, I’ve taken all of my clinical experience, current research on brain science and child psychology, and the insights I’ve gained on my own parenting journey and distilled everything down into easy to understand and actionable parenting insights. So you can tune out the noise and tune into your own authentic parenting voice with confidence and calm. This is Securely Attached.

(00:02:38):

Hello everyone. Welcome to a very special episode of the securely attached podcast. Today we have two just experts in their fields. We have Karen Pando-Mars and Dr. Diana Fosha, and they are here to talk to us about AEDP, which is accelerated experiential dynamic psychotherapy, and we’ll get into all the letters and everything, but welcome. Thank you both so much for being here.

Karen (00:03:09):

Very happy. Thank you. Thanks so much for having us.

Dr. Diana (00:03:12):

Yeah, it’s exciting to be in conversation.

Dr. Sarah (00:03:14):

Yeah, so I would love to just start off our conversation with you, orienting our listeners to how you guys found each other to work on this book that you have and your relationship and the work that you guys do. Before we get into all the good stuff, AEDP stuff.

Karen (00:03:40):

I’ll start and then we can just see. But I will say that I was drawn to a flyer that I received of a workshop that Diana was offering in Marin County, and it was about SEDP and basically went to the workshop, signed up for the immersion course, and got into consultation immediately after and fell in love with a DP. It felt like everything that I had studied was experiential and focusing. And the nineties, there was so much about attachment literature and neuroscience that I graduated prior to the decade of the nineties. And so when I met Diana at a DP, there was just this incredible model that held it all. And so I came with a lot of experience experientially, but with a EDP, I really got the attachment, the brain science, and most of all, importantly the transformational aspect of the work. That’s amazing. So I dove in and along the way became faculty, and along that way in teaching about attachment, the question, what do you do with people if different styles came up? And so I developed the centerpiece of the book. The grids started talking to Diana about that. She encouraged me to write an article and then later the book, and we’ve been working on this together, talking it over for 10, 13 years, something like that. It’s been a long time.

Dr. Sarah (00:05:18):

Wow. God, it must feel so good to have it come be out in the world now and get to really see it materialize.

Karen (00:05:28):

Yes.

Dr. Diana (00:05:28):

Yeah, it’s amazing. It’s amazing. I mean, as the book was officially released, we retraced our history just to see how long has it been and how long have we been working together and what respects and how and so on and so forth. So I mean, we share a DP, we share teaching it and working within it. We share the model and very specifically working on these set of ideas, which started out as a paper or started out as a grid on a bunch of pieces of paper that Karen was taking notes on and grew into a paper. And then the paper became after a very long gestation period, we have to say, became a book and all that sort of proceeded by a DP, which provides the framework and the structure and it, the model assumes it, that we sort of go into it in the book.

Dr. Sarah (00:06:36):

And Diana, you are the creator of AEDP.

Dr. Diana (00:06:40):

I am.

Dr. Sarah (00:06:43):

Do you want to talk a little bit about what it is?

Dr. Diana (00:06:46):

Yeah, thank you for that. So to sort of tell the origin story briefly, I had been trained in psychodynamics psychoanalytic work, which I think of as the sort of Greek and Latin. They provide this kind of fundamental structure, whether you use Latin or ancient Greek, probably you don’t, but it’s there sort of like in the structure.

(00:07:23):

So I think that psychoanalytic training was just very, very crucial. At the same time, I was very interested in effectiveness. I was very interested in aliveness. There was a certain particular thread, and I became interested in things that sort of enhance the effectiveness of the therapy, its speed, duration, et cetera. Did some work in short-term dynamic psychotherapy and became exposed to a model which I learned, which was in some ways rather non congruent with my nature I-S-T-D-P. It was very confrontational and very aggressive, though I grew some muscles in the course of learning it. But what really, really drew me to it was the nature of the transformational phenomena that there were actual experience of deep dropping down into emotion and breakthrough and real transformation happening quickly, not at the end of five years or gradually or slowly, which was incredibly compelling and interesting. And moving to me is number one, so the attraction.

(00:08:58):

But number two, it also became clear to me that there wasn’t a theory to explain I-S-T-D-P had old fashioned drive theory, which has nothing to do with transformational phenomena with quantum leaps or anything like that. So those two things, my interest in phenomenology in describing transformation, but also not thinking that therapy is about this kind of battle or confrontation, but rather much more being with sort of allowed me to bring in my relational developmental, psychoanalytically oriented approach to relationship based on attunement and mother child interaction. So that was one big shift to the developmental and to attachment. And the other was just this fascination that I have with transformational theory. So that’s really the roots.

Dr. Sarah (00:10:13):

Can we talk a little bit about what A EDP is? Because I know we have a lot of therapists that listen to this podcast, but we also have a lot of parents, and I know the parents that listen to this podcast are really, they’re really psychologically savvy parents. I think they might really enjoy understanding what I mean. Obviously this pug is called securely attached. We talk about attachment a lot. So I would love to understand how attachment overlaps and informs this treatment modality and how it might be appealing to parents who either to seek it out as a treatment modality for themselves or their parent-child relationships, but also really to think about how can I pull some of these things and inform my parenting a little bit as well. So yeah, that was a lot. But maybe just start with what is a AEDP?

Dr. Diana (00:11:07):

Maybe I’ll do just a brief account and then turn it to Karen to add Karen, whatever you want. But specifically, or more particularly the attachment aspect, but I guess to try to capture it in a nutshell, because a rather complex model, it’s a model that when people see our videotapes and we work from videotapes and we teach from videotapes, when people see our videotapes, they feel very natural. And one of our colleagues called it deceptively simple just because it has this kind of resonance that sort of hits a certain kind of authenticity in the person, the theory underneath it, it’s more complex. But a couple of things that I just want to highlight. One is that we’re not psychopathology oriented, but we’re healing oriented. We understand things from the point of view, including attachment difficulties, not just the secure attachment, as adaptation, as best efforts, as really evidence of the individuals strivings to heal and to repair and to do their very best.

(00:12:33):

So we’re constantly leaning into what’s adaptive here, what’s transformative, what’s a little glimmer? Maybe there’s a lot of stuff that’s wrong, but what’s the little glimmer of what’s right? So I think that and the kind of stance, the therapeutic stance, which is attunement, which is very much attachment in form, and it’s about being with being affirmative, being loving, gone is the neutrality of long ago, but it’s not just not neutral. It’s actively affirmative and authentic at the same time. It has to be. And the last piece that I will say is that our goal is to sort of help people feel safe enough that they can drop down into their emotions with us, emotions associated with their attachment trauma, with their big T trauma, with difficulties they’ve had in their lives that they haven’t been able to deal with by themselves, but with support and with accompaniment and sort of with dyadic relationship, those emotions can be processed and taken to a good place, which we then really, really then subsequently work with. And that’s the transformational piece. So you actually got all four aspects and I hope less than three minutes.

Dr. Sarah (00:14:13):

Yeah, that is great. And if I’m going to synthesize it, I’m hearing there is this belief that the healing capacity is in you always, right? I’m not assuming that you are sick and I have to heal. You are in pain and maybe suffering and your ability to heal is present here too.

Dr. Diana (00:14:38):

Exactly.

Dr. Sarah (00:14:39):

The second thing I’m hearing is that the attunement of the therapist to the client is the driver of most of the kind of where things go and what is kind of informing the work. And then lemme see if I can remember everything you said. It was good. So good summary you’re talking about, I know there’s maybe another piece I’m missing, but at the end I heard you say once the client is able to really get safe enough to feel that safety and go to these painful places, then there’s this other layer to the work where you’re going to look at that. I think you call it metaprocessing, where you’re looking at, okay, something just happened here. How do we understand that? How did that feel for you? And Ned, there’s a whole piece of work that comes from that element. Did I miss anything?

Dr. Diana (00:15:41):

No, remarkably, I think just to sort of specify it a little bit more, just differentiating between the work with the core emotions which are painful and helping people heal those or take them to a better place, and then when they do get to a better place, really working with a positive experience and amplifying that. So just sort of being a little more granular about those two aspects. But I think you did an incredible job and I really want to be quiet now and just give the baton to Karen.

Karen (00:16:21):

That’s great. So one of the things that I was just listening to Diana say that I think is so much a part of a DP is that we’re not neutral, that we’re engaging from a place of being affirming and loving and caring. And I just think that is so central because part of what that means is that when people are talking, we’re actually leaning into any moments of secure functioning that show up, a willingness to look, a willingness to say, I’ve never told anyone this before, but I feel like I need to say this now. Or I was just supervising witnessing someone’s tape and they were giving both a painful, difficult place and a positive place, the same weight. And I was thinking, no, what we actually want to do is we want to help people choose to. If you can set this aside for now and we can really open into this place that feels nutritive, let’s be with that and see what develops. So with not having a blank face, we also lean into directions that we pretty much have maps that orient us to what’s a good direction to go towards experience towards body-based emotions, towards relational connection.

Dr. Sarah (00:17:47):

So is the idea there to sort of relationally and through the relationship reinforce placing attention on and potentially wiring our connections to these more maybe adaptive or securely driven interactions with another human?

Karen (00:18:11):

Yes, I would say so. And as I’m listening to you, I’m noticing that part of what we talk about in AEDP is a word called transform, which Diana coined, which tends to be the opposite of resistance. And so when we see manifestations of interest, growth, new development, it’s like our attachment systems are wired in, but because of wounding, they often get shut down or pushed away or not trusted. And so what we’re trying to do is set up conditions for that wired in place to kind of self write so that people can get reacquainted with, oh, maybe I can ask for help. Oh, maybe I can admit that I am nervous or afraid or angry or sad or happy. So part of what we talk a lot about in our book is setting the conditions for this security and safety so that we can actually allow the attachment system that’s innate, the seeking system that cept talked about, the exploratory system that Bowlby talked about, that those are innate drives that we can facilitate them arising by how we are with our patients, with our clients.

Dr. Sarah (00:19:44):

That makes so much sense. I really love that idea and I know I just can’t help but notice the parallels between, and this is true for lots of good therapy, but that dynamic between a therapist and a client when it is attachment oriented or informed, there’s so many good parallels to parenting because is the parent, you are not your child therapist, but you are their source of writing the attachment blueprint. And so even if you have an attachment blueprint that needs to be made more secure, you have editing to do to get to that secure place. I have so many parents that ask me, I don’t have a history of secure attachment relationships, and I’m so terrified that I’m going to have just by default, my kid’s going to be insecurely attached too. And I think we have enough understanding that there are things that we can really do to prevent transmitting that. And obviously doing this kind of therapeutic work for yourself as an adult so that you can become more healed and have different attachment strategies and allow that to flow into your parenting. That’s super important. But just as a general parent being like, oh, what does it actually look like to be attuned to my kid and why does it help? This feels so, yeah, we’re talking about therapy, but parents can do this too. In a lot of ways. It seems very transferable.

Dr. Diana (00:21:30):

And I want to add something. I think you’re talking about something really, really important that’s a tendency in the field that has also gotten transmitted to the general public, but it’s also our sort of being so magnetically drawn to what is wrong.

(00:21:58):

So I think the question that you said that parents have, oh my goodness, I wasn’t securely attached. I have this history. Am I doomed? Am I fated to repeat? Am I fated to transmit this to my child unless I have five years of psychotherapy or something like that? Now I’m a huge fan of psychotherapy, but our answer is that much as that potential to heal is wired in, just like Karen was saying, the potential for secure attachment is wired into us and is always present, and we are not sort of slaves to our histories side by side with that. There’s this potential so that being able to sort of see that capacity to give love or to attune or to repair or to sort of hold difficulty without punishing the child or being punitive or abusive is wired in therapy. We want to celebrate it every time we see it, that when we see these glimmers of transformers, when we see these glimmers of risk taking or of connection, we want to really heighten and bring attention to them. And I think there’s also ways in which I think parents can attune to all the things they’re doing right, regardless of their, so without minimizing the other side of it, which is that of course they were affected by how we grew up, but there’s much more of an interplay between the two.

Dr. Sarah (00:24:02):

Yeah, I think that’s so helpful to remember. I think a huge myth that we always often try to bust on this podcast is that attachment is this fixed locked in thing, but reality, even the idea of an attachment style isn’t really an accurate way of describing, it’s just kind of a shorthand that’s gotten adapted by people. But we don’t have one attachment style or we are not a attachment style. We have many, many, many relationships, and in each relationship we show up in different ways, sometimes secure, sometimes less, and we can have these blueprints that got written early on that can prime us to bring things with us that can make us have patterns of showing up in relationships. And that’s I think where things like AEDP would be really helpful in helping people go back to that early blueprint and start to rewrite it a little bit. But if you are in a relationship with someone where they make you feel genuinely seen and safe, you’re probably going to show up relatively secure even if you have a pattern of less secure relating. And I’m just curious your guys’ thoughts on that too and how that ties into the work that you do when you’re using AEDP professionally.

Karen (00:25:27):

I love what you’re saying because in the book I talk about shifting away from styles towards patterns for that very reason that we, in the early studies, it was clear that children have different patterns that show up with different caregivers, and we draw on that in an AEDP in that we want to be a container and a place that sets conditions for that safe haven, if you will. And to create a safe base, which is what parents are doing for their kids, is to draw that parallel. And one of the pieces about patterns that’s really been important to me is breaking down the configuration of each pattern has all these different components, and as psychotherapist, it gives us different entry points to pay attention to When someone’s been really wounded and hurt and had their attachment needs rejected or minimized, that can be very avoidant producing. And so what we’re trying to do in our work is bring and kindness and care so that if attachment needs are in the room, they can be safe to explore and to feel and to be with.

(00:26:56):

There was something I wanted to get back to about with parents. Oh, I know it had to do with what’s something that we work with in therapy but also parents can address. And one of it is really meeting where the person is at, whether it’s our client or our kid. So often when when kids clients are really distressed, sometimes the desire to help actually overrides meeting the distress with like, oh my gosh, you’re so upset right now. Oh my gosh, this is so important and feels so hard to really meet the distress. Because in a lot of the early interactive studies, what was shown is that baby cries, mom’s overwhelmed, mom smiles to make the baby happy, but misses the fact that the baby’s sad and pulling away. Mom leans in trying to help, but baby draws back too much space. And so really that tells us so much about the importance of matching. And you can see in baby studies that when mothers are able to, or caregivers really are able to recognize the baby’s distress and maybe sober their face, if baby’s crying, be still for a minute and actually connect with what’s going on, baby can settle and then maybe might reach back out and mom can reach out. And it’s so subtle, but it teaches us so much about attunement. So there’s that piece.

Dr. Sarah (00:28:34):

Yeah, that makes me too think of, obviously if you are practicing a DP as a therapist, you really have to be so tuned in not just to your client but to your own self because you’re constantly self-regulating in order to be able to attune because we are two way, you know what I mean? There’s this two-way feedback biofeedback happening. We feel the person in our presence, we feel their feelings just as much as we can cognitively identify or whatever. And same with parents, to be a parent is a masterclass in learning, having to learn to self-regulate, to be able to attune. Because what you’re describing, if a parent baby’s crying and the mom leans in or smiles when the baby needs to just be seen, the reason that she’s probably leaning in is because she’s having her own panic. I can’t handle this. I got to turn this off. Or fear or distress or overstimulation, right? Like, oh my gosh, how many times as a parent of a older kid when they’re losing it and totally dysregulated that load of sensory input I’m receiving as the parent, not just the parent that wants to help the kid and feels worried about them or stressed about them, but just as the human being receiving all this screaming and kicking and whatever, I’m getting flooded because it’s activating to be in the presence of such intense affect and sometimes physicality.

(00:30:21):

There’s so many things I have to do at the same time, in order to attune to my kid, I have to tolerate what they’re giving to me. I have to regulate my own nervous system so that I can tap into my capacity to attune, and then I have to be sort of tracking what I’m tuning into and then deciding how to meet that. That’s a lot, but like you say, you watch it on a tape and you’re like, oh, that seems so natural. But all the mechanisms that have to be happening simultaneously to really get it right, it’s a lot.

Dr. Diana (00:30:57):

What I want to add to that is that we don’t have to be perfect, which is very merciful, both as therapists and as parents and everything you named sort of because of that, we’re not going to always get it right. We’re not going to always be able to attune to the kid who’s freaking out while our nervous system is overloaded. There might be those times when you lean in either with destruction or games or anger, whatever non-optimal responses in the moment, which we all have, but those can be repaired.

Dr. Sarah (00:31:39):

Yes.

Dr. Diana (00:31:40):

I think that there are lapses and they don’t feel good. But I think the repair, this is also what we’ve learned from research and really from our therapeutic experience is that making the repair, owning the laps, apologizing for oneself when the dust settles, taking responsibility, being interested in the other person’s experience, doing whatever it takes to sort of set that repair in motion, not expecting it to happen like this just because I apologize, it’s going to be now okay, it’ll take the time that it’ll take to give just a couple of examples. That’s the process. That’s what makes secure attachment. It’s so nice when we get everything and everything sort of works nicely and moves along, but we’ve learned that secure attachment really results from and resilience from the capacity to get through those hard times that don’t always initially go perfectly.

Dr. Sarah (00:32:57):

Yeah, that’s such an important and very hopeful message and reminder. I mean, I’ve seen different research cite different numbers, but I’ve definitely read studies where they’re like maternal attunement like 54% of the time as little as 54% of the time was still predictive of a secure attachment relationship. We are not supposed to get it right all the time, and we really don’t have to just, if attunement is your north star, you’re going to keep coming back to it, and when you deviate from it, you notice and you come back to it, but you’re going to constantly be deviating from it. And it’s the returning to it that I think is far more important.

Karen (00:33:45):

I mean, it’s that showing, it’s the care that comes from returning it to it and trying to get it right and trying to understand what’s needed best for next time. I mean, we talk about chronic studies that say it’s one third, one third, one third. It’s even amazing.

Dr. Diana (00:33:59):

And saying what the one third, one third, one third is?

Karen (00:34:05):

One third attunement, one third disruption, one-third repair. So those moments you’re describing are that disruption, but it’s that desire to come back, the desire to get it right, the desire to care about what made things so upsetting in the first place. All of that makes such a huge difference. And clinically, I have to say, so many folks come in and repair is not on their radar that that’s possible.

(00:34:40):

And that’s just such an interesting marker of insecure attachment is that that repair piece often has been missing. And so I think maybe that’s something that when we’re working with folks, our intention to be there and to hear about what went badly or what went off or what didn’t feel good or what was missed. I had a client just recently really have to tell me how I shortcut something that she was saying, and she really missed being able to feel her experience. And we took a whole session the next time just really talking about what I missed, what she felt, and taking it so slow that it wasn’t like, okay, you got it. Thanks. Now I’ll tell you the thing that I was trying to get to. It doesn’t work like that. We just have to really, like Diana was saying, really be interested in taking what it takes to get back on track.

Dr. Sarah (00:35:41):

Yeah. Is that sort of what you’re describing really staying with the processing of a rupture and not just moving on? Is that part of that meta meta processing element of a DP? Can you talk a little bit more about that aspect?

Karen (00:36:01):

I mean, I think those, I would say are two different things because one is we will talk about WeWork explicitly and experientially with the relational part of the work. So we’re really tuning in and engaging and being honest and authentic and judiciously self-disclosing in service of the patient, but willing to name and be with what our experience is. Metaprocessing itself is about when there shifts, when there’s a change, when there’s a completed emotion, when there’s a new experience, really wanting to foster an understanding of what happens when you feel differently, what happens when you faced this memory that you always kept in the dark? What happens when you share this with me, another person? So we’re really trying to look at what the effects of change is. And then there’s what unfolds is oftentimes different transformational effects. Diana has noticed that in the process of exploring after core emotions that are more often described, sadness, anger, fear, those things that when people have completed something, they might have a sense of mastery or pride or there might be new realizations or enlivenment or feeling really moved and grateful. There’s many aspects of going through changes and facing new things that kind of grow the self, grow the capacity. And so AEDP really tries to harness that and build on that, grow those potentials.

Dr. Sarah (00:37:53):

So you’re really moving slowly in a good way. You’re really willing to stay and review and integrate. It’s not like, I dunno, we move so quickly. Okay, I said the thing, I did the thing that felt good. Let’s move on to this next. We’re really saying, well, not so fast. Let’s not move on just yet. How much are you modeling that ability to just slow down and move all the way through it, including the integration at the end of whatever it is?

Dr. Diana (00:38:31):

If I can just answer that, but piggyback on what Karen saying about Metaprocessing and sort of integrate our example about repair. However you get there, when you do repair, when calm has been restored, when you’re back in the connection, the kid is back in your lap or you you’re playing again or with a patient, there is this sense, okay, I really do feel like you understand me and now I understand something better. The repair has happened to use that example. It’s not just, oh, how great, but okay, so what is it like that we were able to hang in there with the hard stuff and here we are feeling closer and knowing each other better. What’s that? In other words, taking the repair, taking the good feelings that come from whatever it is, whether I feel good that I was able to hang in, I feel grateful to you because you see me and et cetera. And really work with those in a way that sort of expands this realm of these positive effects that are so connected with resilience, with intimacy, with immune health, with everything in the book. We’re broadening and building not just the resilience of having done it, but then so just to sort of unpack metaprocessing meta in that or it’s meta therapeutic processing we’re processing what’s therapeutic about what just happened. That’s the meta part of it.

Dr. Sarah (00:40:31):

And even in a parenting interaction, you’re processing what was therapeutic or bonding or repairing about what just happened. And I would imagine too, because just from a developmental standpoint, you’re also helping a child practice the skill of reflective functioning. You’re saying not just what happened, but how do you feel about what happened or what was it like or what do you think I feel about what that happened? Or I’ll tell you what I feel. So you’re giving them this exercise in reflective functioning.

Dr. Diana (00:41:06):

Or I’m so proud of you for hanging in there with me when it was really hard. What’s it like to know that I’m so proud of you or my God, you did such a good job. I was upset there, but you stayed with me too, right? Something like that. Wow. What’s it like that I’m so taken by it or whatever?

Dr. Sarah (00:41:35):

So you’re taking it one step further.

Dr. Diana (00:41:38):

Or two or three or two or three.

Dr. Sarah (00:41:42):

That’s amazing. I think that’s very helpful.

Karen (00:41:44):

My rewind is like, okay, I over split the relational and the metaprocessing and the effort to kind of speak about that because I was thinking is how important that full session afterwards with this person was, the idea that we actually could repair. And it totally went into the deeper work of how what was happening with me had never happened in a particular significant relationship that was so missed. And so I just want to put that out there.

Dr. Sarah (00:42:17):

No, that makes sense, right, than the split for you to take all that time to give. That’s so caring to say I missed something and you had a feeling about that and I’m going to give you a lot. It’s a gift to give someone so much attention and time on a miss that you caused them to feel pain about, right? Instead of, because I feel like we can be understandably out of our own protection for ourself and our defenses to be like, okay, I know I hurt you and I’m sorry, and I would like for us to get over this quickly please, because uncomfortable for me to have to hold my fault in this. And as parents, of course, we do that all the time because we’re going to mess up all the time and we have guilt and we have shame, and we don’t like hurting or messing up or causing our kids to be afraid of us.

(00:43:19):

We yelled or whatever. But we want, I think we really out of an understandable wanting to get out of the discomfort of that shamey feeling like we want to help elicit the repair and then the move on for our own self. And so it’s like, it’s really a gift to be able to say, it’s generous to be like, I’m going to sit in this discomfort for as long as it you need, and then I’m here. I can tolerate all the feelings that I have about the feelings that you have and I’m still with you. That’s super tricky and really powerful. It just really highlights how relational this is. These are two way, this is not a one way thing. I think a lot of people think of therapy as like I go in and it’s a one way relationship. I tell my therapist everything and they tell me nothing. And it’s not like a two-way therapy, but it is a two-way relationship and there’s a real human sitting in the room with you always. And then well, with ai, who knows nowadays, but typically there’s a real human sitting in there.

Dr. Diana (00:44:35):

Thus far there has been another human.

Dr. Sarah (00:44:37):

I know. Different episode. Different episode. But yeah. And same with being a parent. The parent child relationship is also a, I don’t want to say it’s not asynchronous, that’s not the right word, but it’s not an equal two way relationship either. It’s not parent to parent, it’s parent to child, and the parent is not asking the child to do for them what they need to do for the child. It is not equal in that way, but it’s not a one way relationship. It’s still a two way. It’s two human beings.

Dr. Diana (00:45:17):

We talk in the book about the difference between relationships that are mutual and symmetric. And mutual and asymmetric. So the attachment relationship is mutual. That’s what we’re talking about. It does go both ways, but it is asymmetric. There’s a parent and a child, there’s a therapist and a patient. That’s where we have different responsibilities. We have different roles, we have different developmental levels. That’s the asymmetry comes in, but it absolutely is mutual.

Dr. Sarah (00:45:53):

I think, where the magic happens.

Dr. Diana (00:45:57):

Right, exactly.

Dr. Sarah (00:46:02):

Are there any other pieces of this book that we haven’t talked about that you feel like might be really helpful for therapists that are listening or parents to be aware of that might be helpful for them?

Dr. Diana (00:46:16):

I think the grids, Karen, you have to talk about the grids. We haven’t talked about the grids at all. That’s a sort of centerpiece of the book.

Karen (00:46:23):

Thank you. What I was going to say is when we were talking earlier about regulating and helping our patients or our children regulate, one of the things that when I started looking at what happens differently with different patterns, how I would help someone regulate is going to be different. If I’m working with someone with an avoidant pattern, moving in really closely and saying, can you feel me with, you might actually stir deactivating the attachment system. And so I really started looking at what’s different. What is helpful for one can be dysregulating for the other.

(00:47:07):

Somebody who’s clamoring for help if I offer help is like, oh, finally, someone’s here to help me. But someone else might say, no, I really don’t need your help. I’m just here because I need to figure out blah, blah. So there’s different experiences that people come in with. And so I was asked in teaching what happens with folks with different styles? And that’s when I, in writing, the book started shifting to patterns and I looked at the configuration of each pattern in terms of affect regulation, arousal of the attachment system, self, other patterning, do I go to others? Do I rely on myself? What are the caregiver hallmarks? The caregiver states of mind, what Mary Maine studied in the adult attachment interview and found that parents who were dismissive of attachment needs tended to their children, tended to be avoidant to turn away. I better not need because that might disrupt our bond.

(00:48:16):

Whereas when parents are inconsistent or self occupied, the child might clamor and turn on the attachment system for that if I can finally get your attention. But the settling is different, the difficult for folks sometimes with an ambivalent resistant pattern. So I created these grids in conversation with Diana along the way and then created a third grid. Well, there’s three. One is, what are the patterns of the insecure attachment? What is the configuration of secure so that we can, A, notice what we’re doing to set the conditions for secure functioning with our patients. But also what to notice when someone comes in and is self-regulating or somebody who’s been seeking help from others comes in and says, actually, I didn’t make that 14th call last night. I actually contained and listened to a podcast, or I wrote in my journal, or I called a friend or someone who’s avoidant of relational bids might say, I reached out and I, instead of waiting for my partner to ask me a question, I shared something that I wanted them to know that was new for me.

(00:49:42):

We really want to harness that. So in the secure grid, looking at what are signs of secure functioning that we can affirm and support and celebrate. And then the third grid is really looking at interventions that go alongside many of the different elements of each pattern. And the most, I think contributory of the third grid is really looking at the therapists. What are common reactivities that we might have that come up with certain patterns? If someone’s acting rejecting to us, it’s common to feel rejected. That doesn’t mean that I’m insecure necessarily. It might point to my own wounding and such. But it also can be that some things that happen in relationship trigger common. And there’s also a part about what are the meta skills? What are the intentional sensitivities that we can bring to counter the hallmarks of the pattern of the state of mind or the caregiver hallmark? So for avoidance, being accepting for ambivalence and resistance to maybe be firm, be directive if someone is anxious and hyper activating, if we can slow things down and be calm and firm and caring, but just help things.

Dr. Sarah (00:51:12):

And containing.

Karen (00:51:13):

To contain. And so that’s a taste of some of the grids, but we’ve just really laid it out. And then there’s transcripts and chapters that really take each pattern, the formation and how to treat it. We go deeply with transcripts and examples and things.

Dr. Sarah (00:51:35):

I think that’s so important. It takes this already really incredible model that’s based on attachment and attunement, and it creates a way to deeper, even more deeply individualize it to the person in the room with you, right? Because I say this all the time with parenting, and anyone who has more than one kid has figured this out pretty quickly. They’re different. They’re so different. The parenting strategies that work with one kid might not work with another. And you have to figure out not just their attachment styles, but their regulatory systems, their nervous systems, and how do they receive co-regulation from you and what can they tolerate? And I imagine this is very similar of your, are working with a patient understanding their attachment systems and then how that is different across different people can just elevate your ability to attune in a much more individualized way.

Dr. Diana (00:52:36):

Yes. I think that very much, and I think that in those moments of reactivity or dysregulation for either the parent or the therapist, I think when we have a framework or an idea of what to aim for, so for instance, if I know, okay, when I’m getting dysregulated, maybe I can’t think of seven things at once, but I do know that if I take a moment to breathe or not react, that will help the situation in the same way. So I have an aid, I have sort of an attachment assistance. From a model or from a theory or from a tool. And I think in the same way for therapists, when therapists sort of get triggered or their countertransference gets stirred up, but let’s leave cancer transference. That’s a different thing. But just these common reactivities that Karen is talking about, the preoccupied patient who’s talking nonstop and they want connection, but nothing is ever good enough. Plus they don’t stop enough to let the therapist get a word in edgewise to just know that the goal, however I’m going to achieve it. The goal is to help the person sort of slow down, take a breath, and if anything, shift their focus internal rather than the grasping and the grabbing and so on. If I know that that’s what I’m aiming for, it will help regulate me in the moment. And so for therapists to have ways to deal with their own reactivities as well as an understanding of these different patterns, oh, that’s what’s happening. Their physiology right now is in a shutdown state, so we have to deal with that first. That kind of thing I think is so helpful with these guidelines.

Dr. Sarah (00:54:57):

Yeah, it’s like a playbook.

Dr. Diana (00:54:58):

Oh, it could be therapists or parents better.

Dr. Sarah (00:55:02):

Yeah, no, it’s super orienting. Everyone feels a little better if they’ve got a cheat sheet. You know what I mean?

Dr. Diana (00:55:10):

It’s a cheat sheet. The cheat sheet undoes aloneness, which is one of our big A DP phrases. We don’t want the patient to be alone with their suffering or with their triumphs in the same way the cheat sheet undoes our aloneness. There’s somebody who’s helping me in this moment.

Dr. Sarah (00:55:29):

I know that as a therapist, there’s a million times where I’ve felt helpless in a session. I don’t know what I’m, I feel the disconnect. And I don’t always, it’s like I have to figure out what to do. And sometimes it can be perplexing. And so I think that’s probably why most therapists keep getting more training. We’ve all felt that helpless moment and we don’t like it. And in parenting, oh my God, how many times have I felt helpless? I’m like, I don’t know what I’m supposed to do. And it’s like, yeah, a cheat sheet helps. It really helps us feel not so alone and not so helpless in a moment. And then when we don’t feel alone or helpless, we can lean in and allow that connection with the kid or the patient. Makes so much sense to me.

Karen (00:56:18):

So great to hear. I love hearing your reflections when Diana and I are speaking because it just, this conversation feels so natural in that way. I love hearing what you’re taking from what’s being said. It’s really great.

Dr. Sarah (00:56:31):

Thank you. That makes me feel so good, because that is really always my goal when I get to, that’s the best part about meeting people on this podcast is I get to just get a glimpse into the inner workings of the minds of people who are doing such cool things. And I don’t know, I get to geek out. It’s so fun.

Dr. Diana (00:56:54):

It shows an I sort of love about our collaboration is we call it nerding out, but geeking out that we have similar minds in that way and the back and forth. And it does feel very much like, I agree with Karen. This has been such a flowing conversation and so exciting. And when you said that makes you feel good, I was going to say, okay, if we were an AEDP session now, we would meta a process. So what’s it like that you’ve done this interview in such a way that we love it and you feel good? What’s that for you?

Dr. Sarah (00:57:34):

No, I was thinking my brain was like, oh, this is in real time. It’s happening. And just to close that loop, I’ll reflect on that. It makes me feel like I want to keep doing this against me. Okay, we’re onto something here. And these are connections that matter and personally, but also for the product that we’re creating for other people to like, wow, this is so cool. So thank you and I really appreciate your time and your wisdom. And if people are needing more and wanting to connect with the work that you do, and clearly I recommend getting this book, tailoring treatment and attachment patterns, healing trauma in relationships, definitely go get it. How can we connect people to your work?

Dr. Diana (00:58:29):

Well, I think one, two things just quickly. Just the AEDP website just has a ton of resources, trainings, articles, information training. It is a website for therapists. It’s not for the, I mean people can come on it, but it’s aimed for therapists. But for therapists, there are a ton of resources. And the other thing I wanted to say is we’re going to have a conference in New York City, April 4th to sixth, come join us.

Dr. Sarah (00:59:07):

Okay. I mean, I definitely hope that everyone’s listening should too. We can link to that in the show notes. But yeah. Awesome. I’m here. I live in New York, so I got to come.

Dr. Diana (00:59:18):

It’s called In It Together: The Science and Practice of Healing in Connection.

Dr. Sarah (00:59:27):

Okay.

Dr. Diana (00:59:27):

The title of our conference.

Dr. Sarah (00:59:29):

Amazing. And that’s in New York. And I’m actually aware of this conference, so it’s hybrid, so it’s virtual and in person. So anybody listening who is a clinician and wants to learn more about your work can go right?

Karen (00:59:40):

Absolutely.

Dr. Diana (00:59:41):

Absolutely. It’s in person and online.

(00:59:44):

Yeah, it is hybrid.

Dr. Sarah (00:59:46):

And I know you were saying that your website is resources that are aimed for clinicians. Is there, if someone is listening, and I really want to find a therapist that’s trained in this modality, can they find that on the website as well?

Karen (00:59:57):

There’s a therapist directory.

Dr. Diana (00:59:59):

Yeah. And I didn’t give the URL for the website. It’s AEDPinstitute.org. ADP Institute, one word, www ADP institute.org. And yes, there’s absolutely a therapist directory organized by area, geographic area.

Dr. Sarah (01:00:21):

Perfect. Well, thank you so much. It was so lovely talking to both of you. I’m very excited for your book, and yeah, I hope to stay in touch.

Karen (01:00:31):

Thank you so much. It’s really wonderful to be here.

Dr. Diana (01:00:35):

Yeah, this was fun and very lively, so thank you.

Dr. Sarah (01:00:38):

Thank you.

Dr. Diana (01:00:39):

Thank you for having us.

Karen (01:00:40):

Thank you.

Dr. Sarah (01:00:47):

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