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.
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 describes maneuvers to access the internal system of the patient as well as means to accelerate or decelerate the work in that process of accessing the self-system. Eye movement desensitization and reprocessing (EMDR), ego state therapy, and somatic therapy fit together like hand and glove. An extended preparation phase is often necessary before trauma processing in complex traumatic stress presentations and attachment-related syndromes, particularly when dealing with the sequelae of chronic early trauma. Clinical practice suggests that the adjunctive use of body therapy and ego state interventions can be useful, during stabilization and later on in increasing the treatment response to EMDR. Traditional treatment of complex posttraumatic stress disorder (PTSD) and dissociative disorders has usually included hypnoanalytic interventions, during which abreaction is considered an important part of treatment.
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 conclusion presents some closing thoughts on key concepts discussed in the preceding chapters of this book. The book attempts to contribute to improving children’s lives by providing a comprehensive and effective treatment protocol. To enhance treatment efficacy and improve the trajectory for children’s lives, case conceptualization in child psychotherapy must integrate developmental theory, neuroscience, and best practice models into clinical practice. The book reviews some of the latest research on attachment and neuroscience that impacts case conceptualization in child psychotherapy. In 1989, Shapiro proposed a new treatment approach she entitled eye movement desensitization (EMD) and, later, eye movement desensitization reprocessing (EMDR) to treat trauma. After reviewing the major theories of attachment and Schore’s current rendition that he labels self-regulation theory, the book offers a foundation for therapists to use develop-mentally grounded theory through the lens of adaptive information processing (AIP) to treat attachment issues in clients of all ages.
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.
During the installation phase, the child can experience a felt positive belief about himself or herself in association with the memory being reprocessed. Children with history of early and chronic trauma have difficulty tolerating positive affect. Enhancing and amplifying their ability to tolerate and experience positive emotions and to hold positive views of the self are pivotal aspects of eye movement desensitization reprocessing (EMDR) therapy. This chapter shows a script that may be used with children during the body scan phase. Assisting children in achieving emotional and psychological equilibrium after each reprocessing session as well as ensuring their overall stability are fundamental goals of the closure phase of EMDR therapy. The reevaluation phase of EMDR therapy ensures that adequate integration and assimilation of maladaptive material has been made. The future template of the EMDR three-pronged protocol is a pivotal aspect of EMDR therapy.
This chapter focuses on the desensitization phase during which the therapist processes the dysfunctional material. It explores a range of issues that are frequently raised in this phase, including therapist anxiety and abreactions and explores challenges during the desensitization phase, such as blocked processing and the use of cognitive interweaves. It is not only the client who gets anxious about the desensitization phase. It can be very daunting to the new EMDR practitioner. Performance anxiety can be a block for the therapist as well as for the client. The therapists’ role is distinct in this phase and involves supporting the client verbally with minimum intervention unless the client is stuck. They should help the client to focus on the flow of feelings, thoughts, and body sensations as they unfold. The therapist will observe the nonverbal signs, troughs and peaks of sensations, and will monitor the changes.
The primary goals of the assessment phase are to access the memory network containing traumatogenic material and to access and activate the cognitive, affective, and somatic aspects of the memory. Since the reprocessing phases of eye movement desensitization and reprocessing (EMDR) therapy follow immediately after the assessment phase, the clinician should have prepared potential interweaves in case the child’s processing of the memory gets blocked. Children with complex trauma histories may already have sensitized sympathetic systems that make them prone to being in fight flight mode even in the face of safety. The chronically traumatized children present with sensitized dorsal vagal systems. Current caregiving and attachment behaviors have the potential for activating the attachment system, and with it past dysfunctional attachment experiences. One of the best adjunct approaches that can be used within a comprehensive EMDR treatment is sandtray therapy.
The incorporation of a skill-building phase and eye movement desensitization reprocessing (EMDR) games can greatly enhance and facilitate the utilization of EMDR therapy with children who have a history of complex trauma. Some EMDR games work with cognitive skills, others work with emotional skills, while others work with the body and the language of sensation. The use of positive cognition cards offers a great opportunity to play and use a wide range of card games. This chapter exemplifies how to use negative cognition games. Feeling cubes contain different basic emotions appropriate for children. Clinicians can purchase plain wooden cubes and write different feelings on the cube. A wide range of card games can be used with the feeling cards. The memory wand offers another playful approach to the process of identifying traumatic events with children. The chapter shows a playful way of exploring and identifying parent-child interactions.
The basic goals of phase one are to develop a working relationship and a therapeutic alliance and to determine if the level of expertise of the eye movement desensitization and reprocessing (EMDR) clinician is adequate for the complexity of the case. Other goals are to develop a comprehensive treatment plan and case formulation. EMDR therapy was developed as a form of treatment to ameliorate and heal trauma. Clinicians working with complex trauma must have substantial understanding of the adaptive information processing (AIP) model and the EMDR methodology. During phase one, the clinician works on creating an atmosphere of trust and safety so a therapeutic alliance can be formed with the child and the caregivers. This chapter shows an example of how medical issues can affect the quality of the parent-child communications. The adult attachment interview (AAI) gives us the view of the presence of the experiences in the parent’s life.
International Society for the Study of Trauma and Dissociation (ISSTD)’s professional training institute offers comprehensive courses on childhood dissociation that are taught internationally and online. This chapter briefly cites some of the theories that have emerged in the dissociative field. One system, the apparently normal personality (ANP) enables an individual to perform necessary functions, such as work. The emotional personality (EP) is action system fixated at the time of the trauma to defend from threats. As with the Adaptive Information Processing Model (AIP) in eye movement desensitization and reprocessing (EMDR), each phase brings reassessment of the client’s ability to move forward to effectively process trauma. There are many overlapping symptoms with Attention Deficit Hyperactive Disorder (ADHD) and dissociation that often mask the dissociation. The rate of diagnosis of pediatric bipolar disorder has increased 40 times in the last ten years.
This chapter focuses on case studies of installation, body scan, closure, and reevaluation of eye movement desensitization and reprocessing (EMDR). The installation phase is concerned with integrating the positive cognition (PC) with the targeted memory. The PC should be checked for ecological validity and rated on the validity of cognition (VOC) scale. Closure is important at the end of any therapy, and particularly so after EMDR desensitization. As such, it is important to allow sufficient time for closure, debriefing, safety assessment, and homework. As with any therapy, clients will sometimes find that something occurs that disrupts the therapeutic plan. Modeling, education on social skills, and testing out new behaviors will now be the focus of therapy. This may be an unexpected crisis, such as a relationship breakdown or being diagnosed with cancer, and clients will need support in making adjustments in their present life.
This book was conceived out of the authors' shared vision to synthesize key neurobiological developments with effective developments in clinical practice to offer both understanding and practical guidance for the many practitioners working to heal people burdened with traumatic sequelae. It is unique in bringing in all levels of the brain from the brainstem, through the thalamus and basal ganglia, to the limbic structures, including the older forms of cortex, to the neocortex. The book looks at the neurochemistry of peritraumatic dissociation (PD) and explores the effects on neuroplasticity and the eventual structural dissociation. Individual chapters focus on the definition of PD and tonic immobility (TI) and their associations with posttraumatic psychopathology, and review disturbances in self-referential processing and social cognition in posttraumatic stress disorder (PTSD) related to early-life trauma. Separate chapters focus on the modulatory role of the neuropetides in attachment as well as autonomic regulation, and highlight mesolimbic dopamine (ML-DA) system as central to the experiences of affiliation, attachment urge when under threat, attachment urge during experience of safety, and to the distress of isolation and/or submission. The book while increasing awareness of different parts of the self and ultimately creating a more stable sense of self, also incorporates psychoanalytic, cognitive behavioral, and hypnotic methods, as well as specific ego state, somatic/sensorimotor therapies, eye movement desensitization and reprocessing (EMDR), and variations of EMDR suitable for working with trauma in the attachment period. The latter methods are explicitly information-processing methods that address affective and somatic modes of processing.
Desensitization is a complex and important phase of eye movement desensitization reprocessing (EMDR) therapy. This chapter covers child-friendly strategies and interweaves that support and stimulates the social engagement system, maintain dual awareness and kindle children’s integrative capacities. It presents advanced strategies and interweaves that can facilitate the assimilation of memories of trauma and adversity as well as to promote vertical and horizontal integration. Shapiro developed a strategy to jump-start blocked processing that she called ‘the cognitive interweave’. According to Shapiro, clients spontaneously move through the three plateaus of information processing: responsibility, safety, and control/power, to a more adaptive perspective during reprocessing. Most children injured and traumatized in the adult-child relationship carry within the responsibility of the event. Mindful awareness in EMDR is pivotal during the reprocessing phases. The use of nonverbal communication strategies can greatly facilitate the process for children working on memories of events occurring pre-verbally.
This chapter discusses the client’s ability to self-regulate and handle high levels of affect. The maintaining factors of the effects of trauma- or anxiety-based disorders include fear, avoidance, and loss of control. Building or reinforcing coping strategies allows the client to regain some sense of control over what is happening, which, in turn, can have a positive impact on the fear and avoidance. Many novice Eye Movement Desensitization Reprocessing (EMDR) therapists report additional performance anxiety when their client is a mental health professional. Hyperarousal after a traumatic experience is normal. It occurs when a person’s brain believes that person is at risk again because it misreads an external signal or trigger. Grounding techniques can be taught very easily to clients and are another tool to help the client prepare for dealing with a possible abreaction while undergoing EMDR therapy.
The work directed toward increasing the child’s ability to tolerate and regulate affect, so that the processing of traumatic material can be achieved, is initiated during the preparation phase. The process of providing the neural stimulation to improve the child’s capacity to bond, regulate, explore, and play should begin during the early phases of eye movement desensitization and reprocessing (EMDR) therapy. The Polyvagal theory presents a hierarchical model of the autonomic system. In complexly traumatized children, the development of this system has been compromised due to the early dysregulated and traumatizing interactions with their environments and caregivers. When describing the various forms of bilateral stimulation (BLS), go over the different options and practice with the child. If the child went through the calm-safe place protocol successfully, motivating the child to actually use it when facing environmental triggers is an important goal.
This book is intended to provide to the eye movement desensitization and reprocessing (EMDR) clinician advanced tools to treat children with complex trauma, attachment wounds, and dissociative tendencies. It covers key elements to develop case conceptualization skills and treatment plans based on the adaptive information processing (AIP) model. A broader perspective is presented by integrating concepts from attachment theory, affect regulation theory, affective neuroscience, and interpersonal neurobiology. These concepts and theories not only support the AIP model, but they expand clinicians’ understanding and effectiveness when working with dissociative, insecurely attached, and dysregulated children. The book presents aspects of our current understanding of how our biological apparatus is orchestrated, how its appropriate development is thwarted when early, chronic, and pervasive trauma and adversity are present in our lives, and how healing can be promoted through the use of EMDR therapy. In addition, it provides a practical guide to the use of EMDR within a systemic framework. It illustrates how EMDR therapy can be used to help caregivers develop psychobiological attunement and synchrony as well as to enhance their mentalizing capacities. Another important goal of the book is to bring strategies from other therapeutic approaches, such as play therapy, sand tray therapy, Sensorimotor Psychotherapy, Theraplay, and Internal Family Systems (IFS) into a comprehensive EMDR treatment, while maintaining appropriate adherence to the AIP model and EMDR methodology. This is done with the goal of enriching the work that often times is necessary with complexly traumatized children and their families.
Eye movement desensitization and reprocessing (EMDR) therapy was independently designated as a psychotherapy approach, and was validated by twenty randomized controlled clinical trials. Results of meta-analyses show EMDR as an effective and efficacious treatment for posttraumatic stress disorder (PTSD) in adults and children. Childhood complex trauma refers to the exposure of early chronic and multiple traumatic events. The adaptive information processing (AIP) model constitutes the central piece and foundation of EMDR therapy. Affective neuroscience brings up the importance of PLAY as a healing agent. The polyvagal theory emerged out of the work of Stephen Porges on the evolution of the autonomic nervous system (ANS). Interpersonal neurobiology (IPNB) brings a viewpoint that integrates objective realms of scientific findings and subjective realms of human knowing. The structural dissociation theory of the personality is based on Pierre Janet’s view of dissociation as a division among systems that constitute the personality of an individual.
The Resource Connection Envelope (RCE) derives from the assumption that the dialectical healing movement between negative stored memories or problems and positive stored memories or resources is crucial for adaptive processing. The Assessment Phase in the Standard Eye Movement Desensitization and Reprocessing (EMDR) Protocol makes the problem, which is represented by the traumatic image or picture, more accessible for processing. The RCE aims to complement it by making the resource pole accessible as well. The RCE begins with a Past Resource Connection (PRC), collects the Present Resource Connection (PrRC) that comes up during processing, and ends with a Closing Resource Connection (CRC) chosen from the Present Resources or the Past Resource. In the Assessment Phase of the Standard EMDR Protocol, Compact Focusing is performed on a representative picture of the traumatic event. Different therapeutic approaches have various techniques to enhance accessibility or do their own version of Compact Focusing.
Clients need to be aware that the process of eye movement desensitization and reprocessing (EMDR) treatment can be disturbing and that dissociated material may surface during therapy. Because EMDR has the potential for rapid uncovering of this unsuspected material, some of which may be extremely distressing an assessment needs to be made of the client’s ability to handle strong emotions. For some clients there may be ambivalence about recovery from their dysfunction or distress. Common secondary gains include the loss or reduction of a compensation claim or disability pension. It is strongly recommended that EMDR is not used with clients who have dissociative disorders (DD) unless therapists are confident and competent in their EMDR practice as well as in working with this client population. The chapter also presents a snapshot of Emma’s assessment that should be gathered to determine suitability for EMDR.
This chapter clarifies treatment throughout the similarities as well as the differences between eye movement desensitization reprocessing (EMDR) therapy and sensorimotor psychotherapy in child treatment. Dysregulated arousal and overactive animal defenses biased by traumatic experience are at the root of many symptoms and difficulties observed in traumatized children. Traumatic or adverse experiences are encoded in memory networks in the brain. The adaptive information processing (AIP) looks at different components of the memory network: cognitive, emotional and somatic. EMDR therapy and its phases access not only the cognitive aspects of the memory, but the affective and bodily states. In working with children, microphones may add a playful approach to translating the body’s language. Oscillation techniques are also useful in helping children to shift their focus from dysregulated states to a more resourced experience, which supports flexibility in state shifting and increases awareness of different states.
This chapter serves as a one-stop resource where therapists can access a wide range of word-for-word scripted protocols for Eye Movement Desensitization and Reprocessing (EMDR) practice. The imagery of an “Inner Safe Place” is part of a body of work on stabilization techniques for trauma therapy called “Psychodynamic Imaginative Trauma Therapy (PITT)”. It is used within PITT to prepare clients for EMDR. However, it works very well as a resource for EMDR. It is important to know that clients who live in unsafe circumstances are often not able to develop the images and so seeing what happens while working on installing the inner safe place can tell us something about clients’ external safety. If clients are able to create an inner safe place, the therapist can proceed with the exercise. If clients are unable to create and install a safe place, other stabilization work is used.
The EMDR Accelerated Information Resourcing Protocol (EMDR-AIR Protocol®) is designed to look for that learned generational reaction to trauma that the client is currently using to cope with the current situation while, at the same time, tapping into the historical strengths and resources that enabled survival. These resources are found through the rapid accessing of client history by using Multi-Tiered Trans-Generational Genogram (MTTG). The MTTG seeks to look at family history, birth dates, cultural information, transgenerational behavioral patterns, lifestyle, untold secrets, multi-tiered transgenerational trauma and sexual history, belief systems, historical events, and styles of celebration. The main objectives for the EMDR-AIR Protocol are to recognize potential stuck components in the EMDR processing that are related to trans-generationally transmitted behavioral and emotional patterns and to enable the client to step away from the crisis so as to begin the process of reprocessing with EMDR, with the chronologically most relevant Touchstone Event.
- 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.
David Blore, the author, has now been providing Eye Movement Desensitization and Reprocessing (EMDR) to traumatized miners since 1993. As with other specialized client groups, the Single Trauma (STP) and Recent Trauma Protocol (RTP) have required modifications. David has collated the modifications made, and presented them here as the Underground Trauma Protocol (UTP). The UTP is intended to provide a rapid and effective method of conducting EMDR with traumatized miners and other similar, very specific, client groups. David Blore recommends that the treatment of this client group only be undertaken by fully trained EMDR clinicians who have experience with modifying protocols and existing clinical experience of using cognitive interweave. Important information to ask for during history taking is to be clear how much of the underground environment was involved in the incident. If the integrity of the underground environment is affected, in essence, the whole underground world is affected.
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.
When the perpetrator is the client’s own body, the Illness and Somatic Disorders Protocol can be used. It is important to note that this protocol addresses both psychological and physical factors related to somatic complaints. For many, addressing the psychological dimensions will cause partial or complete remission of the physical symptoms. When primarily organic processes are involved, the psychological issues may be exacerbating the physical conditions. While physical symptoms may not remit, the clinical emphasis is on improving the person’s quality of life. Eye Movement Desensitization and Reprocessing (EMDR) has also been used in the hospital to assist clients who are suffering from intractable pain to let go of the guilt they feel about wanting to die and be released from the pain. There are many ways to bolster the immune system in order to facilitate the healing process, however, death may be inevitable for some clients.
This chapter demonstrates the methodology for formulating cases using the adaptive information processing (AIP) and Indicating Cognitions of Negative Networks (ICoNN) models in conjunction, with clinical case material. Engaging and holding a client with psychosis in the safe intersubjective dynamic requires a biopsychosocial container to be generated within a robust therapeutic alliance. The AIP model of eye movement desensitization and reprocessing (EMDR) therapy invites us to acknowledge that psychosis has meaning that is driven by the dysfunctional memory network (DMN), which is the core pathogen. In ICoNN 1, psychotic phenomena are present on examination and distress the person, causing a functional impairment. The psychological pathogen (DMN) is identified and is acknowledged by the person as holding strong emotion with a negative valence, which is etiologically connected to the psychosis. This DMN may be targeted with the standard EMDR therapy model and reprocessed.
This chapter serves as a one-stop resource where therapists can access a wide range of word-for-word scripted protocols for Eye Movement Desensitization and Reprocessing (EMDR) practice. The rationale behind the creation of “The Four Elements Exercise for Stress Management” is to address the cumulative effect of external and internal triggers that occur over the course of the day. The heart of the exercise consists of four, brief, self-calming and self-control activities. The idea is to take a quick reading of the current stress level using the simple 0 to 10 subjective units of disturbance scale (SUD scale) where 10 = the most stress and 0 = no stress at all. This can occur every time clients observe their bracelets. Working on the Safe Place separately during the session gives it more space and impact. It is then practiced with the bracelet reminder frequently, together with the other elements.
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.
This chapter serves as a one-stop resource where therapists can access a wide range of word-for-word scripted protocols for Eye Movement Desensitization and Reprocessing (EMDR) practice, including the past, present, and future templates. Esly Regina Carvalho is a very visual and artistic person and she used drawings in her psychodrama practice. Carvalho began to ask her adult clients to draw a picture that would illustrate the negative cognition. Sometimes, they would have feelings about themselves or self-perceptions that would also turn into drawings, and from these drawings, the Standard EMDR Protocol ensued. Carvalho usually ask for drawings when people come in with generalities and we need to pin down a specific target to work on. The Drawing Protocol for Adults can be helpful in narrowing down a target, using a metaphor or picture which has a strong gen-eralizable effect instead of a concrete scene from the past.
Protocol for excessive grief is to be used when there is a high level of suffering, self-denigration, and lack of remediation over time concerning the loss of a loved one. Eye Movement Desensitization and Reprocessing (EMDR) does not eliminate healthy appropriate emotions, including grief. The protocol is similar to the Standard EMDR Protocol for trauma. The goal of this work is to have clinicians’ client accept the loss and think back on aspects of life with the loved one with a wide range of feelings, including an appreciation for the positive experiences they shared. Francine Shapiro often brings up the issue: How long does one have to grieve? She asks us to not place our limitations on our clients as this would be antithetical to the notion of the ecological validity of the client’s self-healing process.
- Go to chapter: Simple or Comprehensive Treatment Intake Questionnaire and Guidelines for Targeting Sequence
This chapter explores several approaches in helping a client develop an Eye Movement Desensitization and Reprocessing (EMDR) targeting sequence plan to address the presenting problem(s). As with all psychotherapy approaches, it is important to obtain a full clinical history to identify stabilization needs, environmental management skills, and symptoms where EMDR reprocessing will be appropriate. The client’s presentation may fall into either being simple or comprehensive. For simple presentations, several possible targeting sequence plans are possible, depending upon the client’s dominant symptom. For those presenting with a dominant irrational belief, clustering all incidents within that belief will lend itself to a very efficient targeting sequence plan that addresses all prongs, past incidents starting with the Touchstone Event, present triggers, and future issues anticipating anxieties. The chapter presents Intake Questionnaire, guidelines for creating a Targeting Sequence Plan, and the Worksheets that are invaluable tools in assisting therapists in gathering the client’s information.
Self-Care for Eye Movement Desensitization and Reprocessing (EMDR) Practitioners was derived from the notes of Neal Daniels, a clinical psychologist who was the director of the PTSD Clinical Team at the Veterans Affairs Medical Center in Philadelphia, Pennsylvania. Always concerned about the welfare of clients and practitioners, he put together a short, simple, and effective protocol for the practitioner, on the completion of any session where there was negative affect remaining. 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 idea was to work on the material right after the session or later in the day when time allowed.
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.