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.
- Go to chapter: The Inverted EMDR Standard Protocol for Unstable Complex Post-Traumatic Stress Disorder
The Inverted eye movement desensitization and reprocessing (EMDR) Standard Protocol for complex post-traumatic stress disorder (C-PTSD) is a structured way to assist these clients to reduce their symptoms to the point where they are stable enough to work with more and more of their old memory clusters of the past, such as most often childhood abuse, neglect, and numerous secondary traumas after that. The protocol seems to be especially useful in clients with psychiatric hospitalization histories or inpatient settings. There are three foci for the Inverted Standard Protocol for unstable C-PTSD based on inverting the EMDR Standard Protocol to meet the needs of unstable C-PTSD clients: the future, the present, and the past. The constant installation of present orientation and safety (CIPOS) method assists clients in reducing the stress of triggers of older trauma material in a more controlled manner without getting overwhelmed by the old material.
This chapter presents sets of questionnaires are helpful in working with fertility treatment. Infertility clients often carry within them a strong sense of blame and misplaced personal responsibility. The two primary negative cognitions that appear most often are: “There’s something wrong with me”, and “I must have done something wrong”. The chapter also presents a construction of a Time Line. Each Time Line corresponds to only one theme: responsibility, trust or control. It is important that the client have general information about the Adaptive Information Processing (AIP) Model in order to ensure optimum participation in treatment. The client is informed about what to expect relative to the process and effects of Eye Movement Desensitization and Reprocessing (EMDR). Based on client needs, risk considerations may include: poor self-care and nutrition, side effects of hormone or drug therapy consistent with fertility treatment, marital strain, or weakness in support system.
- Go to chapter: The Method of Constant Installation of Present Orientation and Safety (CIPOS) for Children
The Method of Constant Installation of Present Orientation and Safety (CIPOS) for Children. The fundamental idea of the Method of Constant Installation of Present Orientation and Safety (CIPOS) is to reinforce a client’s current sense of security and stability using bilateral stimulation. The CIPOS method is helpful in assisting children to overcome their fear of their traumatic memories. Drawing and active movement is helpful when working with younger children and for the older, active child as well. Alternatives to catching the ball in the CIPOS Protocol for Children could be using the Safe Place to interrupt the process, or drawing a Safe Place and using the picture. The CIPOS method can motivate the child to tolerate stressful memories or fear of the future and can be a very helpful bridge between resource work and trauma work.
The desensitization of triggers and urge reprocessing (DeTUR) method is an urge reduction protocol used as the center of an overall methodology for the treatment of a wide range of chemical addictions and dysfunctional behaviors. It was initially introduced as a stop smoking protocol at the first eye movement desensitization and reprocessing (EMDR) conference. The basis or foundation is the adaptive information processing (AIP) using bilateral stimulation (BLS) as outlined in EMDR to uncover and process the base trauma(s) or core issues as the underlying cause behind the addiction. DeTUR accesses positive experience through positive body states while the EMDR protocol addresses positive experience through affect and positive and negative cognitions. The cognitive or therapeutic interweave as taught in the EMDR Institute basic training is the therapist’s best tool to aid clients during this desensitization or reprocessing phase.
Clients are ready to begin preparation for working on traumatic material when they have some internal communication and cooperation and have developed coping skills, which they are able to use during their daily lives to manage symptoms. It is helpful to use the standard resources frequently used with clients with a dissociative disorder (DD) during processing, for instance, the affect dial to modulate painful affect; container imagery; and deep-trance dreamless sleep; or any other techniques that are applicable for therapist client. Concern for client stability requires leaving out some steps from the standard eye movement desensitization and reprocessing (EMDR) procedure, and adding others. In the initial stages of developing coping skills, teams often developed to help with daily life functions such as: work, parenting, and driving.
This chapter illustrates how Eye Movement Desensitization and Reprocessing (EMDR) can be applied in the treatment of specific fears and phobic conditions. It includes summary sheets to facilitate gathering information, client documentation, and quick retrieval of salient information while formulating a treatment plan. Treatment of a fear or a phobic condition cannot be started if the therapist is unaware of the factors that cause and maintain the anxiety response. The main features of a specific phobia are that the fear is elicited by a specific and limited set of stimuli that confrontation with these stimuli results in intense fear and avoidance behavior, and that the fear is unreasonable and excessive to a degree that interferes with daily life. The DSM–IV–TR distinguishes the following five main categories or subtypes of specific phobia: Animal type, Natural environment type, Situational type, Blood, injury, injection type, and other types.
The Absorption Technique for Children is a protocol that was derived from the work of Arne Hofmann who based his work on an adaptation of “The Wedging Technique”. The absorption technique for children is a resource technique that supports children in creating resources for present issues and future challenges such as dealing with a difficult teacher or handling a disagreement with a classmate and so forth. This chapter uses resource installation for stressful situations. It includes summary sheets to facilitate gathering information, client documentation, and quick retrieval of salient information while formulating a treatment plan. The absorption technique, and the constant installation of present orientation and safety (CIPOS) technique, are excellent ways to encourage children to work with eye movement desensitization and reprocessing (EMDR) step-by-step even if they are not prepared to work with the worst issue in the beginning.
- 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.
- Go to chapter: EMDR Assessment and Desensitization Phases With Children: Step-by-Step Session Directions
This chapter describes the procedural steps of the Assessment Phase and Desensitization Phase of the Eye Movement Desensitization and Reprocessing (EMDR) Standard Protocol with detailed scripts for steering a child through each phase. It includes summary sheets to facilitate gathering information, client documentation, and quick retrieval of salient information while formulating a treatment plan. Assessment phase note section starts with Target Identification; this is a continuation of what began during the Client History and Treatment Planning Phase. The therapist should already have some idea of what the child may choose given previous target identification procedures such as Mapping and Graphing or other procedures for eliciting targets with children. Once the target has been selected, the therapist continues with Image, negative cognition (NC), positive cognition (PC), validity of cognition (VOC), emotion, subjective units of disturbance (SUD), and body sensation to move on to the desensitization phase.
- Go to chapter: Protocol for Releasing Stuck Negative Cognitions in Childhood-Onset Complex Post-Traumatic Stress Disorder (C-PTSD)
Protocol for Releasing Stuck Negative Cognitions in Childhood-Onset Complex Post-Traumatic Stress Disorder (C-PTSD)
This protocol was developed to help clients with childhood-onset complex post-traumatic stress disorder (PTSD) who have difficulty moving from the negative cognition (NC) to the positive cognition (PC) and instead, experience persistent looping. Packed dilemmas usually require and respond to a protocol comprising a particular sequence of Socratic cognitive interweaves (CI), which disentangles two clusters of confusion in turn: first, responsibility and entitlement, and then responsibility and loyalty. Ordinarily, as eye movement desensitization and reprocessing (EMDR) therapists, the authors attempt to stay out of the way of the client’s processing, and since CIs can influence processing, they use them sparingly. In a packed dilemma, however, they may need to influence the processing because the family attachment patterns are woven into issues of responsibility, which contribute to the embedded immobility of the NC.
- Go to chapter: Using Olfactory Stimulation With Children to Cue Resource Development and Installation (RDI)
According to Korn and Leeds, the main goal of developing and installing resources is to increase the client’s capacity for self-regulation by enhancing their ability to access memory networks that contain adaptive and functional information. The Resource Development and Installation (RDI) Protocol should only be considered based on specific criteria that suggest it is needed for the individual child. The purpose of doing RDI is to increase the child’s ability to change state adaptively and tolerate disturbance so the child can prepare for trauma reprocessing. Traumatized children deserve to be treated with the full eye movement desensitization and reprocessing (EMDR) reprocessing protocol so that they can make a complete recovery. Because of the short attention span in children, this protocol may take two sessions to complete. Often, school-aged children can do the protocol in one session.
The Resource Connection for Children is a search to support children in finding their own unique ways to feel the safety, confidence, and relief of making a solid connection with their therapists in the here and now of the therapeutic session. These are their principle supports as they enter and go through the eye movement desensitization and reprocessing (EMDR) processing. The term Resource Connection, as well as the idea of a continuation of resources threaded through the EMDR Standard Protocol, was first used by Brurit Laub in her work with adults. Instead of asking the child to remember an event as people do with adults, the therapist’s task is to be aware of the child’s resources throughout the protocol. The therapist then focuses and installs sensory, emotional, and cognitive aspects of this resource immediately with bilateral stimulation (BLS).
Eye Movement Desensitization and Reprocessing (EMDR) consultants can also use this measure in their consulting groups to assist consultees in understanding when work with clients have an impact on the therapist. The purpose of using the Clinician Self-Awareness Questionnaire includes assisting in raising awareness of what may be triggering the therapist, assessing what may be coming from the therapist and what may be coming from the client, and developing EMDR relational strategies. Different problems can arise in different phases of the protocol. Sometimes, client information may not evoke negative arousal in the therapist when the client is actively processing. Often times, the therapist’s triggers are from old memories. These memories may be explicit; at other times, implicit. As therapists begin to notice these moments in themselves, they may aid themselves and their clients in continuing productive processing by using the Clinician Self-Awareness Questionnaire.
The Wedging or Strengthening Technique has been modified in Germany and is called the Absorption Technique to create resources to deal with what the client is concerned about in the future, or having stress about working with eye movement desensitization and reprocessing (EMDR) in the future, a present trigger or even an intrusive memory. Having clients imagine a strength or skill that would help them during the problem often helps them to reduce their anxiety. Focusing on a specific strength or coping skill may create a wedge of safety or control that will assist clients with the difficult situation in the future. During the Future Phase of the Inverted Protocol for Unstable complex post-traumatic stress disorder (C-PTSD) use the Absorption or Wedging Technique to develop as many different resources for the different issues about which the client might be concerned.
This chapter demonstrates a sex therapist’s utilization of Eye Movement Desensitization and Reprocessing (EMDR) within the context of the 3-pronged approach to target issues related to sexual dysfunction. Clients undergoing EMDR treatment for sexual dysfunction may often feel anxious and vulnerable during their sessions. This may be because the act of processing certain sexual events may trigger physical arousal that may lead to feelings of embarrassment and anxiety. Sexual dysfunction is a very vast area of study. Each sexual dysfunction has its own diagnostic criteria, assessment, and treatment. It is very important for clinicians to gain enough training and supervision in sex therapy before using EMDR protocol. Clinicians who have not addressed their own inhibitions, guilt or shame about their sexuality may cause harm to clients and to themselves. This protocol works best within the context of ongoing couple therapy and sex therapy.
Eye movement desensitization and reprocessing (EMDR) Standard protocol connects a trauma model of relationships to Bowen’s concept of differentiation. In addition to those couples where a traumatic episode, prior to or during the relationship, has had a clear impact on the relationship, highly reactive couples are those who profit most from integrating EMDR into their couples work. EMDR can play an important role when reactivity in sessions blocks therapist interventions or resists routine interventions; when one or both partners are so reactive as to be abusive. When EMDR is used to treat trauma, therapists generally look for treatment change specific to the trauma and its posttraumatic stress disorder (PTSD)-like symptoms. In couples therapy, the desired outcomes are more the generalized effects of EMDR and those we might expect from EMDR performance enhancement.
Different experiential, psychophysiological, and neurobiological responses to traumatic symptom provocation in post-traumatic stress disorder (PTSD) have been reported in the literature. The term bottom-up processing is used in sensorimotor psychotherapy, a somatic approach to facilitate processing of unassimilated sensorimotor reactions to trauma. Lanius found this approach useful in dealing with dissociative symptoms and adapted it to be used in conjunction with bilateral stimulation (BLS), as part of a comprehensive treatment approach for individuals with complex post-traumatic stress disorder (C-PTSD) and dissociative symptoms. When we use the Standard eye movement desensitization and reprocessing (EMDR) Protocol, we work with sensorimotor, emotional, and cognitive aspects of information. Bottom-up processing is a way to work with issues of dissociation. Traumatic memories appear to be timeless, predominantly nonverbal, and imagery-based. Somatic memory is an essential element of traumatic memory; trauma memories, at least in part, are encoded at an implicit level.
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.
This chapter describes the eye movement desensitization and reprocessing (EMDR) protocol for dissociative identity disorder (DID). It help readers to understand how aspects of the Standard EMDR Protocol need to be adapted to work well with DID clients during the Assessment, Desensitization, and Installation Phases, in particular how to set up the Standard Protocol, establish the subjective units of disturbance (SUD) level, and acquire the negative cognition (NC), positive cognition (PC), and validity of cognition (VoC). An amnestic trauma is by definition a trauma that, when activated, is experienced as happening now. In other words, an amnestic trauma is not over but continues in the present when recalled. The chapter presents an explanation of EMDR and an explanation of three issues critical for successful EMDR processing: not reliving trauma, remaining aware of the present while processing the past, and going through a trauma from start to finish.
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.
The eye movement desensitization and reprocessing (EMDR) method represents a significant advance in psychotherapy. While most of the empirical research on EMDR demonstrates its efficacy as a treatment for posttraumatic stress disorder (PTSD), including relational traumas. Dysfunctional patterns of relating in the family of origin can imprint themselves on the relational template of adults, only to be reenacted in the contemporary couples relationship. Because EMDR can be effective at transforming these earlier relational traumas, adults can become less reactive, enjoy greater distress tolerance, and have a more resilient ego boundary. Thus, EMDR is an invaluable tool in couples therapy. A 5-step protocol is proposed that can guide therapists to develop an EMDR treatment plan within the context of couples therapy. This protocol can and should be applied to both partners in most cases, but of necessity, the therapist must choose one partner to begin with.
The Maze, as a metaphor for a place where problems live and are solved, was developed out of the necessity of working with children who were too anxious, embarrassed, or afraid to experience the uncomfortable feelings around their problem areas. Such children often present as actively oppositional or sullenly silent. It was necessary to find a distancing technique that was both nonthreatening and interesting to gradually establish communication between therapist and child about issues that cause them discomfort. The main purpose of the maze is to gradually sensitize the child to the possibility of exploring the defended inner space where unpleasant, scary emotions dwell. The maze is a concept with which most children are acquainted. They have experienced both feelings of frustration and competence as they followed the convoluted lines with their pencils in workbooks. The elements of the protocol for maze include the following: maze, drawings and footsteps.
Parts, alters, and ego states often believe they are living in the past and they are child sized. Orienting them to adult height can lessen anxiety and gives them more concrete proof that the past is different from the present. Child parts are often surprised when they can reach higher than they thought. This adult perspective is reinforced when using dual attention stimulation (DAS). Responses to this exercise will be specific to the part. The parts’ perceived ages rarely appear to change, with their change in perceived body height, for example, one part needed to be told that even if he was adult height, he was too young to drive. If the part is noticing and feeling positive feelings such as “Wow, I can reach all the way to the top of the door!” short sets of DAS is used to install the positive feelings or experience.
- Go to chapter: The Wreathing Protocol: The Imbrication of Hypnosis and EMDR in the Treatment of Dissociative Identity Disorder, Dissociative Disorder Not Otherwise Specified, and Post-Traumatic Stress Disorder
The Wreathing Protocol: The Imbrication of Hypnosis and EMDR in the Treatment of Dissociative Identity Disorder, Dissociative Disorder Not Otherwise Specified, and Post-Traumatic Stress Disorder
The Wreathing Protocol has been designed as a thorough, planful, and parsimonious way to protect trauma patients from decompensation during the middle phase of trauma. It presumes sophistication and fluency on the part of the clinician who ought to be skilled in advanced hypnosis techniques, ego state therapy, and controlled fractionated abreactions without the use of formal hypnosis or eye movement desensitization and reprocessing (EMDR). To best illustrate the discrete interventions amidst the complexity of dissociative responses, the operationalized EMDR protocols will be exemplified in the paradigmatic dissociative disorder, dissociative identity disorder (DID); however, they also apply for lesser dissociative disorders, dissociative disorder not otherwise specified (DDNOS) and post-traumatic conditions particularly when using an ego state model as an organizing principle in the treatment. Wreathing Protocol represents a skeletal structure around which complex dissociated elements of personality can regroup, blend, and integrate after detoxification and transformation of the traumatic material.
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 chapter includes scripts for Eye Movement Desensitization and Reprocessing (EMDR) pain Protocol for Current Pain and is based on a pilot study for phantom limb pain. It uses current pain as a target for patients with chronic pain. 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. There are three types of EMDR targets that can be distinguished in the treatment of patients with chronic pain: Traumatic memory is a classic trauma or trauma-related memory, such as having experienced a serious accident, amputation, or operation. Pain-related memory is a current emotionally disturbing memory that is related to traumatic pain experiences or the traumatic consequences of the pain. Current pain is a target does not in fact involve a memory, but the pain as it is now and as it is now experienced.
- 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.
Clients with dissociative disorders (DD) or complex post-traumatic stress disorder (C-PTSD) often have issues concerning the “therapist’s trustworthiness, inherent dangerousness and potential abusiveness”. Goals of this exercise are the following: Increase cooperation between the therapist and the dissociative system by communicating knowledge about the therapist, the office, and experience in treatment to all parts of the system; and maintaining the client’s dual awareness while processing information concerning trauma in the past. It is essential for these clients to maintain their connection to the therapist and the present. Dual attention stimulation (DAS) is used to install and communicate the information. Examples of things to notice are the following: pictures on walls, the carpet, a stuffed animal, the wallpaper, where therapist sits, where client sits, typical sounds, and any things in therapist’s office that indicate it’s not the past. Safety-oriented information is also important.
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 comorbidity of post-traumatic stress disorder (PTSD) and substance abuse gives sufficient reason to treat patients who are addicted with eye movement desensitization and reprocessing (EMDR). The concept of addiction memory (AM) and its importance in relapse occurrence and maintenance of learned addictive behavior has gained growing acceptance in the field of addiction research and treatment. The name craving extinguished (CravEx) was given to this EMDR strategy because craving seemed to vanish during EMDR reprocessing of the addiction memory in some of the patients. CravEx, as part of a treatment for comorbid addictive clients, focuses on reprocessing of the addiction memory thus leading to stabilization in the addiction. Major traumas can impact on addictive behaviors and are important to include in treatment planning. Anecdotal reports from clinicians indicate an effect of the reprocessing of the addiction memory in patients addicted to heroin or psychostimulants.
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.