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- 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.
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.
- Go to chapter: Stabilization Phase of Trauma Treatment: Introducing and Accessing the Ego State System
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.
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.
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.
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.
- 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.
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.
Supervisión de casos es un nuevo apartado regular del Journal of EMDR Practice and Research en el que un terapeuta solicita ayuda con un caso complicado y tres expertos le responden por escrito. En este artículo, Amy Robbins, una terapeuta certificada en terapia de desensibilización y reprocesamiento por movimientos oculares (EMDR) de Atlanta, Georgia, describe brevemente un caso complicado en el que una mujer embarazada busca tratamiento por un trauma sufrido durante un tornado. La terapeuta pregunta si es recomendable hacer tratamiento con EMDR y qué precauciones debería tener en cuenta. La primera especialista, Carol Forgash, ofrece información general sobre el embarazo y la psicoterapia y señala aspectos a tener en cuenta, precauciones y contraindicaciones a la hora de proceder con EMDR. Recomienda que si se escoge este tratamiento, la terapeuta proceda con un protocolo de trauma reciente para hacer blanco específicamente sobre los recuerdos traumáticos del reciente tornado. El segundo especialista, Andrew Leeds, comenta sobre la ausencia de ensayos controlados aleatorizados (ECA) u otros informes científicos que exploren la seguridad del tratamiento EMDR con mujeres embarazadas. Señala que las mujeres embarazadas con síntomas de estrés postraumático tendrían que entender que hay grandes posibilidades de que el EMDR mejore su calidad de vida como madre y que, probablemente, los riesgos de sufrir efectos adversos en la estabilidad del embarazo son muy bajos, aunque siguen siendo desconocidos. La tercera especialista, Claire Stramrood, explica que los pocos estudios de casos que han evaluado el EMDR durante el embarazo han encontrado efectos positivos, pero estaban relacionados con mujeres con trastorno de estrés postraumático (TEPT) posterior al nacimiento del bebé. Afirma que una vez que se haya consultado al obstetra, se haya informado a las mujeres de los posibles riesgos y beneficios y hayan firmado un consentimiento informado, deberían de poder decidir si comenzar la terapia EMDR durante el embarazo.