Le trouble de la personnalité narcissique et le trouble de traits narcissiques sont associés à des conduites égoïstes et à un défaut d'empathie envers les autres. Les patients dont la présentation initiale dans la psychothérapie correspond à l'un ou l'autre de ces tableaux ont un profil égocentrique ; ils manquent d'empathie ou se préoccupent peu de la souffrance qu'ils peuvent provoquer chez d'autres personnes, mais ceci n'est qu'un élément parmi d'autres. Parfois le défaut d'empathie et l'égoïsme ne sont que des défenses. Pour appréhender pleinement ce problème, il faut également avoir conscience des difficultés sous-jacentes à se définir soi-même qui sont à l'origine des manifestations comportementales du narcissisme. Comme c'est le cas pour tout problème psychologique, le traitement EMDR nécessite une compréhension de la manière dont les expériences en début de vie conduisent aux symptômes ultérieurs. La compréhension des voies qui relient les expériences vécues à un jeune âge aux traits narcissiques (y compris les présentations latentes) est essentielle à une conceptualisation de cas adéquate, tout comme il faut cerner les structures mentales défensives qui empêchent l'accès aux expériences défavorables fondamentales sous-jacentes aux symptômes.
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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.
It appears that sets of bilateral stimulation (BLS) have the potential to invite unfinished traumatic experience into awareness. This can be a problem for clients who are dissociative, or who are on the verge of being overwhelmed by a traumatic memory. The memory can feel more real than the real situation the patient is in, and the experience can be one of nontherapeutic retraumatization. For clients who are potentially dissociative, the degree of orientation to the present situation can be assessed through the use of the back of the head scale (BHS). This procedure allows both therapist and client to be able to closely monitor and maintain the dual attention aspect of successful trauma processing; the simultaneous co-consciousness of the safe present and the traumatic past. The use of the BHS throughout a therapy session can be very useful in insuring that client is staying present while reprocessing disturbing memories.
One way of thinking about procrastination is to regard it as a form of addiction; an addiction to putting things off. As with other addictive patterns, the client will choose a short-term gratification instead of going for a long-term result that might, in the end, be more satisfying or empowering. As with other addictions, a procrastinating client often suffers ongoing erosion of her self-esteem. Quite often, procrastination may function as a defense as a way to avoid other life issues that are disturbing. With this type of problem, we can use a variation of Popky’s addiction protocol, and the level of urge to avoid (LoUA) procedure. It is also important to use resource installation procedures to help the client develop an image of the benefits that would come with being free of this problem.
- Go to chapter: Dysfunctional Positive Affect: Codependence or Obsession With Self-Defeating Behavior
This chapter outlines script in an easy-to-use, manual style template, consistent format for use with eye movement desensitization and reprocessing (EMDR) clients. The scripts distill the essence of the Standard EMDR Protocols. They reinforce the specific parts, 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 (AIP) model. The chapter includes summary sheets for each protocol to facilitate gathering information, client documentation, and quick retrieval of salient information while formulating a treatment plan. When there is a repetitive interaction pattern in a client’s life that is difficult to resolve because the codependent behavior in question has become part of the client’s identity or a lifetime way of connecting, it can be helpful to use a protocol that targets this positive affective urge.
When working with ambivalence, it is helpful to identify the two or more sides of the ambivalence, such as the client who wants to work on a disturbing memory but is too afraid. Sometimes, if the client impulsively uses avoidance and is frustrated with her ambivalence, the most accessible point of entry into effectively using eye movement desensitization and reprocessing (EMDR) to process a problem may be to target the feeling of relief associated with avoiding that problem. The procedures for unwanted avoidance defenses script notes were partially derived from Popky’s Desensitization of Triggers and Urge Reprocessing (DeTUR) Protocol for using EMDR to treat addictive behaviors. Usually, when this procedure is used, the level of urge to avoid (LoUA) scores will go down with continuing sets of bilateral stimulation (BLS), until the client spontaneously begins direct targeting of the memory or issue.
Feeling the pain of rejection by someone we love is one of the most difficult experiences that we can have as human beings. Often, this terrible feeling is, in part, based on an unrealistic idealization of the lost lover. Eye movement desensitization reprocessing (EMDR) Standard Protocol assists our client in focusing on those aspects of the remembered love relationship that retain the intense positive affect, so that a disinvestment process can occur, and the client can come to see the former relationship more realistically, with all its good and bad aspects. The level of positive affect or (LoPA) score is a scale of 0 to 10 that is used instead of the subjective units of disturbance (SUD) scale for this protocol. When setting up this protocol, the positive representative image, the LoPA for the positively felt emotion, and the location of that number in positive body sensations, are elicited.
The Constant Installation of Present Orientation and Safety (CIPOS) method can be used to extend the healing power of eye movement desensitization and reprocessing (EMDR) to many clients who are potentially vulnerable to dissociative abreaction because of a dissociative personality structure, or because of the client’s intense fear of their own memory material. By constantly strengthening the person’s present orientation through bilateral stimulation (BLS) and carefully controlling the amount of exposure to the trauma memory, the individual is more easily able to maintain dual attention. At the start of the procedure, when the client is most vulnerable to being overwhelmed by disturbance, BLS is not paired with information directly related to the traumatic disturbance. The CIPOS interventions are continued until the client is able to report, using the Back of the Head Scale (BHS), that she is oriented once again toward the present reality of the therapist’s office.
This book has two main goals: to provide descriptions of specific eye movement desensitization and reprocessing (EMDR) therapeutic “tools” and, by incorporating these tools, to develop an overview of an Adaptive Information Processing (AIP) model of the treatment of complex PTSD. The development of EMDR-related tools has been ongoing since the introduction of EMDR three decades ago. What will EMDR be in 2030? Unfortunately, the field—the field of psychotherapy for trauma-related disorders—has at times had a kind of dissociative disorder. Some therapists identify with one theoretical approach, and others are strong adherents of another identity. Often, these two “identities” do not communicate sufficiently, and sometimes they mistakenly think they have to fight with each other. Clearly, the author’s primary identification as a therapist is with EMDR-related methods based on an AIP approach, but the author attempting in the following chapters to also integrate the concepts and methods of cognitive approaches—approaches that are not only useful, but at times essential in the treatment of dissociative clients. The chapters of this book are divided into four parts. The first, comprising Chapters 1 and 2, is an overview of the application of the AIP model to complex PTSD and other dissociative conditions. The second part, Chapters 3 to 6, presents ways of treating (i.e., resolving) psychological defenses that are often linked intrinsically to disturbing memories but can be conceptually defined as separate entities because defenses typically contain dysfunctional positive affect, as opposed to the disturbing affect within memories of traumatic events. The third part, Chapters 7 to 14, focuses on several issues important in the EMDR treatment of dissociative conditions. And Chapters 15 to 17 are detailed case reports illustrating how these AIP “tools” can be employed in actual treatment sessions.
Individuals who repeatedly return to an abusive and dangerous relationship can often benefit from standard Eye Movement Desensitization and Reprocessing (EMDR) therapy, to resolve their confusion, resolve feelings of shame and helplessness, and make positive choices. Some return to the relationship because of a fear of violent consequences if they attempt to leave, and in these situations, therapy is better focused on creating an action plan to successfully and safely leave a dangerous situation. However, a subset of individuals, who return to a relationship following violence, may be blocked in utilizing the therapeutic power of EMDR by their strong emotional investment in an unrealistic positive image of the abusive partner. The chapter describes a procedure to assist such clients in removing this block to processing, through identifying and targeting a “best moment” memory that represents the distorted idealized image of the partner and of the relationship.
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 article: Caring:The Essence of Professional Nursing Practice and an Integral Component of the Magnet Journey
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.
This article illustrates the transtheoretical evolution of caring science within complex systems from the discovery of the theory of bureaucratic caring, in 1981, to the emergence of the metatheory relational caring complexity in 2011. The theory of bureaucratic caring, derived from research, is the sentinel grounded theory in the area of caring and economics, and complex healthcare systems in general. Its tenets remain applicable to contemporary nursing practice. Other grounded theories advanced from the original theory, including struggling to find a balance, the paradox between caring and economics, relational complexity, and relational self-organization in workforce redevelopment, as well as professional and patient relational caring questionnaires are presented and discussed.
- Go to article: Idealization and Maladaptive Positive Emotion: EMDR Therapy for Women Who Are Ambivalent About Leaving an Abusive Partner
Idealization and Maladaptive Positive Emotion: EMDR Therapy for Women Who Are Ambivalent About Leaving an Abusive Partner
After ensuring safety, treatment of victims of intimate partner violence is typically focused on the adverse and traumatizing experiences and related negative emotions. In addition, in many cases, idealization of the perpetrator and maladaptive positive emotion are initial elements that also need to be taken into account. The concept of dysfunctionally stored information described in the adaptive information processing model can be viewed as being broader in nature than maladaptive negative emotions from memories for adverse experiences and can include dysfunctional defenses such as maladaptive positive emotion and idealized life experiences. Self-defeating, dysfunctional, and unrealistic idealization in a relationship can be treated through targeting, with focused sets of bilateral stimulation, specific positive affect memories that are the origin of the distorted idealization. In this way, the client is able to develop adaptive resolution, that is, a more accurate perception of both past events and the present nature of the relationship. This approach to targeting idealization defenses is illustrated with 3 case examples of women who were ambivalent about leaving a highly abusive partner.
Narcissistic personality disorder and narcissistic trait disorder are associated with selfish behaviors and lack of empathy toward others. Clients with either of these initial presentations in therapy show a self-centered profile and lack of empathy or concern about the suffering they may cause in other people, but this is only part of the picture. Sometimes the lack of empathy and selfishness is only a defense. To fully understand this problem, it is also necessary to be aware of underlying self-definition issues that drive the behavioral manifestations of narcissism. As in any psychological problem, eye movement desensitization and reprocessing treatment needs an understanding of how early experiences lead to future symptoms. Understanding the pathways from early experiences to narcissistic features (including covert presentations) is essential for an adequate case conceptualization as well as comprehending the defensive mental structures that impede accessing the core adverse experiences underlying the symptoms.
- Go to article: Idealización y afecto positivo disfuncional: Terapia EMDR para mujeres que sienten ambivalencia con respecto a dejar a una pareja abusiva
Idealización y afecto positivo disfuncional: Terapia EMDR para mujeres que sienten ambivalencia con respecto a dejar a una pareja abusiva
Después de asegurarse de que haya seguridad, el tratamiento de las víctimas de violencia interpersonal (VIP) suele centrarse en las experiencias adversas y traumáticas, y en las emociones negativas relacionadas. Además, en muchos casos, la idealización del perpetrador y la emoción positiva desadaptativa son elementos iniciales que también han de tenerse en cuenta. El concepto de información almacenada disfuncionalmente (DSI, siglas en inglés de Dysfunctionally Stored Information)–descrito en el modelo de Procesamiento Adaptativo de la Información (PAI)–va más allá de las emociones negativas desadaptativas de los recuerdos de experiencias adversas y puede incluir defensas disfuncionales como emoción positiva desadaptativa y experiencias vitales idealizadas. La idealización autodestructiva, disfuncional e irreal en una relación puede tratase haciendo diana, con tandas focalizadas de estimulación bilateral, sobre recuerdos específicos de emociones positivas que son el origen de la idealización distorsionada. De esta manera, la paciente es capaz de desarrollar una resolución adaptativa, es decir, una percepción más precisa tanto de los acontecimientos pasados como de la naturaleza actual de la relación. Este abordaje para trabajar las defensas de la idealización se ilustra con tres ejemplos de casos de mujeres que se sentían ambivalentes con respecto a dejar a un compañero muy abusivo.
The purpose of this phenomenological research was to capture the meaning of caring as experienced by nurse managers during interactions with staff nurses. Data analysis was guided by the phenomenological method (Ray, 1985; van Manen, 1990). Essential themes of growth, listening, support, intuition, receiving gifts, and frustration were described by participants. Variant themes of touch, humor, flexibility, counseling, limitations, and competency also emerged. Interpretive themes of nurses’ way of being, reciprocal caring, and caring moment as transcendence were identified. The unity of meaning, which unfolded, is presented as a poetic expression. Implications for transforming nursing administration into a practice grounded in caring are presented.
- Go to article: Idéalisation et émotions positives inadaptées : thérapie EMDR pour femmes ambivalentes à l'idée de quitter un partenaire violent
- Go to article: Caring: The Essence of Professional Nursing Practice and an Integral Component of the Magnet Journey
El trastorno narcisista de la personalidad y los rasgos narcisistas están asociados con conductas egoístas y falta de empatía hacia los demás. Los pacientes con alguna de estas presentaciones iniciales en terapia muestran un perfil centrado en sí mismos y una falta de empatía o preocupación por el sufrimiento que pueden causar a otras personas, pero esto es sólo parte de la historia. En ocasiones, la falta de empatía y el egoísmo son sólo una defensa. Para entender completamente este problema, también es necesario ser consciente de los problemas subyacentes de autodefinición que llevan a las manifestaciones conductuales del narcisismo. Como en cualquier problema psicológico, el tratamiento con la terapia de desensibilización y reprocesamiento por movimientos oculares exige comprender la manera en la que las primeras experiencias dan lugar a los futuros síntomas. Es fundamental comprender el recorrido desde las experiencias tempranas a las características narcisistas (incluidas las presentaciones encubiertas) para poder realizar una buena conceptualización del caso, así como entender las estructuras mentales de defensa que impiden acceder a las experiencias adversas nucleares que subyacen a los síntomas.