In the Shadows: On Meta-Awareness and Spiraling Effects in Psychotherapy—Comment on Nicole Vigoda Gonzalez and Diana Fosha
Keywords:depersonalization/derealization, schizoid personality, phenomenological description, Accelerated Experiential Dynamic Psychotherapy (AEDP), case study, clinical case study
AbstractI want to commend Nicole Vigoda Gonzalez (2018) for her sensitive, sophisticated, and successful treatment in the case of Rosa; and I want to commend Diana Fosha (2018) for the development of her phenomenologically sophisticated and effective Accelerated Experiential Dynamic Psychotherapy (AEDP) model, which Vigoda Gonzalez used. In this commentary I focus on a contrast between two different perspectives in Fosha’s model, and implications for the case of Rosa. This contrast includes: (a) AEDP’s focus on descriptive phenomenology, emphasizing the richness of each client’s moment-to-moment, subjective experience, versus (b) Fosha’s seemingly unqualified advocacy, in the Second Avatar version of AEDP, of the therapist explicitly encouraging meta-processing—that is, explicit self-awareness—as a final step of therapeutic healing. In my commentary I suggest that there seem to be certain limiting conditions for such advocacy. Specifically, I discuss how the clinical research literature argues that while meta-processing may be very helpful for some clients, for others—e.g., those employing the distancing defenses of derealization and depersonalization—meta-processing can be psychologically counterproductive. I conclude by re-emphasizing the importance of retaining a descriptive phenomenological perspective in AEDP.
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