Research Article
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Abstract
This qualitative case study explores using eye movement desensitization and reprocessing (EMDR) therapy informed by attachment and neuroscience research about the importance of safety (trust) and relationship (attunement). This was chosen to enable a young child to create vital positive neural networks and process early trauma while remaining within the window of receptivity, despite issues of avoidance and control. A single case study design was used with a 5-year-old child who experienced early traumas. Observable symptoms included separation anxiety, avoidance, compromised motor skills, and compromised speech. Data were obtained from carer, child, and teacher report, notes, observations, case file, ratings of emotions, and behaviors. The data were explored for outcome data points, validity, and protocol adherence. Key findings were that EMDR used with attunement and trust-building strategies appeared to support developmental progress while facilitating pervasive posttraumatic growth. EMDR appears to offer appropriate opportunities for incorporating neuroscience and attachment research in order to facilitate trauma processing. Future research into EMDR storytelling procedures and possible causative relationships between trust-building and attunement with neurodevelopmental markers would be a possible next step.
Figures
Figure 1.
Drawing from Session 3. Child and therapist on chairs in single colors, no groundline. Figures have no arms, bodies, hair, eyes, noses, or mouths. The large squiggles around the child’s head is her hair bow.
View in ContextFigure 2.
Drawing from Session 6. Child with hair, eyes, nose, and mouth (all one color), showing cut covered with plaster.
View in ContextFigure 3.
Drawing from Session 8. Multicolored drawing of child and carer (child bigger than carer) with hair, eyes, nose, mouth, bodies, arms, and legs touching the ground, random letters.
View in Context
Tables
Table 1.
Subjective Units of Distress Scale by Session
| Session | Time 1: Start of Session | Time 2: End of Session |
|---|---|---|
| Session 3 | 8 | 2 |
| Session 4 | 8 | 4 |
| Session 5 | 8 | 2 |
| Session 6 | 4 | 0 |
| Session 7 | 4 | 0 |
| Session 8 | 0 | 0 |
| Session 9 | 0 | 0 |
| Session 10a | 8 | 3 |
| Session 11 | 8 | 2 |
| Session 12 | 2 | 0 |
| Session 13 | 0 | 0 |
| Session 14a | 8 | 0 |
| Session 15 | 8 | 0 |
| Session 16 | 0 | 0 |
| Session 17 | 4 (ending) | 0 |
| Session 18 | 0 | 0 |
a Denotes the occurrence of destabilizing or traumatizing incidents just prior to session.
Table 2.
Change in Markers of Trust and Attunement Over Sessions
| Markers of Trust and Attunement | Sessions 1–3 Examples | Sessions 16–18 Examples |
|---|---|---|
| Eye contact with therapist | Little evidence: not looking at therapist, hiding face | A lot of evidence: looking at therapist, nonverbal communication, smiling |
| Body orientation to therapist | Turned away, holding on to carer | Turned toward or straight |
| Controlling (mistrust - defense) | A lot of evidence: distracting carer from task, e.g., bringing up nonrelated events, refusing to take part orally (saying no) and behaviorally (head and body turned away, no eye contact) | No evidence |
| Participation and communication | None to very little: not talking, not engaging with toys or therapist | Fully participating and initiating: talking, choosing activities, sharing information, actively contributing to Phase 4 processing and to activities. |
| Exploring and play (secure base) | None to very little: not getting off carer’s lap, not looking at or showing interest in toys and materials | Exploring and sharing new ideas and new play: sitting on own chair, choosing own toys and materials, trying new activities |
| Doing new things | No evidence | Evidence of many new actions,e.g., riding pony off lead, riding bicycle without stabilizers, swimming in sea, going out with dad, going to city center shopping center |
| Leading play | No evidence | Initiating the use of materials and activities and leading new activity (dance) in last session |
| Appropriate independence | Holding carer’s hand tightly, sitting on carer’s lap and holding on to her tightly | Sitting on own seat and walking/skipping down hall by self. |
Table 3.
Change in Markers of Neurological Development Over Sessions
| Markers of Neurological Change | Sessions 1–3 | Sessions 16–18 |
|---|---|---|
| Speech | Multiple letter substitutions in each word including first letter. Carer and therapist unable to understand child’s speech. Short single sentences. | Able to pronounce a wide range of words correctly and no first letter substitutions. Carer and therapist have no difficulty understanding child’s speech. Able to use multiple sentences, including longer sentences. |
| Fine motor skills | Writing single letters with letters poorly formed. | Writing multiple sentences with more correctly formed lettering. |
| Drawing | Figures with head and legs only. Single or few colors. | Figures with head, hair, facial features, arms, legs, bodies, and awareness of foreground. More use of varied colors. |
| Coordination and gross motor skills | Balance poor and tripping over own feet. No evidence of skipping or dancing. | Able to dance, skip, and leap. Requesting ballet lessons. |
| Play | No/very little evidence of any play in early sessions. | Creative play seen in many sessions and initiating play and sharing play with therapist and carer. |
| Separation anxiety | High number of separation anxiety behaviors daily (e.g., clinging, crying, screaming). | None. |
| Creativity | No evidence of creativity in early sessions. | Evidence of creativity, including making up stories with toys, making up dance moves and songs. |
| Social engagement | No friends. | Friends at school and locally. |
Table 4.
Co-occurring Markers of Trust and Attunement and Neurological Functioning
| Session | Negative Markers of Trust and Attunement | Negative Neurological Markers | Positive Markers of Trust and Attunement | Positive Neurological Markers |
|---|---|---|---|---|
| 1–3 | No/little eye contact Body turned away No/little participation No/little exploring and play Avoids new things Controlling others Separation anxiety Distressed at contact with biological mother | Compromised speech Compromised fine and gross motor skills Poor coordination Poor sleep No/little creative play No social engagement | ||
| 9 | Good eye contact, body turned toward, participation, communication, play, and exploration. Doing new things and increased independence Asking about mother Going into school on own No separation anxiety or controlling others | Clear speech More detailed drawings Sleeping well Improved fine and gross motor control, e.g., writing and balance Increased interest and skills in friendships More creative play Riding bike without stabilizers | ||
| 10a | No/little eye contact Body turned away No/little participation No/little exploring and play Avoid new things Controlling others Separation anxiety Avoiding contact with biological mother | Compromised speech Compromised fine and gross motor skills Poor coordination Poor sleep No/little creative play No social engagement | ||
| 16–18 | Good eye contact, body turned toward, participation, communication, exploration, and play Doing new things and increased independence Showing leadership Talking to biological mother Skipping into school No separation anxiety or controlling of others | Clear speech including complex words Sleeping well Improved fine motor control, e.g., writing Improved gross motor skills and coordination, e.g., riding bike without stabilizers, dancing, and leaping More creative play Increased interest and skills in friendships |
[i] aDisturbing incident occurred.
Article usage
| Period | Abstract | Full | Total | |
|---|---|---|---|---|
| Apr 2024 | 14 | 10 | 7 | 31 |
| Mar 2024 | 35 | 10 | 2 | 47 |
| Feb 2024 | 28 | 6 | 3 | 37 |
| Jan 2024 | 38 | 57 | 7 | 102 |
| Dec 2023 | 26 | 6 | 3 | 35 |
| Nov 2023 | 19 | 5 | 1 | 25 |
| Oct 2023 | 18 | 14 | 6 | 38 |
| Sep 2023 | 27 | 9 | 8 | 44 |
| Aug 2023 | 25 | 7 | 6 | 38 |
| Jul 2023 | 34 | 14 | 3 | 51 |
| Jun 2023 | 28 | 20 | 6 | 54 |
| May 2023 | 27 | 6 | 2 | 35 |
| Apr 2023 | 29 | 10 | 8 | 47 |
| Mar 2023 | 53 | 12 | 8 | 73 |
| Feb 2023 | 25 | 10 | 5 | 40 |
| Jan 2023 | 14 | 14 | 7 | 35 |
| Dec 2022 | 15 | 6 | 9 | 30 |
| Nov 2022 | 29 | 8 | 4 | 41 |
| Oct 2022 | 22 | 16 | 10 | 48 |
| Sep 2022 | 23 | 27 | 9 | 59 |
| Aug 2022 | 24 | 10 | 3 | 37 |
| Jul 2022 | 25 | 6 | 5 | 36 |
| Jun 2022 | 21 | 9 | 4 | 34 |
| May 2022 | 20 | 5 | 6 | 31 |
| Apr 2022 | 15 | 12 | 9 | 36 |
| Mar 2022 | 642 | 7 | 6 | 655 |
| Feb 2022 | 24 | 6 | 5 | 35 |
| Jan 2022 | 45 | 11 | 5 | 61 |
| Dec 2021 | 13 | 7 | 7 | 27 |
| Nov 2021 | 19 | 7 | 6 | 32 |
| Oct 2021 | 17 | 18 | 5 | 40 |
| Sep 2021 | 21 | 5 | 3 | 29 |
| Aug 2021 | 17 | 7 | 4 | 28 |
| Jul 2021 | 33 | 8 | 8 | 49 |
| Jun 2021 | 16 | 26 | 6 | 48 |
| May 2021 | 21 | 20 | 4 | 45 |
| Apr 2021 | 23 | 46 | 20 | 89 |
| Mar 2021 | 31 | 43 | 9 | 83 |
| Feb 2021 | 16 | 40 | 7 | 63 |
| Jan 2021 | 33 | 58 | 11 | 102 |
| Dec 2020 | 38 | 47 | 12 | 97 |
| Nov 2020 | 44 | 77 | 16 | 137 |
| Oct 2020 | 28 | 65 | 11 | 104 |
| Sep 2020 | 27 | 73 | 9 | 109 |
| Aug 2020 | 19 | 58 | 10 | 87 |
| Jul 2020 | 17 | 64 | 8 | 89 |
| Jun 2020 | 17 | 72 | 5 | 94 |
| May 2020 | 29 | 98 | 12 | 139 |
| Apr 2020 | 28 | 52 | 8 | 88 |
| Mar 2020 | 31 | 98 | 15 | 144 |
| Feb 2020 | 24 | 57 | 6 | 87 |
| Jan 2020 | 21 | 34 | 14 | 69 |
| Dec 2019 | 25 | 22 | 3 | 50 |
| Nov 2019 | 45 | 0 | 1 | 46 |
| Oct 2019 | 31 | 1 | 1 | 33 |
| Sep 2019 | 23 | 0 | 0 | 23 |
| Aug 2019 | 21 | 0 | 1 | 22 |
| Jul 2019 | 165 | 0 | 6 | 171 |
| Jun 2019 | 45 | 0 | 3 | 48 |
| May 2019 | 55 | 1 | 11 | 67 |
| Apr 2019 | 58 | 2 | 13 | 73 |
| Mar 2019 | 36 | 6 | 15 | 57 |
| Feb 2019 | 60 | 10 | 20 | 90 |
| Jan 2019 | 23 | 5 | 7 | 35 |
| Dec 2018 | 55 | 12 | 26 | 93 |
| Nov 2018 | 17 | 3 | 8 | 28 |
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