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.

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.

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.