About This Interview
In this MINDinMIND Legacy Interview, Diana Fosha reflects on the ideas behind AEDP, her attachment-based and experiential approach to therapy, and on one of the central questions in her work: what changes when emotional suffering is no longer borne alone. She is joined by Stephen Porges, Ed Tronick and Shigeru Iwakabe, who bring perspectives from neuropsychology, infant development, rupture and repair, psychotherapy process and research.
For clinicians, the interview offers a way to think about therapy as a process in which distress becomes more bearable because it is no longer held alone. Using videoed clinical material, Diana shows how small shifts in the body, in state and in relational contact can become clinically significant, especially when moments of relief, vitality or positive affect are noticed rather than passed over too quickly.
Diana’s work sits at the meeting point of attachment theory, psychoanalytic thinking, trauma treatment, affective neuroscience and experiential therapy. As the developer of AEDP, she has built a model founded on the premise of ‘healing from the get-go’. It asks not only what has gone wrong for an individual, but what remains alive, responsive and available within them, even in the presence of serious emotional suffering?
At the heart of Diana’s work is a simple but far-reaching proposition: much psychological suffering can be understood as unwanted aloneness in the face of overwhelming emotional experience. Her interest in aloneness is not only clinical. At a time of rising loneliness and social disconnection, her work speaks to a wider question: what happens when pain has to be carried alone, and what becomes possible when it is met within a responsive relationship.
AEDP begins from the idea that what was once too much to bear alone can become more bearable when it is co-felt, co-regulated and processed with an engaged other. This is where Diana’s work meets the contributions of her special guests: Stephen Porges on the physiology of safety and social engagement, Ed Tronick on dyadic regulation, mismatch and repair, and Shigeru Iwakabe on how the delicate processes of therapeutic change can be studied without losing their clinical complexity.
Diana’s writing has also helped the field think more carefully about what happens after a moment of relief, recognition or new possibility appears in therapy. Through her work on metatherapeutic processing, she shows that the patient’s experience of change can itself become part of the work. Rather than passing too quickly over relief, strength, tenderness, pride or vitality, AEDP asks how these experiences can be noticed, deepened and integrated.
In this conversation, Diana reflects on the personal and clinical influences that shaped AEDP, including her early life growing up in Communist Romania, her psychoanalytic formation, her encounter with short-term dynamic psychotherapy and her search for a way of working that could retain clinical depth while making transformation more active, relational and immediate.
The interview invites therapists to think about trauma, aloneness, emotion, safety and positive affect not as separate themes, but as part of one larger clinical question: what helps change take root in the presence of another person?
“You can’t do attachment work with a still face.”
– Diana Fosha
Why This Conversation Matters
A central challenge in psychotherapy is that patients are often asked to return to experiences that were originally too much to bear alone. They may be able to speak about trauma, shame, grief or fear, yet still be unable to stay in contact with those experiences in a way that allows them to heal.
Diana Fosha’s work matters here because AEDP begins from a clinically precise idea: that aloneness in the face of overwhelming emotion is not simply part of the patient’s history, but part of the suffering itself. This offers therapists a clearer way of understanding why some patients can describe overwhelming experience without yet being able to bear or integrate it, and why emotional accompaniment is not incidental to treatment but central to it.
In AEDP, the therapist’s presence is active and emotionally engaged, helping the patient stay with what once felt unbearable while attending closely to whether care can actually be received.
The model also gives particular attention to what happens when change begins, asking how moments of relief, vitality, hope or recognition, heightened through experience, can themselves become part of the therapeutic process. For therapists trying to work deeply with trauma without becoming procedural or adversarial, that makes Fosha’s thinking especially useful now.
What This Conversation Will Add to Your Thinking
- How undoing aloneness, and experiential work with the patient’s receptivity, can lie at the centre of trauma work and therapeutic change
- How experiential work integrates with a developmental, relational and psychoanalytic perspective
- How to think clinically about patients who can speak about traumatic experience yet still cannot bear, process or integrate it
- What an emotionally engaged therapeutic stance asks of the therapist, and how it differs from approaches that become confrontational or overly procedural
- What Diana means by transformance, and why it matters to notice signs of vitality, emergence and change from the very beginning
- How Diana understands what happens during and after a therapeutic shift, and why the experience of change itself may become a catalyst for further change
- How Diana’s work helps us think more deeply about trauma, dissociation, the core self and the return of vitality after overwhelming experiences
Special Guests
Stephen Porges
Distinguished University Scientist at Indiana University, founding director of the Traumatic Stress Research Consortium, and MINDinMIND Legacy Interviewee. Through his development of Polyvagal Theory, Stephen has transformed understanding of how the autonomic nervous system shapes emotional regulation, social connection and responses to trauma.
Ed Tronick
Developmental and Clinical Psychologist, University Distinguished Professor at the University of Massachusetts Boston, and MINDinMIND Legacy Interviewee. Best known for creating the Still Face Experiment and developing the mutual regulation model, Ed transformed understanding of how infants and caregivers create meaning together. His work across infant research, maternal depression, cultural caregiving and psychotherapy has had a lasting influence on generations of clinicians and researchers.
Shigeru Iwakabe
Professor of Clinical Psychology at Ritsumeikan University in Japan. Shigeru is a clinical psychologist and psychotherapy researcher whose work has made an important contribution to the empirical study of AEDP. In collaboration with Diana Fosha and colleagues, he has helped advance research into how transformational change can be studied in practice, including AEDP’s effectiveness and longer-term outcomes. He brings research rigour, clinical understanding and clarity of thought to some of the field’s most important questions about how psychotherapy works. He is Past President of the Society for Psychotherapy Research.
About Diana Fosha
Diana Fosha is the developer of AEDP, a transformation-oriented model of psychotherapy that has become an influential presence in contemporary psychotherapy. Her work brings attachment theory, emotion theory, developmental research, neuroplasticity and affective neuroscience into close contact with the lived realities of therapy. Her major contribution has been to articulate a model in which attachment trauma, dissociation, overwhelming emotion and the experience of not having been met can be worked with directly and experientially in the therapeutic relationship. Her writing on undoing aloneness, dyadic affect regulation, transformance, metatherapeutic processing and the neurobiological core self has given therapists a richer language for describing how change unfolds in the room. Her books include The Transforming Power of Affect, The Healing Power of Emotion and Undoing Aloneness and the Transformation of Suffering into Flourishing: AEDP 2.0, which received the 2021 PROSE Award in Clinical Psychology and Psychiatry.
“What drove me to develop AEDP was a deep conviction that the potential for healing exists in every human being. Inspired by Winnicott’s vision of an intact true self waiting for the right conditions to emerge, I came to believe that this potential, the brain’s capacity to change and heal, had to be grounded in relationship. Certain powerful techniques I learned in intensive short-term dynamic training, once stripped of their confrontational character, informed my increasingly experiential clinical work.
What truly shaped the emerging conceptual framework was the intellectual explosion of the 1990s: the rapid advances in attachment theory and research, the work of Jaak Panksepp and Antonio Damasio illuminating how the brain processes emotion, Allan Schore’s integrative work on the neurobiology of attachment and affect regulation and the seminal work of the ‘baby watchers,’ such as Ed Tronick, Beatrice Beebe, and Colwyn Trevarthen, on moment-to-moment mother-infant interaction. Emotion, and emotional experience in relationship, declared themselves as the central agents of transformation.
Transformation itself also became a focus: one of AEDP’s original discoveries was that attending to the experience of change gives rise to a further round of change. Out of this emerged something genuinely new: a healing-oriented theory of transformation at the heart of an attachment-based, emotion-focused practice. AEDP was born.”
– Diana Fosha
Who This Is For
- Therapists working with trauma, dissociation and attachment disturbance
- Clinicians wanting to understand AEDP from its founder
- Psychotherapists interested in emotional processing, vitality and transformational change
- Supervisors and teachers looking to deepen their thinking about what actually promotes change in therapy
- Mental health professionals seeking a clinically grounded, relationally serious approach to trauma work
- Therapists who believe that it is possible to rewire internal working models, but wish to grasp how.
Interviewer
Diana is in conversation with Jane O’Rourke.
Jane O’Rourke, founder of MINDinMIND and a former award-winning BBC journalist now practising as a Child and Adolescent Psychotherapist, draws upon her combined expertise to create rich and thoughtful conversations with leading mental health clinicians. Her interviews weave together the personal and professional threads of her guests’ journeys, capturing the experiences that have shaped their clinical work and thinking.
Feedback from attendees
“I liked Diana’s honesty and transparency. She described the AEDP model well, connecting her approach with the clinical interventions in the session she conducted.”
– Diana Fosha Legacy Interview attendee
“Diana Fosha’s interview was my first time in attending a MINDinMIND event. I thoroughly enjoyed watching Jane O’Rourke style in facilitating the interview and panel.”
– Diana Fosha Legacy Interview attendee
“I liked the thoughtful in depth questions inviting Diana’s authentic presence and self disclosure as well as professional description of AEDP and its development.”
– Diana Fosha Legacy Interview attendee