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.

Children are exposed to distress, violence, and trauma even before they are born. In-utero and early childhood exposure can contribute to severe medical and psychological consequences. Children who have been exposed to such traumatic events often arrive at the psychotherapist’s office with emotional and behavioral symptoms suggestive of reactive attachment disorder (RAD), post-traumatic stress disorder (PTSD), and dissociation. This chapter reviews relevant theories of dissociation integrated with theories of development to provide a summary of how attachment impacts dissociation. With a developmentally grounded theory of dissociation, the chapter describes clinical interventions for treating the dissociative sequelae of attachment trauma in children. This theoretical framework offers a developmentally grounded and integrative framework for working with children with complex trauma and dissociation. Symptoms of dissociation are common with PTSD, but an extreme response to trauma can be dissociation and dissociative disorders.

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 focuses on identifying and working with dissociative symptoms and dissociative disorders in a therapeutic context, providing a road map to assist with the pacing and planning of clinical interventions. Rapid eye movement (REM) sleep can be conceptualized as a household strength processor that can accommodate the usual processing requirements of daily life. Posttraumatic stress disorder (PTSD) has been historically defined as requiring a trauma that is outside the range of normal human experience. Hypoarousal and parasympathetic activation that are an intrinsic part of dissociative symptoms are much more difficult to assess. The original painful memories live on in flashbacks and nightmares as well as in reenactments of the unconscious dynamics captured from the family of origin’s enactments of perpetration, victimization, rescuing, and neglect. Excessive sympathetic nervous system activation is easily construed to be an indicator of psychopathology.

This chapter reviews the disturbances in self-referential processing and social cognition in posttraumatic stress disorder (PTSD) related to early-life trauma. It talks about the neural underpinnings of self-referential processing and examines how they may relate the integrity of the default mode network (DMN). The chapter describes the deficits in social cognition, with a particular focus on theory of mind in PTSD and the neural circuitry underlying direct versus avert eye contact. It then addresses the implications for assessment and treatment. Johnson demonstrated that self-referential processing is associated with the activation of cortical midline structures and therefore overlaps with key areas of the DMN in healthy individuals. Healthy individuals exhibited faster responses to the self-relevance of personal characteristics than to the accuracy of general facts. Less activation of the medial prefrontal cortex (PFC) was observed for the contrast of self-relevance of personal characteristics relative to general facts as compared to controls.

This chapter provides information for therapists to integrate theories of neuroscience into the practice of child psychotherapy. Neuroscientists have described how the brain develops, documented the impact of external experiences on the developing brain, and integrated theories of neurodevelopment and neuroplasticity into our understanding of the impact of our interpersonal relationships on our brain. The chapter focuses on developmental trauma disorder and the research on the impact of trauma on children. The majority of the research on trauma in children has focused on the assessment and diagnosis of Post traumatic stress disorder (PTSD); however, there are a limited number of studies that have documented the efficacy of the treatment of PTSD in children. The chapter reviews diagnoses specific to neurodevelopment, including autistic spectrum disorders (ASD) and sensory processing disorders (SPD).

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.

Sexual trauma includes any type of physical touching or other activity of a sexual nature that is against our will or done without our consent. This chapter defines sexual trauma as anything that occurred or was threatened to occur that was experienced as a violation of a sexual nature. Sexual trauma occurs in many different forms and any sexual trauma can be deeply wounding, requiring new skills for healing. Military sexual trauma (MST) refers to experiences of sexual trauma that occur while a person is serving on active duty military service. The link between MST and homelessness is a perfect example of accumulated symptoms. MST was related to symptoms of posttraumatic stress disorder (PTSD). Forced sex may be viewed as an act of domination to inflate one’s sense of self-importance or power. Psychological symptoms include negative thought patterns such as negative thinking, negative thoughts around trust, safety, and self-blame.

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.