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.
This book provides a standard that reflects the basic elements of the 11-Step Standard Procedure; and the Standard 3-Pronged EMDR Protocol as they are applied to different populations. The diverse population includes children and adolescents; couples; clients suffering with complex post-traumatic stress disorder and dissociative disorders; clients with anxiety; clients who demonstrate addictive behaviors; clients who deal with pain; clinicians themselves. The book serves as a basis to encourage research into these various applications for EMDR. It is divided into seven parts. Part I is devoted to the scripted EMDR protocols such as olfactory stimulation, which are used to develop resources for children and adolescents who may have suffered traumatic events in their life. The protocols take into account the particular difficulties of this developmental group and help minimize common difficulties and major hurdles. Part II describes scripted EMDR protocols designed by couples therapists and sex therapists to further the progress of their patients precisely targeting templates of relational interaction, anxiety, or sexual dysfunction. Part III concerns the scripted protocols for dissociative disorders and complex post-traumatic stress disorder. The protocols represent the structured scripted efforts of many trauma therapists over a considerable number of years. Parts IV and V of the book address the concretization of much needed scripts for the EMDR treatment of addictions and pain—two interconnected public health worries. Part VI looks at the world of people’s adaptation to fears and tackles the usage of scripted protocols to detoxify the impact of specific phobias. Part VII demonstrates the usage of scripted EMDR protocols in clinician care and in the management of secondary post-traumatic stress disorder and vicarious traumatization.
Eye Movement Desensitization and Reprocessing EMDR Therapy Scripted Protocols and Summary Sheets:Treating Eating Disorders, Chronic Pain, and Maladaptive Self-Care Behaviors
This book focuses on applying eye movement desensitization and reprocessing (EMDR) scripted protocols to medical related conditions. It delivers a wide range of step-by-step protocols that enable beginning clinicians as well as seasoned EMDR clinicians, trainers, and consultants alike to enhance their expertise more quickly when working with clients who present with medical-related issues. The scripts are conveniently outlined in an easy-to-use, manual style template, facilitating a reliable, consistent format for use with EMDR clients. The scripts distill the essence of the standard EMDR protocols. They reinforce the specific parts, sequence, and language used to create an effective outcome, and illustrate how clinicians are using this framework to work with a variety of medical related issues while maintaining the integrity of the Adaptive Information Processing model. Following a brief outline of the basic elements of EMDR procedures and protocols, the book focuses on applying EMDR scripted protocols to key medical issues. The book is organized into four parts comprising ten chapters. Chapter one presents protocol for EMDR therapy in the treatment of eating disorders. Chapter two describes EMDR therapy protocol for the management of dysfunctional eating behaviors in anorexia nervosa. Chapter three discusses EMDR therapy protocol for eating disorders. Chapter four presents the EMDR therapy protocol for body image distortion. Chapter five discusses EMDR therapy and physical violence injury: “best moments” protocol. Chapter six describes EMDR therapy for chronic pain conditions. Chapter seven presents EMDR therapy treatment for migraine. Chapter eight discusses EMDR therapy for fibromyalgia. Chapter nine describes the impact of complex posttraumatic stress disorder and attachment issues on personal health. The final chapter presents the EMDR therapy self-care protocol.
Supervision de cas est une nouvelle rubrique régulière du Journal of EMDR Practice and Research, où un thérapeute demande de l'aide au sujet d'un cas difficile et où des réponses sont apportées par trois experts. Dans cet article, Amy Robbins (Atlanta, Géorgie), une thérapeute certifiée de la désensibilisation et du retraitement par les mouvements oculaires (EMDR) décrit brièvement le cas difficile d'une femme enceinte qui souhaite traiter un traumatisme subi au cours d'une tornade. La clinicienne demande s'il est indiqué de faire de l'EMDR et quels sont les précautions qu'elle devrait avoir à l'esprit. Le premier expert, Carol Forgash, fournit des informations générales sur la grossesse et la psychothérapie et expose les considérations, les soucis et les contre-indications relatifs au traitement EMDR dans ce cas. Elle recommande que, si le choix se porte sur le traitement EMDR, le thérapeute utilise le protocole de traumas récents pour cibler spécifiquement les souvenirs traumatiques de l'épisode récent de la tornade. Le second expert, Andrew Leeds, commente l'absence d'essais contrôlés randomisés (ECR) ou d'autres rapports scientifiques explorant la sécurité du traitement EMDR chez les femmes enceintes. Il estime que les femmes enceintes présentant des symptômes de stress post- traumatique doivent comprendre qu'il y a de fortes chances pour que l'EMDR améliore leur qualité de vie et que les risques d'effets indésirables sur la stabilité de la grossesse sont probablement faibles, mais qu'ils demeurent cependant inconnus. Le troisième expert, Claire Stramrood, explique que les rares études de cas ayant évalué l'EMDR pendant la grossesse ont rapporté des effets positifs, mais qu'elles concernaient des femmes souffrant d'un état de stress post-traumatique (ESPT) suivant un accouchement. Elle fait valoir qu'après consultation de l'obstétricien, une fois que les femmes ont été informées des risques et bénéfices potentiels, et qu'elles ont donné leur consentement éclairé, elles doivent être en mesure de choisir de commencer ou non la thérapie EMDR au cours de leur grossesse.
This article is an excerpt from Healing the Heart of Trauma and Dissociation with EMDR and Ego State Therapy (edited by Carol Forgash and Margaret Copeley, 2007, pp. 1–59). The preparation phase of eye movement desensitization and reprocessing (EMDR) is very important in the therapy of multiply traumatized clients with complex posttraumatic stress disorder (PTSD) and dissociative symptoms. EMDR clinicians who treat clients with complex trauma will benefit from learning specific readiness and stabilization interventions that are inherent to Phase 1 of a well-accepted phased trauma-treatment model. Extending the preparation phase of EMDR by including these interventions provides sequential steps for the development of symptom-management skills and increased stability. Additional focus is placed on helping clients work with their ego state system to develop boundaries, cooperative goals, and healthier attachment styles. Following an individually tailored preparation phase, the processing of long-held traumatic memory material becomes possible.
As the health care system in the United States is becoming increasingly more politically and economically oriented, the concept of political caring needs to be advanced in contemporary nursing practice (Ray, 1989, 2001; Turkel, 2001). The purpose of this article is to present a model outlining the process of policy analysis through a phenomenologica research study illuminating the life world descriptions of experiences of United States Air Force personnel with managed care in the military and the civilian health care system. This process shows how qualitative data are used to give voice to a moral crisis and contribute to health care policy.