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.
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- Go to chapter: ACT-AS-IF and ARCHITECTS Approaches to EMDR Treatment of Dissociative Identity Disorder (DID)
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.
The “Image Director Technique” was developed to target recurring nightmares or bad dreams and those targets that are directly related to a traumatic experience. This technique is a special module that is embedded in the Standard Eye Movement Desensitization and Reprocessing (EMDR) Protocol. The technique begins with the worst image of the dream and then accesses and measures it as in Phase 3 of the Standard EMDR Protocol that includes the image, cognitions, emotions, and sensations. Clients are more likely to work with short clips or films if the subjective units of disturbance (SUD) of the target image is low. This technique can also be considered an imagery exposure method that is based in systematic desensitization, a behavioral approach. Often, clients prefer the tactile bilateral stimulation (BLS) because they can close their eyes in order to be visually undisturbed during the creation of the new images.
This chapter provides an overview of working with clients who present with more complex trauma. Many of the clients that come for Eye Movement Desensitization Reprocessing (EMDR) will have a history of complex trauma or a chaotic childhood. Clients who have experienced complex trauma may lack basic life skills or have missed out on developmental stages due to a chaotic childhood, for example, parents who were absent, neglectful, or abusive. Clients may not have been taught how to regulate their emotions in early childhood. They may present with impulsive, risk-taking, or suicidal behaviors. Before carrying out the desensitization phase of EMDR, individuals need to have an adequate level of resilience and be sufficiently resourced. Clients with Dissociative Identity Disorder (DID) display at least two distinct and enduring “alters” or identity states that recurrently take control of their behavior.
- Go to chapter: Integrating Theories of Developmental Psychology Into the Enactment of Child Psychotherapy
Child psychotherapy requires case conceptualization through the lens of developmental psychology in a multimodal approach to assessment, diagnosis, treatment planning, and clinical interventions. This chapter outlines a blueprint for therapists to provide treatment for children by integrating these fundamental principles while collaborating with the other people in the child’s life. The chapter guides the therapist through case conceptualization that integrates the most efficacious treatment interventions into the eight-phase template of eye movement desensitization and reprocessing (EMDR). Adaptive information processing (AIP) theory drives treatment with EMDR throughout the eight phases of that protocol and provides a template for case conceptualization and treatment planning. The use of the EMDR approach to psychotherapy is well documented and approved as evidence-based practice in Substance Abuse and Mental Health Administration (SAMHSA) and California Evidence-Based Clearinghouse for Child Welfare (CEBC).
This chapter presents how eye movement desensitization and reprocessing (EMDR) therapy and Theraplay can be used together when treating children with a history of complex trauma. Theraplay focuses on the parent-child relationship as the healing agent that holds within it the potential to cultivate growth and security in the child. The chapter shows some core concepts that help define and illuminate the application of Theraplay. Now that a clear review of basic Theraplay principles has been provided, people need to look at EMDR therapy and the adaptive information processing (AIP) model in conjunction with Theraplay and Theraplay core values. Early in its development, Theraplay integrated parental involvement into its therapeutic model. During the reprocessing phases of EMDR therapy, Theraplay can be very helpful in providing different avenues for emotion regulation and for the repairing of the attachment system.
This chapter integrates elements and strategies of internal family systems (IFS) psychotherapy into eye movement desensitization and reprocessing (EMDR) therapy with complexly traumatized children. It shows a description of healing a part using in-sight with a child. In-sight involves having the client look inside to find and work with parts that he or she sees or senses and describes to the therapist. The IFS therapist starts by ensuring the client’s external environment is safe and supportive of the therapy. In a self-led system, polarizations are absent or greatly diminished, leaving more harmony and balance. However, when and how the self is formed may be seen and conceptualized through different lenses in adaptive information processing (AIP)-EMDR and IFS. According to the AIP model, the human brain and biological systems are shaped by the environmental experiences they encounter.
This book offers practical guidance and strategies to avoid the common pitfalls of eye movement desensitization and reprocessing (EMDR) practice through the 8-phase protocol. It proposes to guide those therapists into a safer way of working while encouraging them to access accredited training and supervision for their practice. The scope of the book is limited to EMDR practice with adults. Phase 1 of the standard EMDR protocol is history taking. It is important to determine whether the client is appropriate for EMDR selection. The therapist needs to help the client to identify and practice appropriate coping strategies that will support the client throughout the therapy. Therapists need to address any fears that the client (or therapist) may have about the later desensitization. Failing to do this can result in problems later. Many of the clients that come for EMDR will have a history of complex trauma or a chaotic childhood. The treatment plan needs to identify specific targets for reprocessing. This will be a three-pronged approach that includes the past memories that appeared to have set the pathology in process, the present situations that, and people who, exacerbate this dysfunction, and the desired future response, emotionally, cognitively, and behaviorally. Clients and therapists need to understand the rationale for selecting a particular target utilizing prioritization and clustering techniques as illustrated with the case study. Choosing the correct target can involve some detective work, but this will be time well spent. The book guides practitioners on how to identify the components of a memory network for reprocessing. It then focuses on the assessment phase and the importance of negative cognitions (NCs) drawing heavily on illustrative case vignettes.
The inclusion of parents and family caregivers throughout the phases of eye movement desensitization and reprocessing (EMDR) therapy is essential for best treatment outcome with highly traumatized and internally disorganized children. Parental responses that create dysregulation in the child’s system also appear to be related to the parent’s capacity to reflect, represent and give meaning to the child’s internal world. This chapter shows a case that exemplifies how the caregiver’s activation of maladaptive neural systems perpetuates the child’s exposure to multiple and incongruent models of the self and other. Helping parents arrive at a deeper level of understanding of their parental role using the adaptive information processing (AIP) model, attachment theory, regulation theory and interpersonal neurobiology principals will create a solid foundation. The thermostat analogy is designed to assist parents in understanding their role as external psychobiological regulators of the child’s system.
This chapter presents several strategies, analogies, and metaphors to address dissociation from different angles and perspectives. Clinicians will have a wide range of methods of introducing and explaining dissociation to children. Analogies and stories that help children understand the multiplicity of the self may be presented during the preparation phase of eye movement desensitization and reprocessing (EMDR) therapy. A good way of introducing the concept of dissociation is by using the dissociation kit for kids. Stimulating interoceptive awareness is a fundamental aspect of the work needed during the preparation phase of EMDR therapy with dissociative children. Visceral, proprioceptive, as well as kinesthetic-muscle awareness should be stimulated. The installation of present resolution (IPR) was inspired by an exercise developed by Steele and Raider. In this exercise, the child is asked to draw a picture of the past traumatic event followed by a picture of the child in the present.