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: ACT-AS-IF and ARCHITECTS Approaches to EMDR Treatment of Dissociative Identity Disorder (DID)
This chapter describes key steps, with scripts, for the phases of therapy with a dissociative identity disorder (DID) client, and for an eye movement desensitization and reprocessing (EMDR) session with a DID client. In brief, the method employs the artful use of EMDR and ego state therapy for association and acceleration, and of hypnosis, imagery, and ego state therapy for distancing and deceleration within the context of a trusting therapeutic relationship. It is also endeavoring to stay close to the treatment guidelines as promulgated by the International Society for the Study of Trauma and Dissociation. The acronym ACT-AS-IF describes the phases of therapy; the acronym ARCHITECTS describes the steps in an EMDR intervention. Dual attention awareness is key in part because it keeps the ventral vagal nervous system engaged sufficiently to empower the client to sustain the painful processing of dorsal vagal states and sympathetic arousal states.
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.
The important elements of the Eye Movement Desensitization and Reprocessing (EMDR) and Phantom Pain Research Protocol are client history taking and relationship building, targeting the trauma of the experience, and targeting the pain. This protocol is set up to follow the eight phases of the 11-Step Standard Procedure. This chapter presents a case series with phantom limb patients obtained a few before and after EMDR magnetoencephalograms (MEGs) at the University of Tübingen, Germany on arm amputees that show the presence of phantom limb pain (PLP) in the brain images before EMDR and the absence of it after EMDR. In these case series, it is found that PLP in leg amputations is much easier to treat than arm amputations, likely due to the much more extensive and complex arm and hand representation in the sensory-motor cortex compared to the leg and foot representation.
Clients with dissociative identity disorder (DID) or dissociative disorder not otherwise specified (DDNOS) live with a multiple reality disorder where parts are often living in the past and are not aware of where they are, the current date, or the time. The goal of this resource is to reduce the anxiety of parts living in the past and increase the client’s ability to differentiate the past from the present. Beginning with the host, adult, or other oriented parts, make a list of information that the disoriented parts need to be oriented and to decrease anxiety. Once the list is developed, install the list using dual attention stimulation (DAS). Useful items tend to be concrete and help differentiate the past from the present. If the client is being abused in some way in the present, often there are ways to differentiate the past from the present.
- Go to chapter: Modified Resource Development and Installation (RDI) Procedures With Dissociative Clients
The most critical therapeutic work with dissociative clients is stabilization. This chapter describes the modified Resource Development Installation (RDI) procedures that can help such clients slowly develop skills that lead to this kind of stabilization. There are many reasons stabilization is a central facet of work with the dissociative disorders. Frequently, there are physical symptoms, visual intrusions, sleep difficulties, nightmares, barraging inner voices, and other negative affects. The chapter conceptualizes the cause of the particular kinds of negative affect listed above as consequent to intrusions from or responses to activated traumatic memory. Managing the intense negative affects associated with eye movement desensitization and reprocessing (EMDR) is not yet part of the client’s repertoire. Such capacities must be developed for the client to use EMDR effectively. Learning how to support and provide self-care can result in present time satisfactions and the decrease in the experience of negative affect.
This chapter includes scripts for Eye Movement Desensitization and Reprocessing (EMDR) treatment of clients with cancer, eating disorders, headaches, somatic disorders, sexual disorders, and more. It also includes summary sheets for each protocol to facilitate gathering information, client documentation, and quick retrieval of salient information while formulating a treatment plan. The treatment of chronic pain is a new and growing application of EMDR. The suitability of EMDR for chronic pain stems from a number of sources. There are similarities and overlaps between traumatic stress and physical pain that would suggest EMDR as an appropriate addition to working with chronic pain. Negative Cognition (NC) is optional when the pain is not related to trauma. If possible, the NC will elicit clients’ attitudes or beliefs about themselves around their pain. Positive Cognition (PC) is about how clients would like to feel about themselves in relation to their pain.
This chapter focuses on self-care for Eye Movement Desensitization and Reprocessing (EMDR) practitioners. The protocol was derived from the notes of Neal Daniels, a clinical psychologist who was the director of the posttraumatic stress disorder (PTSD) Clinical Team at the Veterans Affairs Medical Center. In Dr. Daniels’s words, the procedure is short, simple, effective. Right after the session or later on in the day when it is possible, bring up the image of the patient, do 10–15 eye movements (EMs); generate a positive cognition (PC) and install it with the patient’s image, and do 10–15 EMs. Once the negative affects have been reduced, realistic formulations about the patient’s future therapy are much easier to develop. Residual feelings of anger, frustration, regret, or hopelessness have been replaced by clearer thoughts about what can or cannot be done. Positive, creative mulling can proceed without the background feelings of unease, weariness, and ineffectiveness.
The Butterfly Hug was originated and developed by Lucina Artigas during her work performed with the survivors of Hurricane Pauline in Acapulco, Mexico, 1997. For the origination and development of this method, Lucina Artigas was honored in 2000 with the Creative Innovation Award by the eye movement desensitization and reprocessing (EMDR) International Association. By 2009, The Butterfly Hug had become standard practice for clinicians in the field while working with survivors of man-made and natural catastrophes. The “Butterfly Hug” provides a way to self-administer dual attention stimulation (DAS) for an individual or for group work. This chapter explains many uses for the Butterfly Hug. During the EMDR Standard Protocol, some clinicians have also used it with adults and children to facilitate primary processing of a fundamental traumatic memory or memories. Use of the Butterfly Hug in session with the therapist can be a self-soothing experience for many trauma-therapy clients.
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.