Affect-Focused Dynamic Psychotherapy

In Affect-Focused Dynamic Psychotherapy, Dr. Leigh McCullough demonstrates a system of therapy aimed at getting through a client's defense structure to elicit emotions. Because people tend to avoid difficult feelings, they often erect obstacles to experiencing emotion. According to this system of therapy, these emotional blocks usually lie at the core of a client's presenting problems.

In the session shown, Dr. McCullough works with a young mother named Janice who, although she appears very strong, is actually emotionally rigid and resistant to experiencing her feelings. The example session illustrates how a client first sees her pattern of defense, then works through it and begins to change her sense of self and others.

This form of psychotherapy centers on emotion: The objective of this approach is to help clients to work through any defenses they may have to experiencing their feelings, because ultimately, the fear of feelings—or affect-phobia—underlies most of the work psychotherapists do. Because people are afraid of their feelings, especially strongly negative feelings, they will avoid them. To do this, they create barriers to feelings so that they do not even begin to experience their emotions. These maladaptive emotional blocks sometimes lie at the core of clients' presenting problems, so that simply eliciting feelings is often the most direct path toward resolving any therapeutic issues.

The approach follows three primary steps:

• Work through emotional defenses (Defense restructuring).
• Elicit feeling (Affect restructuring).
• Change sense of self and sense of others (Self–other restructuring).

The approach emphasizes emotions but includes cognitive therapeutic aspects as the therapist leads clients to understand their feelings. In a sense, the approach is a sort of exposure therapy typically used to treat phobias. In this case, the therapist exposes the client to their emotions so that they lose their fear of feelings and begin to experience their emotions naturally and appropriately.

Leigh McCullough, PhD, is an associate clinical professor and director of the Psychotherapy Research Program at Harvard Medical School. She was the 1996 Voorhees Distinguished Professor at the Menninger Clinic and received the 1996 Michael Franz Basch Award from the Silvan Tomkins Institute for her contributions toward the exploration of affect in psychotherapy.

She is on the editorial board of the journal Psychotherapy Research and conducts training seminars in short-term psychotherapy worldwide. She is the author of four books; two that teach short-term therapy are Changing Character (1997) and Treating Affect Phobia (2002, with coauthors A. Kaplan, N. Kuhn, S. Andrews, J. Wolf, and C. Lanza).

Dr. McCullough has held positions as director of research at the Beth Israel Medical Center's Short-Term Psychotherapy Research Program in New York and director of assessment at the Center for Psychotherapy Research at the University of Pennsylvania. She is currently a visiting professor at the Norwegian University of Science and Technology in Trondheim, Norway, which for the past 7 years has been conducting a clinical trial comparing her short-term dynamic treatment model to a cognitive therapy model. She is in private practice in Dedham, Massachusetts.

• McCullough, L. (1997). Changing character: Short-term anxiety-regulating psychotherapy for restructuring defenses, affects and attachments. New York: Basic Books.
• McCullough, L., Kaplan, A., Kuhn, N., Andrews, S., Wolf, J., & Lanza, C. (2002). Treating affect phobias: A manual for short-term dynamic psychotherapy. New York: Guilford Press.
• McCullough, L., Kuhn, N., Andrews, S., Hatch, D., Valen, J. & Osimo, F. (in press). The reliability of the Achievement of Therapeutic Objectives Scale: Five studies. Journal of Brief Psychotherapy.

APA Videos

• Brief Dynamic Therapy
  Stanley B. Messer
• Emotion-Focused Therapy for Depression
  Leslie S. Greenberg
• Experiential Psychotherapy
  Alvin R. Mahrer
• Three Approaches to Psychotherapy With a Female Client: The Next Generation
  Judith S. Beck, Leslie S. Greenberg, and Nancy McWilliams
• Three Approaches to Psychotherapy With a Male Client: The Next Generation
  Judith S. Beck, Leslie S. Greenberg, and Nancy McWilliams
• Short-Term Dynamic Therapy
  Donald K. Freedheim

APA Books

• Emotion-Focused Therapy: Coaching Clients to Work Through Their Feelings
  Leslie S. Greenberg
• Emotions and Life: Perspectives From Psychology, Biology, and Evolution
  Robert Plutchik
• Emotions in the Practice of Psychotherapy: Clinical Implications of Affect Theories
  Robert Plutchik
• How to Practice Brief Psychodynamic Psychotherapy: The Core Conflictual Relationship Theme Method
  Howard E. Book
• How to Survive and Thrive as a Therapist: Information, Ideas, and Resources for Psychologists in Practice
  Kenneth S. Pope and Melba J. T. Vasquez
• Interpretive and Supportive Psychotherapies: Matching Therapy and Patient Personality
  William E. Piper, Anthony S. Joyce, Mary McCallum, Hassan F. Azim, and John S. Ogrodniczuk
• Learning Emotion-Focused Therapy: The Process-Experiential Approach to Change
  Robert Elliott, Jeanne C. Watson, Rhonda N. Goldman, and Leslie S. Greenberg
• Reconciling Empirical Knowledge and Clinical Experience: The Art and Science of Psychotherapy
  Edited by Stephen Soldz and Leigh McCullough
• Recovery in Mental Illness: Broadening Our Understanding of Wellness
  Edited by Ruth O. Ralph and Patrick W. Corrigan
• The Therapeutic Alliance in Brief Psychotherapy
  Edited by Jeremy D. Safran and J. Christopher Muran
• Understanding Psychotherapy Change: A Practical Guide to Configurational Analysis
  Mardi J. Horowitz