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.
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- Go to chapter: Constructive Avoidance of Present Day Situations: Techniques for Managing Critical Life Issues
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.
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.
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.
- 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.
- Go to chapter: Summary Sheet: The Impact of Complex PTSD and Attachment Issues on Personal Health: An EMDR Therapy Approach
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.
Case consultation is a new regular feature in the Journal of EMDR Practice and Research in which a therapist requests assistance regarding a challenging case and responses are written by three experts. In this article, Amy Robbins, a certified eye movement desensitization and reprocessing (EMDR) therapist from Atlanta, Georgia, briefly describes a challenging case in which a pregnant woman seeks treatment for trauma suffered in a tornado. The clinician asks if it is advisable to provide EMDR treatment and what concerns she should be aware of. The first expert, Carol Forgash, provides some general information about pregnancy and psychotherapy and outlines considerations, concerns, and contraindications for proceeding with EMDR. She recommends that if treatment is chosen, the therapist proceed with a recent trauma protocol to specifically target the traumatic memories of the recent tornado. The second expert, Andrew Leeds, comments on the absence of randomized controlled trials (RCTs) or other scientific reports exploring the safety of EMDR treatment of pregnant women. He states that pregnant women with symptoms of posttraumatic stress should understand that there is a high probability that EMDR will improve maternal quality of life and that the risks of adverse effects on stability of pregnancy are probably low, but that these remain unknown. The third expert, Claire Stramrood, explains that the few case studies that evaluated EMDR during pregnancy have found positive effects but pertained to women with posttraumatic stress disorder (PTSD) following childbirth. She asserts that once obstetricians have been consulted, women have been informed about possible risks and benefits, and, given their informed consent, they should be able to choose to commence EMDR therapy during pregnancy.
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.