In the Shadows: On Meta-Awareness and Spiraling Effects in Psychotherapy—Comment on Nicole Vigoda Gonzalez and Diana Fosha

Abstract

I 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.