The Role of Exposure Therapy in Accelerated Experiential Dynamic Psychotherapy: The Case of “Chris”
The aversive and insidious impact of unresponsive and punishing parenting practices is often evident in the psychological wellbeing, affective expression, and interpersonal dynamics of adult clients. Behavioral and dynamic theories regarding emotional development in the context of learning and trauma, and their corresponding treatments of emotional avoidance, are often viewed as distinct. The following study serves to first explore factors of change in Exposure Therapy (a behavioral treatment) and in Accelerated Experiential Dynamic Psychotherapy (AEDP; a relational and experiential treatment). Next, detailed consideration of the case of “Chris” is utilized to highlight elements of AEDP and Exposure Therapy present across eight individual treatment sessions. Finally, the case study serves to propose that the key principle of change in this treatment—that is, the approach of previously-avoided emotional experiences within the context of interpersonal relationships—is ultimately the same when conceptualized from both an exposure-based and an AEDP-based approach.
The study explores the treatment of “Chris,” a 30-year-old man who presented to treatment with chronic feelings of loneliness, a family history of neglect, a tendency to avoid accessing and expressing affect, and a pattern of relating to others that is characteristic of dismissing/avoidant attachment. The predominantly AEDP-guided treatment, which lasted for 8 in-person sessions over a period of about 6 weeks with a virtual follow-up session 8 months later, involved establishing a secure attachment relationship within the therapeutic alliance from which to jointly approach previously-avoided emotional experiences. Across sessions, Chris demonstrated an increased willingness to access previously-avoided emotions, express his emotions to others, and tolerate the emotional expression of others, ultimately leading to a decreased sense of loneliness. A combination of qualitative and quantitative indicators evidenced the positive impact of treatment on Chris’s self-awareness, self-compassion, and quality of life. This study serves to highlight commonalities in conceptualization and effective treatment of emotional avoidance due to aversive parenting practices across dynamic and behavioral orientations in the hopes of increasing accessibility of treatments across orientations and improving treatment integration.
Key words: depression; loneliness; complex PTSD; Accelerated Experiential Dynamic Psychotherapy (AEDP); Cognitive-Behavior Therapy (CBT); Exposure Therapy; attachment theory; case studies; clinical case studies