Healing-Oriented Versus Insight-Oriented Psychotherapy
The differences in psychotherapy methods matter.
Posted Aug 10, 2020
As Laura shared her story with me, her eyes filled with tears. Recognizing that she was having an emotion, I invited her to slow down and pay attention to the feeling of sadness in her body. She stopped speaking and focused inward. As she did, the wave of sadness increased. Her tears flowed, unencumbered by conflict, as I sat quietly with her.
Soon the wave of Laura's sadness passed. I then gently directed her to stay focused on what was happening in her body now that the sadness had been released. After about 30 seconds, she looked up at me with bright eyes. “I feel calmer now,” she said. “I really was a very sad child,” Laura reported with newfound insight, clarity, self-compassion, and recognition for how her parents’ difficulties had affected her.
Ever since I was a little girl, I wanted to become a psychoanalyst — like Freud. And that is exactly what I did. And then I learned of an entirely new way of working where the focus was not only on helping a person gain insight but also on fostering a lasting and deeply healing experience.
I first heard about this new way of working at an academic conference on emotions. It was there that I saw videos showing psychotherapists skillfully guiding patients into their emotions by focusing on the physical sensations that came along with each emotion. Fascinated, I had never seen anything like it. Since that time, experiential methods have become my focus. I am now certified in and supervise therapists in training in a healing-oriented, experiential method of psychotherapy called Accelerated Experiential Dynamic Psychotherapy (AEDP).
Whereas in psychoanalytic work I was taught to listen and make interpretations, experiential work is much more purposeful and directive. I typically say, “I am interested in everything you have to say and I am wondering if we could slow way down to notice what you are experiencing as you share with me how your boss criticized you," for example. This type of intervention helps a person recognize not only the thoughts in their mind but also what they are experiencing below the neck. Listening to the body is the starting point for deep and transformational work with emotions.
Working experientially is healing and transformational for many reasons. Here are four:
- Experiential work actively cultivates a mindful, non-judgmental, compassionate stance that helps a person become aware of their inner experiences and permanently changes the brain for the better.
- Experiential work helps people lean into their core emotions of sadness, fear, anger, joy, excitement, and disgust. This helps us process emotions instead of avoiding them (because they are uncomfortable, painful, or because they overwhelm us). Sensing emotions in the body paves the way to using emotions for well-being, instead of being controlled by them, or burying them, which leads to symptoms like anxiety and depression.
- Experiential work diminishes anxiety, depression, and other symptoms in predictable, reproducible ways, which is why it is considered healing-oriented. The Change Triangle is the tool that shows the relationship between emotions, anxiety, and the protective defenses we think we need and that, unfortunately, leads to psychological symptoms like depression and low self-worth.
- Experiential work teaches people to become their own therapist, giving them practical life skills to work with their emotions and the emotions of others in ways that are constructive and sustain emotional health.
Below is an example of what interventions in each method looks like:
Psychoanalytic Intervention Example
Patient: My boss really upset me this week. I did a huge report for him that wasn’t even my job and he didn’t so much as say thank you. In fact, he talked about it in a meeting like he did all the work instead of me.
Psychoanalytic Therapist: Sounds like you didn’t like that. Tell me more.
The traditional talk therapist adopts a neutral stance and focuses on the content of the story. The therapist listens openly and makes interpretations to help create meaning or identify irrational thoughts, which is the primary focus of cognitive-behavioral therapy (CBT). Insight, of course, is important, and at the same time, there is so much more we can do to create well-being. Attending to underlying emotions, for example, helps people feel more immediately alive and ultimately more comfortable in their skin. And greater insight often follows an emotional experience.
Experiential (AEDP) Intervention Example
Patient: My boss really upset me this week. I did a huge report for him that wasn’t even my job and he didn’t even say thank you. In fact, he talked about it in a meeting like he did all the work instead of me.
Experiential Therapist: I see feeling in your face and I notice your hands are making fists. Do you notice that? Can we slow way down so you can stay with what is happening inside as you share your story with me now?
The experiential psychotherapist notices both verbal and non-verbal communication of emotions. A goal is to help a person understand, deepen, release, and ultimately make positive use of emotions, the way nature intended. Actively creating safety during this process is a top priority. AEDP therapists track what is happening in the session, moment-by-moment. If a patient's anxiety spikes or they feel too vulnerable or embarrassed, AEDP therapists actively calm anxiety and shame using the safe connection they have cultivated with the patient, as well as various techniques like deep belly breathing and grounding.
Continuing with the example above where my patient was upset with her boss, once a person is in contact with the visceral experience of their anger, the energy of the impulse needs to be released in constructive ways, rather than acting out or acting in. One way to process anger in a constructive way is to use fantasy/imagination to express an impulse. Another way to process anger is to stay with the visceral sensations that anger evokes until something in the body shifts or releases.
Enhancing our emotional capacity offers a host of benefits including a calmer mind and body, increased self-confidence, courage, curiosity, and compassion (both in ourselves and others), connectedness, and clarity of thought. Being in touch with our core emotions and having skills to process them increases our vitality—we feel more alive! Our relationships also benefit greatly when we understand and constructively deal with our emotions.
There are many different kinds of experiential therapies: Accelerated Experience Dynamic Psychotherapy (AEDP), Affect Phobia Therapy (APT), Intensive Short-Term Dynamic Psychotherapy (ISTDP), Gestalt Therapy, EMDR, Somatic Experiencing, Hakomi, Psychodrama, Expressive Arts Therapy, Equine Therapy, Dance Therapy, and more.
I gravitated towards AEDP because it was firmly grounded in current neuroscience, trauma theory, and how to use emotions for positive transformation. AEDP builds and expands on people’s strengths, not only focusing on their struggles. The AEDP psychotherapist has permission to be authentic and authentically caring, which creates safety. The stance of the therapist is informed by excellent research in attachment. Providing an emotionally safe environment makes it possible for people to explore new aspects of themselves that were previously too scary or shameful to approach.
To heal the mind, we need to experience the emotions that go with our stories. Often we need assistance connecting to our emotions. The same way we avoid painful or conflicting emotions in our everyday lives is the same way we avoid emotions in therapy sessions. Avoidance is not intentional, it’s just how the mind habitually protects itself from pain. An experiential therapist helps people safely get in touch with what they are feeling and defending against feeling in the here and now of the moment, as they share their stories. Healing-oriented methods like AEDP use techniques that reliably lead to positive, profound, and long-lasting transformation and brain change.
While my psychoanalytic education serves me in my thinking, my experiential training allows me to foster predictable healing in patients who come in with anxiety, depression, and other symptoms. All therapists and patients must find the models that work best for them and that feel most comfortable. Still, I encourage therapists and prospective patients alike to familiarize themselves with AEDP and other experiential ways of working. Learning to notice and deepen emotional experience is truly a gift both personally and professionally and can be incorporated into most other models.
Fosha, D. (2000). The Transforming Power of Affect: A Model for Accelerated Change. New York: Basic Books
Hendel, H.J. (2018). It’s Not Always Depression: Working the Change Triangle to Listen to the Body, Discover Core Emotions, and Connect to Your Authentic Self. New York: Random House
Levine, P. (1997). Waking the Tiger: Healing Trauma. Berkeley: North Atlantic Books