Speculations on Emergence

Working the Edge of Transformational Experience and Neuroplasticity

Diana Fosha


Published in The Neuropsychotherapist Issue #1


“The literature abounds with papers and discussions of resistance;
yet how little we study the vagaries of the force that is on the side of psychic healing, the impulse to grow, to surrender, to let-go”
(Ghent, 1990).

I almost feel selfish,” is what she said. Clara is a woman in her 60s, plagued by a lifelong sense of shame and unworthiness.

To the outside world, she is impressive and accomplished; yet inside, she knows that what she has accomplished nowhere near taps her potential. And this is not only devaluation at work—it is the truth. It is creative and mystical pursuits, areas which Clara has studied and delved into, that deeply move her and engage her creativity. It is in these areas that Clara’s heart and soul—and self, I would add—resonate. Her achievements have been in the academic mainstream. Her hundreds of poems and thousands of pages on history and philosophy have never see the light of day. Few have read them and nothing has been published.

I will not go into the specifics of an early history of violence and mind-numbing neglect and isolation, as well as lifelong traumatic losses. Suffice it to say that she has significant “big T” and “small t” trauma.

For months in therapy, Clara made little eye contact. Left to her own devices, she spent her time talking about the needs and problems of her significant others; never herself. In recent weeks, however, a shift has been occurring.

In fact a bunch of things simultaneously: a sense of lightness is sometimes breaking through the pervasive, burdened heaviness; she is making more spontaneous eye contact with me; her focus is starting to be on herself and—wonder of wonders—increasingly on her inner experience. A shy, luminous smile is often on her face as she sits down and begins the session. More and more, she is both experiencing and explicitly articulating her experience of therapy as a deeply valued and valuable place for herself; and not only valuable, but also somehow pleasurable and joyful, despite the painful nature of the traumatic material that often surfaces. Furthermore, whereas previously shame was lived and could not be spoken, as it was inaccessible to reflection, recently, at the patient’s initiative and initiation, it is the topic of explicit exploration as Clara is coming to appreciate the depths of her shame and the devastating impact that her sense of unworthiness has had on all areas of her life.

And so we return to our last session: Clara sits down and a shy smile lights up her countenance. She starts by speaking of how much she has been looking forward to her session and how glad she is to be here. Then it happens. With tentative, yet definite eye contact, she says: “I almost feel selfish” (emphasis mine).  I, as Clara’s therapist, am happy.  I fasten on “almost.”  It means: “In the past, I would have felt selfish to have something valuable for myself, but in this moment (though I can feel the edge of old procedural experience, thus the ‘almost’), I don’t.”

Decades of therapy instruction from the experts have taught us to hear that utterance and focus on the patient’s self-accusation of selfishness in response to anything good for herself.  And for good reason: “selfish” is  an opportunity, a gateway, a trailhead to exploring the patient’s lifelong shame, sense of unworthiness, and all the stuff that has compromised her and which in fact needs deep working through.

However—and here is my speculation—I think that in the “almost” of “I almost feel selfish” (meaning but I don’t), we have another huge opportunity: a gateway, a trailhead, to working with neuroplasticity in the moment—in action, as it is happening.  The “almost” constitutes the leading edge of “emergence”, of new experience, of transformation as it is happening.

Much of my work in the last decade has been devoted to developing therapeutic interventions to process transformational experience with the same assiduousness and rigor we devote to processing traumatic experience.  I have called this metatherapeutic processing, i.e., the processing of what’s therapeutic about therapy: thus meta-therapeutic processing or metaprocessing for short. Metaprocessing is one of the hallmarks of a therapeutic model called AEDP (Accelerated Experiential Dynamic Psychotherapy—see Fosha, 2000, 2009a, 2009b). This work has led to the discovery that processing new emergent transformational experiences is transformational in and of itself. Sometimes this work leads to further trauma processing. Sometimes it leads to recursive non-finite upward transformational spirals, the stuff of flourishing.

My speculation is that moments like Clara’s “almost” are nodal points where it might be possible to study neuroplasticity in action, and moments where the clouds of patterned conditioned existence part to reveal, even if only for a fleeting moment, what Panksepp (2009) calls the soul and Panksepp & Northoff (2008) call the neurobiological core self. This endeavor might be furthered by AEDP’s technique of metaprocessing, which takes fleeting moments and, by making them the objects of both experiential work and reflection on the emergent experience, enlarges, deepens and expands them, making these experiences more conducive to being both neuroscientifically and psychotherapeutically explored.



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