This chapter aims to help clinicians learn stabilization interventions for use in the Preparation Phase of eye movement desensitization and reprocessing (EMDR) treatment. Using these interventions will aid clients in developing readiness for processing trauma, learning how to manage symptoms of dissociation, dealing with affect regulation, and developing the necessary internal cohesion and resources to utilize the EMDR trauma-processing phase. Earlier negative experiences stored dysfunctionally increase vulnerability to anxiety disorders, depression, and other diagnoses. When assessing a client with a complex trauma history, clinicians need to view current symptoms of post-traumatic stress disorder (PTSD) or depression as reflections of the earlier traumas. The chapter outlines the strategies dealing with dissociative symptoms, ego state work, and internal stability that help clinicians to develop an individualized treatment plan to successfully guide the client through the EMDR phases of treatment.
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- Go to chapter: Stabilization Phase of Trauma Treatment: Introducing and Accessing the Ego State System
- Go to chapter: Constructive Avoidance of Present Day Situations: Techniques for Managing Critical Life Issues
The purpose of the constructive avoidance script is to assist clients in dealing with their anxiety or stress-provoking present day situations. Dissociative clients generally are phobic or avoidant of many activities such as medical procedures, going to the dentist, taking examinations, going for job interviews, and so forth due to the complex nature of their traumas, panic, anxiety, and other trauma-related problems. When the client is going to encounter a situation that has caused high stress or triggering in the past and has not completed eye movement desensitization and reprocessing (EMDR) target focusing on that issue, chances are that the ego states involved are not yet ready to deal with the situation. The client can practice with the parts before the upcoming event in sessions and as homework between sessions. This protocol assumes that clients have already established a Home Base and Workplace.
The purpose of the orienting to present reality (OPR) exercise is to help clients with a dissociative disorder, or help dissociative symptoms work with their ego state system to begin to experience present time and place. This generally enhances feelings of reality and security for the system as well as their sense of appropriate caring and protection by the adult client. The OPR Protocol is done in three steps: getting to know the ego state(s), using the workplace, and comparison between the present and the past. Generally, OPR will need to be repeated many times during treatment, since parts may appear who need orientation or reorientation during any phase in the therapy. This includes times during eye movement desensitization and reprocessing (EMDR) trauma processing when a disoriented part(s) may appear.
Clients who have experienced severe trauma often feel that there is a lack of safety in their lives. Therefore, it is helpful to have an uncontaminated place where it is possible for the client to meet and get acquainted with the ego states and a place where they can meet with each other and work together. The use of the Workplace for stabilization activities promotes awareness of the ego states or parts and also develops coconsciousness between the parts. Client and ego states’ reactions to these ideas that support communication and connection range across the affective spectrum from surprise to relief, feelings of normalcy, disapproval, disgust, revulsion, somatic reactions, or all of the above. Many types of workplaces or conference rooms are suggested in the literature in which the client sits at an oval table and invites ego states to sit in the empty chairs around the table.
There are a series of readiness activities that assist in helping dissociative clients access and work with ego states or parts of the self. The readiness activities are sequential steps that help clients and their ego state systems build safe and stable internal structures, become acquainted, establish boundaries, develop healthier attachment styles and learn techniques to manage symptoms in present life. The Home Base (HB) can be a stable place for the internal ego state system. The HB imagery may be installed or strengthened with bilateral stimulation (BLS) if they are comfortable with it. It is a different place from the adult client’s place for relaxing. Initially, the home base metaphor may be very sketchy, unclear, and difficult for the client to use. For a client who grew up in a chaotic, violent, or abusive family environment, this idea may be an impossible thought at first.
- Go to chapter: Summary Sheet: The Impact of Complex PTSD and Attachment Issues on Personal Health: An EMDR Therapy Approach
- Go to chapter: The Impact of Complex PTSD and Attachment Issues on Personal Health: An EMDR Therapy Approach
Complex trauma is prevalent in the general therapy population and is rooted in early neglect, and traumas of long duration, resulting in posttraumatic stress disorder (PTSD), dissociative disorders, attachment problems, and personality disorders. This chapter provides information that will help Eye Movement Desensitization and Reprocessing (EMDR) therapists enhance their ability to provide effective EMDR treatment for clients diagnosed with complex trauma who are also dealing with current health problems. It highlights the use of the adverse childhood experiences (ACE) questionnaire, which provides much needed information on childhood abuse, neglect, attachment disorders, PTSD, and dissociation. This questionnaire, when combined with a broad developmental and health history, will be very helpful in case conceptualization and development of targets for work in phases 4 to 7. Additionally, the chapter describes the links between the ACE issues and later health risks and problems that make these clients difficult to treat.